Thesis Submitted in Fulfilment of the Requirements for the Degree Of

Home , Ellalan, Govigama, House of Vijaya, Karuna Amman, Navatkuli, Polonnaruwa

Post-Traumatic Stress Disorder and Sri Lanka's 30 Year Civil War: A Study of Transgenerational Trauma

Neeraja Sanmuhanathan

December 2020

Faculty of Medicine and Health

University of Sydney

A thesis submitted in fulfilment of the requirements for the degree of

Doctor of Philosophy

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Statement of Originality

I, Neeraja Sanmuhanathan, declare that the work contained within this thesis entitled “Post-

Traumatic Stress Disorder and Sri Lanka's 30 Year Civil War: A Study of Transgenerational

Trauma” is, to the best of my knowledge and belief, original except as acknowledged in the text. I hereby declare that I have not submitted this material, either in full or in part, for a degree at this or any other institution.

This thesis contains material published in ‘Sanmuhanathan N. (2020). Tamil Women in the

Home Away from Home: The Impact of War Trauma on Psychological Wellbeing. In:

Kandasamy N., Perera N., Ratnam C. (eds) A Sense of Viidu. Palgrave Pivot, Singapore.’ I was the sole author of this published chapter. Parts of the published material is contained within

Chapter 1, Chapter 5, and Chapter 10.

This thesis also contains material published in ‘STARTTS. (2015). Tamil Community

Consultation Report. Sydney: STARTTS.’ I was the sole author for the section ‘Background to the Sri Lankan Tamil Community’. Parts of the published material is contained within

Chapter 3 and Chapter 4.

………………………………….. …………………………….

Neeraja Sanmuhanathan Date

University of Sydney

Acknowledgement

I acknowledge and pay respect to the traditional owners of the land, the Gadigal people of the

Eora Nation. It is upon their ancestral lands that the University of Sydney is built. As I share my own knowledge, learning, and research practices within this University, I also pay respect to the knowledge embedded forever within the Aboriginal Custodianship of Country.

I would like to first and foremost express gratitude for my supervisors, the late Dr Gomathi

Sitharthan, Dr Rob Heard, and Dr Shakeh Momartin. Without the guiding support of all of them, this work would not have been possible. I am especially grateful to Dr Rob Heard who took the leading role as primary supervisor following the sudden passing of Dr Gomathi

Sitharthan at the beginning of 2016. His endless patience, generosity, kindness, and motivation have been immense, and I am forever thankful. Without you, Rob, this thesis would not exist.

Thank you for believing in me and pushing me well beyond what I thought was possible.

To Gomathi, I still remember our first meeting. You had walked in with a churithar (traditional

Indian attire consisting of a long top and pants), bangles on both hands, a small bindi on your forehead, and a smile before you insisted on a hug rather than a handshake. Although we did not have as much time together working on this project as we had hoped for, I hope you know the inspiration I took from your strength and optimism as you battled a horrible disease. To

Shakeh, thank you for being there to answer every question I had. I deeply value your expertise and knowledge in this field. Thank you for all your kindness and motivation along this journey.

I would like to thank the brave individuals who stepped forward from the Tamil community to participate in this research study. I am in awe of your strength. I am very grateful for your generosity in sharing some of your most horrible memories of a war you may have wanted to forget.

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I would like to acknowledge my appa (father), amma (mother), my parents-in-law, my immediate family, and my husband for their unconditional support. Thank you all for your faith in my ability to finish this when I often doubted myself. My parents left a war-torn country to provide a better life for my brother and me. They encouraged us to pursue our education to the highest level possible. My parents often reminded us that knowledge could not be stolen. I later recognised that their motivation for their children to pursue education was directly related to their experiences of loss in Sri Lanka. They had lost homes, livelihoods, culture, education, and families. Thank you especially for allowing me to travel to Christmas Island and other detention centres in Australia where I first heard the voices of asylum seekers. I know that you were worried about your 22 year old daughter being away from home for weeks at a time. This experience played a crucial role in expanding my interest to learn further about the plight of asylum seekers and refugees.

I am especially thankful to my husband Ramanan. Thank you for being the kindest and most understanding human throughout the past few years as I embarked on full-time trauma work, part-time teaching, and part-time studying. You are the best friend and life partner I could have ever imagined.

I would like to acknowledge all other researchers and academics who have contributed significantly to this field of study. Your important work allowed me to follow in your footsteps and pursue this study. I also pay my gratitude to the clients I have met during my time at

STARTTS (NSW Service for the Treatment and Rehabilitation of Torture and Trauma

Survivors) working as a Torture and Trauma Counsellor. Your perseverance, motivation, and resilience continue to inspire me long after I have sat across from every one of you. I consider myself privileged having heard your life stories filled with loss, discrimination, displacement, persecution, separation, hardships, but also survival, hope, love, and never-ending faith. I have learnt so much about myself and the world listening to your horrific stories. Although I wish

University of Sydney we lived in a world where we never had to meet, I am for the better having met you all. I especially would like to thank my clinical supervisor Dr Nooria Mehraby and Direct Services

Coordinator Gordana Hol-Radicic at STARTTS who supported my learning and created opportunities to further my passion. I am also forever indebted to my colleagues at STARTTS who contributed significantly to my learning.

Last but not least, my sincere thanks to the University of Sydney for the opportunity to pursue my education with amazing teachers. They inspire their students to achieve the impossible. I could not have pursued my PhD without the Research Training Scheme Scholarship. I also want to thank the following people for the assistance they provided with the study, Dr Selliah

Kasynathan for the translations of the study questionnaire and Mr Hazar Budak for his assistance with statistical analysis.

I was born in Jaffna in the Northern Province of Sri Lanka in June of 1987. The Sri Lankan civil war between the Liberation Tigers of Tamil Eelam (LTTE) and the government of Sri

Lanka was well under way. It was also the year that the LTTE had carried out its first suicide mission by driving a truck into a Sri Lankan army camp. My mother recounted the difficulty of finding a safe route to the hospital in Innuvil, where I would be born. The following weeks were challenging as my parents struggled to find safety for a newborn. Although a life that began within a civil war, I still remember happy childhood memories filled with family, friends, adventures, laughter, scraped knees, marbles, swings, and hideouts amongst the trees in the backyard. Most of my memories are synonymous with authentic Sri Lankan food. The life as I knew it was to be short-lived as the civil war escalated again in 1995 before I had the chance to celebrate my eighth birthday. The start of the civil war in 1995 began my journey to reach safety in Sydney, Australia. This journey is captured in the first chapter as I reflect on what has inspired me to embark on this project along with a client story de-identified and recounted with their permission.

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As a seventeen year old, I wrote a series of short stories depicting the Sri Lankan civil war guided by my then English Extension 2 teacher Ms Marilynn Ramsey. I was inspired reading

No gun for Asmir by Christobel Mattingley, To Life by Ruth Minsky Sender, and Anil’s Ghost by Michael Ondaatje. Each character found their place in the world following war and persecution. I had hoped that one day my interest would grow into something more meaningful. Yet I did not anticipate how painful it would also be to acknowledge the pain a community that I belong to has faced over the years. By sharing these voices, I hope their stories of survival are never forgotten.

I am forever grateful to this country for everything it stands for: freedom of speech, endless opportunity, recognition of hard work, and mateship for all. I was only able to achieve my education in the comfort of safety because I was able to leave a war-torn country as a child.

For that, I owe Australia everything.

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Dedication

To the Tamil men, women and children who lost their lives in a war not of their choosing.

To the families that continue their search for a safe home.

To my parents, who sacrificed it all to provide something better for me.

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CONTENTS STATEMENT OF ORIGINALITY….………………………………………………………..ii ACKNOWLEDGEMENT……………………………………………………………………iii DEDICATION……………………………………………………………………………….vii ABSTRACT………………………………………………………………………………….xv

CHAPTER ONE: WORKING THERAPEUTICALLY WITH TAMIL ASYLUM SEEKERS: A PERSONAL REFLECTION……………………...………………………….17

CHAPTER TWO: INTRODUCTION 2.1 Overview…………………………………………………………………………24 2.2 Organisation of the Thesis…...…………………………………………………...29

CHAPTER THREE: ASYLUM, MIGRATION AND AUSTRALIA 3.1 Overview………………………………………………………………………....31 3.2 Australia’s Migration History…..………………………………………………..31 3.3 Sri Lankan Migration to Australia…………………...…………………………..32 3.4 Sri Lankan Tamils and Asylum…...……………………………………………...33 3.5 Australia’s Response to Asylum Seekers……….………………………………..34 3.5.1 Temporary Protection Visas……...…………………………………….38 3.6 Summary ………………………………………………………………………...39

CHAPTER FOUR: HISTORICAL, SOCIAL AND POLITICAL HISTORY OF SRI LANKA 4.1 Overview…………………………………………………………………………41 4.2 Demographics…………………………………………………………………….43 4.3 The Formation of a National Identity…..………………………………………...46 4.4 Sri Lankan Governance, Beginnings of Parliament and the Path to Independence……………..………………………………………………………51 4.5 The Rise of Buddhism and Sinhalese Nationalism……..………………………..57 4.6 The Rise of the Liberation Tigers of Tamil Eelam and the Final War…..……….62 4.7 Allegations of War crimes and the Search for Justice …...………………………68 4.8 The Ongoing Persecution of the Tamils and Another Era of Oppression….…….70 4.9 Challenges and Next Steps: A Summary……...……………………..…………..78

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CHAPTER FIVE: THEORETICAL PERSPECTIVES: TRAUMA, POST-TRAUMATIC STRESS DISORDER AND TRANSGENERATIONAL TRANSMISSION OF TRAUMA 5.1 Overview………………………………………………………………………...82 5.1.1 Trauma: An Introduction……..…………………….…………………..83 5.1.2 Biology and Cognition of Trauma…..…………………………………84 5.1.3 Single Versus Multiple Traumas…………..…………………………...87 5.2 Post-Traumatic Stress Disorder (PTSD)………………………………………....89 5.2.1 Trauma and PTSD……………………………………………………...89 5.2.2 PTSD and DSM IV…………………………………………………….92 5.2.3 PTSD and DSM V……………………………………………………..92 5.2.4 Complex PTSD………………………………………………………...94 5.2.5 PTSD and Sri Lanka…………………………………………………...95 5.3 Trauma Theories…………………………………………………………………96 5.3.1 Post-Colonial Theory of Trauma.……………………………………...96 5.3.2 Judith Herman’s Trauma Theory…………….………………………...99 5.3.3 Refugee Trauma Theory..…………………………………………..…102 5.3.4 Feminist Theory of Trauma…………..……………………………….109 5.3.5 Collective and Cultural Trauma Theory………………….…………...112 5.3.6 Post-Traumatic Growth and Resilience Theory…………...………….114 5.4 Transgenerational Trauma………...…………………………………………….117 5.4.1 Transgenerational Trauma: An Introduction……….…………………117 5.4.2 Shattered Assumptions Theory…...………………..………………....121 5.4.3 Attachment Theory………...………………………………………….126 5.4.4 Family Systems and Communication Theory…………….…………..130 5.4.5 Secondary Traumatisation…...………………………………………..134 5.5 Summary and Conclusion…………...………………………………………….137

CHAPTER SIX: LONG TERM PSYCHOLOGICAL IMPACT OF WAR AND PERSECUTION: HISTORICAL EVIDENCE OF TRANSGENERATIONAL TRAUMA 6.1 Overview………………………………………………………………………..138 6.1.1 The Armenian Genocide……………………………………………...140 6.1.2 The Holocaust………………………………………………………...145 6.1.3 The Vietnam War……………………………………………………..154

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6.1.4 Cambodia’s Killing Fields………………………….………………… 160 6.1.5 The Rwandan Genocide…………….………………………………… 166 6.1.6 The Srebrenica Genocide………….…………...……………………... 171 6.1.7 Australian Aboriginal Community: Historical and Collective Trauma. 175 6.1.8 Sri Lankan Tamils: Persecution, Discrimination and the Civil War.…181 6.2 Summary………………………………………………………………………..185

CHAPTER SEVEN: AIMS AND OBJECTIVES 7.1 Overview………………………………………………………………………..187 7.2 Guiding Concepts……...………………………………………………………..187 7.3 Current Gaps …………...……………………………………...……………….189 7.4 Summary ……………………………………………………………………….192 7.5 Research Questions: An Overview……...………….…………………………..193

CHAPTER EIGHT: METHODOLOGY 8.1 Overview……………………………………………………………………….. 194 8.2 Research Questions…………………………………………………………...... 195 8.2.1 Research Question 1………………...………………………………...195 8.2.2 Research Question 2………...………………………………………...195 8.2.2.1 Probable PTSD……………………………………………...195 8.2.2.2 Self and Household Only Experiences of Trauma Type...….195 8.2.2.3 Severity of Trauma Type…………………………………... 196 8.2.2.4 Complexity of Trauma Type….…………………………….196 8.2.2.5 Complexity of Interference of Trauma on Everyday Life Events...……………………………………………………..196 8.2.3 Research Question 3…………...……………………………………...197 8.2.4 Research Question 4……...…………………………………………...197 8.2.4.1 Probable PTSD……………………………………………...197 8.2.4.2 Self and Household Only Experiences of Trauma Type...….198 8.2.4.3 Severity of Trauma Type………..…………………………..198 8.2.4.4 Complexity of Trauma Type…….………………………….199 8.2.4.5 Complexity of Interference of Trauma on Everyday Life Events…………………………………………...…………..199

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8.2.5 Research Question 5………...………………………………………...199 8.3 Research Design……………………………………………………….………..200 8.4 Sampling……………………………………………………………………….. 200 8.5 Data Collection Instruments…………………………………………………….201 8.5.1 Demographic Questionnaire…………………………………………..203 8.5.2 Post-Traumatic Stress Disorder Symptom Scale Self-Report ………. 203 8.5.3 Amendment of PSS-SR……………………………………………… 205 8.5.4 Probable PTSD………………………………………………………. 205 8.6 Procedure………………………………………………………………………..206 8.6.1 Ethics Approval……...………………………………………………..206 8.6.2 Recruitment…………………………………………………………... 207 8.6.3 Confidentiality………………………………………………………...208 8.6.4 Risks and Participant Withdrawal……………………………………. 209 8.6.5 Benefits………………………………………………………………..209 8.7 Data Management and Data Analysis………….…………………………….....210 8.7.1 Quantitative Data Analysis………..…………………………………..210 8.7.2 Qualitative Data Analysis…………..…………………………………211

CHAPTER NINE: RESULTS 9.1 Overview………………………………………………………………………..214 9.2 Demographic Characteristics of the Sample ……………………………..…….214 9.3 Research Question Findings…………………..………………………………...216 9.3.1 Research Question 1………...………………………………………...216 9.3.1.1. Generation 1 Trauma Experiences…………………………216 9.3.2 Research Question 2……...…………………………………………...219 9.3.2.1 Probable PTSD……………………………………………...219 9.3.2.2 Self and Household Only Experiences of Trauma Type...... 220 9.3.2.3 Severity of Trauma Type………..…………………………..221 9.3.2.4 Complexity of Trauma Type…………….…………….……222 9.3.2.5 Complexity of Interference of Trauma on Everyday Life Events………………………………………….…………....222 9.3.3 Research Question 3……………………...………….…….………….223

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9.3.3.1 Generation 2 Trauma Experiences…..………...…………....223 9.3.4 Research Question 4…………………………………………………..227 9.3.4.1 Probable PTSD……………………………………………...227 9.3.4.2 Self and Household Only Experiences of Trauma Type...….227 9.3.4.3 Severity of Trauma Type……..……………………………..228 9.3.4.4 Complexity of Trauma Type……….……………….………229 9.3.4.5 Complexity of Interference of Trauma on Everyday Life Events……………...…………………………..……………230 9.3.5 Research Question 5………………...………………………………...231 9.3.5.1 Grief and Loss………………………………………………232 9.3.5.2 Violence and Torture………………………………………..234 9.3.5.3 Survival and Stories……………………………………...… 235 9.3.5.4 Social Displacement………………………………………...237 9.3.5.5 Reflections…………………………………………………..238 9.4 Supplementary Analysis………...………………………………………………239 9.4.1 Complexity of Trauma and PTSD………...…………….………...…..239 9.4.2 Birthplace and PTSD …………………………………………………240 9.5 Summary……………………………….…………………………….………… 241

CHAPTER TEN: DISCUSSION AND CONCLUSION 10.1 Overview………………………………………………………………………242 10.2 Interpretation of Findings…………...…………………………………………243 10.2.1 Trauma Experiences and PTSD Prevalence……………...………….243 10.2.2 Severity of Trauma Type..………….………………………………..247 10.2.3 Complexity of Trauma Type and Their Associations………..…...…249 10.3 Trauma Themes Across Generations………….………………………………251 10.3.1 Grief and Loss………….……………………………………………252 10.3.2 Violence and Torture………………………………………………...254 10.3.3 Stories and Survival…………………………………………………256 10.4 Transgenerational Trauma ……………..………….………………………….258 10.4.1 Silence and Over-Disclosure…..…………….………………………259 10.4.2 Identification ……………………………….………………………. 261

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10.4.3 Re-enactment ……….……………………………………………… 262 10.5 Implication of the Findings………………………………………………..….. 262 10.5.1 Implications for the Understanding of Transgenerational Trauma.… 262 10.5.2 Implications for Therapeutic Work ……………………………...... 263 10.5.3 Implications for Trauma Measures……………...………………...…265 10.5.4 Implications for Protection Visa Determination Interviews…………266 10.6 Additional Consideration………...………………………………...………….267 10.6.1 Mental Health, Stigma and Help-Seeking Behaviour...….….…....…267 10.7 Limitations……………………………….………………………...…………. 268 10.8 Further Research and Conclusion ………………………...……..………...…..271 REFERENCES……………………………………………………………………………...273 APPENDIX A Human Research Ethics Committee Approval Letter….………….……….329 APPENDIX B Demographic Questionnaire in English…………...……………………...... 330 APPENDIX C Demographic Questionnaire in English and Tamil…………..……………..331 APPENDIX D Participant Information Sheet in English………………………..………….332 APPENDIX E Participant Information Sheet in Tamil ………………………..…..……….334 APPENDIX F PTSD Symptom Scale Self Report Questionnaire in English…...……….…337 APPENDIX G PTSD Symptom Scale Self Report Questionnaire Amended in English…...339 APPENDIX H PTSD Symptom Scale Self Report Questionnaire Amended in Tamil…….342 APPENDIX I Content Analysis ……………………………………………………...…….346 APPENDIX J Australian Tamil Congress Study Support Letter….………………………..357

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Tables TABLE 1 University Admission Marks 1971…………………..…………...…………….....59 TABLE 2 Demographic Characteristics of the Sample………..………………………...…215 TABLE 3 Trauma Events Experienced by Generation 1 Participants…………………...... 217 TABLE 4 Generation 1 Direct and Indirect Trauma Experiences……………………...…..218 TABLE 5 Trauma Events Experienced by Generation 2 Participants………………..…….224 TABLE 6 Generation 2 Direct and Indirect Trauma Experiences………………………….226

Figures FIGURE 1 Map of Sri Lanka…………………………………………...……………………45 FIGURE 2 Torture Sites……………………………………………………………………...74 FIGURE 3 H5 Model…………………………………………………………………...…..106 FIGURE 4 Histogram of PTSD Scores for Generation 1 Participants……....……………..220 FIGURE 5 Histogram of PTSD Scores for Generation 1 Participants…………………..…227 FIGURE 6 PTSD Score Range of Participants Born in Australia …………………………240 FIGURE 7 PTSD Score Range of Participants Born in Sri Lanka ……………….…...…...240

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Abstract

This cross sectional study aimed to investigate the trauma experiences of the first and second generation of Sri Lankan Tamils who have been directly or indirectly impacted by Sri Lanka's thirty-year civil war. Sri Lanka's civil war was one of the longest-running civil wars in Asia. It resulted in mass civilian casualties, loss of property and livelihoods, and displacement of many as internally displaced persons (IDPs). Many Tamils fled Sri Lanka seeking asylum in countries such as Canada, the USA, the United Kingdom and Australia. In particular, this study explored Post-Traumatic Stress Disorder (PTSD). PTSD is characterised by intense fear, helplessness, or horror resulting from exposure to extreme trauma.

Both quantitative and qualitative methods were undertaken to analyse the study data. These included descriptive statistics, inferential statistics, and content analysis. The findings revealed that the first generation participants overwhelming reported greater direct experiences of trauma than indirect experiences of trauma. This finding was consistent with the generation 1 participants having lived in Sri Lanka for a prolonged period and having greater exposure to trauma events. A total of 35 participants (68.63%) in generation 1 met the probable PTSD score of 14 or over. The experiences of torture and sexual assault, considered as severe trauma event types, were positively correlated with PTSD scores rpbs.344, p < .05. Participants who disclosed these trauma event types were likely to exhibit greater psychological distress and a higher

PTSD score. Generation 2 participants disclosed greater indirect trauma event types. This was consistent with almost half of these participants (n=21) being born in Australia and not exposed to Sri Lanka’s civil war. Of the 44 generation 2 participants in this study, only two participants reported a PTSD score of 14 or above meeting the threshold for probable PTSD.

The findings of this study provide evidence of transgenerational transfer of trauma in generation 2 participants with household only experiences of sexual assault and torture positively associated with PTSD scores and all three PTSD subscales including re-

University of Sydney experiencing, avoidance and arousal. These findings support evidence consistent with transgenerational trauma literature that trauma experiences of one generation can be passed onto another through complex mechanisms that facilitate the transfer of trauma symptoms.

Content analysis of the qualitative data identified four major themes. These were grief and loss, violence and torture, stories and survival, and social displacement.

The findings of the current study are examined with references to the relevant trauma literature.

The study’s implications for the current understanding of transgenerational trauma, trauma work, trauma measures, and asylum interviews are also explored. Mental health stigma within the Sri Lankan Tamil community and the impact that this may have on help-seeking behaviour is also discussed. Finally, further study opportunities are identified before drawing appropriate conclusions.

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Chapter 1

Working Therapeutically with Tamil Asylum Seekers: A Personal Reflection

She huddled with her eight month old son inside a tent that barely protected them from the

elements, let alone the heavy artillery. Her seven year old son sat in a corner with his uncle, both having just finished their meals. The sound of gunfire rang out, each closer than the last.

In between the gunfire, the sound of fighter planes was hard to ignore. As she strengthened

the grip on her son and moved him closer to her chest, she prayed.

She prayed for her son. She prayed for her husband, who had left her to bring back his

nephew’s body.

She prayed for her land and her people.1

On the 30th of October 1995, half a million Tamil men, women and children fled from their homes as the Jaffna exodus began. The Sri Lankan army was on its way to reclaim the Jaffna peninsula with a major military offensive. The operation was labelled Operation Riviresa, meaning operation sunrays. For many Tamils fleeing Jaffna, this was their darkest day. The peninsula had experienced many previous waves of displacement. However, this was on a scale never seen before. This was the historic exodus out of the narrow roads and lanes of Jaffna. A city proudly considered as the cultural capital of the Tamils became empty overnight. Families fled, many on foot, leaving behind their traditional land, ancestral homes, their livelihoods, animals, and ailing family members. Some would never return to their homes. They crossed the Navatkuli Bridge with their belongings on their backs and made the dangerous boat journey into the Vanni region that was still controlled by the Liberation Tigers of Tamil Eelam (LTTE).

1 This story of survival was disclosed during a counselling session at STARTTS, this has been shared as part of this thesis with the client’s consent.

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By mid-November 1995, my mother had made her decision. She bundled my brother and I, aged seven and eight, along with a few bags of clothing into the back of a bull drawn cart towards Killinochi in search of safety. A few months earlier, my father had travelled to the capital of Colombo and his sister had convinced him to leave the country. She had heard rumours of a looming unrest. Killinochi was about sixty-six kilometres from Jaffna. My mother had prepared for the uncertain journey ahead with pillows, food items, and kerosene lamps.

The few thousand rupees kept for emergencies was hidden in her top. We made our way to the

Navatkuli Bridge and waited in line with thousands of others to cross over into the safety of

Kaithady and then on towards Chavakachcheri. Chavakachcheri became a makeshift campsite for many Tamil families. My father’s friend’s photography studio became our refuge. After a few nights of rest and as the shells grew near, we reached Kilali and climbed into a small dinghy that would cross the Kilali lagoon. Later, my mum recalled that ours was the last dinghy to cross this lagoon. When the fighting intensified, the LTTE had closed this path. Eventually, we found our way to Colombo, the capital, and waited in anticipation of seeing my father again in

Sydney.

I was lucky to have my father living abroad. Almost a year after we were displaced, due to the escalating civil war, we were reunited with him in Sydney. I will forever admire the strength and courage of my mother, who single-handedly dragged two young children in the pouring monsoon rain while shells fell around us.

This was our flight for survival.

I am a strong believer that survivor narratives should be heard, understood and celebrated. The power of the first-hand experience is significant in understanding the complexities attached to stories of suffering as well as stories of survival and resilience. Their voices as experts of their experiences matter. However, the stigma surrounding mental health may silence these voices.

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I recall sitting across from a client at STARTTS (NSW Service for the Treatment and

Rehabilitation of Torture and Trauma Survivors) and hearing her harrowing asylum journey by boat from Indonesia to Australia. She had fled Sri Lanka following the civil war’s final bloody end in May 2009 with her children, husband and a plastic bag filled with their precious identity documents.

To protect her identity, we shall refer to her by the name of Yalini. Although Yalini’s real name and age have been changed to protect her identity, her refugee journey and presenting symptoms are authentic. Yalini was born in Nallur, Jaffna. She moved with her husband soon after marriage to the Vanni region where his family resided. This was a tradition for many

Tamil women. Yalini had helped many Jaffna Tamils when they were displaced in 1995 by providing her land to build makeshift shelters as the exodus reached her town. She had experienced displacement many times herself and wanted to pay forward the kindness others had shown her and her family.

As the final civil war escalated at the end of 2008, Yalini and her family listened eagerly to radio announcements of nearing army forces and advice about where to move. This advice was dependent on where the safety zones were being established by the Sri Lankan government.

Yalini stated that they had faith that their town would be spared. However, one morning they received the announcement to start moving to a safer area. Yalini and her family were displaced from their home in early December 2008. She packed her life into a few bags and began her seventeen month journey to safety. Yalini recounted walking past burning treetops and strewn bodies lying in rain-soaked clothes. Yalini said she struggled to find shelter and food after a few days on the move. She boiled rice and added salt (or sugar for the children) before they shared a small meal under a tree that provided enough shade against the hot sun. She was displaced every few days as shells fell closer to them, even in spaces deemed safe by the Sri

Lankan government. The attacks which took place within this No Fire Zone would be

University of Sydney scrutinised years later by the United Nations and added to the calls by the Tamil diaspora for an independent war crimes investigation.

Yalini recounted her moments of sombre reflection as she climbed onto a dinghy that would take her and her family to the bigger fishing vessel waiting a few hundred metres from the shore. At that moment, Yalini thought about her birth in a hospital in Northern Sri Lanka amidst unrest and her mother later recounting the fear she felt as she pushed to welcome her firstborn.

She wondered whether she would leave the world in a similarly chaotic circumstance, amidst a civil war with shells and bombs as the background music to her final moments of life.

I greeted Yalini in the reception foyer at the STARTTS office in Auburn, Sydney. She was petite, had dark hair down to her waist and was dressed in a traditional churithar. We made our way to the privacy of a counselling room after grabbing a cup of water. As I sat in front of

Yalini in a small counselling room at STARTTS, she introduced herself as a mother of two and enquired if we would finish the session by 3 pm. I reassured her that we would so she can pick up her children from school. When I introduced myself, the service and the process of counselling, she stated that she had never been to a counselling session before although it was offered to her on Christmas Island. Christmas Island is where she had spent three months in detention after the Australian navy intercepted her boat. I reassured that it was okay she had not accessed counselling and that I would tell her more about the counselling process. I provided basic information about what talk therapy is and asked her about where she would traditionally seek help if she was struggling with a problem or was feeling sad. She identified her amma (mother) as a source of support growing up, then a paati (an elderly grandmother) living two houses down from hers in her uur (village), followed by her husband and more recently a Tamil, female neighbour in Sydney who was also an asylum seeker having arrived a few years before Yalini.

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I explained confidentiality and limitations within the counselling space. She was oriented to time and place, her voice cracked as she started to tell her story. She said she was glad to have someone who spoke her language. Yalini asked whether anyone else would know that she came to speak with someone about the things that made her feel like she was crazy. She reported feeling that there was something wrong and weak about her. I explained that I was bound by ethical guidelines not to disclose any information outside the room unless disclosure of information was necessary to keep her or others around her safe. We briefly talked about suicidal ideation and the steps I would take to keep her and others safe while remaining transparent with her at all times. I also explained my responsibilities as a mandatory reporter.

Yalini stated that growing up in Sri Lanka she always heard stories of people losing their mind and seeking help from ‘mind’ doctors. Yalini recounted her mother scaring her and her younger brother as children and threatening to take them to the ‘mental hospital’ if they did not behave themselves. This threat was used sparingly over the years and Yalini had grown to believe that bad people were taken to these hospitals to be punished. She never wanted to be one of those people. Yalini acknowledged that she was not feeling well. She said she was scared of going crazy if she did not seek help soon. Yalini recounted that she had heard the term mental when people around her had referred to people who were not mentally stable. I explained that the term mental is defined as of the mind. I reassured Yalini that she was not crazy. Her reactions and symptoms following her journey through the Sri Lankan civil war were normal reactions to the abnormal situations reflective of multiple traumatic experiences and torture.

Yalini stated that she often woke up with horrible nightmares of bombs falling from the sky; she was always running in her nightmare searching for her children but never finding them.

She often woke up in the middle of the night screaming out for her youngest child. Yalini stated that her husband was supportive but had grown quite frustrated as his sleep too was disrupted by her nightmares. Yalini described the complicated grief she was feeling due to the

University of Sydney disappearance of extended family members. She did not know the whereabouts of her two cousins since they were last seen in a rehabilitation camp in Vavuniya. Yalini also disclosed that she was increasingly worried for her younger brother’s safety who continued to be harassed ever since Yalini’s family fled Sri Lanka.

During the counselling session, I provided psychoeducation regarding trauma and the brain, and normalised her difficulties. Yalini listened as I explained how behaviours designed to help survive danger become maladaptive in new environments. We talked about the impact of trauma on the brain and how it changes brain structures. It changes the way we think, remember and plan. The trauma can live on in our bodies long after we have escaped the war. Towards the end of the session, I explored the behaviours that had helped Yalini become a survivor. I asked her to tell me a little bit more about her resilience to survive the years of war and raise two healthy children. She answered with a common idiom of distress within the Tamil community ithu engadai thalaivithi (This was our fate) because the war was her life. And life was war. She talked about her uur (village), people who looked after each other and considered one another family through the years of war when they did not feel safe. Yalini said that she was still searching for safety in her mind but was keen to move forward for the sake of her children, pillaihalukaha valathan venum (I need to live for my children). Her self-identity was deeply rooted in her cultural sense of duty as a mother. It was clear that her identification as a mother had become her greatest protective factor to stay alive.

We also discussed that changes that occur due to trauma were not always permanent. I explained to her that we now have research that demonstrates the brain’s plasticity and how it changes in response to new social and environmental experiences. This is likely to happen when one finds safety and a supportive environment. We had arranged to meet fortnightly for ongoing counselling sessions. On her way out, Yalini said she might stop at the shops to buy

University of Sydney her youngest one some snacks as he was often hungry before the walk home. I smiled and acknowledged her anticipation of her child’s hunger.

I sat with my privilege after saying goodbye to Yalini. I thought about the other Yalinis out there, not yet making it to safety. They may be waiting in a detention centre in Sri Lanka or a jail in Thailand. They may be on a boat to Christmas Island with hope of a safe future despite the Australian government’s billboards advising them that they will never be settled in

Australia. It was common knowledge that the Australian and Sri Lankan governments continued to work closely to reduce asylum seeker numbers. Yet many still paid up to $15,000 to guarantee their spot on a boat. I also thought about the Yalinis who perhaps had made it to safety but were struggling with flashbacks, nightmares and the guilt of surviving. As clinicians, we call this survivor guilt.

Not everyone is lucky enough to have a family member abroad in a country that offers refuge to those escaping wars. I was without a doubt one of the lucky ones. The space of a few years would have meant that my family’s story would have been very different. It is hard to not acknowledge this when working with asylum seekers and refugees from your own country.

The personal struggle is not always made easier by talking but I try and provide a safe space for survivors to share their difficult experiences. I reassure them that there is nothing wrong with them. They are healthy human beings struggling to process an abnormal experience that no one should endure in a perfect world. I remind them of their strengths that brought them here against all odds. I let them know that they may not feel okay right now and that’s okay too. I am reminded of the privilege and honour that I have been given to hear stories of survival every time I sit in a chair in a counselling room. For many, establishing safety and positive new relationships in their new home is the first hopeful step in their journey towards healing.

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Chapter 2

Introduction

2.1 Overview

No one leaves home unless

home is the mouth of a shark.

you only run for the border

when you see the whole city

running as well.

You have to understand,

that no one puts their children in a boat

unless the water is safer than the land

You only leave home

when home won’t let you stay.

An excerpt from Home by Warsan Shire, a British Somali poet

The idea of home for many people is one of safety, shelter, security, love, healing, and peace.

Home is often the anchor to everything else in life. For those affected by mass violence, displacement, and civil wars; home is no longer safe. The survivor’s trauma experiences, along with their hope of establishing a new home, are transported to their host countries. Sri Lanka is identified as a refugee-producing country. Over the years, Sri Lankan Tamils have fled their homes due to the escalating civil war, violence, persecution, and systematic discrimination.

The military occupation of predominantly Tamil areas in the North and East of Sri Lanka is also a push factor in Tamils leaving Sri Lanka (discussed further in Chapter 4). Although

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Tamils’ migration to Australia is not unprecedented, the past decade has seen an increase in boat arrivals of Sri Lankan Tamils seeking asylum on Australian shores (discussed further in

Chapter 3). The Tamils arrive with the hope of being granted a protection visa in Australia at the conclusion of their asylum interviews. This protection visa allows them to begin their life in Australia as a recognised refugee.

A refugee is not fully defined by international law. However, they are recognised under the

Refugee Convention of 1951 and the later amendment of this leading to the Protocol of 1967

In the aftermath of World War 2 and the mass exodus of millions seeking refuge, the international community came together to establish protections to uphold the human rights of those displaced. The 1951 convention was established in response to European refugees after

World War 2. However, the Protocol of 1967 expanded its scope to include refugees displaced around the globe. According to the United Nations 1951 Convention on the status of refugees

(UN General Assembly, 1951), a refugee is:

A person who is outside his/her country of nationality or habitual residence; has a well-

founded fear of persecution because of his/her race, religion, nationality, membership

in a particular social group or political opinion; and is unable or unwilling to avail

himself/herself of the protection of that country, or to return there, for fear of

persecution (Article 1)

(UNHCR, 2020)

The United Nations High Commissioner for Refugees (UNHCR) statistics show that we are currently facing the highest levels of displacements on record. At the beginning of 2020,

UNHCR figures show that up to 70.8 million people have been forced to leave their homes

(UNHCR, 2020). Amongst the 25.9 million are refugees with more than half being under the

University of Sydney age of eighteen. Alarmingly, one person is forcibly displaced every two seconds around the world (UNHCR, 2020).

Over the years civil war, state-sponsored violence, human rights violations and political unrest around the globe have resulted in mass civilian casualties as well as millions seeking asylum in neighbouring countries. At the end of 2018, there were twenty-seven armed conflicts around the world (Stockholm International Peace Research Institute, 2019). Those who escape the atrocities experience mental health challenges that continue to impact their day to day functioning long after wars are won or lost.

Australia has been a recipient of refugees and asylum seekers since the start of its migration program. Australia’s migration portfolio started in 1945, following World War 2, that saw many Europeans displaced. The Australian government was keen to increase the Australian population to stimulate post war economic development (Jupp, 2001). Following the abolition of the White Australia Policy in 1969, there was a change in Australia’s immigration pattern.

Prime Minister Gough Whitlam introduced the Universal Migration Policy which saw increased migration from Asia, Africa and the Pacific (discussed further in Chapter 3). In the

70s and 80s, Australian governments facilitated safe passage for asylum seekers from Vietnam,

Cambodia and Laos under its obligations to the United Nations (UNHCR, 2017). Following

World War 1, World War 2, and the Vietnam War, refugee numbers increased. The community may have not only been fleeing persecution, but they may have also fled sites of trauma, hardship and economic deprivation. Although the civil war in Sri Lanka may be over, Tamils continue to fear their return to Sri Lanka. Their fear is linked to both the history of their persecution experiences as well as the ongoing perceived risks to their life (discussed in

Chapter 4).

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The impact of civil war and armed conflicts on the mental health of individuals has been researched extensively (discussed further in Chapter 6). The World Health Organization

(WHO) has defined mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO, 2004). The

American Psychiatric Association (APA) has defined mental health problems as

“psychological and behavioural patterns that are associated with emotional suffering, or disability, loss of freedom, and increased mortality. These conditions are considered to arise from a biological, behavioural, or psychological dysfunction within the individual (American

Psychiatric Association, 2000). This may result in disorders such as Generalised Anxiety

Disorder, Major Depressive Disorder, Social Anxiety Disorder and Post-Traumatic Stress

Disorder (PTSD). The most common disorder that is attributed to the direct experience of war and combat is PTSD.

PTSD is a psychological disorder that develops in some individuals following exposure to a trauma event that threatens their safety or that of others around them (discussed further in

Chapter 5). PTSD has been identified in survivors of civil war and torture and trauma war experiences through a number of research studies (Silove, Sinnerbrink, Field, Manicavasagar,

& Steel, 1999; Smith, Perrin, Yule, & Rabe-Hesketh, 2001; Terheggen, Stroebe, & Kleber,

2001; Steel, Momartin, Bateman, Hafshejani, Silove, Everson et al., 2004; Lie, 2002;

Westermeyer, Neider, & Callies, 1989 amongst others). Yet the effects of trauma-induced

PTSD can extend beyond those immediately affected. Transgenerational trauma, which explores the trauma passed on from one generation to another, can be used to describe the process by which parental traumatic experiences and resulting symptoms may lead to trauma symptoms in their offspring.

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The psychological cost of war and armed conflicts is immense. Elbedour, Bensel, and Bastien

(1993, p.806) described the children and families caught in the experience of war as the

“collaterally damaged” population. Communities around the world are directly and indirectly impacted by civil war and armed conflicts. There is limited research data available on the Sri

Lankan Tamil population and their war trauma experiences. An empirical research study is difficult to conduct within a war environment due to the high level of risk to the researchers as well as the survivors of war. Furthermore, there is a lack of access to survivors, as well as a general environment of chaos during periods of war. There are situational circumstances that make research during times of war difficult, such as when governments and local authorities systematically restrict access to any outside entity to the areas and communities affected by war. These restrictions are likely to persist long after wars have ended especially with access to a losing side.

Sri Lanka has tightly controlled the information it releases to the international community by limiting journalists’ press freedom. In 2020, Reporters Without Borders ranked Sri Lanka 127th out of 180 nations on their press freedom index (Reporters Without Borders, 2020). Sri Lanka has also been described as one of the most dangerous places for journalists to carry out their work (Amnesty International, 2010). Research studies are more likely to be conducted with migrant populations in their respective foreign countries, sometime after the war and in an environment outside the war zones where primary trauma takes place. In recent years, many survivors of the Sri Lankan civil war have fled to countries such as Australia, the United

Kingdom, the USA, Canada, and other European countries. Detailed studies of war survivors and their offspring will provide greater insight into PTSD symptoms as well as the transgenerational experiences of trauma.

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2.2 Organisation of the Thesis

This dissertation consists of ten interrelated chapters.

Chapter 1 preface provides reflections from the author’s clinical experience working therapeutically with Sri Lankan Tamil asylum seekers. It also provides the author’s account of escaping war torn Sri Lanka that has inspired her to pursue this thesis.

Chapter 2 introduces the study and provides background information to the study’s purpose.

Chapter 3 examines the historical, social and political history of Sri Lanka.

Chapter 4 explores Australia’s migration and asylum policies, practices and challenges over the years, particularly with reference to migration from Sri Lanka.

Chapter 5 reviews and details major theories and discusses models to better understand trauma, Post-Traumatic Stress Disorder and transgenerational (also known as intergenerational) trauma.

Chapter 6 critiques relevant literature that relates to civil wars, armed conflicts and massacres.

The chapter examines current literature that supports the phenomenon of transgenerational trauma.

Chapter 7 addresses the study’s objectives and significance. It summarises the guiding concepts from previous chapters and identifies the current gaps in literature and theory. Finally, the chapter identifies the study’s research questions.

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Chapter 8 describes the research methodology, including study design, data collection and data analysis. It further details the research questions identified in the previous chapter.

Chapter 9 presents the quantitative and qualitative findings from the study. Quantitative data was analysed using descriptive and inferential statistics. Qualitative data was analysed using content analysis.

Chapter 10 discusses the significance of the findings with references to relevant trauma literature and theories. It considers the study’s implications for the current understanding of transgenerational trauma, asylum interviews, trauma work and trauma measures. The chapter also examines the role of mental health stigma on help seeking behaviour in the Sri Lankan context. Finally, the chapter acknowledges the limitations of the study, identifies further research opportunities, and draws appropriate conclusions.

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Chapter 3

Asylum, Migration and Australia

3.1 Overview

This chapter provides an introduction to Australia’s migration history. It explores Australia’s commitment to the Refugee Convention of 1951 and the country’s initial response providing asylum to those seeking safety at the end of World War 2. Sri Lankans have called Australia home as early as the 1871 census. As the Tamils’ experiences of persecution increased, they migrated to Australia to seek a better life. The end of Sri Lanka’s civil war in 2009 led to a greater number of Tamils seeking asylum in Australia. In response, the Australian government introduced a range of policies to reduce asylum seeker numbers. Some of these policies have been identified as causing psychological harm.

3.2 Australia’s Migration History

Australia has a rich migration history that has contributed to the multicultural communities of today. From 1788 to 1868, Britain transported approximately 160,000 convicts from its prisons to the Australian colonies (Department of Immigration and Multicultural Affairs, 2001b). This was the first migration from Europe to Australia. The convicts were met by approximately

500,000 Aboriginal Australians who had established their communities at least 60,000 years before this arrival. The convicts’ migration was followed by English, Scottish and Irish agricultural workers and free settlers. Between 1851 and 1860, the gold rush brought more than

600,000 people to Australia. Most were from the United Kingdom, however Europeans and

Chinese were also part of this migration group. In 1901, Australia became a federation. At this time, the British, Germans and Chinese were considered the largest three migrant groups in

Australia. In the same year, the Immigration Restriction Act was introduced and the White

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Australia Policy was established as a tool of racial exclusion. A dictation test in a European language was introduced as a means of restricting those from non-European countries (Jupp,

2001). The Commonwealth was tasked with the role of selecting migrants and there was a preference to preserve racial homogeneity. The British, Irish and Europeans were given priority to settle in Australia through assisted passages. These assisted migration schemes allowed

Australia to pick and choose who migrated to Australia in the early years. For decades after

Federation, Australia was a monocultural nation. When Australia’s preference towards

European migration was perceived to be out of step with the post-war realities, the White

Australia Policy was relaxed. The dictation test was abolished in 1958. In 1972, the then

Immigration Minister Al Grassby introduced a structured system where migrants were selected according to their personal, social, and occupational attributes rather than country of origin. In

1973, he declared Australia a multicultural society.

3.3 Sri Lankan Migration to Australia

Sri Lankans have migrated to Australia since the start of the 19th century. A total of 58 Sri

Lankans were first counted in the 1871 census (‘Immigration History from Sri Lanka to

Victoria’, 2017). They were likely to have been labourers in mining towns in Victoria. In the late nineteenth century, Sri Lankan migrants came to Australia to work on the sugar cane plantations of northern Queensland. In 1901, there were 609 Sri Lanka-born individuals recorded in Australia (Department of Home Affairs, 2020).

In the late 1960s and early 1970s, following the easing of Australia’s migration policies, Asian migrants, including Sri Lankans, were arriving in Australia. During the 1960s, the Burghers comprised the largest proportion of Sri Lankan migrants to Australia (Department of Home

Affairs, 2020). They identified as Christian and were English-speaking which helped them find

University of Sydney employment easily (Jupp, 2001). Burghers were a small Eurasian ethnic group of Portuguese,

Dutch, and Sri Lankan descent. Their migration was likely due to the Sinhala Only Act of 1956 which resulted in the change of official language from English to Sinhala (discussed in chapter

4). The Sinhala Only Act saw the mass exodus of Sri Lankans to other countries in search of better opportunities. The exodus of Tamils was triggered by years of discrimination, changes to the constitution, and the escalating civil war (discussed in chapter 4). Many Tamils left on migrant and skilled visas, travelling by plane to Europe, Canada, the USA, and Australia.

Permanent migration to Australia since the mid-1990s has seen an increase of skilled visas and a reduction in family migration visas (Hugo, 1999). Jayasuriya and McAuliffe (2013) explain that migration outflows of Sri Lankans can be categorised into five groups: temporary workers

(skilled, semi-skilled and unskilled), skilled settlers, students, asylum seekers, and tourists. In

Australia, the mid-1990s saw the introduction of a skilled temporary worker visa (subclass 457)

(Khoo, McDonald, & Hugo, 2009). This changed Australia’s migration program and increased

Sri Lankan migration to Australia.

3.4 Sri Lankan Tamils and Asylum

As a result of persecution, Sri Lankan Tamils have traditionally fled to neighbouring countries such as Indonesia, Malaysia, and India. As ethnic tensions rose in the late 1980s, many Tamils fled to South India. India is Sri Lanka’s closest geographical neighbour, where Tamils continue to live in refugee camps (Feith, 2014). Approximately 60,000 Tamils live in 107 refugee camps in Tamil Nadu. A further 40,000 live outside the refugee camps. India is not a signatory to the

1951 Refugee Convention and does not have a national framework to protect refugees. India’s

Foreigners Act 1946 and Citizenship Act 1955 define all non-citizens who enter India without visas as illegal migrants. Refugees in India’s refugee camps have limited rights and the living conditions in the camps are often very basic. The assassination of Indian Prime Minister Rajiv

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Gandhi in 1991 by a suicide bomber belonging to the Liberation Tigers of Tamil Eelam (LTTE) forever changed India’s public opinion of the Tamil refugees. Although India is Sri Lanka’s closest neighbour, Tamil asylum seekers attempt to reach Australian shores as it allows them hope of permanent resettlement. Malaysia and Indonesia are also Sri Lanka’s neighbouring countries. Many Tamils flee to these countries in search of immediate safety. However, they soon make the second journey to another country as a result of discrimination, ongoing safety concerns, and significant wait times for resettlement. They also understand that they may never receive citizenship. Many Tamils have been denied citizenship even after forty years of living in India (Lakshminarayan, 2020). Although 145 countries have signed onto the UN Refugee

Convention, only about 30 states participate in the voluntary refugee resettlement program.

This allows for a limited number of asylum seekers to be resettled in other countries every year.

3.5 Australia’s Response to Asylum Seekers

Australia signed onto the United Nations Refugee Convention of 1951 and the 1967 Protocol that extended Australia’s offer of protection to those fleeing persecution beyond Europe’s borders (discussed in chapter 1). Australia first utilised the term ‘boat people’ with the arrival of Vietnamese refugees following the Vietnam War in the 1970s. The first cohort of asylum seekers was from East Timor and Vietnam. Increased conflicts around the world left marginalised communities fleeing violence, armed conflict, state-sanctioned abuse, and human rights violations. In the 1970s, the Australian national interpreting and translating service was established and the first migrant resource centre opened in Victoria to support the growing multicultural community. Australia, under Gough Whitlam’s leadership, accepted thousands of Vietnamese asylum seekers. This was followed by boats from Cambodia and Southern China in the late 1980s. In the 1990s, boats started to arrive from Middle Eastern countries such as

Iraq and later from Asian countries such as Afghanistan and Sri Lanka as the civil wars in the

University of Sydney region led to mass movements of individuals seeking safety. Since Federation in 1901,

Australia has resettled millions of migrants and over 800,000 refugees (Refugee Council of

Australia, 2016).

According to the Refugee Convention of 1951, Australia has a legal obligation to determine whether an individual has a right to claim protection once they have reached Australian shores regardless of whether they have travelled by boat or plane. The asylum process determines whether a person engages Australia’s protection obligations as set out in the Migration Act. In

1992, the Keating government introduced mandatory detention for all asylum seekers arriving without a valid visa. This policy has been maintained by successive governments. In October

1999, the Howard government introduced the Temporary Protection Visa (TPV) as a deterrent to asylum seekers arriving by boat. The TPV was a 3-year visa that provided some medical and welfare support. However, this visa restricted family reunion and travel rights. More than 90% of refugees on a TPV visa were eventually granted permanent protection visas (Evans, 2008).

In 2001, the Howard government introduced an offshore processing plan titled the Pacific

Solution following the Tampa incident, where 433 asylum seekers were rescued from their sinking ship by a Norwegian freighter. Australia refused its entry into their waters, even though this refusal was contrary to international law. The Pacific Solution saw the transfer of all asylum seekers who arrived by boat to detention centres established on Nauru and Papua New

Guinea’s Manus Island. The then Prime Minister John Howard declared in parliament that ‘We will decide who comes to this country and the circumstances in which they come.’ During this period, boat arrivals decreased. Those who were detained on both Nauru and Manus Islands were eventually resettled in Australia and New Zealand. Offshore processing was criticised by refugee advocates as punishing those in need of protection and transferring Australia’s responsibility to the poorer nations in our region. In 2008, temporary protection visas and

University of Sydney offshore processing were abolished by the Rudd government. The Rudd government reverted to permanent visas for asylum seekers once they were recognised as refugees under the Refugee

Convention.

Beginning in 2008, an increased number of Tamils fled from the North and East of Sri Lanka.

This was due to the escalating violence, ongoing threats to their lives, risk of sexual abuse, and lack of livelihood as the final war began (discussed in chapter 4). Tamil asylum seekers who arrived in Australia before March 2012 were screened and allowed an interview to assess their refugee status through one of two mechanisms: protection obligation determination (POD) or a refugee status assessment (RSA). Both these mechanisms offered a face to face interview

(telephone interviews in limited circumstances) with an immigration officer who collected the relevant information to decide whether the individual experienced a real chance or real risk if returned to their country of origin. This real chance or real risk referred to the likelihood of persecution if sent back to their country of origin. This is a different standard of measure to other areas of law that require either beyond a reasonable doubt or the balance of probabilities.

The individuals who were not granted protection were able to appeal for a review with an independent protection assessment (IPA) or independent merits review (IMR). These processes allowed for an independent person, often a tribunal member, to review their claims and overturn the decision if appropriate. This process allowed for changes in circumstances, such as country information, to also be considered as part of the review. Country information reports are prepared by the Department of Foreign Affairs and Trade (DFAT) for protection status determination. It draws on information from government bodies, academic institutions, media, and international human right organisations. A country information report provides an overview of the country’s most updated circumstances to help a decision-maker understand an asylum seeker’s subjective fear based on objective circumstances (ACCORD, 2004). Asylum seekers also had further rights to request a judicial review of the independent reviewer’s

University of Sydney decision in the Federal Circuit Court of Australia (Refugee Advice and Casework Service,

2014).

Following the Rudd government’s dismantling of the Pacific Solution and the re-introduction of permanent visas, asylum seekers travelling by boat increased. In response to the rise in the number of unauthorised boat arrivals and intense political pressure, the Gillard Government re- introduced offshore processing of asylum seekers in 2012 (Karlsen, Phillips & Spinks 2014).

In 2012, the Gillard government also introduced a policy of ‘enhanced screening’ for Sri

Lankan Tamils after the increase in boat arrivals (Australian Human Rights Commission,

2013). The enhanced screening process included a face to face interview with an immigration officer. The asylum seeker was often not aware that they had rights to seek legal assistance.

The enhanced process was aimed at deciding within a limited time whether an individual’s claim was well-founded and credible. This allowed for asylum seekers to be rejected on their claims and sent home within days of arrival. Greg Lake, a former immigration departmental officer, disclosed the enormous pressure he faced from the Prime Minister’s office to repatriate up to four hundred asylum seekers a week (Cooper, 2013). The enhanced processing was used to send up to 1200 Tamil asylum seekers back to Sri Lanka in 2013 (Cooper, 2013).

In December 2014, the Abbott government re-introduced Temporary Protection Visas. The

Abbott government pursued a harder line in stopping the boats. Operation Sovereign Borders, implemented by the then Immigration Minister Scott Morrison, included boat turnbacks, offshore detention processing, and tighter control of boat arrival information. The 2014

Migration and Maritime Powers Legislation Amendment (Resolving the Asylum Legacy

Caseload) Bill stated that asylum seekers who arrived by boat between August 2012 and

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December 2013 may not make an application for any kind of a visa, including a temporary protection visa, without the Immigration Minister’s invitation.

3.5.1 Temporary Protection Visas

Two types of temporary visas were introduced by the Abbott government in December 2014.

These visas continue to be granted today. These include a 3-year Temporary Protection Visa

(TPV) and a five year Safe Haven Enterprise Visa (SHEV) (Karlsen, Phillips & Spinks, 2014).

The visas are re-assessed at the end of their duration and a decision is made whether to grant another temporary visa to the individual. Both visas allow for an asylum seeker to be recognised as a genuine refugee. They also provide work rights, access to Medicare, and welfare support.

Many asylum seekers perceive the temporary protection visas to be a restrictive visa that allows them to live in Australian society with conditions attached. Although they have been deemed genuine refugees who are owed protection by the Australian government, the refugees with temporary protection visas are not able to exercise similar rights to that of their fellow

Australians. Their temporary protection visas restrict family sponsorships, travel overseas and permanency in Australia (Refugee Advice and Casework Service, 2015). This is often perceived as a punitive measure by the asylum seeker community. These additional stressors experienced in the resettlement process are likely to cause further trauma to asylum seekers and their families.

The re-introduction of temporary protection visas has been followed by advertisement campaigns in Sri Lanka to re-affirm that permanency is no longer granted by Australia to those that seek asylum. International law states that temporary protection should be used in exceptional circumstances where mass movements of asylum seekers limit individual refugee status determinations (UNHCR, 2000). However, Australia’s temporary protection scheme has

University of Sydney been used to grant protection to asylum seekers who have been assessed individually as needing protection. Australia’s asylum policy has been controversial as the government struggles to balance attending to the immediate needs of those seeking asylum and being in control of national borders.

3.6 Summary

Globally, Australia has earned the reputation of having strict border control and limiting the number of asylum seekers arriving on Australian shores. There have been significant delays in the processing of their applications. In 2020, a small number of Tamil asylum seekers continue to wait for interviews to assess their refugee claims. Over the years, there have been deaths, violence, protests, and unrest reported in detention centres in both Nauru and Manus

Island. Christmas Island currently houses a single Sri Lankan family from Biloela, whose case has been widely reported in the media. At the time of writing, they are waiting to find out if they are owed protection by Australia after a court ruled that their youngest daughter was not given procedural fairness. The Biloela family have been detained on Christmas Island since

August 2019. As the family waits for an outcome, the immigration department steadily maintains that they do not satisfy the criteria for a protection visa.

Tamil asylum seekers in the community continue to fear being forcibly returned to Sri Lanka.

Temporary protection visas do not provide a long term permanent resettlement option.

Nickerson et al.’s (2019) study showed that refugees with insecure visas (bridging visa, temporary visa) had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas (permanent residency or Australian citizenship). Human rights organisations have also argued that individuals face greater challenges in integrating into a new culture and environment whilst on

University of Sydney a temporary protection visa (Amnesty International, 2016). Jupp (2007) and Tavan (2005) argue that the White Australia ideology has continued to shape Australia’s refugee policies in the 21st century with bipartisan support for offshore processing and the re-emergence of Senator

Pauline Hanson’s One Nation Party.

The Sri Lankan civil war’s impact was far-reaching and transcended wealth, class, and caste.

In the 2016 Australian census, a total of 109,849 individuals identified themselves as Sri

Lankan born. This included 70,375 individuals identifying as Sri Lankan, 14,447 identifying as Sinhalese, and 9570 individuals identifying themselves as Tamils (Department of Home

Affairs, 2018). There were 28,732 Sri Lankans living in New South Wales. The 2016 census found Buddhism (44,784), Catholicism (22,778), and Hinduism (20,634) as the three major religious associations reported by Sri Lankans.

The terms ‘migrant’ and ‘refugee’ traditionally describe two different circumstances. A migrant often leaves in search of a better life while a refugee flees persecution. However, this study examines the trauma experiences of both Tamil migrants and refugees as both groups may have fled Sri Lanka due to their experiences of the civil war, persecution and discrimination. Although the two groups’ method of arrival to Australia may have differed, their trauma experiences may not be very different. A large number of Tamils call Australia home today. To date, there is limited information regarding the trauma experiences of this migrant and refugee community. It is hoped that through this research, there is a greater understanding of their experiences and challenges faced in their new home.

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Chapter 4 2

Historical, Social and Political History of Sri Lanka

4.1 Overview

Any attempt to make meaningful commentary on Sri Lanka’s Tamil community, their trauma experiences and why they fear a return to their traditional homeland needs to begin by briefly understanding the history and roots of the ethnic conflict that resulted in the 30-year civil war.

Divisions and conflict between groups have existed for centuries in Sri Lanka. The transition from colonial to post-colonial society has seen a shift in power to the numerical majority

Buddhist Sinhalese. A rise in militant Buddhist nationalism has manifested in policies favouring the Sinhalese Buddhist community, to the detriment of less numerous communities, even in such basic matters as legal rights, personal safety, and access to education and work.

As the largest minority, the Tamil community has been particularly affected. Tamils faced an uncertain future as a minority group within the country. Tamil leaders such as Samuel James

Veluppillai Chelvanayakam advocated for federalism as a means of sharing power between the two communities of Sinhalese and Tamil people. Two pacts (Bandaranaike-Chelvanayakam

Pact 1957 and Dudley-Chelvanayakam Pact 1965) were signed to devolve powers to Tamils that included equal status for Tamil and the Sinhala language, autonomy for Tamil provinces, restoration of citizenship to Indian Tamils and ceasing colonisation of Tamil lands. They upheld the idea that territorial identity of the minority Tamils must be preserved for ongoing peace. However, these pacts were rescinded by the Sri Lankan government due to pressure from the Sinhalese nationalists. The Bandaranaike-Chelvanayakam Pact was rescinded in 1958

(Kloos, 2007). The Dudley-Chelvanayakam Pact was rescinded in 1966 following the death of a Buddhist monk during a protest after the pact was presented in parliament. As a result,

Chelvanayakam and the Tamil political parties shifted away from federalism towards

2 Please note that this chapter contains confronting material including quotations from torture survivors.

University of Sydney separatism. The ideology surrounding separatism led to the formation of LTTE (Liberation

Tigers of Tamil Eelam) who waged a 30 year civil war against the Sri Lankan government state. It is estimated that between 80,000 100,000 civilians may have died as a result of the civil war (ABC, 2009).

Due to uncertainty about the future and the violence of the ongoing civil war, Tamils migrated to Western nations where opportunities would arise to lead a dignified, purposeful and free life.

Many migrated to the United Kingdom, Canada, South Africa, America, Switzerland, and

Australia (Velamathi, 2009). More recently, following the end of the civil war in 2009, Tamils have fled by boat in increasing numbers due to persecution (discussed further in Chapter 3). It is a violation of Sri Lankan migration law to leave the country unofficially through ports

(March, 2014). Yet many take the dangerous journey with the hope of reaching safety. Asylum seekers often face detention if they are caught before reaching International Waters. Detention in Sri Lanka is dangerous as torture and sexual violence has been reported over the years by both men and women (Sooka, 2017). Tamil refugees continue to fear being returned to Sri

Lanka as they do not believe they are able to lead a life free from persecution (Anantharajah,

2018).

Although the government of Sri Lanka has built infrastructure to facilitate economic growth, racial harmony appears to be more difficult to achieve. Racial tensions remain long after the civil war has ended, with families searching for missing loved ones, a war crimes investigation halted, and ongoing human rights abuses highlighted by various non-government organisations ten years after the war (Amnesty International, 2013; Human Rights Watch, 2018; International

Committee of Red Cross, 2016).

This chapter does not intend to detail the entirety of Sri Lankan history. However, key events and themes relevant to examining the research question have been discussed below. The

University of Sydney research question has been influenced and inspired by socio-political history and the country’s context before, during and after the civil war. Understanding Sri Lankan history is a prerequisite to recognise the country’s current circumstances and to explore ongoing challenges. This chapter will outline the demographics of the country, explore the policies that helped form the national identity, provide an overview of ethnicity struggles pre and postcolonial period, and highlight the persecution and trauma history as well as the ongoing challenges faced by the Tamil community today. This chapter also hopes to provide a relevant context in understanding the complexities that surround the fear of return for many Tamils to their traditional homeland.

It is crucial to understand the policies and practices that have led to the civil war, persecution, and oppression of a minority community. In addition to mental health concerns reported in a stable environment, the prevalence of mental illness in Sri Lanka is further compounded by the

30-year civil war, the 2004 Tsunami and ongoing political challenges. It is imperative to explore the psychological consequences of the conflict on Tamil survivors and their children in their new home away from home.

4.2 Demographics

Sri Lanka (formerly known as Serendib or Ceylon) is an island located in the Indian Ocean, lying east of the southern tip of the Indian subcontinent. Sri Lanka is known as the pearl of the

Indian Ocean. Sri Lanka's national languages are Sinhala and Tamil. English is widely spoken throughout the country, as a consequence of its colonial occupation by Britain from the 18th to

20th century. Sri Lanka’s total population was 20.36 million in the last census (Census of

Population and Housing 2012). More recently, the World Bank listed Sri Lanka’s population

University of Sydney at 21.40 million (World Bank, 2019). In the Census of Population and Housing (2012), the population of Sri Lanka was reported under eight ethnicities. These include Sinhalese, Sri

Lankan Tamil, Indian Tamil, Sri Lankan Moor, Burger, Malay, Sri Lanka Chetti, and Bharatha.

According to this census, ethnic Sinhalese comprise 74.9 per cent of Sri Lanka’s total population. Tamils constitute the largest ethnic minority at 15.3 per cent of the population and

Muslims (Sri Lankan Moor) constitute 9.3 per cent of the total population. Nearly 30 per cent of Sri Lankans live in the Western Province, home to the country’s commercial capital,

Colombo. Most Sri Lankan Tamils live in the North and East of the country in places such as

Jaffna, Batticalo, Vavuniya, Killinochi, Trincomalee as well as the capital of Colombo.

The Sri Lankan population practises a variety of religions. Fourteen million Sri Lankans identified as Buddhists (following specifically Theravada Buddhism) in the 2012 census. There were approximately 2.5 million Hindus, 1.9 million Muslims, and 1.2 million Roman Catholics

(Census of Population and Housing, 2012). The majority of Tamils identified as Hindus.

Geographically, Sri Lanka can be divided into three regions. This includes a lowland dry zone in the north and east, a mountainous region in the central part of the island, and a lowland wet zone in the south and the west.

The World Bank identifies Sri Lanka as an upper middle-income country. The country’s human development index in 2018 was 0.780 (high human development category) which placed Sri

Lanka 71 out of 189 countries and territories (United Nations Development Program, 2019).

The International Monetary Fund predicted a national growth of 3.5 per cent in 2020 as tourism returned to Sri Lanka following the terrorist attacks of April 2019 (International Monetary

Fund, 2019). Please see below a map of Sri Lanka in Figure 1.

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Figure 1: Map of Sri Lanka

Source: UN Cartographic Section. Accessed online through the Nations Online Project

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4.3 The Formation of National Identity

To understand the impact of colonisation on minority Tamils, it is necessary to explore what the pre-colonial era brought to Sri Lanka. It must be acknowledged that before the arrival of

European powers in the 16th century, Sri Lanka was a nation that had experienced violence, hostilities and dynastic rivalries. Sri Lanka was a nation of kingdoms separated along ethnic and religious lines.

Over the years there has been an ongoing debate about who occupied the island first, the Tamils or the Sinhalese. Some historical studies have shown that both the Tamils and Sinhalese are descended from the Mesolithic people who occupied the nation in the prehistoric period

(Indrapala, 2005; Ranaweera et al., 2014). The political struggle between the numerical majority Sinhalese and numerical minority Tamils started before the colonial era. Hostilities based on ethnic identity could be traced to a single historic literature text that has played a key role in shaping the island as we know it today, by providing a dominant narrative to Sinhalese

Buddhist nationalism. The text an epic poem, ‘Mahavamsa’, was written by Buddhist monk

Venerable Mahanama Thera in the 6th century Common Era (CE). The Mahavamsa describes key events and people who forged Sri Lankan history. It tells the story of the first King Vijaya’s arrival to the island in the 4th century BCE to the reign of King Mahasena in Anuradhapura. It also recounts the battles in the kingdom until the 6th century CE. The Mahavamsa is one of the most important works of Buddhist literature documenting the early history of Sri Lanka.

Venerable Mahanama Thera portrayed Sri Lanka as, the ‘Dammadeepa’, the chosen land of

Buddha (Roberts, 2001). The Mahavamsa identified the Sinhalese community as the sole guardians of Buddhism by marginalising all others. It also provided them with a sense of identity (Nesiah, 2001). One key part of this book describes a historic battle between two

Kings, Elara and Dutthugamani, for the Kingdom of Anuradhapura. Elara, also known as

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Ellalan, was a Tamil King who ruled over Anuradhapura for forty-four years. Anuradhapura was the first Kingdom in Sri Lanka and was considered to be the capital of the country. This historic battle was won by King Dutthugamani, a Sinhalese King. King Elara and many Tamils living within the Kingdom were killed. King Dutthugamani was portrayed as a heroic young warrior fighting for Buddhism and the nation collectively. It is said that Dutthugamani’s war cry was ‘Not for Kingdom, but for Buddhism’. During the 5th and 6th century, Sinhalese

Buddhist Kingdoms were threatened by the Hindu empires in South India. These included the

Tamil Kingdoms of Pandya, Pallava, and Chola. Buddhism faced a threat in India as the country’s majority practised Hinduism. The Buddhist clergy also became concerned about the threat to Buddhism from South Indian rulers and in turn, appealed to the Sinhalese community’s racial and religious sentiments to protect their King.

Spencer (1990) identified Mahavamsa as contributing to early cultural nationalism in the country. The responsibility placed on the Sinhalese Buddhist community to safeguard

Buddhism, has continued to be reinforced through Sinhalese school history lessons and

Buddhist clergy and politicians’ speeches over the years inclusive of the colonial era. The historic battle depicted in Mahavamsa is seen in the contemporary era as a major racial confrontation between the Tamils and the Sinhalese. The identity created through the influence of Mahavamsa led to the justification of violence as a means to protect Buddhism. Tamils were often depicted as being opposed to Buddhism. As a nation carving its national identity in the

19th century, Sri Lankans struggled to foster any empathy towards non-believers of Buddhism

(Gunawardana, 1976). Farmer (1963) identified strong similarities between Jewish communities’ and Sinhalese communities’ connection to their land. The two communities identify their land as holy and as being established by God for the people. In Sri Lanka’s case, the God figure was Buddha (Farmer, 1963). The Kingdom of Anuradhapura remained the capital of the country from about the 5th century to the 11th century. By the 11th century, the

University of Sydney island’s dominant kingdom was in Polonnaruwa which is to the south-east of Anuradhapura.

Polonnaruwa was defeated by the Chola dynasty as vengeance for helping the Pandya dynasty wage a war against them in South India. Sri Lanka remained a province of the Chola dynasty for seventy-five years. When the Sinhalese Kingdom was destroyed, the Sinhalese community moved to the south of the country while the Tamils moved to the North and Eastern provinces.

In this period in the 14th century, Sri Lankan Tamils started to develope a unique identity independent of the Sinhalese Kingdom of Kotte (South West). The Kingdom of Kotte also developed significantly due to its involvement in the maritime trade during the 14th century.

Although Tamil settlements as a whole were isolated from the rest of Sri Lanka, there continued to be lively trade across these locations and South India. Sri Lanka’s position in the Indian

Ocean allowed it to become a major port for merchant ships with goods from the East (South- east Asia, China) traded with goods from the West (Europe, Africa, South-west Asia). Tamil inscriptions in Galle port, along with Persian and Chinese incriptions, appear to show the multinational nature of trade in Sri Lanka as early as the 15th century, before the European arrival. Trade relations appear to have functioned separately to cultural and religious developments, and promoted productive and positive contact between religious and cultural groups.

Prior to European invasion and influence, Sri Lanka was a country with a complex history that encompassed a diversity of ethnic, religious, political and social groups. The island also had a tradition of conflict dating back to battles between kingdoms. The current politics of Sri Lanka, and refugee migration from Sri Lanka, has been strongly influenced by the ways in which various European powers used the existing alliances and divisions in Sri Lankan society to further their own agendas. The remainder of this chapter highlights the steps taken by European powers, and the aftermath of colonial interventions.

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The first Europeans to land on the island of Sri Lanka were the Portuguese. When the

Portuguese occupied the Island in the 16th century, there was a separate kingdom for the Tamils in the North of Sri Lanka (The Jaffna Kingdom) and a kingdom for the Sinhalese (the Kingdom of Kotte) (Mehta, 2010). The Portuguese were able to seize control over Jaffna and Kotte

Kingdoms. Those who were dissatisfied with Portuguese rule, abandoned existing Kingdoms and fled to the mountainous region of Sri Lanka and established a new kingdom, the Kingdom of Kandy. During the Portuguese era, many lowland occupying Sinhalese were forced to convert to Christianity. Sri Lankan Muslims (Moors) were also persecuted religiously, and they retreated to the Central highlands.

Later the Dutch took control of the Island (1658-1796). The Dutch maintained the status quo of the population distribution. The Jaffna Kingdom was recognised as the traditional homeland of the Tamils where they were able to establish their livelihoods, families and practice their traditions (Manogaran, 1987). By 1760, the Dutch controlled the entire island except for the kingdom of Kandy in the central upland. The Burghers, a mix of Dutch and Sinhalese, are the legacy of Dutch rule and still currently live in Sri Lanka (Mehta, 2010). Sri Lanka, divided into three separate Kingdoms, was maintained during the occupation of the Portuguese and the

Dutch in the 16th and 17th century. During this period of Dutch and Portuguese rule, all three kingdoms of the Island were recognised as governing systems. The local administration systems were allowed to maintain social order within each kingdom and caste politics allowed control in the hands of the native powerholders. The Kandyan king was regarded as the successor to the ancient King of Anuradhapura. The King was expected to run the Kingdom according to the principles of good rule guided by the Mahavamsa. The Kandyan Kingdom shifted towards Theravada Buddhism as its central ideology in line with teachings of the

Mahavamsa.

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Prior to the introduction of communal representation by the British in the form of parliament,

Sri Lanka was dominated by caste politics that privileged the ruling elite. The caste system has been described as the division of power and labour in a society. Caste politics in Sri Lanka differed between Sri Lankan Tamils, Indian Tamils and the Sri Lankan Sinhalese (Silva, 2009).

The Sri Lankan Northern Tamil caste system was based on farming. This includes the Vellalar, the landowning elite, at the top with greater power and influence (Mahroof, 2000). The Jaffna elite were Vellalar. The Eastern Tamils prioritised the fishers as the backbone of their caste system while the plantation Tamils preserved their caste identity from South India (Mahroof,

2000).

The Sinhalese society organised a feudal social order accompanying the political system. The dominating caste was the Govigama who were agriculturalists. The lower caste communities were excluded from power, land ownership, honour and human dignity. Buddhism on one hand condoned the caste system but also used the system to set up a social order within the society

(Malalgoda, 1976). Within the Sinhalese community, Rajakariya, or the King’s work, connected each caste to an occupation that was required. The Sinhalese caste system was divided between up-country and low-country.

Although caste politics dictated social order within communities, the Mahavamsa helped create a single narrative within the Sinhalese society of Sri Lanka as the guardians of Buddhism.

Mahavamsa was written in the Pali language using a Kāvya style, an Indo Aryan language of

North Indian origin. In the 19th century, it was translated into Sinhala and English by the British colonial rulers. Prior to the translations, many Sinhalese were not able to read the Pali language. The British relied on Mahavamsa and other local chronicles to write the history of

Ceylon and add to the continual belief of Sri Lanka being a country solely for the Sinhalese

Buddhists. This led to the belief that Tamils, Muslims, Sinhalese Christians, and others who

University of Sydney did not identify as Buddhists could never be wholly Sri Lankan. The Mahavamsa minimised

Tamil origins in Sri Lanka and contributed to increased Sinhalese nationalism. It established

Sri Lanka as a nation given by Buddha to the Sinhalese community to establish and maintain

Buddhism (Sriskanda Rajah, 2017). During the British era, Anagarika Dharmapala emerged as the father of modern Sinhalese Buddhist identity. He was a prolific writer who allowed for a new identity to emerge in a colonial society. He encouraged Buddhists to reject British customs and dress (Dharmadasa, 1992) and rejected all things foreign and alien towards Sinhalese

Buddhist culture (DeVotta, 2007). In particular, his writings encouraged two key points.

Firstly, the Sinhalese were a small community surrounded by alien races and secondly the need for the community to overcome foreign forces to safeguard Buddhism (Amunugama, 1985).

4.4 Sri Lankan Governance, Beginnings of Parliament and the Path to Independence

Sri Lanka was colonised by the British in 1796. The roots of the current political conflict date back to British colonial rule when the country was known as Ceylon. In 1802, Sri Lanka was made a crown colony with a governor. Additionally, an advisory council (consisting of

Colonial Secretary, Chief Justice, Commander of Troops, and two civil servants) was formed to assist the governor and to limit his unchecked powers (Samaraweera, 1973b). By 1820, the

British government abolished the remaining separate Kingdoms that had existed prior to and during the Dutch period. The British divided the country on a territorial basis into five provinces: Northern, Eastern, Southern, Western, and Central. Each of the provinces was governed by a British government agent who was appointed by the governor of Ceylon. This was later expanded to nine provinces.

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The British reformed the island nation with the abolition of slavery, improvement of internal communications, the building of infrastructure to increase travel internally, and support of the

Christian missionary activities that included English education being introduced to the Island

(Manogaran, 1987). The British enacted policies that recognised that all persons were equal before the law. During British rule, missionary schools that promoted English were set up in greater numbers in urban areas, proportionally giving more access to Tamils. Rural communities had little to no access to these schools. The Tamils also pursued education as a way of securing employment rather than solely rely on their cash crops that were dependent on a volatile trade market. Additionally, those with means gained greater access to education in fee-paying English schools.

Sri Lanka’s education system that was managed by Christian missionaries promoted English as a means for financial success. Only English speaking Sri Lankans could become teachers and government servants and as a result, these positions were mostly occupied by high caste

Hindus or Tamils who had access to missionary schools (Manogaran, 1987). The Sinhalese communities in the South enjoyed farming opportunities and business opportunities set up by the British. During this period, there was growing Sinhalese Buddhist nationalism as a reaction to the British rule that brought Christianity to the country. There was a greater focus on maintaining Sinhalese culture, ethnicity and the Buddhist religion, in particular Theravada

Buddhism (Durham, 2015). Sri Lankan Tamil nationalism during this period was centred on the right to independence and political autonomy. Hindu revivalists influenced Tamils to build their temples, schools and societies as a response to increasing Protestant missionary activity during this period (Mehta, 2010).

Having occupied the island, the British introduced a uniform administrative system in 1833 following the Colebrook Commission (Mills, 1933). Although Sri Lanka was under British

University of Sydney rule, it was only in 1833 that the colony was politically unified through the establishment of political, economic, and judicial reforms. Executive and Legislative councils were set up reducing the Governor’s previous oversight, and sharing the task of governance. Communal representation, introduced in 1833, allowed the governor to nominate individuals to represent their ethnic groups at the Legislative Council of Ceylon (Manogaran, 1987). Unofficial native members were appointed to the Legislative Council along with British members. The native members were chosen to represent their community; a low-country Sinhalese, a Burgher and a

Tamil. A further change in 1889 saw two additions; a Kandyan Sinhalese and a Muslim native member. This representation of communities reflected the different ethnicities on the island without territorial dominance. Here emerged the beginnings of parliament as we know it today.

However, this communal representation also stirred up political and social tensions within the communities as they formed their independent associations such as the Kandyan Association, formed in 1917, and the Ceylon National Congress in 1918. In 1921, the Tamil leaders of the

Ceylon National Congress parted ways and created the Ceylon Tamil Congress after not being given representation in the Western Province by the Sinhalese leaders. The Manning reforms to include terroritial representation as well as the differences that existed between Tamil and

Sinhala conservative elites and the urban working class also contributed to the split.

The communal representation established in 1833 was abolished following the Donoughmore

Constitution of 1931. This was based on the recommendations of the Donoughmore

Commission, a committee sent by the British to revise the Ceylonese Constitution. The aim of the Donoughmore Commission was to increase the participation of the population in how members were elected to the Legislative Council to govern the country (Manogaran, 1987). Sri

Lanka became the first country in Asia to have universal suffrage. However, when universal voting was achieved along with territorial representation, the ratio of Sinhalese to Tamil representation had increased from 2:1 to 5:1. As a result of this Constitution, three significant

University of Sydney steps were taken. Firstly, those over the age of twenty-one who resided in Sri Lanka were allowed to vote. Prior to the Donoughmore Constitution, voting was limited to wealthy and educated males above the age of twenty-one years. Secondly, communal electorates were abolished to be replaced by territorial constituencies to have a more united Sri Lanka. Thirdly, a State Council with legislative and executive powers was established. This resulted in newly established State Council elected territory representatives from electorates based on area and population numbers. As a result, the Sinhalese community, with a significantly larger population, gained increased numbers of representatives on the State Council body. The state council’s role was to bring together elected territorial members to have financial and revenue power. However, decisions regarding public administration, defence, and foreign affairs were carried out by three British officials nominated by the governor of Ceylon. The Tamils opposed this change as it drastically reduced the minority’s representation in the parliament that was achieved through communal representation. Ponnambalam, a Tamil representative on the state council and a lawyer by profession, demanded half of the seats in an independent Sri Lanka to be allocated to minorities. (Singh & Kukreja, 2014). Tamil political leaders including

Ponnambalam objected to the Donoughmore Constitution as the state council would be dominated by Sinhalese members and create opportunities for discrimination. Following the state council elections of 1936, Tamil representatives were excluded from the cabinet and a pan Sinhalese Ministry was formed. A path to the politicisation of ethnicity had begun.

Ponnambalam formed the All Ceylon Tamil Congress Party in 1944 alongside another Tamil political leader and lawyer Chelvanayakam to give voice to the Tamil community.

Ponnambalam argued that universal voting rights was a mistake and voting should be shared instead between educated upper caste Tamils and educated upper caste Sinhalese in a 50:50 split with balanced representation (Manogaran, 1987). The critics argued that Ponnambalam’s demands were unreasonable and not reflective of equality under principles of democracy. They

University of Sydney also criticised Ponnambalam for not acknowledging the Tamils’ status as a minority in the country. As a result, the demands were not accepted by the majority Sinhalese community.

However, Ponnambalam raised the Ceylon Tamils’ consciousness about their rights. As

Sinhalese representation on legislative bodies increased, the Tamil community’s capacity to voice their concerns and be heard reduced. The increased Sinhalese representation allowed minorities such as the Tamils to be held at their mercy with respect to their fundamental rights.

This soon led to racially-based violence. The first racial riot was reported following a speech by Ponnambalam where he attacked the historical text Mahavamsa.

The Soulbury Commission, another British commission, was established in 1944 to recommend a new constitution. Under this commission’s review, Ponnambalam’s submission to demand greater representation in parliament was not successful as it was not deemed democratic by the commissioner (Manogaran, 1987). The Soulbury Constitution supported the previous Donoughmore constitution and retained adult voting rights and electorate representation of the state council. Furthermore, a House of Representatives with responsibility for domestic affairs was established. The most significant development as a result of the

Soulbury Commission was the establishment of bicameral legislature leading to a Senate in Sri

Lanka. This legislature established under the Soulbury constitution became known as the parliament with a Lower House (House of Representatives), Upper House (Senate) and the

Queen (Governor General acted as the representative of the Queen).

The House of Representatives was elected according to the geographical electorates and majority voting system. A further six members, including a member from a minority group, were appointed by the Governor-General to meet the representation needs. The fourth amendment to the Soulbury Constitution increased House of Representatives membership to

157, with 151 members elected from 145 electorates and six appointed by the Governor-

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General (Manogaran, 1987). The Senate consisted of thirty members who were partly elected and partly nominated. Fifteen members were nominated by the governor-general on the instructions of the Prime Minister. The remaining fifteen members were elected by the House of Representatives. As a result of the government’s influence in electing Senate members and the reduced powers of the Senate, it did not function as an effective check on the Lower House.

Another crucial criticism of the Senate was that it failed to include representation of a minority community member. Appointed by the British monarch, the Governor-General had ceremonial powers only. The Parliament of Ceylon was established in 1947 by the Soulbury Constitution and replaced the State Council. This constitution paved the way for an Independent Sri Lanka with a British style Westminster model parliamentary system.

Sri Lanka gained independence in 1948. The United National Party (UNP), a coalition of communal and nationalist parties that were right-leaning and pro capitalistic, won this election.

Senanayake, who was elected as the first Prime Minister of Sri Lanka after the elections, created the Citizenship Amendment Act of 1948. This had the effect of reducing the voting power of those who disagreed with the party’s policies. The 1948 constitution included guarantees against discrimination towards minorities. Ponnambalam joined the Don Stephen

Senanayake government as a parliament member having failed to secure the 50:50 representations. However, Chelvanayakam did not cross the floor to join UNP. He and fellow followers later formed the Tamil Federal Party (FP) in 1949. Chelvanayakam advocated for federalism as a means to share power between majority Sinhalese and minority Tamils. He argued for the benefits of living as one country without a call for a separate state for the Tamils.

Two pacts (the Bandaranaike–Chelvanayakam Pact 1957 and the Dudley-Chelvanayakam Pact

1965) were signed to devolve powers to Tamils that included equal status for Tamil and Sinhala languages, autonomy for Tamil provinces, restoration of citizenship to Indian Tamils and to cease colonisation of Tamil lands. However, these pacts were rescinded by the Sri Lankan

University of Sydney government in 1958 and 1966 due to pressure from Sinhalese nationalists. This was a key moment in Tamil political leaders taking a step towards separatism as an answer to the rising ethnic tensions.

In 1971, the Senate was abolished under the 8th amendment of the Soulbury Constitution. In

1972, Sri Lanka established its constitution independent of any British influence. The 1972

Constitution changed the name of the country from Ceylon to Sri Lanka. The President replaced the Governor-General as the head of state. Driven by Buddist clergy, the Republic of Sri Lanka shifted to consider Buddhism as the foremost religion. The Tamils and other minority populations argued that they were not consulted and had no input into the Soulbury

Constitution. Furthermore, this Constitution abolished safeguards in place within the previous

Constitution of 1946 to protect the judiciary and independence of the civil service. Critically, the 1972 Constitution abolished bicameralism and introduced a single chamber house to Sri

Lankan politics. The new republican constitution, introduced by the then Prime Minister

Srimavo Bandaranaike, replaced the House of Representatives and parliament with the unicameral National State Assembly. By becoming a unicameral state, Sri Lanka lost legislative protection for minorities.

4.5 The Rise of Buddhism and Sinhalese Nationalism

The British system of parliament established in 1948 was based on principles of democracy.

However, the system lacked the protection of minorities and did not allow for grievances of the minorities to be heard. During their rule, the British brought Tamils from India to Sri Lanka as a labour force to work on tea plantations in the up-country areas (Tambiah, 1992). The government of D. S. Senanayake passed legislation in 1949 that stripped Indian Tamils of their

Sri Lankan citizenship and effectively reduced the Tamil voting population overnight. It is important to acknowledge that both Jaffna Tamil and Sinhalese elite supported this legislation.

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Jayawardena (1990) argues that this inter group collaboration was based on class rather than ethnicity. In 1948, the Tamils had 33 percent of voting power in parliament. Following the marginalisation of the Indian Tamils, this number had fallen to 20 percent (Tambiah, 1986).

This Act meant that more than a million Tamils of Indian origin were stateless. It also divided the Tamil community in Sri Lanka. Post-independence, the Sinhalese communities protested their lack of equal access to education. This became a source of antagonism between the two ethnic groups. In 1956, the Sinhala Only Act was passed by the parliament. This Act made

Sinhalese the official language of the country. It was a fulfilment of the campaign promise made by S.W.R.D. Bandaranaike in his landslide victory in the general election. The Sinhala

Only Act, while being anti English, forced the resignation of many Tamil government workers who lacked fluency in the Sinhala language. The Sinhala Only Act attacked the livelihoods of

Tamils as the English language had been the enabler for social mobility into government administrative services and other professional roles.

As a result of opposition from Tamils to the Sinhala Only Act, the passage of the bill was followed by violent riots, and a state of emergency was declared. Over 100 Tamils were killed after Tamil parliamentarians protested. The riots also challenged Ceylon’s political modernity

(Jeganathan, 1998). Tamils continued to face barriers in other spheres of life. In 1971, the admissions standards of the Sri Lankan university system introduced a standardisation process.

This discounted individual students’ examination results from the admission process (Tambiah,

1992). This made it more difficult for Tamil students to access universities as they had to score higher marks on their admission compared to Sinhalese students (refer to Table 1). The new policy aimed to make the student population reflect the national population and was promoted as an equal opportunity measure. Whatever its intention, abandoning the merit-only system met the vocal interests of the All Ceylon Buddhist Congress (Anuzsiya, 1996), whereas Tamils on

University of Sydney the Island considered the new policy as both discriminatory and racist. It therefore became a focus of division in the Sri Lankan community.

Table 1: University admission marks 1971(De Silva, 1976)

Degree Marks required for a Sinhalese Marks required for a Tamil

student student

Medicine and Dentistry 229 250

Physical Science 183 204

Bioscience 175 184

Engineering 227 250

Veterinary Science 181 206

Architecture 180 194

The standardisation process focused along ethnic lines aggravated further tensions amongst the two communities. Although the Sri Lankan government had argued for proportionate representation of students through the district quota system, marks were determined based on ethnicity rather than district. This process resulted in the Tamil community feeling powerless and unable to raise their concerns through any existing government party. The power to make decisions impacting the country was in the hands of the unicameral Sinhalese dominated parliament.

During this period, tensions were also increasing in the south of the country. The brutality of

Sri Lankan government’s response was seen during the 1971 uprising of Sinhalese youths as they attempted to capture state power. The Janatha Vimukthi Peramuna (JVP) was an underground organisating comprised of Sinhalese Buddhist youths who were disgruntled at the lack of employment opportunities and felt neglected by the government. These youths often

University of Sydney only completed secondary studies in Sinhala language schools and were drawn from rural areas of the South. The uprising in 1971 saw JVP members attack ninety-two police stations across the country. Between 8000 - 10 000 Sinhalese youths were killed along with 53 members of the Sri Lankan security forces (Bush, 2003). Jiggins (1979) argued that the uprising was the result of the Sri Lankan’s paternalistic government that did now allow for the political participation of an individual to create meaningful change.

Following the 1977 landslide victory in parliamentary elections, the United National Party proposed a development plan titled the ‘Accelerated Mahaweli Program’. The United National

Party is a conservative party founded by Don Stephen Senanayake in 1946. This program based along the Mahaweli River, the longest running river in Sri Lanka, was part of a number of programs introduced after the 1927 land commission ruling allowing government to hold crown land in trust and allocate to the people for their benefit (Gunawardena, 1981). These programs allowed thousands of Sinhalese families to be relocated from the wet zones into the dry zones. Under the Mahaweli Accelerated Program, the thirty-year proposed plan in 1968 was promised to be delivered in six years. The scheme saw thousands of Sinhalese families relocated from the South to the North and East of the country. Many Tamils perceived this as a land grab opportunity and an attempt at changing the demographics of their traditional homeland. The resulting ethnic redisturbution contributed to many Sinhalese equating the colonisation of the dry zones with a symbolic return to the ancient Sinhalese Buddhist Kingdom

(Peebles, 1990).

The army had been sent to Jaffna in 1979 due to increased Tamil militancy. On May 31st 1981, the Jaffna library was torched by state security forces and state-sponsored Sinhalese mobs that rioted through the city (Tambiah, 1986). The Jaffna library was one of the largest libraries in

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Asia. It hosted 95,000 books as well as centuries-old newspapers, artefacts and ancient palm leaf manuscripts. The loss was said to be irreparable (Tambiah, 1986). To the Tamils, the Jaffna library was a symbol of their knowledge, cultural heritage, literature, and their link to Tamil scholarly works. This library was of emotional significance to the Tamils. Virginia Leary wrote in Ethnic Conflict and Violence in Sri Lanka - Report of a Mission to Sri Lanka on behalf of the International Commission of Jurists (ICJ), that the destruction of the Jaffna Public Library caused the most distress to the people of Jaffna (Leary, 1983).

The violence also spilt into the streets soon after. In July 1983, an anti-Tamil pogrom took place in Colombo, the capital of Sri Lanka. This violence followed an ambush of an army patrol and then spread to Colombo when the government held the funerals of the soldiers. During this pogrom, more than 100,000 Tamils were displaced and thousands were massacred. Over the course of a few days in July, Sinhalese mobs burned down Tamil homes, businesses and killed

Tamils in the capital Colombo. Tamils believed this was pre-planned as the then President of

Sri Lanka Jayawardene was quoted as saying the excerpt below in an interview with Ian Ward of the London Telegraph in 1983 (Janani, 2008).

I am not worried about the opinion of the Jaffna people now… Now we cannot think

of them. Not about their lives or of their opinion about us… The more you put pressure

in the north, the happier the Sinhala people will be here… really, if I starve the Tamils

out, the Sinhala people will be happy.

The Black July pogrom that took place on the back of Sinhalese nationalism and the rise of

Buddhism saw up to 4000 Tamils killed. This would later be remembered and commemorated each year as the Black July Massacre. The violence was shortly followed by restrictions to the movement of foreign journalists and strict press censorship imposed throughout the island.

There were also accusations that the government was involved in the riots and the mass

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Sinhalese uprising that occurred. Elements within the government parties were suspected of providing voter lists to the mobs. Some examples include mobs being dropped off in specific locations in government-owned vehicles such as the State Timber Corporation, the Cooperative

Wholesale Establishment, the Ceylon Electricity Board, and the Sri Lanka Transport Board

(Senaratne, 1997).

The Black July tragedy left eighteen thousand homes destroyed and many Tamils fled the country for countries such as Australia, Canada, the United Kingdom and the USA. This was also the first time that foreign media recorded and publicised an incident where Tamils were the targets. A Norwegian tourist, Mrs Skarstein, had been holidaying in Sri Lanka with her then fifteen year old daughter. She witnessed twenty Tamils burned to death when a mob stopped a minibus in Colombo and poured petrol over it before lighting it on fire (Eleanor, 2008). The mob also prevented anyone from escaping the burning minibus by blocking the front doors.

She later related her story to the Norwegian newspaper Verdens Gang. In the article published by the Norwegian newspaper, she also referred to a group of Swedish tourists she had met who reported to have seen crowds pouring petrol on Tamils and setting fire to them (Eleanor, 2008).

The horror of the Black July Massacre transformed the moderate Tamils towards the armed struggle to restore their community (Jeyaraj, 2010). It also became a recruiting tool for the

Tamil militant group that was emerging and strengthened the notion of a separate Tamil homeland within the island of Sri Lanka.

4.6 The Rise of the Liberation Tigers of Tamil Eelam (LTTE) and the Final War

In 1976, Tamil parties, including the All Ceylon Tamil Congress and the Tamil Federal Party, united to form the Tamil United Liberation Front (TULF). They proposed an independent state for the Tamils in Sri Lanka called The Secular Social State of Tamil Eelam. In the 1977

University of Sydney parliamentary elections, TULF contested and won all fourteen seats in the Tamil dominated

Northern Province. TULF predominantly included older generation conservative Tamils that believed in a nonviolent means of achieving political autonomy. However, the Tamil youth were becoming increasingly impatient and were navigating a path towards militancy to achieve their goal of separatism. Frustrated by the lack of progress through political, diplomatic and nonviolent means, Tamil youth started to form militant groups in the seventies. Some of the major militant groups included Eelam People's Revolutionary Liberation Front (EPRLF), the

Tamil Eelam Liberation Organization (TELO), the Eelam Revolutionary Organization of

Students (EROS), the People's Liberation Organization of Tamil Eelam (PLOTE), and the

Liberation Tigers of Tamil Eelam (LTTE). In 1985, a single umbrella organisation called the

Eelam National Liberation Front (ENLF) was formed bringing in the major Tamil militant groups together with the exception of PLOTE. However, the LTTE left the umbrella organisation and went on to build a single front to lead a military response to the political problem.

On the 29th July 1987, the Indo-Sri Lanka Accord was signed between Indian Prime Minister

Rajiv Gandhi and Sri Lankan President Junius Jayewardene to end four years of violence between the Tamils and the Sinhalese. It allowed for a military-style involvement by India in

Sri Lanka’s conflict by sending in the Indian Peace Keeping Force (IPKF). The Sinhalese community vehemently opposed this intervention by India and protests were organised across the country. The purpose of this Accord was to restore Tamil rights, disarm the LTTE, and to resolve the war in Sri Lanka (Bullion, 1994). However, the LTTE laid down their arms in a token act with a ceremony in Jaffna. Hostilities increased in the North and East between the

LTTE and IPKF resulting in the death of innocent civilians. The IPKF soldiers also committed atrocities against the Tamil civilians inclusive of murder, rape and violence. Somasundaram

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(1998) described the increased rate of suicide amongst Tamil women who were raped by IPKF forces. The IPKF were also responsible for the Jaffna hospital massacre in 1987 that resulted in the murder of doctors, nurses and patients. The presence of the IPKF increased tensions in the

Sinhala community in the south of the country. However, their criminal behaviour significantly eroded the trust the Tamil people placed on their individual safety and security in their homeland. The Tamils were not protected from violence by their own state or that of the forces of their trusted neighbouring country. The cumulative impact of atrocities committed by the

IPKF as well as the Sri Lankan army fostered an environment where Tamils’ decision to escape from their country of origin was a sensible course of action.

The LTTE also increasingly fought against other Tamil militant rival groups as the rivalry increased. The movement established itself as the main armed group fighting for an independent state in the north and east of the island after killing rival groups’ leaders and absorbing their trained cadres. India was forced to withdraw the IPKF. In May 1991, Rajiv Gandhi was assassinated by an LTTE suicide bomber in Chennai, India. Although the LTTE never took direct responsibility for the murder, many believe Rajiv Gandhi was targeted by the LTTE for ordering Indian troops to intervene in the Sri Lankan civil war.

Sri Lanka had been under emergency rule for most of the time since the early 1980s with successive governments maintaining past policies that continued to discriminate against minority groups. As tensions increased in the community, the Tamil people began to intensify demands for a separate State (Tambiah, 1986). As the suffering increased, they gave greater support to the liberation movement and its armed struggle. The LTTE was headed by Velupillai

Prabhakaran, a leader who established the rebel group through guerrilla-style warfare in the early years. By 1985, the LTTE had engaged in major battles with the Sri Lankan government

University of Sydney and controlled Jaffna, Northern Province of Sri Lanka. Other major LTTE operations included a 1992 landmine explosion in Jaffna that killed senior commanders of the Sri Lankan military, the 1993 assassination of the then President Ranasinghe Premadasa, the 1996 suicide bomb attack on the Central bank of Colombo that killed one hundred civilians, and the 2001 guerrilla- style attack on Colombo’s international airport that destroyed half of Sri Lanka’s commercial airlines. The LTTE emerged as a strong military group with suicide bombing as their expertise.

In 1995, the civil war came to the doorsteps of the Jaffna community. The operation labelled

“Riviresa”, meaning Sunrays, by the Sri Lankan military was aimed at overthrowing the LTTE.

It resulted in the mass exodus of Tamils out of Jaffna towards Killinochi as they sought safety from the advancing army. After forty-nine days of fighting, Jaffna fell under the control of the

Sri Lankan military. The LTTE was driven out of Jaffna and established their headquarters in

Killinochi, south-east of Jaffna. Killinochi also became the de facto capital of the LTTE.

In 1988, University Teachers for Human Rights (Jaffna) was founded in order to share the whole truth of the ground reality in Jaffna. This included capturing the terrors of the Sri Lankan military, the IPKF and the LTTE. As LTTE built its stronghold, there were concerns raised about its practices. In particular, the conscription of children became one of the concerns that the University Teachers for Human Rights (Jaffna) (UTHR-J) group raised (Hoole, 2009). The

U.S Department of State placed the LTTE on its terror list in 1997. However, the LTTE enjoyed significant support from the diaspora community around the globe due to its appeal as the sole voice for the Tamils in Sri Lanka. The LTTE created their civil administration for the de facto

State – including a judiciary, police force, several banks, and research and development units in agriculture, industrial expansion and infrastructure development. In 2002, the Tamil National

Alliance (TNA) was formed with the blessings of the LTTE leader Veluppillai Prabhakaran.

The goal of the TNA was to work within the parliamentary system to bring about a solution to

University of Sydney the plight of the Tamil people. The TNA also supported the LTTE’s calls for a separate state.

The LTTE continued their armed resistance while the TNA pushed forward for a parliamentary solution.

The LTTE became the sole representative of the Tamils at the 2002 Ceasefire Fire Agreement

(CFA) with the Government of Sri Lanka (Ganguly, 2004). This agreement was facilitated by the Norwegian government. The de facto state, in the Northern and Eastern parts of the island of Sri Lanka where the LTTE maintained control, was strengthened further following the 2002

Ceasefire Agreement. They LTTE were able to specifically strengthen their social, political, economic and cultural structures. This peace agreement also provided a context where the

LTTE was able to train more fighters, bring greater resources into the country and engage in a process of state-building within their areas of control. During this agreement, the LTTE also faced accusations of forced conscriptions, abductions, and killings to gain greater power and influence over other paramilitary groups as well as Sri Lanka’s military (Human Rights Watch,

2006). The minority Tamils faced brutality not only under the Sri Lankan military but also at the hands of the LTTE (Human Rights Watch, 2006). The Sri Lankan military were also accused of the murders of Joseph Pararajasinhgam, a Tamil civil servant, and Dharmeratnam Sivaram, a Tamil journalist, during the ceasefire period. In 2004, a major split occurred between the eastern and northern factions of the LTTE. The Eastern faction leader Colonel Karuna Amman accused the LTTE of discriminating against the Eastern Tamils and sacrificing the interests of the East in favour of the North (Human Rights Watch, 2004). This split resulted in a sense of despair and confusion for the Tamil people and their struggle.

Mahinda Rajapakse was elected as the President of Sri Lanka in 2005. In 2006, the Sri Lankan government and the LTTE representatives met in Geneva, Austria to further discuss a peace agreement. However, the talks failed after both sides were unable to reach an agreement. The

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Sri Lankan government and the LTTE agreed to uphold the 2002 Ceasefire Agreement although violations were already reported. In 2003, the LTTE pulled out of talks with the government.

However, the Ceasefire held. The LTTE engaged in further battles in 2004 as they regained territory in the East of Sri Lanka. By April of 2006, the civil war had resumed with increased hostilities and battles reported. Within a year of commencing his presidency, President Mahinda

Rajapaksa abandoned any further peace talks and started to rely heavily on the Sri Lankan military force for an end to the civil war. By characterising the final war as a ‘war on terror’, the government sought to cover up its brutality and to gain support from Western governments according to a report by Human Rights Watch (2007). The beginning of 2007 saw the Sri

Lankan government capture the LTTE stronghold of Vakarai, a coastal town in the Eastern

Province, leaving thousands displaced. In March of the same year, the LTTE carried out their first air raid on a military base North of Colombo leaving three dead and sixteen wounded. In

January 2008, the Sri Lankan government unilaterally withdrew from the 2002 Ceasefire

Agreement and launched an offensive against the LTTE. The final civil war was well underway by December 2008.

By February 2009, thousands of civilians were trapped between the Sri Lankan government military forces and the LTTE forces. The calls by international bodies and human right groups for a temporary cease-fire were rejected by the Sri Lankan government (Human Rights Watch,

2009). The final war was restricted to a small area near Mullaitivu with a lagoon on one side and the Indian Ocean on the other. Thousands of civilians were cornered into a government- designated no fire zone before they were attacked. The UK’s Channel 4, as part of their documentary titled ‘Sri Lanka’s Killing Fields that aired in 2011, provided evidence and testimony that the Sri Lankan Army systematically and knowingly bombed designated safety zones including schools and hospitals. Indiscriminate shelling and bombing continued over

University of Sydney weeks and months from both sides of the conflict as thousands of civilians sheltered in makeshift bunkers and tents. Human Rights Watch (2009) spoke to a thirty-five year old Tamil man who was waiting in the food line with his wife and two year old child when the shelling began. He stated the following:

There had been no distribution of milk powder for three months, and so when they

announced that there would be distribution today [April 8], hundreds of people lined in

the queue. It was early in the morning. I heard the first shell and hit the ground. Then

several more landed nearby, after three or four minutes. I survived by a miracle, but my

45-year-old uncle died on the spot - he lost both legs.

On the 19th May 2009, the government declared victory over the LTTE. The Sri Lankan military had captured the remaining rebel-held territory and the death of LTTE leader

Velupillai Prabhakaran was shared across nation’s media outlets. The final war resulted in the death of thousands, large-scale violations of international humanitarian law, and over 300,000 internally displaced persons (IDPs) (Norwegian Refugee Council, 2009). Both sides of the conflict were also accused of war crimes during the final stages of the war. The end of the war also resulted in mass displacement and migration of Tamils with many fleeing abroad as asylum seekers.

4.7 Allegations of War Crimes and the Search for Justice

As refugees fled the end of the civil war in 2009, many carried horrendous stories of survival as well as loss to their new homes. These stories brought to light the loss of loved ones, the disappearance of family members, survival in torture camps, experiences of sexual violence, and persecution for voicing resistance. These stories also encapsulated details that would provide evidence to a potential war crimes enquiry. Allegations of war crimes first came to

University of Sydney light in early 2009 at the height of the final war when the Sri Lankan government was accused of indiscriminately shelling civilian areas. Witness accounts depict the use of cluster bombs used in the final stages of the civil war. Furthermore, unexploded cluster bomblets were discovered in the Puthukudiyiruppu, an area of northern Sri Lanka, in 2012 (Nessman, 2012).

The International Crisis Group (2010) report accused both the LTTE and the Sri Lankan government of violating international humanitarian law and being responsible for the death of thousands of civilians. The LTTE was accused of using Tamil civilians as human shields during the final days of the war. They also faced criticisms of forced conscriptions of children. The

International Crisis Group report argued that government and military leaders were likely to have given commands resulting in these crimes (International Crisis Group, 2010). However, it was accepted that leaders of LTTE were all deceased and will never face justice. The Crisis

Group called for a credible international war crimes investigation to investigate the following: the intentional shelling of civilians, the intentional shelling of hospitals, the intentional shelling of humanitarian operations, the intentional shooting of civilians and the intentional infliction of suffering on civilians. The group acknowledged that they had collected credible eyewitness testimonies that would provide crucial evidence in a war crimes enquiry.

The Lessons Learnt and Reconciliation Commission (LLRC) was established by the then

President Mahinda Rajapakse in 2010 to examine the conflict between the Sri Lankan government and the LTTE. The mandate was broad and tasked the commission with investigating the breakdown of the cease-fire agreement in 2002, the events of the final days of the war as well as what needed to happen for reconciliation and unity of the country. The main finding was that there was no deliberate targeting of civilians within the no-fire zone by the Sri Lankan military. However, the report acknowledged that there were significant civilian casualties, hospitals were shelled, and security forces may have been implicated in the death

University of Sydney and injury of civilians (LLRC, 2011). The LLRC report has faced criticism for lack of a mandate to investigate abuses, lack of witness protection, limited transparency and failure to meet minimum international standards. It has also been viewed as a means of deflection from an international investigation looking into human right abuses committed by both sides in the war (Amnesty International, 2011). Following on from the final report, there has been little to no implementation of recommendations from the LLRC report. Nalawatta and Weeraratne

(2016) argue that the Tamil community has not been provided with the dignity it deserves due to lack of educational and economic opportunities since the end of the civil war in 2009, although infrastructure has been developed. The Government of Sri Lanka has continued to block international monitors, journalists and non-government organisations from monitoring, reporting and questioning the ground situation. There has been no effective political response to the Tamils’ grievances and legitimate aspirations that led to the start of the conflict

(International Crisis Group, 2010). In March 2014, the United Nations Human Rights Council adopted a resolution to launch a war crimes investigation into alleged violations committed by the Sri Lankan government forces as well as the LTTE (United Nations, 2014). This has been a response to shine a light and bring early attention to possible violations of human rights and international law by both sides of the war (Francis, 2016). The evidence continues to be collected in foreign countries where Sri Lankan migrants, asylum seekers and refugees currently reside.

4.8 The Ongoing Persecution of Tamils and another Era of Oppression

It is argued that post-war conditions have not improved for the minority Tamils in Sri Lanka

(Amnesty International, 2011; Hogg & Human Rights Watch, 2013). Since the end of the civil in May 2009, the Northern and Eastern Provinces have been heavily militarised. The government has argued that this is a necessary step to maintain peace and security. Human

University of Sydney right groups, locals and the international diaspora have highlighted a number of problems that have arisen as a result of militarisation (International Crisis Group, 2011). The Sri Lankan military has continued to have a significant presence in the north, including approximately

30,000 personnel in the Jaffna Peninsula. This increased further following the introduction of emergency regulations after the Easter bombings that took place on the 21 April 2019. Under these new emergency regulations, military and police have increased powers to search and detain people, and greater control of what is published in the media. In December 2019,

Colombo Page (2019) reported that Sri Lanka's Defence Secretary, Kamal Gunaratne, confirmed that military bases in the Northern and Eastern provinces will remain as they are needed to maintain national security. This has maintained the increased militarisation of the

North and the East of Sri Lanka since the end of the civil war in 2009.

The increased militarisation of the north and east of Sri Lanka has affected an already vulnerable Tamil population. This has included increased incidents of gender-based violence as well as land grabs (Gamage, 2016). Many Tamil women in the north and east of the country have faced an increased lack of security following the civil war (International Crisis Group,

2011). The military currently occupies large areas of land and as a result, the people of

Keppapilavu have been protesting for the return of their land for more than three years. This protest at the entrance of the army camp is currently ongoing in March 2020 and is one of the longest protests recorded in the country. Additionally, 14 out of the 21 divisions of the Sri

Lankan army are stationed in the Northern Province. Tamil women have become increasingly reliant on the military to meet their everyday needs. This may result in long term reduction of personal and community capacity as well as increased vulnerability to exploitation. The

Oakland Institute’s report (Mittal, 2015) details the occupation of land by the Sri Lankan military. The Sri Lankan military has continued to expand property developments on land

University of Sydney belonging to displaced Tamils. The recent land grabs are a reminder of a familiar pattern that has resulted in the marginalisation of Sri Lanka’s Tamil population through the historical use of government orchestrated policies. Furthermore, there were at least 160,000 Sinhalese soldiers stationed in the north resulting in almost one soldier for every six civilians (Mittal,

2015).

In 2017, figures compiled by Adayaalam Centre for Policy Research and People for Equality and Relief in Lanka (2017) estimated that there is approximately one soldier per two civilians in the Mullaitivu district, making it one of the most heavily militarised regions in the world in the 21st century. Many in the Tamil communities in the North and East of Sri Lanka have reported police raids, sexual harassment, arbitrary detentions and even abductions as becoming more common (Nessman, 2008). The increased militarisation has contributed to feelings of mistrust towards anyone who is considered as part of the security forces. Dr Paikiasothy

Saravanamuttu, Executive Director of the Centre for Policy Alternatives in Colombo, argues that there needs to be a balance between democratic rights and human rights and the right security measures need to be implemented. He further states that a community as a whole cannot be alienated in the name of security measures (Nessman, 2008).

Allegations of sexual violence have been raised since the end of the civil war. Sexual violence is a common feature in armed conflicts around the world. It can be used as a weapon of war to terrorise, threaten and punish both an individual and a community. Women’s vulnerability and insecurity are heightened during conflict and post-conflict era. The end of the almost 30-year civil war saw many Tamil women in the North widowed. The International Crisis Group (2011) reported that a large number of Tamil males may have been detained in military camps. The change in the social structure after the end of the civil war has led to more households being

University of Sydney led by women in the Eastern and Northern provinces (Silva, 2012). Households headed by widows have greater vulnerabilities including poverty (Silva et al., 2012) and gender-based discrimination (Silva et al., 2012). These vulnerabilities can lead to exploitation of women.

Allegations of sexual violence have been reported in Sri Lanka over many years. Human Rights

Watch identified that between 1990 and 2013 there have been incidents of sexual violence against Tamil women by the Sri Lankan security forces, primarily in the north and east of the country (Hogg & Human Rights Watch, 2013). More recently, sexual violence against Tamil men have also been reported by The International Truth and Justice Project (ITJP).

The ITJP report titled ‘Unstopped’ by Yasmin Sooka (2017), a leading human rights lawyer, contains 24 individuals’ sworn testimonies of illegal detention and torture. Eighteen individuals disclosed experiencing sexual violence. These allegations of sexual violence are said to have occurred in 2016 and 2017 in Sri Lanka under the Sirisena government and were disclosed by individuals when they had reached the safety of another country. Overall, the ITJP has documented 57 testimonies of torture, abduction and sexual violence cases from 2015 - 2017.

Seven international investigators documented testimonies in Holland, the UK, and Switzerland and these testimonies were often supported by medical and psychological reports as well as documents from International Committee of Red Cross, International Organisation for

Migration and courts. These violations are reported to be systematic and with the support of the highest military and government structures. The evidence for this includes biometric fingerprinting used in torture chambers, senior military officers entering torture chambers and having knowledge of their existence, victims questioned about the information they shared in previous interrogations as a result of centralised intelligence gathering and torture and violence taking place in known military and police sites. This report included testimonies from both men and women who were raped. The report highlighted the high number of men who disclosed

University of Sydney sexual violence by the Sri Lankan military. Please see below Figure 2 identifying the torture sites.

Figure 2: Torture sites

ITJP report by Sooka (2017) documented the following eyewitness testimonies:

Two came together and sexually assaulted me. They raped me anally by inserting a

metal pipe in my anus on 3 to 4 occasions. I bled extensively at the time after I had been

raped and then got an infection. The men also urinated on me and forced me to drink

the urine. It was sickening. The pain was unbelievable. I felt extremely ashamed and

dirty.

Male Witness 221, (Sooka, 2017)

The males who were subjected to sexual violence reported increased feelings of shame and anger.

His hand was on top of my hand and he forced me to masturbate him by moving my

hand up and down his penis to rub it. While he was doing this he tried to take off my

jeans but I pushed his hands away. I felt that my hand became a bit wet so I think that

he ejaculated on my hand. I did not look at what was happening but looked towards the

wall as it felt abhorrent. I managed to free my hand after about two to three minutes

and I stepped back. He then kicked me to the floor before he left and locked the door. I

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fell down onto the floor and began to cry. This incident made me feel very ashamed

and guilty.

Male Witness 203, (Sooka, 2017)

Sooka (2017) also documented sexual violence practices that were cruel and humiliating towards women. The three women interviewed for this report were all raped and recounted assaults by male military officers. The below excerpt is from a woman who stated that she was sexually assaulted as she was signing a confession document. The same officer had beat her during an interrogation earlier.

I tried to move my body so that he could not touch them but I couldn’t. I felt disgusted

and was crying.

Female Witness 260, (Sooka, 2017)

The experiences above highlight the punishment and humiliation experienced at the hands of the Sri Lankan military by both men and women who were detained under the justification of national security. It also highlights the fear of detention for many Tamils as it could lead to experiences of torture in camps guarded by emergency laws and secret locations. For asylum seekers who are almost always detained before release, the threat of persecution is real.

Under the Sri Lankan government, journalists have also faced persecution over the years. In

Sri Lanka, a culture of impunity exists whereby individuals who criticise the government are often punished. In particular, Tamil media have been the target of attacks and censorships during and after the civil war period (Reporters Without Borders, 2015). Although the current constitution allows for freedom of expression on paper, other policies can limit how one exercises this right. The 1979 Prevention of Terrorism Act contains broad restrictions that allow police to search, detain and arrest individuals suspected of breaking the law under this

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Act. It also includes the prohibition on bringing the government into contempt. This means that the Official Secrets Act bans any reporting of what the government labels as classified information. Those who report on such matters are threatened with 14 years in prison. J.S

Tissainayagam, a senior Tamil journalist and columnist for The Sunday Times, was arrested in

March 2008 by the Terrorist Investigation Division (TID). He was held without charge for five months under the Prevention of Terrorism Act before being charged with promoting terrorism

(in the form of communal hatred through his writings) through the magazine Northeastern

Monthly. He was sentenced to twenty years in jail by the Colombo High Court before being pardoned in 2010 following international outcry and criticism (BBC, 2010).

Sri Lanka is ranked 127th out of 180 countries in the 2020 Reporters Without Borders press freedom index (Reporters Without Borders, 2020). Freedom of expression is still limited especially within the Northern and Eastern provinces. Journalists who attempt to report fairly on the Sri Lankan conflict and visit the north of the country are often detained without a trial.

Reporters Without Borders (2019) found that in 2018, Tamil journalists working in the north and east were threatened or denied access to particular regions by the security forces. The

Committee to Protect Journalists (2017) reported the arrest of five intelligence officers in connection with journalist Lasantha Wickramatunga’s 2009 murder. Investigations were undertaken under the Sirisena government but no charges were laid. The International Press

Institute (Heikura & Sanomat, 2020) has called on the Sri Lankan government to investigate the killing of Lasantha Wickramatunga and bring those responsible to justice eleven years after the murder.

Since the end of the armed conflict, more than 70,000 people remain unaccounted for. Many

Tamil families have reported their missing loved ones to the government and human rights

University of Sydney bodies within Sri Lanka (International Committee of the Red Cross, 2016). The families were interviewed by Red Cross staff regarding their beliefs about the fate of their loved ones and many were conflicted about whether their family members were dead or alive. The Red Cross reported that within the interviewed families, 56% of all families expressed economic difficulties, and 86% showed symptoms of anxiety or depression (International Committee of the Red Cross, 2016). In 2013, the then President Rajapaksa created a Presidential Commission to investigate those missing. Since then, the scope of the commission has expanded to include allegations of war crimes and violations of international humanitarian law by the LTTE and the Sri Lankan armed forces. Many believe that the focus has been taken away from those that remain missing today.

The Tamils in the North, especially in places such as Vavuniya, Kilinochchi, Mullaitivu, have continued to protest to demand further information about their loved ones who have disappeared. They have demanded to know the location of secret detention centres, detention lists and any information that may confirm whether their loved ones are still alive. These protests by the roadside began in 2013 by the families of the disappeared in the North and the

East. Recently, the protesters have faced harassment by the newly elected government in

January 2020. Human Rights Watch (2020) reported that a member of the advocacy group

Mothers of the Disappeared was repeatedly visited by a member of the Criminal Investigation

Department (CID) and asked questions regarding the nature of meetings between group members and what was discussed. Her son disappeared in 2009. The mother stated:

They have come and asked who is going to meetings. And who is going to Geneva [to

attend the UN Human Rights Council]. These are children who were taken by white

vans from our houses or who surrendered [to the army]. These are the children we are

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talking about. I want to know what happened to my son – whether he is dead or alive,

and if he is not alive, what happened to him and who did it; whether he was beaten,

whether they broke a limb.

Human Rights Watch, 2020.

Sri Lanka’s Missing Persons report (Office on Missing Persons, 2018) on its interim findings included recommendations to support family members of the disappeared. This included financial aid, debt relief, housing development, and education support programs. The report also recommended the Sri Lankan state implement an appropriate legal framework to ensure timely and effective investigation and prosecution of enforced disappearances. In 2020, the newly elected president Gotabaya Rajapaksa announced that those who had disappeared will be formally declared as dead and death certificates will be issued to the families. The office of the President stated that the disappeared were taken by the LTTE or forcibly conscripted.

However, the families of the disappeared maintain that they handed over family members to the Sri Lankan military when they requested the surrender of those with any links to the LTTE.

In late May 2009 Father Francis, a Catholic Tamil Priest, negotiated the surrender of approximately 360 LTTE cadres, their families and children. They all boarded military buses and were never seen again. For many, missing family members and friends will continue to be a constant reminder of the trauma of the conflict.

4.9 Challenges and Next Steps: A Summary

Since the end of the civil war in May 2009, Sri Lanka has faced continued political turmoil resulting in uncertainty over the future of the country. President Maithripala Sirisena was elected on the 8th January 2015 following a surprise defeat of the previous president Mahinda

Rajapaksa. President Sirisena promised significant changes during the government’s first 100 days. This included the abolition of the Executive Presidency and the 18th Amendment to the

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Constitution. These were new legislation introduced by the previous President Mahinda

Rajapaksa in 2010 to remove term limits to the Executive Presidency. This enabled a President to seek unlimited terms and to run the country for an indefinite time. The new legislation also brought together independent commissions under the Presidency, limiting the transparency of such commissions and creating greater power in the role.

The Tamil diaspora, as well as the Tamils living in Sri Lanka, were hopeful that President

Sirisena and Prime Minister Wickramasinghe would deliver on much of their other proposed reforms. Many believed that this was the only way to achieve a genuine approach to reconciliation and accountability (Human Rights Council, 2016). President Sirisena was considered to be in a position to reverse Rajapaksa’s earlier calls for the rejection of international involvement in the post-civil war era investigations (Iyer, 2015). The international

Tamil diaspora was aware that the new administration could not afford to pass on this opportunity as it ran the risk of losing much of its credibility internationally (Iyer, 2015).

However, Sirisena failed to deliver on policies that promoted reconciliation and also faced economic challenges that drastically impacted his popularity. He further faced international criticism after the country was plunged into a constitutional crisis in 2018 after he illegally sacked his Prime Minister Ranil Wickremesinghe. The Easter Bombings of 2019 also highlighted the internal conflict of the governing party after international intelligence agencies identified that crucial information was not shared with relevant government bodies. If shared, this information is likely to have helped prevent the largest loss of human lives since the end of the civil war.

In 2019, Presidential elections were held in Sri Lanka and Sri Lanka’s former wartime defence secretary Gotabaya Rajapaksa became the President. Gotabaya Rajapaksa is the brother of previous president Mahinda Rajapaksa who presided over the country during the defeat of the

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LTTE in 2009. The 2019 election results divided the country along ethnic lines with Gotabaya winning in Sinhalese majority areas and current opposition leader Sajith Premadasa winning in Tamil dominated areas. Human Rights Watch World Report (2020) reported that fundamental human rights were in jeopardy following the election of Rajapaksa. This report also scrutinised the lack of mechanisms available to investigate allegations of war crimes and the low likelihood these would be implemented by the new President.

Sri Lankan Tamils continue to fear their return to Sri Lanka due to the likelihood of persecution.

Many are worried that the re-election of a Rajapaksa family member would take the country on a regressive path to another civil war with further violence and ethnic tensions between the communities. President Gotabaya Rajapaksa played a leading role in crushing the LTTE and is hailed a hero by members of the Sinhalese population. The Rajapaksa administration has maintained their denials of accusations of rights abuses, war crimes and missing people over the years. President Gotabaya Rajapaksa has been praised by the Sinhalese community for bringing political stability to the country after years of infighting during the last administration.

However, he is deeply distrusted by the Tamil community due to his crucial role in ending the war. In his role as Defence Minister, he denies any accountability for war crimes committed under his command. President Rajapaksa has stated that he would like to turn a chapter and be the president for all the communities in the country. His brother, the previous President

Mahinda Rajapaksa, had previously focused on the country’s development and created infrastructure supporting a recovering economy and a booming tourist sector.

The Sri Lankan parliament today continues to be unicameral. There is no current agreement regarding a bicameral legislature. Professor Ranjith Amarasinghe (Department of Political

Science, University of Peradeniya) argues that a separation of powers is crucial to bring about

University of Sydney democratic governance in Sri Lanka (One Text Initiative, 2011). In this context, he proposes a senate as a second chamber. Professor Amarasinghe recommends that every province be given equal representation in the senate and there be special provisions to represent minority communities. In Sri Lanka, there is currently no mechanism in place to protect the rights of the minorities and marginalised groups.

The path forward is forged with uncertainties for Tamils due to not being able to look at the future without genuinely addressing the injustices of the past. The Tamil diaspora continues to call for a credible war crimes enquiry that would enable crimes committed in the final days of the war to be investigated and bring to justice perpetrators who have enjoyed diplomatic immunity over the years. The Tamil community in Sri Lanka continues their acts of resistance by staging protests over lost ancestral lands and missing loved ones. Yet they potentially face a higher cost for speaking out compared to the freedom of speech the Tamil diaspora enjoys in their newfound places of safety. The Human Rights Watch (2020) World Report identified that ethnic tensions are on the rise since the Easter Bombings of 2019. The Tamil Muslim community has been persecuted as a result of increasing tensions and the government has again failed to protect a minority community. The global community may not continue to remember and prioritise an island nation’s ethnic struggles that started long before Independence. But for many Tamils, the trauma of the civil war continues to be still fresh in their minds eleven years after the armed conflict ended as there has been no justice achieved. The sustained trauma due to past government policies, historical abuses, armed conflict, suppression of rights and lack of access to psychological support need to be better understood. Understanding the interplay of historical, political and social context is important in understanding the lived experiences of

Tamil migrants and asylum seekers as well as their subsequent migration to in Australia.

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Chapter 5

Theoretical Perspectives: Trauma, Post-Traumatic Stress Disorder and

Transgenerational Transmission of Trauma

5.1 Overview

This chapter explores the current theoretical understanding of trauma, Post-Traumatic Stress

Disorder (PTSD), and transgenerational trauma. In this chapter, trauma is introduced by briefly examining the biology and cognitive understanding of trauma events, differentiating between a single trauma event and multiple trauma events, and defining complex trauma. The origins of our knowledge of PTSD is explored and clinical symptoms discussed in reference to the

Diagnostic and Statistical Manual of Mental Disorders Criteria (American Psychiatric

Association, 2000). Trauma theories are reviewed to understand how trauma has been explained and debated by researchers over the years. The theories reviewed include Post- colonial theory of trauma, Judith Herman’s trauma theory, Refugee trauma theory, Feminist trauma theory, Collective and Cultural Trauma theory, and Post Traumatic Growth and

Resilience theory. These theories help us understand how an individual, family and community may experience traumatic events and the impact of this on their psychological wellbeing.

There has been increased interest in recent times in how trauma may be passed from one generation to another. The transmission of trauma, labelled as transgenerational or intergenerational trauma, can occur from one generation to the next through complex trauma transfer mechanisms. Transgenerational trauma is introduced with references to the origins of research, beginning in the 1960s, after the Holocaust. Transgenerational trauma is further explored with reference to other atrocities such as the Rwandan Genocide, Armenian Genocide and the Srebrenica Genocide (discussed in Chapter 6). The mechanisms of trauma transmission are discussed using the models of Shattered Assumptions Theory, Attachment Theory, and

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Family Systems and Communication Theory. Secondary traumatisation is also discussed in reference to interchangeable terms found in trauma literature.

5.1.1 Trauma: An Introduction

The word ‘trauma’ is rooted in the Greek language and translates as ‘wound’ or ‘injury’ (Webb,

2004). Trauma is a blow to a person’s psyche that breaks through their defences leaving them unable to respond effectively. It refers to an event that overwhelms an individual’s emotional psychological well-being and results in experiences of fear, helplessness or horror (Briere &

Scott, 2006). In the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-

5) (American Psychiatric Association, 2013), traumatic events are defined as “exposure to actual or threatened death, serious injury, or sexual violence”. Direct or indirect exposure to traumatic events can have detrimental impacts on mental and physical health, particularly if resulting symptoms of traumatic stress are chronic and untreated (Scott et al., 2013). van der

Kolk (2014) maintains that trauma affects not just those who have suffered but also those who surround them. He states that:

One does not have be a combat soldier, or visit a refugee camp in Syria or the Congo

to encounter trauma. Trauma happens to us, our friends, our families, and our

neighbours. Research by the Centre for Disease Control and Prevention has shown that

one in five Americans was sexually molested as a child; one in four was beaten by a

parent to the point of a mark being left on their body; and one in three couples engages

in physical violence. A quarter of us grew up with alcoholic relatives, and one out of

eight witnessed their mother being beaten or hit.

(Prologue, van der Kolk, 2014)

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The trauma theories discussed in this chapter argue that traumatisation occurs when both the internal coping resources of the trauma sufferer and the external resources available to help them are inadequate to cope with external threats (van der Kolk, 1989). Our understanding of trauma expanded in the 1970s in response to Vietnam War veterans and other survivor groups such as survivors of the Holocaust, natural disaster survivors, refugees and survivors of sexual abuse. It enabled a shift in our thinking from that of those affected by trauma as merely sick, to recognising that they are in fact psychologically injured and in need of assessment and treatment. This research study aims to establish that a generation of Sri Lankan Tamils may have experienced trauma due to the thirty-year civil war and as a result may exhibit PTSD symptoms. This generation may have also passed on their trauma to their offspring through complex trauma transfer mechanism resulting in trauma symptoms in the second generation of

Tamils.

5.1.2 Biology and Cognition of Trauma

Traumatic stress reactions are normal reactions to abnormal circumstances. Initial response to trauma may include exhaustion, confusion, agitation, numbness, physical arousal, and blunted affect. When we are exposed to a traumatic event, we perceive it with our senses; we see it, we hear it, we smell it and sometimes we also feel it. Trauma information is transmitted from our sensory organs to the brain. Sensory perceptions are transmitted to a section of the brain called the thalamus and then specifically to two additional areas, the cortex and amygdala. The amygdala, the alarm system, then transmits the information to four other systems; the memory creation system, the sympathetic nervous system, the hormonal system and the serotonin system (Bonfiglio et al., 2011). Trauma can physiologically change the workings of the brain.

Reduced hippocampal volume is a significant marker of PTSD (Martisova et al., 2012, Texel et al., 2012). When the brain experiences a threat, the brain’s flight, fight or freeze response (a

University of Sydney biological mechanism to protect oneself from harm) is activated through the increased production of a hormone known as Cortisol. Cortisol is the body’s main stress hormone, made by the body’s adrenal glands located above the kidneys, that enables our flight, flight and freeze responses in response to danger (Oakley & Cidlowski, 2013). Although Cortisol is self- protective and activates an immediate response in an emergency, chronic threats and stress can damage neurons in critical regions of the brains. Studies suggest that low Cortisol levels at the time of exposure to psychological trauma may predict the development of PTSD in some individuals (Yehuda, 2006; Wahbeh & Oken, 2013; Dekel et al., 2017). Over time, the more danger we are exposed to, the more sensitive we become to danger. It can also result in a constant state of hyperarousal where non-dangerous situations can be perceived to be dangerous. Any changes in this circuit of the brain have been found to have a link in the development of PTSD (Rauch, Shin & Phelps, 2006; Woon et al., 2010; Hartley et al., 2011;

Morey et al., 2012). As a result, this response becomes maladaptive and drastically changes an individual’s sense of safety long after the danger has passed.

Cognition refers to the higher-level functions of the brain that help us navigate the world. It refers to individual awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem solving (Tranel & Cooper, 2003). Festinger (1957) described cognition as elements of knowledge that people have about their behaviour, attitude, and the environment. The psychological experience of trauma can change an individual’s cognition and result in long-lasting effects. The symptoms of trauma alter factors such as memory, problem solving, attention, and planning. Cognitive models indicate that people exposed to traumatic events remember the emotional information that evokes an emotional response more than neutral information. This is as a response to their bias toward threat related information

(Chemtob et al., 1988; Kensinger, 2007). These individuals are likely to be in a prolonged state of hyperarousal looking for signs of any threat. The modulation hypothesis explains that

University of Sydney emotional information is remembered better due to the amygdala’s influence on the hippocampus (McGaugh et al., 1996). The hippocampus, part of our limbic system, is involved in the consolidation and recall of memory. The amygdala, pre-frontal cortex, and hippocampus are involved in fear-associated learning that impacts cognition (Maren et al., 2013). Research has identified that those with an increased sense of fear following a trauma event struggle to find safety due to difficulties with contextual processing (Liberzon & Abelson, 2016).

Contextual processing refers to a core brain function that allows a person to understand that a stimulus requires different responses depending on the context. It helps us respond appropriately both emotionally and physically. This process is disrupted in individuals with

PTSD leading to them not feeling safe in their environment.

Janoff-Bulman (1992) found that trauma changes the fundamental core beliefs that help individuals navigate the world. Core beliefs describe the way we see ourselves, our world and those around us. They contribute to our cognitive content which influences our perception.

Psychopathology may arise when the emotional stress of experiencing a traumatic event changes a person’s cognition that had allowed them to create meaning in their world (Lang,

1977). It is during armed conflicts and civil wars that human rights are infringed upon the most

(discussed further in Chapter 6) and the world as we know it is destroyed before our eyes. In the context of mass violence and human rights violations, the suffering caused by fellow humans leads to greater impact on our world view (Sandole & Auerbach, 2013). This is as a result of not being able to reconcile human imposed suffering with our previous belief that our fellow humans could be trusted. Trauma survivors whose belief systems have changed also experience severe mental health outcomes with Depression (Lilly, Valdez, & Graham-

Bermann, 2011) and Post-Traumatic Stress Disorder (Goldberg & Matheson, 2005).

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5.1.3 Single versus Multiple Traumas

A single trauma event is considered as a one-off trauma. This can be a natural disaster such as bushfire, a car accident or a sexual assault. Although a single trauma event is traumatic and can result in the affected individual needing to seek psychological treatment, the more serious psychological symptoms are likely to occur as a result of multiple trauma events over the course of a person’s life (Karam et al., 2014; Wilker et al., 2015). Violence experienced in the family and community as a result of the unrest, war trauma, captivity, uprooting, displacement, sexual violence, and refugee experience is considered as complex trauma (van der Kolk et al., 2005).

In complex trauma, an individual experiences multiple trauma events. The effect of complex trauma events on the person is said to be significant with individuals exhibiting more complex psychopathologies than individuals who experience a single trauma event (van der Kolk et al.,

2005). Complex trauma events are highly likely to occur in the context of civil war and armed conflict where an individual may experience multiple trauma events such as sexual assault, imprisonment, and torture. Trauma experiences can be both complex and cumulative. It was a common experience for individuals to experience severe and multiple trauma events in a war zone. In the systematic review of twenty-two studies with refugee children between 2003 and

2008, Bronstein and Montgomery (2011) found that cumulative effects of pre-migration trauma experiences were positively associated with distress. The study found evidence of PTSD symptoms, depressive symptoms, and emotional and behavioural problems. In the current study, complex trauma refers to the exposure of multiple types of trauma events, rather than multiple repetitions of individual traumatic events.

Briere et al. (2016) considered the role between different trauma events and PTSD in two groups of participants; a general population sample and a prison sample. The study found that previous trauma exposure was high in the prison sample surveyed. Previous trauma experiences

University of Sydney related to events prior to their current incarceration. Cumulative interpersonal trauma predicted

PTSD for both groups. Furthermore, exposure to multiple types of trauma events also predicted

PTSD. The general population sample predicted current likelihood of PTSD as 0% per cent when having experienced a single trauma event. This increased to 12% when having experienced 6 or more different trauma events. However, in the prison sample, participants with a single type of trauma exposure had a 17% per cent likelihood of current PTSD. This number drastically rose to 64% likelihood of PTSD for those exposed to 6 or more other trauma events. The difference observed between the two samples for the likelihood of PTSD following a single trauma may be linked to the prison participants’ socioeconomic status (Briere et al.,

2016). A lower socio-economic status, which may result in increased experiences of daily stressors, has been correlated with PTSD. Furthermore, the general sample included fewer participants who reported childhood sexual trauma (15%) and sexual abuse (12%). This was in contrast to the prison sample who disclosed more common experience of severe trauma types such as childhood sexual trauma (57%) and sexual abuse (55%).

Although it is acknowledged that exposure to multiple traumatic events are common

(Kilpatrick et al., 2013) and leads to greater psychiatric symptoms (Green et al., 2000), limitations of this finding must be identified. It is important to acknowledge that cumulative trauma can lead to significant psychological impact. However, a single severe trauma event such as sexual assault and sexual abuse can also contribute to significant psychological impairment for the individual. A single trauma event may result in a PTSD diagnosis for some individuals due to its severity. The current study exploring transgenerational trauma in Sri

Lankan migrants hypothesises that compared to a single trauma exposure, multiple trauma exposure would be associated with higher levels of PTSD symptoms. However, the experience of torture or sexual violence may also be associated with psychological distress and a greater

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PTSD score. Complexity and severity of trauma events are likely to predict psychological distress and result in higher levels of PTSD symptoms.

5.2 Post-Traumatic Stress Disorder

5.2.1 Trauma and PTSD

Post-Traumatic Stress Disorder is the most common psychological response to trauma (Ehlers

& Clark, 2000). Evolutionary psychology supports the idea that traumatic stress has been part of the human condition from our earliest origins (Birmes et al., 2003). Following the American

Civil War (1861-1865), there were reports of soldiers disclosing what we would now call PTSD symptoms. This includes heart palpitations, unexplained tremors, a wish to return home (called nostalgia at the time) and paralysis. Da Costa’s term of ‘soldier’s heart’ during the American

Civil War (Da Costa, 1951; Wooley, 1982) documented over stimulation of the heart’s nervous system. This was later termed as ‘da Costa’s Syndrome’. Da Costa also noted in his paper that although he had focused on returning soldiers, the findings were equally interesting for civilians (Wooley, 1982).

Early reports of PTSD symptoms were described following civilian manmade disasters from steam driven machinery during the Industrial revolution period. Physicians were confused by the symptoms displayed by survivors of these accidents. Some believed organic roots such as a microscopic lesion in the spine or the brain to be the cause of these symptoms. As a result, these symptoms became known as ‘railway spine’ or ‘railway brain’. Oppenheim, a Berlin neurologist, described 42 selected cases caused by railway or workplace accidents

(Oppenheim, 1892). Out of these cases, 38 were industrial workmen and railway employees who had been seriously injured while using machinery. Oppenheim labelled their symptoms

University of Sydney as ‘traumatic neuroses’. These were the first trauma symptoms observed outside of the battlefield.

Early accounts of PTSD surround the notion of hysteria and trauma neurosis through the work of Pierre Janet (1907) and Sigmund Freud (1919). During World War 1, British medical psychologist Charles Samuel Myers observed symptoms of amnesia, paralysis and inability to talk in returning soldiers. Myers identified that these patients were neither malingering nor physiologically injured and were likely suffering from shell shock (Myers, 1915). His belief was that shell shock was caused by the soldier’s close proximity to the shell explosion.

However, this definition was soon challenged as some soldiers who had not witnessed any shelling also exhibited shell shock symptoms. Following World War 1, shell shock was labelled as war neurosis by Abram Kardiner (Kardiner, 1941). However in 1947, Kardiner published a revised edition of his book following his experiences working with soldiers from World War

2. In this book Kardiner & Spiegel (1947) identified traumatic neurosis as ‘physioneurosis’, linking somatic and psychological symptoms together. In contrast to World War 1, World War

2 allowed researchers and clinicians to study the chronic nature of trauma symptoms (Archibald

& Tuddenham, 1965).

Years later, the Vietnam War resulted in almost a quarter of the US soldiers requiring psychological support after returning to the United States. The Vietnam War became the turning point for our understanding of PTSD and its long term effects. The National Vietnam

Veterans Readjustment Study (NVVRS), which was congressionally mandated, found that approximately 30.9 percent of all men surveyed met the criteria for PTSD (Kulka et al., 1990).

Out of the participants surveyed, only 15% had been assigned to combat units. Furthermore, an additional 22.5% of men developed partial PTSD. Partial PTSD was described as clinical symptoms that fell short of the PTSD diagnostic threshold. This amounted to 53.4 % of men

University of Sydney who had served in the Vietnam War, both in combat and other roles, developing partial or full

PTSD symptoms (Kulka et al., 1990). It should be noted that DSM-III-R lacked the inclusion of Criterion F (impairment) during this period. This may have impacted the high prevalence rate of PTSD. This meant that the men’s oral testimonies of symptoms without identified impairment were likely to have been included in the study’s findings as evidence of a disorder.

Criterion F was introduced in the fourth edition of the DSM manual (American Psychiatric

Association, 2000).

In 1952, DSM – 1 included PTSD symptoms under the disorder titled ‘Gross Stress Reaction’ in response to World War 2 returning soldiers exhibiting psychological symptoms of trauma.

This was the start of evidence gathered to support the notion that those who were exposed to trauma, even without previous psychological problems, may exhibit psychological symptoms.

At this time, the Korean War (1950-1953) was also taking place. Out of the 200,000 returning soldiers of this war, 25% were found to have a psychiatric problem. Their symptoms were labelled as ‘operational fatigue’. One of the reasons for this labelling may have been to avoid the neurotic nature of the illness. The military-style language may have also painted a less severe picture of the symptoms (American Psychiatric Association, 2013). In 1968, DSM – 2 was published and Gross Stress Reaction was removed due to relative peace between 1952 and

1968. However, a new term of ‘Transient Situational Disturbance’ was introduced. This definition captured the acute reactions of what we now refer to as PTSD. However, these two definitions predicted that these reactions would be short-lived. The journey to including PTSD as a disorder following a stressful traumatic event was significantly influenced by the returning soldiers from the Vietnam War and the need to assess and treat their symptoms of flashbacks, intrusive memories and symptoms of anxiety. PTSD was clinically included as part of DSM 3 in 1980, five years after the Vietnam War.

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5.2.2 PTSD and DSM IV

For the purpose of this study, the Post-Traumatic Stress Disorder Symptom Scale Self-Report

(PSS-SR) was utilised (discussed in chapter 8). This questionnaire is based on the DSM IV definition of PTSD. DSM V was released in 2013 after the current study had commenced and the study questionnaire identified. However, the most recent PTSD criteria as per DSM V is explored in the next section. In DSM IV, PTSD was included in the chapter identifying anxiety disorders. PTSD diagnosis is established when an individual satisfies the full criteria labelled

A to F. To meet criterion A1, an individual must have “experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” (American Psychiatric Association, 2000, p. 467). Criterion A2 specifies that ‘the person’s response to the event involved intense fear, helplessness, or horror’ (American Psychiatric Association, 2000, p. 467). Criterion B includes experiencing one or more re-experiencing symptoms related to the traumatic event, criterion C includes experiencing three or more of avoiding or numbing symptoms, and criterion D includes two or more symptoms of prolonged and persistent hyperarousal. The duration of symptoms must exist for more than 30 days (criterion E) and cause significant impairment as a result of experiencing trauma symptoms (criterion F) (American Psychiatric Association,

2000). The DSM IV definition stipulates that PTSD is diagnosed by the presence of three clusters of symptoms that can result from exposure to a traumatic event (criteria B-D).

5.2.3 PTSD and DSM V

PTSD is currently included in DSM-5 within the chapter identifying Trauma- and Stressor-

Related Disorders. DSM-V defines PTSD as exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence (American Psychiatric

Association, 2013). PTSD diagnosis is established when an individual satisfies the full criteria

University of Sydney labelled A to H. To meet Criterion A1, the individual must have direct exposure, witness the trauma event occurring to others, learn that a relative or close friend was exposed to a trauma event or experience indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g. first responders, medics) (American Psychiatric Association, 2013).

DSM-V proposes four distinct symptomatology clusters; intrusion, avoidance, negative alterations in cognitions and mood and alterations in arousal and reactivity. A single intrusion symptom needs to be identified for Criterion B. Criterion B includes the following intrusion symptoms: unwanted upsetting memories, nightmares, flashbacks, emotional distress after exposure to traumatic reminders, physical reactivity after exposure to traumatic reminders. A single avoidance symptom also requires to be identified to meet Criterion C. This includes avoidance of trauma-related thoughts or feelings or trauma-related external reminders.

Criterion D needs to at least identify two negative alterations in cognitions and mood. The individual must experience any two symptoms of the following: inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect, decreased interest in activities, feeling isolated or difficulty experiencing positive affect.

Additionally, the individual must experience trauma-related arousal and reactivity that began or worsened after the trauma in the following way(s): irritability or aggression, risky or destructive behaviour, hypervigilance, heightened startle reaction, difficulty concentrating, difficulty sleeping (American Psychiatric Association, 2013). The PTSD criterion states that

PTSD symptoms must exceed one month (Criterion F) and create distress or functional impairment for the individual (Criterion G). According to the exclusion criterion, the symptoms cannot be due to medication, substance use or any other illness (Criterion H). DSM-5 moved

PTSD out of anxiety-related disorders to trauma and stress-related disorders. This is as a result

University of Sydney of recognising that PTSD symptoms are not always anxiety related. These symptoms can include dissociative experiences and self-destructive behaviour.

5.2.4 Complex PTSD

Complex PTSD has been identified in individuals who have survived prolonged or multiple trauma events. Complex PTSD has also been labelled as ‘disorders of extreme stress not otherwise specified’. This can include prolonged experiences of mass violence and persecution.

Survivors of civil war and armed conflicts have been victimised over a prolonged period. This results in impairment much more extensive than in PTSD, with survivors experiencing symptoms of depression, anxiety and dissociation. Although it is not formally recognised within the DSM-V handbook, clinicians have proposed the inclusion of this disorder for over two decades (Herman, 1997; van der Kolk, 1996). More recently, Cloitre et al. (2013) identified distinct differences between PTSD and Complex PTSD. They found that the types of trauma, symptom profiles, and levels of impairment differed between the two disorders. Although complex PTSD was not included in DSM-V, it broadened the Criteria for PTSD to include criterion D to capture additional symptoms of negative alterations in mood or cognitions.

In 2018, Complex PTSD was included as a distinct clinical entity in the WHO International

Classification of Diseases, 11th version (World Health Organisation, 2018). ICD is recognised as the international standard for all medical diagnoses including mental illness. The ICD-11 diagnosis of Complex PTSD requires the presence of the core symptoms of PTSD (re- experiencing, avoidance, and hypervigilance) and the presence of at least one symptom in each of three self-organization features. This includes affect (emotional dysregulation, self- destructive behaviour, emotional numbing), self-concept (negative beliefs, shame, guilt), and relational disturbance (difficulties with social engagement and emotional connections) (Hyland

University of Sydney et al., 2016). The overwhelming majority of studies looking at PTSD have been conducted on subjects who have directly acquired the condition through the experience of intense trauma in their environments such as civil war, assaults and accidents. Yet there is a growing field of work that seeks to know about the indirect experiences of trauma.

5.2.5 PTSD and Sri Lanka

In Sri Lanka, PTSD was a term that emerged as a result of the civil war. It helped clinicians identify the symptoms of collective grief, anxiety, nightmares and feelings of hopelessness in survivors. For years, clinicians in Sri Lanka believed that PTSD was an American illness

(Jayatunge, 2012) . Sri Lankan military leaders also believed that the reaction of shock in officers was indicative of cowardice or indiscipline (Jayatunge, 2012).. PTSD was undiagnosed due to a lack of awareness and psycho-education. However, the mental health consequences of the thirty-year civil as well as the Tsunami tragedy has made this term very familiar in Sri

Lanka. In 1978, a medical practitioner in Negombo recorded the following:

A constable returned from Jaffna has unusual fears about Tiger gunmen who did several

killings in the North. He became extremely frightened after hearing Inspector

Bastianpillai’s death. He is unable to sleep and has nightmares about gunmen who

travel by bicycles and shooting the Policemen in Jaffna. He is imploring a transfer to

his hometown in Tangalle. In my opinion, he is unfit to serve.

Jayatunge, 2012.

Although research relating to PTSD relies heavily on Western populations, it is crucial to consider the impact of culture on how people respond to trauma events that lead to PTSD. Sri

Lanka is a collectivist culture. Watters (2010) described the scenes following the 2004 Tsunami where Western psychologists observed Sri Lankans helping each other before they helped

University of Sydney themselves. This was clinically described as signs of denial and shock by Western-oriented clinicians without the acknowledgement that they were likely observing a collectivist culture respond to a tragedy. The very act of helping one another can be identified as a protective factor from psychological distress. The history and traditions of clinical practice lead it towards taking a very individualist perspective, and this perspective may inhibit understanding of community- level traumatic events. Community ties allow the healing process to begin but they can also contribute to the under-reporting of symptoms. As individuals focus on helping others, they may not look inwards to notice changes in their mood and perception of the world (Watters,

2010).

Sri Lanka has experienced both natural and man-made disasters over the years. Although there is research exploring trauma and PTSD, transgenerational trauma is less studied. Shaley et al.

(2007) identified that individuals who experience chronic PTSD may engage in behaviours of avoidance that increases social isolation, withdrawal, and contributes to the breakdown of families. These individuals alienate themselves from traditional and collectivist support systems. In a collectivist culture, individuals who self-isolate cannot participate in the community using the existing structures. They also face social stigma in seeking professional help for their symptoms and may suffer in silence. Without the necessary support, their trauma symptoms nay also impact their offspring.

5.3 Trauma Theories

5.3.1 Post-Colonial Theory of Trauma

In 1914, a third of the world’s population and half of its territory were under colonial rule.

Colonial rule resulted in countries being robbed of their resources. Post-colonial theorists

University of Sydney explore the impact of colonisation on communities and societies today (Hyndman, 2000). The theory looks at issues of power, religion, politics and culture. Stef Craps’ (2013) work titled

Postcolonial Witnessing: Trauma Out Of Bounds argues that there is an ongoing impact of colonialism on non-Western and minority cultures. This impact needs to be recognised more significantly in the trauma field to ensure that culturally appropriate psychological support can be provided. Craps (2013) highlights that trauma theory is Western-centric. Craps identifies four aspects of trauma theory as problematic: “they marginalise or ignore traumatic experiences of non-Western or minority cultures, they tend to take for granted the universal validity of definitions of trauma and recovery that have developed out of the history of Western modernity, they often favour or even prescribe a modernist aesthetic of fragmentation and aporia as uniquely suited to the task of bearing witness to trauma, and they generally disregard the connections between metropolitan and non-Western or minority traumas” (Craps, 2013 p. 2).

Additionally, by not considering the social environment, issues such as racism, discrimination or oppression may not be captured in the narratives relating to trauma.

Craps (2013) highlights that racism neither fits into a classical definition of trauma nor a structural understanding of trauma. Racism is considered a historical trauma that is not captured in our understandings of trauma. Craps (2013) discusses the notion of insidious trauma by

Maria Root, a clinical psychologist. In Western nations, experiences of overt racism may be limited. Instead, the overt expression has been replaced with microaggressions including not being promoted, targeted by security, and witnessing the stereotypes of a minority group on the media. An overt racist crime committed that includes an act of violence will fit the PTSD

Criterion A of a direct threat to life or physical safety. However, microaggressions are unlikely to meet this threshold. Craps argues that cumulative micro-aggressive behaviour can lead to traumatisation although a single event is likely to be considered a non-traumatic event. Root

(1992, 1996) has argued that insidious trauma is identity-based and is directed at those who are

University of Sydney marginalised by those in power and privilege. Brown (1995) describes insidious trauma as multiple lower level, harmful events that occur throughout a person’s lifetime. This is explored in Watson et al’s (2016) study of women of colour. The study explored multiple experiences of oppression among women of colour including experiences of racism, sexism, and sexual objectification. The study found that racism led to lower self-esteem which in turn was related to more trauma symptoms. Similarly, Kira et al’s study (2016) found that perceived racism alone was enough to decrease self-esteem.

The dominant understanding of trauma has been criticised for classifying trauma as an individual phenomenon and not acknowledging the cross-cultural environment (Summerfield,

1999) in which the trauma takes place. Watters (2010) criticises the psychological support provided to the Sri Lankan community following the Tsunami in 2004. He labels “the grand project of Americanising the world’s understanding of the human mind” as contributing to a disregard for cultural differences. Watters argues that Western counsellor’s work in Sri Lanka to increase their psychological resources and encourage the confrontation of the trauma event in talk therapy had failed to understand existing mechanisms of processing grief and trauma. It also failed to capture their resilient behaviour. Instead, this was perceived as a denial of the trauma event. Watters suggests that the act of being encouraged to recount the trauma event may have both ineffective and harmful consequences (Watters, 2010). The process of assigning the value of talk therapy onto another population without consideration of their own needs and cultural practices could be argued as an example of colonialism in the modern era.

Berry et al. (2002) identify four levels at which Western psychological research can be deemed as ethnocentric. This includes the selection of items and stimuli, the choice of instruments and procedures, the definition of theoretical concepts, and the choice of a research topic. There also appears to be limited scope for variations of cultural norms and religious practices to be taken

University of Sydney into consideration in mainstream assessment and treatment of mental health disorders. The

Western framework of psychology has been argued to have colonised cultures in a way that some culturally healthy behaviours may have been pathologised as a disorder.

Using a sociological perspective, Marie-Anik Gagne (1998) argues that colonialism is a traumatic act. Although acknowledging that trauma causes significant emotional and psychological damage to individuals, Gagne explores the trauma experienced by society as a result of colonialism. She hypothesises that colonialism is the seed that grows dependency that leads to cultural genocide, racism and alcoholism. These factors further lead to sexual abuse, family violence, child abuse and accidental deaths and suicide. Gagne (1998) criticises the lack of discussion in PTSD research surrounding historical trauma and the impact of this on First

Nations peoples. Although Gagne’s model heavily focuses on the impact of colonialism on

First Nations people, it draws parallels to the ongoing difficulties faced by the minority Tamil population. Gagne encourages PTSD researchers to take into account the impact of colonialism on populations and how this has led to dependency. In Sri Lanka, the British strategy of ‘divide and rule’ sowed the seeds for violence in the nation. The policies created by the British ignored minority safeguards and this led to ethnic tensions between the Tamils and Sinhalese communities, the start of the civil war (discussed in Chapter 4) and the trauma experiences of displacement and persecution.

5.3.2 Judith Herman’s Trauma Theory

Trauma is described as the persistent presence of malaise that remains even after a threat has passed (Herman, 2015). Judith Herman (1997) states that ‘traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life’. She argues that trauma results in the destruction of systems of care, protection and meaning that support life. Herman (1997) describes violations including rape,

University of Sydney child abuse, and violence as too terrible to speak about and becoming unspeakable for the survivor. These violations that result in trauma lead to feelings of shame and stigma. An individual’s capacity to share the pain is reduced. Even when wanting to speak about it, one may not find the right words. Herman (1997) argues that one has to remember and tell the truth about these horrific atrocities experienced for healing to happen.

Herman identified three stages of trauma recovery. The first stage is the establishment of safety.

This is considered the most important step in the therapeutic relationship. This begins by focusing on the control of the body before expanding to control the environment. Survivors of trauma often feel unsafe in their bodies as they do not recognise or feel uncomfortable with the symptoms they are experiencing. Environmental safety factors such as security and housing may need to be explored at this stage. Trauma survivors within this stage may find it difficult to move past current violent relationships and establish physical safety in their lives. In this first step, Herman encourages the clinician to consider the client’s economic and social ecosystem. When safety has been established, the clinician can move onto the second stage of recovery with the client.

The second stage is to tell the story of trauma. By sharing their story, there is an opportunity to reconstruct the trauma memory to fit in with the client’s survival life story. However, the decision to share as much or as little information is left up to the client. The clinician can assist the client to assemble the fragmented parts of the trauma story into an organised narrative

(Herman, 2002). This organised narrative that is placed within the client’s trauma context allows them to acknowledge their responses to the trauma. This second stage can also create a new understanding of the trauma event and the client may also mourn the loss of the old self

(Herman, 1997). In the final stage of recovery, Herman encourages reconnection which is

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Herman critiques the American Psychiatric Association’s definition of a trauma event in 1980 as an event ‘outside the range of usual human experience’ as this proves to be inaccurate when looking at women’s experiences of rape and violence or an individual’s experiences of civil war. The first National Comorbidity Study established that experiencing a traumatic event is no longer an abnormal experience. This study by Kessler et al (1995) found that 61 per cent of

American men and 51 per cent of American women had experienced at least one trauma in their lifetime. This study found the following trauma events as most common amongst the participants: witnessing a trauma, being involved in a natural disaster, and/or experiencing a life-threatening accident. The violence that occurs in the context of war and armed conflict is prolonged and repetitive. This leads to a community that experiences multiple trauma events overwhelming their adaptive capacity. Long after these survivors reach the safety of host countries, the feeling of danger is likely to persist. For many asylum seekers and refugees, establishing safety is a crucial first step in their journey towards healing. Although Herman

(1997) strongly encourages the survivor to have a choice in what trauma experiences are disclosed and when this disclosure takes place, the immigration process acts as a barrier. This process requires survivors to narrate their whole trauma story in the first instance in order to establish the credibility of their asylum claim. Reconnection as a final step in the healing process is further complicated for refugees seeking asylum in Australia as a result of Australia’s visa provisions for asylum seekers arriving by boat. The temporary visa conditions enforced on asylum seekers destroy any sense of permanence and opportunity for reconnection even when the protection visa is granted.

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5.3.3 Refugee Trauma Theory

A refugee’s journey is one of violence, displacement, persecution, loss and uncertainty. Many refugees and asylum seekers arrive on the shores of host nations with a history of traumatic stress exposure (Almqvist & Brandell-Forsberg, 1997). The impact of grief, loss and trauma continue for many refugees and asylum seekers after they have resettled in a host country

(Momartin, Silove, Manicavasagar, & Steel, 2004). Trauma experienced in resettlement, as well as the stressor of living in exile, can often challenge a person’s way of life, thinking and belief in the world (Silove, 1999; Mollica et al., 2001). This highlights the need for trauma therapists to include living in exile as a stressor as it may be premature to consider all host nations as safe places. Australia’s migration policies have contributed to the suffering of many asylum seekers who have been subjected to offshore detention centres, limited medical and psychological care and little to no pathway for permanent settlement in Australia. The trauma asylum seekers and refugees endure is often prolonged and repeated due to the nature of civil war and violence that can last years if not decades as was the case with Sri Lanka.

Silove (1999) noted that the refugees’ experiences of mass violence and gross human rights violations may impact on their adaptations well beyond the symptoms that are captured in the current PTSD definition. Similarly, this concern is identified by Bronstein & Montgomery

(2011) who called for increased understanding of the factors that motivate asylum seekers to leave their country of origin as well as what host countries offer asylum seekers. These variables are likely to contribute to an individual’s mental health. An example would be the differences in violence exposure between asylum seekers. This combined with what services a host country can provide for asylum seekers may determine their mental health state. A refugee who has been granted temporary protection is likely to feel anxious compared to another refugee who has been granted a permanent visa. The study also called for standardising

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University of Sydney measuring tools to compare refugee research across countries. When measures are standardised and culturally validated, it allows researchers to compare across contexts (Porter, 2007).

Bronstein & Montgomery (2011), as well as Silove (2007), argue that the current PTSD criteria do not allow for pre-migration and post-migration factors to be considered as variables impacting mental health. This has raised questions as to how refugee mental health is currently being researched within the confinement of the PTSD criteria. As a result, Silove has proposed an alternate theoretical framework to understand their experiences.

In Silove’s (2013) Adaptation and Development After Persecution and Trauma (ADAPT) model, he argues that trauma disrupts the following five systems that are core psycho-social pillars of society: (i) safety/security; (ii) bonds/network; (iii) justice; (iv) roles and identities; and (v) existential meaning. Establishing personal safety involves a post-traumatic environment that is safe, predictable and stable (Silove, 2013). This is similar to Herman’s trauma model where establishing safety is a significant first step. Silove (1999) identified that refugees experience prolonged threats to their sense of safety in their resettlement environment.

This includes a lack of social support as well as increased uncertainty due to lack of control over their lives. He argues that the ongoing lack of safety experienced in the resettlement environment may maintain the psychopathology of PTSD. The model recognises that refugees have experienced loss both symbolically and literally. As a result of war, displacement and persecution, they have lost family members, livelihoods, status, culture and long-held traditions. This is likely to also be a factor in disrupting the sense of self and connections to others. (Silove, 1999; 2013). Interpersonal bonds also need to be restored to unite communities that have faced mass violence. The reconnection is considered vital for healing. Silove argues for relief efforts to focus on reuniting families and re-establishing pre-trauma connections.

When these connections are re-established within the community, it also allows for cultural practices of grieving and mourning to take place (Silove, 2013).

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The third pillar of this model is Justice. Justice is an important component to healing as many refugees experience violations of their human rights inclusive of torture. Torture survivors have significantly higher rates of trauma symptomatology than the other groups of traumatised individuals (Van Ommeren, 2002). Although refugees may physically be safe in their new environment, they may not feel that justice has been achieved and continue to carry feelings of betrayal and anger. Silove (2013) argues that refugee research has not given sufficient significance to understanding the sense of injustice as a psychological construct. Rees et al’s study (2013) found that ongoing pre-occupation with cumulative past injustices can lead to the maintenance of psychological symptoms. However, even when individuals participate in truth commissions, there is a lack of evidence to support any psychological benefit. This is likely due to the perpetrators escaping prosecution (Silove & Steel, 2006).

The fourth pillar is roles and identities; the experience of violence, war and displacement changes established roles within a family (Silove, 2013). An example of this is when a widow becomes the main breadwinner for a family within a traditional culture where she is usually bound to the home. The refugee’s experience of discrimination and/or racism can also impair the mental health and impact their sense of belonging in a host country. The fifth and final pillar examines the changes to existential meaning. Refugees experience disruptions to their continuity of life due to persecution, displacement and resettlement. These experiences result in changes to worldview, belief systems and values. Silove (2013) debates the need to advocate for multiculturalism where refugees are welcomed and integrated into the pluralistic society.

Silove’s ADAPT model acknowledges that refugee traumas are multiple and their meaning to both the survivor and community need to be better understood. It also highlights that trauma does not always result in PTSD symptoms as long there is potential for positive adaptations to occur. Support systems play a vital role in how adolescents adapt after surviving trauma. The

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Almqvist and Broberg (1999) study explored the impact of peer relationships, exposure to bullying and harassment, marital discord/harmony and parental mental health on the mental health and social adjustment of refugee adolescents and children in Sweden. Both parents and children were interviewed. A total of 39 children and their families participated in the study.

The results showed that time and good quality peer relationships were protective factors for the children. Having a good friend determined a child’s self-worth and social adjustment. The study also found that the mother’s wellbeing predicted the wellbeing of the child (Almqvist &

Broberg, 1999). Further studies also show that having support from their respective ethnic communities that help maintain cultural and religious traditions also acts as a protective factor to maintain good psychological health (Punamaki, 1996; Rousseau, 1995). Silove (2013) further highlighted the need for programmes to reunite families and pre-existing networks as well as to foster a space where cultural grieving and mourning practices can be practised. In

Somasundaram’s study exploring ongoing challenges in post war Sri Lanka, he identified the community’s reluctance to participate in mourning rituals due to fear of further persecution and harassment at the hands of the Sri Lankan military.

Mollica et al. (2015) introduced the H5 model of refugee trauma to examine the mental and physical health issues attributed to trauma in refugees. It recognises that refugees have a traumatic life history. Refugee communities also have experienced past trauma and they are likely to experience ongoing and future trauma events. The H5 model considers five key dimensions that are needed before recovery can begin. This model anchors the trauma story at the centre of the model. The key dimensions required for healing surround the trauma story.

The H5 model is presented below in Figure 3.

Figure 3: The H5 model.

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Mollica et al. (2015) identify trauma story as the core part of this model. The model recognises that it is important for a refugee to share their story of violence with someone they trust. They must share their story in their own way and without any influence. This story must be recorded and acknowledged. The act of sharing the trauma story helps the healing process for the individual. It is also thought to guide the listener and society towards healing and survival

(Mollica et al., 2015). The trauma story also allows for the individual to share their sociocultural history (traditions, customs, cultural meaning of trauma) and their spirituality

(likelihood of post traumatic growth). The dimensions of the model are detailed below.

H1 Human Rights - Refugees are often subjected to human rights violations in their country of origin and on their journey to seek asylum. Mollica at al. (2015) advocate for refugees to share their stories once they have reached a refugee camp. This story details their experiences of human right violations. Those in acute stress may not be able to share their story. However, there must be an acknowledgement provided by the listener, in this case often the camp official or immigration official, to the storyteller. In this process, justice must be discussed with both the individual and the community. It is acknowledged that justice may not be pursued with a

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University of Sydney legal pathway or an official apology. However, the acknowledgement of wanting and needing justice is deemed important (Mollica, 2015).

H2 Humiliation - This dimension acknowledges that refugees experience humiliation through acts of violence especially rape. Mollica (2006) described humiliation as when:

Perpetrators try to introduce into the minds of their victims their fundamental

worthlessness. During acts of violence there is a complete absence of love, affection,

and empathy. In trauma stories of extreme violence, the feeling of humiliation is fully

revealed, allowing us to achieve a complete appreciation of all dimensions. Humiliation

is a very complex human emotion because it is primarily linked to how people believe

the world is viewing them. It is not a clear-cut emotion like fear, but rather a state of

being, characterized by feelings of physical and mental inferiority, of uncleanliness and

shame, of spiritual worthlessness and guilt, and of repulsiveness to others, including

God or higher being. (p.72).

Humiliation can lead to feelings of worthlessness, reduced self-respect, helplessness and hopelessness. These feelings can be further maintained in a refugee camp or a detention centre where refugees are held without access to work and as a result are unable to support their families financially. Mollica et al. (2015) state that there must be a clear stance taken that violence is wrong regardless of any justification. This is an essential part of a healing response.

Feelings of humiliation must be identified and power must be re-established.

H3 Healing (self-care) - Refugees experience healing in their new places of safety through therapy and increased social connections. Sharing their trauma story is a crucial part of the healing journey. By sharing the trauma story, the individual is able to reduce their emotional memories that have become maladaptive. Mollica et al. (2015) identify self-healing as the end

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University of Sydney point once new meaning is created from experiences of violence. Additionally, there is a need to further understand existing strengths and support systems within the refugee community is also needed.

H4 Health Promotion - Civil war and armed conflicts lead to refugees experiencing psychological and physical health problems. This includes the development of chronic illness such as Diabetes and reduced life expectancy (Roberts et al., 2012). Trauma events that are caused by fellow humans are considered the most toxic resulting in chronic ill health. The H5 model acknowledges that there hasn’t been significant research undertaken to explore trauma related health risks in the refugee population. The model advocates for greater health promotion with refugee populations.

H5 Habitat - The H5 model recognises that need for refugees to have a healing environment that can support their recovery. The model advocates for adequate and safe housing options for refugees. Although this is a new area of refugee mental health research, Mollica et al (2015) argue that the inclusion of this particular dimension is an important first step in recognising the impact of physical environment on an individual’s mental health and recovery.

The violence destroys the human rights of the individual. Silove (2013) points out that there has been lack of attention given to sense of justice as a psychological construct rather than a human rights construct. He highlights the difficulties in achieving transitional justice as this may take time and perpetrators are often provided amnesty and diplomatic immunity (Silove

& Steel, 2006). Transitional justice involves the philosophical, legal, and political investigation following the aftermath of conflict and mass human right abuses. It deals with the legacies of war and explores the most effective and legitimate pathway to address past wrongs, help survivors recover and establish stability. Silove recommends (2013) mental health programs to include human rights as a central theme for all activities to promote justice. The Sri Lankan

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Tamils have also struggled to achieve transitional justice although there has been international pressure for a credible war crimes investigation (discussed in Chapter 4). Tamil asylum seekers and refugees in Australia have played a key role in contributing their trauma narratives as witness statements to the War Crimes Evidence Project. This is a global project to collect statements from individuals who may have witnessed or been the victim of a war crime. These statements may be provided to the International Criminal Court at an appropriate time with the hope of achieving transitional justice.

It is hypothesised that participants of this study who also have a refugee experience may exhibit increased PTSD symptoms due to prolonged experience of war, combat, torture, and continued feelings of helplessness and hopelessness attributed to the prolonged state of injustice.

5.3.4 Feminist Theory of Trauma

Feminist theory argues that women’s experiences of living in a patriarchal society are not captured within the current trauma theory definition. This includes the lack of acknowledgement of women’s experiences of oppression, discrimination, violence and inequality. Trauma theory is criticised as only considering the experiences of the dominant class; white, young, able bodied and educated men (Burstow, 2003). However, this has changed over the years with trauma research increasing to include more diversity such as research looking at women’s experiences, Culturally and Linguistically Diverse (CALD) communities’ experiences, asylum seekers’ experiences and those with disability and their experiences. Over the years, feminist trauma therapists have worked to apply trauma theory taking into consideration the socio-political context of women’s experiences of child abuse and sexual violence. Trauma theory in early 20th century, especially Freud’s work in

Psychoanalysis, looked at the hysteria symptoms in women as resulting from psychic trauma

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(Haaken, 1998). Brown (2004) argues for women’s psychological presentations to be assessed not simply as a medical brain-based distress but rather through a social analysis. This is similar to Judith Herman’s approach in her book titled Trauma and Recovery (Herman, 1997) where she challenges gender inequality in society. Herman (1997) recommends that trauma therapy take place by first understanding the patriarchal assumptions that contribute to the ongoing trauma exposure of women. In civil wars, women and girls experience higher risk of sexual violence, rape, forced marriage and unwanted pregnancies.

The impact of sexual violence can be overwhelming because of the strong communal reaction to the violation and pain experienced by families. Sexual violence not only terrorises the individual and the nation being occupied, it also destroys family as well as community bonds that may exist. An example of common violence perpetuated by the military during civil war is sexual violence. UNHCR first published Sexual Violence against Refugees: Guidelines on

Prevention and Response in 1995. This was a welcome step in combating gender-based violence within refugee communities. The problem though with this was that it came too late for the Tutsi women of Rwanda and the women of Bosnia. Sexual violence has been documented in many armed conflicts including those in Cambodia, Haiti, Sri Lanka, Bosnia and Uganda (Ba & Bhopal, 2017). Woldetsadik’s study (2018) explored the long term effects of war time sexual violence on women and families in Uganda. The study’s results showed that the families and siblings of these women who survived sexual violence all reported some form of traumatic stress including anger, anxiety, sadness and withdrawal. The surveyed family members also disclosed that the relationship with the survivor became complicated and further conversations regarding the trauma were not encouraged. Instead the families hoped to forget the trauma and focus on their faith to get through the difficult time. Key recommendations identified in this study include increasing land rights for women as it is considered a primary resource on which women can be employed if they face stigma elsewhere, increasing women

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University of Sydney survivor’s access to economic opportunities as well as fostering greater community dialogue on the impact of sexual violence on women (Woldetsadik, 2018).

Sri Lankan Tamil women have been traditionally viewed as nurturers and homemakers. This view that preceded the civil war was in line with the strict norms of Tamil society. Women were responsible for the care of their children, their home, and the elderly (David, 1991). Tamil women were socialised from birth to be brought up in a protected space that was guided by traditional values and customs. Caitrin Lynch (2007) interviewed a father who explained the vulnerability of Tamil girls:

The reason is, she is a girl. She does not understand very much about the troublesome

state of things in our country. When she goes, men talk to her for love and might even

harm this child by taking her… This is a girl not a boy, right? There must be protection

for girls, right? If it is a boy it is okay. (pp. 159-160)

However, Tamil women in the North and East of Sri Lanka have had their traditional roles changed as a result of years of conflict. They have transformed into heads of households and breadwinners having left behind traditional domestic roles of housewives and nurturers. An

International Crisis Group report (2017) found that many Tamil women who were either widows or wives of missing men have been forced into the public sphere to engage politically, socially and economically. This paradigm shift in Tamil women's roles requires new ways of examining the impacts of civil war on society that include the confluence of social and psychological factors.

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5.3.5 Collective and Cultural Trauma Theory

Cultural trauma is defined by Jeffrey C Alexander as occurring in a community as a whole where members feel that they have been subjected to horrific events that impact on their group consciousness and change their identity forever (Alexander et al., 2003). Refugees, migrants and asylum seekers represent a diverse range of cultural, religious and ethnic backgrounds.

Trauma theorist Jerome Kroll (2003) perceived trauma as a timeless biological response to adversity that is dependent on culture. Reactions to adversity are shaped by culture. The experience of psychological trauma and the emotional reactions differ from culture to culture. Trauma can affect individuals but it also affects communities that experience traumatic events. Many Eastern communities have collectively existed for generations. A collectivist society focuses on meeting the needs of the community as a whole by working together to achieve shared common goals. This way of life emphasises the needs and wants of the group over the needs and wants of the individual. A collectivist society has a different value system to the Western societies of Australia, the United Kingdom and the USA. It is crucial to acknowledge the way of life and values attached to a collectivist culture in our current trauma approaches.

Culture represents “the learned, shared, and transmitted knowledge of values, beliefs, norms, and lifeways of a particular group that guides an individual or group in their thinking, decisions, and actions in patterned ways” (Leininger, 1995, p. 60). Kai Erikson (1976) describes collective trauma as a loss of communality. Following the Buffalo Creek disaster in West

Virginia USA in 1972, Erikson and colleagues described the broken culture of the North

American Indians following the forced displacement, massacres, family separation and dispossession of traditional lands. PTSD symptoms impact the individual following the experience of a traumatic event. However, there is a greater focus in exploring beyond self to

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(2002) describes the impact of collective trauma in the Indigenous community where people are related through the kinship system to others in the community. The experience of colonisation, forced removal of children, dispossession of traditional lands and forced assimilation has continued to impact the community. The Aboriginal community has strong beliefs embedded in the body, mind, soul, and spirits. As a result, the impact of trauma is felt psychologically, physically, and spiritually. Duran and Duran (1995) propose that historical trauma can become normalised within a culture as it is embedded in the collective, cultural memory of a people and is passed on by the same mechanisms as culture.

Hofstede’s (2001) cultural dimensions theory states that highly collectivist cultures believe that the group is the most important unit. It describes traits of a collectivist culture including identity based on social systems, decisions based on the best interests of the group, sharing of resources, and greater emphasis on belonging where children maintain lifelong contact with the family and security through social networks. The role of culture in the construct of self has been found to impact on the nature of individual experience. Although Hofstede’s dimensions were derived from data gathered at the workplace, they have been used in multiple studies examining cultural differences in other settings (Yang, 2000; Mesquita & Walker, 2003). Collective events and consequences may have greater impact on collectivist cultures (Somasundaram, 2007). The cultural background of the Sri Lankan Tamil community is a collectivist community that is family-centric in orientation. It is a community that cherished farms and cattle and where religion and spirituality was part of daily life. The Sri Lankan Tamils deeply valued and pursued education opportunities (Pandalangat, 2012). Tamils have a rich cultural history that was also disrupted as a result of Sri Lanka’s thirty-year civil war. Somasundaram’s (2007) work looking at collective trauma in Northern Sri Lanka highlights the role of family during

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University of Sydney and following a traumatic event. He describes the family unit coming together in solidarity to face the threat, interpret the event and give it meaning collectively. The families also decide on strategies to cope with the stress. The family unit provides a structure to process a traumatic event; similarly the village also provides a network to process a traumatic event. An individual’s identity becomes strongly engrained into their village or uur in Tamil

(Somasundaram, 2007). It is hypothesised that those who have directly experienced trauma in

Sri Lanka may exhibit greater PTSD symptoms due to the lack of available resources to process traumatic information. The survivors may not have had access to a trusted circle within a traditional collectivist community as a result of war, displacement and settlement in a new country. It is hypothesised that participants who were born or significantly lived their lives in

Australia may exhibit reduced PTSD symptoms due to having greater connections to their community. These participants were likely to have attended school and university in Australia.

This may have allowed them to create stronger ties to the community and to receive the support necessary to process trauma.

5.3.6 Post-Traumatic Growth and Resilience Theory

Historically, studies have explored adverse outcomes and pathological symptoms following trauma. However, more recent research has focused on the concept of post traumatic growth that nurtures adaptive behaviour, new learning and resilience (Linley & Joseph, 2004;

Bonanno, 2004) as well as resistance and recovery (Yehuda & Flory, 2007). Park & Fenster,

(2004) suggested that post traumatic growth was a result of new learning that was due to refugees learning to cope in different ways to multiple stressors experienced. This new understanding shifted our thinking that not everyone who was exposed to trauma developed psychopathology (Ssenyonga et al., 2013). Post traumatic growth describes the transformation that takes place following exposure to trauma. Linley and Joseph (2004) also suggest that the

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University of Sydney highest level of post traumatic growth occurs when the trauma exposure has been serious, for example the traumatic event is personally life threatening. Psychologists Dr Richard Tedeschi and Dr Lawrence Calhoun developed the concept of post traumatic growth to better understand the growth that occurs following experiences of adversity, struggles and stressful life experiences. Tedeschi and Calhoun (2004) describe post traumatic growth as:

The experience of individuals whose development, at least in some areas has surpassed

what was present before the struggle with crises occurred. The individual has not only

survived, but has experienced changes that are viewed as important, and that go beyond the

status quo. (p.4).

Tedeschi and Calhoun (2004) argue that post traumatic growth is not the result of trauma. It is about the person’s struggle through the experience of trauma. Additionally, post traumatic growth is not a return to base line function but rather an improvement in self (Tedeschi &

Calhoun, 1996). As the person processes the trauma experience, they find new meaning and seek a new belief system resulting in personal growth. The Post Traumatic Growth Inventory

(PTGI; Tedeschi & Calhoun, 1996) was developed to explore positive responses in five areas including:

1. Appreciation of life

2. Relationships with others

3. New possibilities in life

4. Personal strength

5. Spiritual change

Tedeschi & Calhoun (1996) argue that two traits of a person help their post traumatic growth: openness to experience and identifying as an extrovert. Someone who is open to new

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University of Sydney experiences allows their core beliefs to be challenged and an extroverted person is likely to seek out new active responses following trauma that increase connection to others and reduce isolation. Ssenyonga et al.’s (2013) study explored PTSD, resilience and post traumatic growth among Congolese refugee residents at Nakivale camp in Southwest Uganda. The Posttraumatic

Growth Inventory, the Connor-Davidson Resilience Scale, and the Posttraumatic Diagnostic

Survey were used collect information. The participants were interviewed by bilingual interviewers and the three measures were translated from English to Kiswahili. It was found that these refugees had high levels of PTSD when compared to other previous studies undertaken in Uganda. The study also found that post traumatic growth and resilience acted as protective factors against PTSD symptoms in refugees.

Although the surveyed participants witnessed or experienced traumatic events, 38.3% did not develop PTSD. This was attributed to increased social support from their family and previous experiences of displacement. These two factors were identified as promoting resilience. It is hypothesised that generation 1 participants in this study, those who had lived in Sri Lanka for at least ten years, may exhibit some post traumatic growth as a result of learning that occurred from multitude experience of stressors. Following exposure to trauma, some individuals may develop symptoms of PTSD. However, some individuals display resilience and post traumatic growth despite their trauma exposure. Although the current study focuses on trauma presentation within the Tamil population living in Sydney, it is also important to acknowledge post trauma adaptations of the Tamil community.

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5.4 Transgenerational Trauma

5.4.1 Transgenerational Trauma: An Introduction

The study of trauma that is passed from one generation to another is called transgenerational trauma. Trauma can be transferred through complex mechanisms from the first generation of survivors that have experienced or witnessed it directly to the next generation (Atkinson et al.,

2010). Trauma researchers have traditionally looked at single event trauma and its impact and less research has been undertaken to explore transgenerational trauma. Our current understanding of transgenerational trauma is mainly from research studies with survivors of the Holocaust, genocides, World War 2 as well as Indigenous communities who have endured colonisation. In particular, a number of studies looking at genocides in Rwanda, Nigeria,

Cambodia, and Armenia identified distinct psychopathological symptoms in offspring of survivors (Danieli, 1998; Daud et al., 2005). Children of torture survivors have increased PTSD and depression symptoms when compared to children whose parents were not tortured (Daud et al., 2005). Other studies initially undertaken looking at transgenerational trauma identified that the offspring of Holocaust survivors often displayed changes to their worldview, increased fear, difficulties with communication, separation anxiety and chronic sadness (Danieli, 1981;

Barocas & Barocas, 1979). This literature has increased from the 1980s and currently there is increased interest in exploring this with migrant communities and experiences relating to displacement, violence and civil wars.

The transgenerational transmission of war trauma and PTSD has been reported in literature over the years (Lehrner & Yehuda, 2018; O’Toole et al. 2017). Traditionally native communities describe transgenerational trauma as soul wounds across generations. It is the trauma that has not been resolved within one generation and then is passed down to the next generation. It was during the post-Holocaust era that a consistent literature on the

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University of Sydney transgenerational effects of parents' traumas emerged and there was interest in studying this phenomenon further (Felsen, 1998, Kellerman, 2001b, Solomon, 1998). In 1966, Canadian psychiatrist Vivian M. Rakoff and colleagues (Rakoff et al. 1966) researched Holocaust survivors’ offspring and their symptomatology. Dr Vivian Rakoff was working at the Jewish

General Hospital in Montreal and this became the first study in medical literature looking at transgenerational trauma. The study found that a significant number of offspring were in psychiatric care showing signs of psychological distress. Rakoff (1966) noted that:

Within the last year or two, it has been my experience – similar to that of other

psychiatrists – that I am seeing more adolescents than one would expect whose parents

are survivors of the Holocaust… It could be argued that the population I encounter is

unique; perhaps because I work in Montreal, which is one of the immigration cities of

the post war world. I encounter more rootless refugees than in other cities. But the

parents, the actual victims in these cases are not conspicuously broken people. (p.18).

Rakoff (1966) suggested that for Holocaust survivors who were living in Montreal, life was difficult. As a result, he found that the children may have struggled with meeting parents’ expectations of who they became and were not able to live their lives on their own terms.

Rakoff hypothesised that the expectations set by parents of their children may be related to the trauma of murdered loved ones. Sigal and Rakoff (1971) found that parents often engaged in behaviours that were overprotective (warning the children of disasters), created feelings of guilt

(children’s life was so much better), and placed significant expectations on children to fulfil a purpose. In more recent studies (Field et al. 2013, Bryant et al. 2018) exposure to interpersonal trauma as well as PTSD symptoms experienced by parents have been identified as leading to

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University of Sydney overprotective or harsh parenting practices. Overprotective and harsh parenting practices have been associated with poorer mental health outcomes for refugee children.

Sigal and Rakoff (1971) describe transgenerational trauma transmission in terms of trauma affecting survivors’ parenting practices. In contrast, Yehuda and Lehrner (2018) reviewed transgenerational trauma transmission research and found evidence of trauma transfer from survivors to offspring through epigenetic mechanisms. Epigenetic transmission of trauma describes the process of how genetic trauma materials may be passed on from one generation to the next through mechanisms affecting DNA function and gene transcription. In animal model research, exposure to stress, cold, or high-fat diets has been shown to trigger metabolic changes in future generations (Chen et al. 2016). Human studies have found preliminary evidence linking parental experiences of stress and resulting changes to offspring. Offspring may be affected by their parents’ exposure to trauma even before they are conceived (Yehuda,

2018). Yehuda and Lehrner (2018) argue two distinctive pathways that are likely to be responsible for the epigenetic transmission of trauma. Firstly, the offspring’s early environmental exposure to maternal and paternal trauma (post-natal as well in in utero) may lead to a change in function of the DNA. Secondly, preconception parental trauma may remain in the germ cell following conception and impact the offspring’s development. Epigenetic changes may serve as biomarkers to predict who may be at a greater risk to other mental health disorders. However, there has been caution to not over generalise epigenetic findings across populations as it may stigmatise individuals and their families.

Evans-Campbell (2008) has criticised a number of limitations with the PTSD criteria. He argues that the current PTSD criteria do not allow for transgenerational trauma to be captured.

These criteria are also inadequate to explore individual’s responses to multiple stressors as the

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University of Sydney current focus is solely on the individual’s experience. The current PTSD framework also fails to take into consideration the intersection of historical events and contemporary trauma.

Interventions at the individual, family and community level for those exposed to transgenerational trauma will require an acknowledgement of socio-cultural, historical and political factors that have contributed to the suffering. Understanding transgenerational trauma further is crucial to exploring the clinical implications for therapy with traumatised populations.

The current study intends to further the understanding of transgenerational trauma by exploring a migrant population’s response to trauma across generations. This is undertaken by not only exploring direct experiences of trauma but the indirect or vicarious experiences of trauma experiences of the family.

The following three theories are explored below to better understand the impact of trauma on survivors and the resulting consequences on their parenting practices, as a way of understanding how transgenerational trauma transmission might happen. A history of trauma can impact a parent’s view of the world, ability to read and respond to their child’s emotions and their capacity for age appropriate and effective communication.

1. Shattered Assumptions Theory - This theory proposes that as a result of exposure to

trauma, an individual’s core beliefs about the safety and predictability of their world

and self is destroyed. This is considered as evidence of primary traumatisation.

However, the shattering of the assumptive world for a parent may lead to behaviours

that likely influence how an offspring perceives their world. A world perceived as

unsafe by a parent is likely to be passed onto the offspring with parenting practices that

are overprotective and cautious. Janoff-Bulman provides a theoretical framework to

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understand the traumatic beliefs and assumptions that survivors communicate to their

children as a result of their own disruption of personal safety and security in the world.

2. Attachment Theory - This theory emphasises that the quality of early childhood

relationships between children and their caregivers determines later functions in life.

This theory argues that a caregiver with unresolved trauma may not have the capacity

to attune to the needs of their children and meet their basic needs.

3. Family Systems and Communication Theory – This theory recognises that each family

has their own communication style. It acknowledges that trauma disrupts family

interactions and communications. Survivors may either over share their trauma

experiences or maintain their silence’. Both behaviours may lead to children feeling

confused and overwhelmed. The children may engage in re-enacting their parents’

trauma experiences that have been shared in a manner that is fragmented or overbearing

in order to create new meaning.

5.4.2 Shattered Assumptions Theory

Our assumptions, what we consider as true about the world, help us navigate life.

‘Assumptions’ refer to a set of core beliefs and values that help us direct our cognition and behaviour, interpret our experiences and create meaning. These assumptions bring purpose and meaning to our lives (Parkes, 1988). The worldview that we hold assists our decision making process, impacts the relationships we maintain and influences our perspective of our external world. John Bowlby (1969) stated that everyone builds a representation of who they are and the world in which they live in order to make sense of events and their future. Individuals construct their reality by developing cognitive schemas that includes our beliefs, assumptions and expectations of ourselves, our loved ones and the world around us. People’s perception of their world as a safe, predictable, logical, and just place forms their assumptive world (Janoff-

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Bulman, 1992). Weakened world views can also lead to increased feelings of anxiety

(Edmondson et al., 2011). The assumptive world captures all that we know true about the world from our previous experiences. This assists us to feel safe and secure. This also helps an individual to operate in their world by controlling what happens to them and understanding their and others’ role in that world. Following a traumatic event, we question the world that we live in, and this event can shatter the basic beliefs that we have of our world, in particular our own safety.

Janoff-Bulman (1992, p.6) described three assumptions of the world that are challenged following a traumatic event.

1. The world is benevolent – The world is relatively a safe place. However, when an

individual is traumatised, their world is no longer safe. If an individual feels rejected

through the social response to the trauma, this feeling of lack of safety is further

exaggerated.

2. The world is meaningful – The world is believed to be a just place with meaningful

relationships of family, community and society. The self has personal control of the

environment. When an individual is traumatised, the just world is questioned as a guilty

perpetrator may not be held accountable while the innocent victim suffers.

3. The self is worthy – The self is worthwhile and capable of exercising sound judgement.

When an individual is traumatised, they may experience self-blame and shame

associated with the trauma event.

These assumptions allow people to function in their world in a healthy manner without fear and uncertainty. Although minor assumptions about the world can often by challenged in everyday lives, these three core assumptions are very unlikely to be questioned in our lives

(Janoff-Bulman, 1992). Janoff-Bulman (1992) argues that these core assumptions have been

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University of Sydney inflexible as there was never a previous need for them to be defended in everyday life. As a result, the trauma experience shatters an individual’s assumptive world. One of the criticisms related to this theory is that it requires participants to retrospectively identify what their assumptions about the world were prior to experiencing the trauma. This may result in under reporting or over reporting of how these assumptions may have changed as a result of the trauma experience.

Janof-Bulman (1989) provided a framework to understand how individuals’ assumptions about the world and others may be altered following exposure to trauma. The study by Magwaza

(1999) looked at sixty five victims of human rights violations who were persecuted by the previous South African government and had appeared before the South African Truth and

Reconciliation forum. Thirty-six participants had witnessed the death of an immediate family member and 29 participants had experienced direct personal trauma including torture and detention. The participants all had a diagnosis of PTSD prior to the study. The study corroborated Janof-Bulman’s theory with 77% of participants reporting feelings of apathy and hopelessness when considering the meaningfulness of the world. Furthermore, 83% of participants perceived the world as a source of sadness and 91% believed that the world was not just and had philosophical questions related to existential dilemmas such as ‘why did it happen to me’, ‘why did they do it?’. All participants also struggled with survivor guilt and self-blame.

A war trauma survivor may no longer find the world safe after experiences of sexual violence and torture. Their understanding of the world is shattered and replaced by the realisation that the world is unsafe, humans do horrible things to each other, bad things happen to good people and self is defenceless. The subsequent symptoms that follow including helplessness, fear,

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There has been research undertaken to explore negative changes in assumptive worldviews following trauma such as combat (Dekel, Solomon, Elklit & Ginzburg 2004) and war related violence and torture (Magwaza, 1999). Janoff-Bulman (1992) suggests that survivors recover when they re-establish an integrated assumptive world that incorporates their traumatic experience. A degree of self-awareness and introspection is required to establishing an integrated assumptive worldview, this involves an individual recognising their vulnerability as well as their own strength and resilience (Padmanabhanunni & Edwards, 2015). Refugees and asylum seekers who have endured prolonged violence, displacement and persecution will experience reduced emotional and physical capacity to integrate their trauma into their newly established assumptive world. This is further delayed as a result of time spent in detention centres, prolonged visa process and separation from family members. Migrants may also struggle to re-establish an integrated assumptive world due to the challenges faced in their immediate environment such as discrimination, financial difficulties and the challenges of establishing a new home.

It is hypothesised that migrants and refugees may not be able to re-establish a healthy and positive assumptive world incorporating new meaning of their trauma experiences. As a result, their assumptions of the world as unsafe and unpredictable may in fact be taught to their offspring with the intent to protect. For example, a parent who believes that their world is dangerous may constantly warn their child to be extra careful when going out to an unfamiliar place. Kellerman’s (2001a) research looking at Holocaust survivors found that parents who were survivors conveyed overt messages to their children to be careful and not to trust anybody.

The anxiety provoking warnings are well intentioned to be protective however these warnings may also transform a child’s assumptions about their world, resulting in them feeling more

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University of Sydney fearful and anxious. It is hypothesised that generation 1 participants who experienced prolonged trauma exposure in Sri Lanka and continued lack of permanency in Australia may exhibit increased trauma symptoms due to not having a safe space to integrate their trauma experiences and re-establish their assumptive world. As a result of not re-establishing their assumptive world, the survivors may pass on their fear based warnings to their offspring.

Although Janoff-Bulman presents a theoretical framework to understand how trauma impacts an individual’s beliefs and worldview, this approach can be argued as an ethnocentric perspective on how individuals develop their world view. Culture provides a lens to view and interpret the world. There is a need to acknowledge the cultural differences that may be contributing to an individual’s set of values and beliefs. Although the value of basic safety could be acknowledged as a universal need, how this is achieved and prioritised by different communities would look very different. Individualistic and collectivist cultures have varying value systems that determine identity, belonging, relationships, and worldview. Collectivist cultures are more interdependent and as a result may not prioritise their individual capacity to control their world. There may be systems in place that already control for this within their communities. There are identified differences of perception of worldview within a single nation that is collectivist. This may be due to the varying life experiences of each community’s historical trauma and experiences of oppression. Sri Lanka is identified as a collectivist society that promotes unity, selflessness, and group belonging. However, Tamils as a minority group are deeply impacted by years of discriminatory government policies as well as the violence of the civil war. These experiences have resulted in the community adapting their worldview over time to still continue and function effectively. Somasundaram (2007) has identified transformed worldviews in Tamil war survivors that are linked to cultural notions of fate and

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University of Sydney punishment for past sins. It is important to acknowledge the role culture and historical trauma experiences that may impact an individual’s worldview.

5.4.3 Attachment Theory

John Bowlby’s (1969) theory of attachment states that children come into this world pre- programmed to form relationships and attachment with others in order to survive. The attachments that children form in their early childhood years also influence the relationships they establish as adults. Mary Ainsworth (1970) made significant contributions to attachment theory by exploring the concept of the attachment figure as a secure base from which an infant can explore the world, as well as infant mother relationships. Bowlby (1969) and Ainsworth et al. (1978) observed three styles of infant attachment to caregivers.

1. Secure attachment - This style of attachment occurs when parents are attuned to their child’s need. In turn, children are confident that their caregiver will meet their basic needs. They use their caregiver as a safe base to explore the world around them and return when they are distressed. As a result of this secure attachment, children learn how to regulate their emotions and feel more confident in exploring new environments. Both the parent and child are comfortable with intimacy.

2. Avoidant attachment - This attachment style is one that is uncomfortable with closeness, values independence, and rejects an intimate relationship. The parents may not be emotionally available to the children. An example of this is a parent ignoring their crying child. This results in children not seeking out their parents in times of distress. They may develop self-soothing behaviours and self-nurturing behaviours.

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3. Anxious-ambivalent or preoccupied attachment - This style of attachment is described as a child who is constantly worried about rejection, feeling overly sensitive, requiring frequent reassurances. Caregivers may be inconsistently attuned to their children. A mother may not be predictable in her availability to the child. She may infantilise the child and encourage dependency and helplessness.

4. A fourth attachment style was included by Main and Solomon (1990), known as disorganised or unresolved attachment, in which infants demonstrated disorientation of movement

(wandering, freezing), confused expression and signs of fearfulness when confronted with inconsistencies in their parents’ behaviour. The three attachment styles; avoidant attachment, anxious ambivalent and disorganised attachment are all examples of insecure attachment.

Disruptions in attachment representations have been studied in emerging research (Blankers,

2013). Maternal PTSD symptoms have been associated with greater impairment in mothers’ prenatal attachment to their child (Schechter et al. 2010). Insecure attachment relationships have been linked to anxiety. In particular, disorganised attachment relationships in children have been found to reduce adaptive coping strategies compared to children who are securely attached (Brumariu, Kerns, & Seibert, 2012) The Zeanah and Zeanah (1989) study explored parental trauma and the subsequent impact on their children. The study found that parents who were anxious ambivalent or preoccupied, were less able to resolve their loss and as a result were not able to engage in a healthy and securely attached relationship with their children. The lack of resolution for their traumatic losses also results in disorganised bonding between a child and a parent. This is due to the emotional unavailability of the parent.

Parents can also share their horrific trauma stories in an inappropriate manner, further impacting their relationships and over-burdening children (Bar-On et al., 1998). Alternatively,

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University of Sydney parents with their own unresolved trauma and symptomatology may also exhibit frightened behaviour or a fear response. They are unlikely to have the capacity to be attuned to the emotional needs of their children. Belsky (2008) argued that warfare increases harsh, rejecting and insensitive parenting as it benefits the offspring’s fitness in the environment. Parenting behaviours can include lack of emotional responsiveness, hostile behaviour, and negative attribution of a child. This style of parenting may result in symptoms of depression and anxiety in the child as well as establish an insecure attachment relationship. Belsky (2008) argues that insecure attachment style may help a child prepare for the dangerous environment of warfare exposure. The anxiety and depression symptoms can become survival tools. The anxiety symptom of hypervigilance can help a child to recognise and escape danger, and depression symptoms can help an individual appear submissive to an enemy, reducing chances of violence

(Dalgleish, Moradi, Taghavi, Neshat-Doost, & Yule, 2001).

Bar-On et al. (1998) identified that the phenomenon of transgenerational trauma may well be parental disorders of attachment. Attachment theory brings together psychodynamic and family systems perspectives. Bowlby and Ainsworth’s work exploring attachment theory identified insecure patterns of attachment leading to negative outcomes for children. The study by Zeanah and Zeanah (1989) found that when adults have an anxious ambivalent or preoccupied attachment style, they are less able to organise their relational experiences and manage grief and loss symptoms. As a result, they may not be emotionally available to meet the children’s needs. Dinshtein et al.’s study (2011) explored the long term impact of living with a father with

PTSD on a child. The impact was examined through the measure of emotional distress, stress response and capacity for intimacy. These children were compared to a control group living with a father not diagnosed with PTSD. The study found that children, who lived with a father diagnosed with PTSD, reported higher levels of intrusion and avoidance symptoms and reduced

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University of Sydney capacity for intimacy compared to those in the control group. One of the limitations of this quantitative study is the lack of information to understand the subjective experience of transgenerational trauma.

However, Dinshtein’s study’s limitation has been addressed in the qualitative study by

McCormack and Sly (2013). This study examined the subjective experience of being a child of a Vietnam War veteran. Three sisters, now adults, were interviewed about their experience of growing up with their father, a Vietnam War veteran with a diagnosis of combat related PTSD with comorbid alcohol abuse. The interviews were transcribed and themes were identified amongst the three participants. The themes included betrayal and neglect (absent father, good dad/bad dad), like father, like daughter (self-medication, feeling on alert), fragile intimate self

(shame and self-blame, burden of self-responsibility), and finally forgiveness and self-care

(forgiveness, making meaning and acceptance). One of the participants Lucinda (pseudonym) disclosed the following when talking about trying constantly to gain her father’s attention and failing.

Well—I—we never knew and that’s the thing I guess we—a lot of the things I used to

beat myself up with because I used to be always looking at dad going (crying) “how

can you be like this when you’ve got three daughters—we do nothing wrong, we’re

educated, we—we do everything right and you’ve got a beautiful wife who does—does

everything for you and for her children and (crying still) how can you be this unhappy

because you’ve got this (crying still)—I think why are we not good enough to make

you happy’—and I think that’s just one of the things that yeah—just—I just could never

understand and I think we were just always trying to do right and we just couldn’t

understand why he wouldn’t be happy. It wasn’t enough.

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Similarly, Klaric et al.’s study (2008) of Bosnian and Herzegovina children found evidence of negative behaviours in children where there was a parental diagnosis of PTSD. The behaviours included exaggerated crying, overeating, oversleeping, psychophysiological instability, hyperactivity, and delayed development. This study found that the chaotic family environment associated with emotional unavailability and angry outbursts was the result of disorganised attachment patterns of the parent with PTSD. Children perceived their families as unsafe and unpredictable and developed both behavioural and developmental problems. Children may also become parentified, having responsibility within their family greater than their age capacity

(Bar-On et al., 1998). Children may be assigned or take on the role of an adult well beyond their age, due to family and external circumstances. They may become a parent figure to their parent or a sibling. This is likely to happen as a result of role reversal. Role reversal can be due to parents’ emotional unavailability due to problems with attachment. In times of war, children have been known to become parentified due to carrying greater responsibilities for the survival of their families. Additionally, when a parent is struggling with their own mental health, a child may become a parental figure to a sibling. It is hypothesised that parents who have survived prolonged exposure to war may have parenting styles that impact on how a child navigates his or her sense of self and relationships with others.

5.4.4 Family Systems and Communications Theory

The two previous theories described transgenerational trauma as the result of trauma damaging a survivor’s ability to parent. Family systems and communications theory explores the dysfunctional communication patterns in families enmeshing children in the traumatising experiences themselves. As a result, children too are likely exposed to the traumatising events.

Each family has its own unique style of communication. The way we share stories, culture, traditions, rituals and memories vary from one family to another. In order to understand

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University of Sydney individuals, we need to understand families. Dr Murray Bowen (1966) argued that individuals cannot be understood in isolation as they exist as part of a family unit. Individuals grow and develop in interaction with their physical and social environment (Bowen, 1971; Teater, 2014).

Each individual is expected to respond to one another in line with their role in the family.

Family systems are interconnected and interdependent with family members maintaining roles and similar patterns of behaviour. This allows for a healthy balance within the family (Bowen,

1966; Bowen, 1971). Trauma causes disruptions to family interactions. The nature of the trauma event and symptoms that follow impacts the way in which we share our experiences with one another. Family trauma history can interact with cultural rules to influence how two generations communicate. In Lin and Suyemoto’s study (2016) transgenerational communication about trauma is defined as “communication that is voiced or silent, intended or unintended, in which information about the older generation’s trauma experiences is expressed, received, and interpreted between generations of a family” (p.401). This can include communication filled with meaningful silences, halting speech or sharing too much by spilling

(uncontrolled and uncontained disclosure of too much information) (Lin & Suyemoto, 2016).

Communication models suggested that both the child and the parents protect one another from painful experiences by maintaining silence. Some families may have limited interactions in their communication to avoid pain. They are less likely to share the painful experiences with one another. Within these closed systems the children become overly concerned with their parents’ wellbeing and strive to shield them from any painful experiences (Klein-Parker, 1988).

Somasundaram’s (2007) work exploring collective trauma in Northern Sri Lanka found that in families of widows and children who had lost their husband/father, maladaptive dynamics followed. The loss of an individual within a family unit causes disharmony. Somasundaram

(2007) also suggested that the conspiracy of silence is maintained when a family member is detained or disappeared and the mother has no avenue to pursue a genuine investigation. The

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University of Sydney mother does not share the truth of her husband’s loss with her children. This silence is increased further when the disappearance is caused by a Tamil militant group as opposed to the Sri

Lankan military. Disclosure of this disappearance would mean that the mother and children are ostracised by the Tamil community or branded as traitors by their own family.

Parents’ silence has been identified as one of the mechanisms by which the effects of trauma are transmitted from parents to children. This silence can cause children to fantasise about the actual events (Daud et al., 2005). Research shows that silence can pass on traumatic messages as powerfully as words (Ancharoff, Munroe, & Fisher, 1998). Literature suggests that a

‘conspiracy of silence’ could be a central risk factor for mental health problems and problematic relationships in Holocaust and other survivor families (Ancharoff, Munroe, &

Fisher, 1998; Danieli, 1998). Fargas-Malet & Dillenburger (2016) explored the impact of the political conflict in Ireland known colloquially as ‘the Troubles’ on survivors’ children. The study (2016) found that almost half of the parents disclosed that they had not discussed any of the Troubles with their children as it was not necessary for them to be aware. Parents were quoted as saying ‘she doesn’t need to know’, ‘too young to understand’, ‘didn’t want to implant my thoughts and feelings’, ‘don’t want my kids to know the hurt and pain of the Troubles’.

The study found that 70% of children depicted violence in their drawings when their parents found it difficult to talk about their experiences. However, when the parents communicated about the Troubles with their children, the children exhibited lower levels of behaviour problems.

Disclosure as opposed to silence is seen as a positive step in reducing symptomology in children. Dalgaard et al’s (2019) study exploring the harmful impact of silence after trauma on children in Palestinian families found that children exhibited less PTSD symptoms when parents had provided higher levels of reasons and meaning regarding past national trauma.

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However, in Montgomery’s study (1998) of Middle-Eastern refugee families in Denmark, it was found that children’s higher levels of anxiety were associated with the parents’ disclosure of their experiences of imprisonment and torture. There appears to be contradictory evidence regarding the impact of silence and disclosure within a family following trauma. Other studies have also reported increased symptomology following disclosure of past trauma events. In these studies, silence is seen as a protective factor (Angel et al. 2001). In another study, the traumatic past was in fact communicated by parents to their children. Baranowsky et al. (1998) found evidence of trauma transmission across generations of Holocaust survivor families. The study found that parents either over shared their traumatic history or did not share at all, continuing to maintain their silence within the family. Both types of communication were found to have contributed to the transfer of parents’ Holocaust trauma to the children.

The above example gives weight to the argument that both complete silence and oversharing can result in symptomology in offspring. A balanced approach may be to advocate for a modulated disclosure of past trauma. Modulated disclosure asks for parents to disclose information about their past trauma to their children in an age-appropriate and sensitive manner. This may be more appropriate to allow offspring to understand the parents’ past trauma in a way that they can assign meaning to what had happened and safely incorporate this information into their world. This type of disclosure has been found to be protective in some studies (Rousseau et al., 2013; De Haene et al., 2013).

Research also suggests that the content of what was disclosed is more significant than the silence or the disclosure itself for the children’s mental health (Dalgaard et al., 2019). Danieli

(1998) argued that parental disclosure of previous trauma experiences and open family communication regarding past trauma could result in positive mental health of children. This

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University of Sydney is evidenced in the study by Fossion et al. (2003) where the re-telling of war-related experiences by survivor grandparents to their grandchildren, particularly when presented together with their own pre-war existence, has helped grandchildren to have a better understanding of the silent legacy of Holocaust trauma within families. The re-telling experience has also acknowledged and validated both the trauma experience of the Holocaust but also their story of survival and resilience. It is not clear how the trauma was shared between parent and child in both these studies. However, the latter study appears to provide a safe space for the children to integrate the new information about their parents’ traumatic past in a safe way into their own stories of survival and resilience. Literature supports considered and age-appropriate sharing of trauma narratives to help create new meaning and integrate a deeper understanding of survival and resilience for the offspring. Both scenarios of silence and over disclosure are likely to negatively impact the mental health of second generation offspring resulting in increased findings of trauma symptoms in the PSS-SR questionnaire.

5.4.5 Secondary Traumatisation

Transgenerational traumatisation can be considered as a sub-type of the more general phenomenon of secondary traumatisation. The psychological impact of trauma on people in close contact with direct trauma survivors was first labelled as secondary traumatisation

(Figley, 1983). Secondary traumatic stress, compassion fatigue, and vicarious traumatisation have been used interchangeably in literature. Secondary trauma has been identified in a number of studies over the years. The term has been used to describe the transmission of trauma from survivors to therapists in therapy settings (Jordan, 2010; Knight, 2013) as well as to describe trauma symptoms in the offspring of trauma survivors (Kassai & Motta, 2006). The distinction of primary and secondary traumatisation has been difficult to differentiate in literature that explores transgenerational trauma. However, a primary trauma experience is one in which an

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University of Sydney offspring may witness or experience a trauma event directly. Secondary traumatisation refers to an offspring who learns of the traumatised survivor parents’ worldview through the parent- child relationship, as described in the previous sub section. However, in both scenarios the offspring may experience trauma symptoms such as visualising the trauma event and replaying this in their mind repeatedly. The offspring who experiences the trauma directly visually codes the memory and relives this experience, while the offspring with secondary traumatisation constructs a visual memory from the information received from their survivor parents. The notion of secondary traumatisation has never received a universal definition (Suozzia & Motta,

2004). Ancharoff et al (1998) argue that both primary and secondary traumatisation may occur simultaneously and differentiating the two is more of an academic process than practically possible.

Secondary traumatisation is commonly labelled as vicarious traumatisation or compassion fatigue in research with individuals in the helping and caring professions. In this context, secondary trauma refers to the emotional duress experienced after hearing about the first hand experiences of trauma. The process of secondary traumatisation in the therapy setting refers to the repetitive nature of hearing traumatic narratives of extreme human suffering and the impact of this on the clinician’s mental health. Experiencing secondary trauma is considered inevitable when working with individuals who have experienced trauma. Vivid recounting by the survivor combined with the clinician’s emotional and psychological representation of the events has been linked to symptoms that parallel PTSD. Daniel Siegel (2009) describes the process by which a therapist reads their client’s emotional state through the reading of their own body’s response to the client’s narrative and their nonverbal language. As a result, therapists inadvertently also experience some of the client’s own experience.

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Secondary traumatisation has been linked to emotional exhaustion, detachment and reduced levels of personal accomplishment (Craig & Sprang, 2010). The therapist experiences the trauma through the disclosure of the horrific details shared by the client. The horrific details shared by the client in the therapy setting may result in the therapist questioning her assumptive world. The study by Sui & Padmanabhanunni (2016) explored the vicarious trauma experiences of psychologists working with trauma survivors in South Africa. Using a phenomenological analysis, the study found that psychologists reported changes in their core beliefs relating to their safety in the world. One psychologist reported the following after supporting a sexual assault survivor:

If I see a young girl who’s been raped, I will definitely say to my daughter, ‘just

remember when you go on dates, men might do things, don’t take a drink from them

that is open’. So some of the stuff that I’m getting in the session I’m definitely feeding

to her. (Jennifer)

This is an example of the shattering of the psychologist’s assumptive world. This example also shows how the psychologist’s worry about the safety of the world and benevolence of others, is then passed onto her young daughter. The label of secondary traumatisation as secondary

PTSD in mental health care workers has been argued as pathologising a reaction into a disorder

(Zimering, 2003). Although there has been significant research that has led to improved understanding of direct trauma events and the resulting impact, the experiences of secondary traumatisation is less researched and less understood. The limited research combined with the interchangeable terms describing secondary trauma has resulted in a lack of conceptual clarity in understanding this phenomenon further.

For the purposes of the current study, transgenerational trauma transmission is a specific case of secondary trauma transmission. Trauma can affect children of trauma survivors,

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University of Sydney contemporaries or relatives of trauma survivors, or professionals working with trauma survivors. Some of the mechanisms proposed for transgenerational transmission such as assumptive world and the over-sharing part of communication theory can also be applied to understand secondary transmission of trauma. However, other particular mechanisms such as silence and attachment disruption are unique to the phenomenon of transgenerational transmission. Although secondary traumatisation is the more general form of the transgenerational transmission phenomenon, there are potential mechanisms that are unique to the transgenerational transmission sub-type of this more general concept.

5.5 Summary and Conclusion

Theoretical understanding of trauma and how this trauma is transmitted across generations allow us to capture the complex experiences of survivors holistically. Civil war and armed conflicts result in prolonged and repeated exposure to a number of traumatic events. Exposure to trauma is a risk factor in developing PTSD. This chapter has highlighted current knowledge as well as gaps within our contemporary understanding of trauma theory. Theoretical literature has expanded in the past two decades to account for variations of experiences following atrocities across the globe. Although understanding of trauma related disorders such as PTSD has advanced since it was first described as shellshock, trauma informed and culturally appropriate frameworks appear to be limited. Furthermore, we have limited literature to understand how trauma is transmitted across generations, the impact of these trauma experiences across generations and whether our current measures capture these experiences accurately. These gaps in our understanding need to be minimised so that war trauma survivors are more effectively supported on their journey towards healing and recovery.

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Chapter 6

Long Term Psychological Impact of War and Persecution: Historical Evidence of

Transgenerational Trauma

6.1 Overview

The previous sections have described potential mechanisms by which traumatisation and transgenerational transmission of trauma may take place. This chapter examines historical evidence to make the case that such transmission is commonly reported following community- level traumas. Civil wars and armed conflicts have resulted in the deaths and displacement of millions around the globe. War not only kills but also destroys social institutions, contributes to food insecurity, increases sexual and gender based violence and tears communities apart.

During World War 1, eighty percent of casualties were soldiers. This had changed during the

1990s when almost ninety percent of all casualties were non-combatant women and children

(Borer, 2009). The main targets of a civil war have often been the marginalized ethnic groups and the poorest sectors of society (Kienzler, 2008). In particular, women and children suffer unspeakable atrocities committed against them. UNHCR estimates that up to 50% of refugees include women and children (United Nations High Commissioner for Refugees, 2020). As a result of armed conflict and political unrest, millions of people have been displaced and many have sought asylum under the 1951 Refugee Convention which provides protection from persecution of race, religion, nationality, membership of a social group or political opinion

(discussed in Chapter two).

Armed conflicts resulting in allegations of genocide have also caused trauma in communities across the globe. The first genocide of the 20th century occurred when two million Armenians living in Turkey were forced out of their homeland through deportations and massacres.

Genocide is one of the most heinous crimes against humanity. Over the years, there has been

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University of Sydney limited success in the pursuit of justice for survivors of genocide. In September 1998, the

International Criminal Tribunal for Rwanda (ICTR) announced the first conviction of guilty for genocide following the trial of Jean-Paul Akayesu. Akayesu was the mayor of the Rwandan town of Taba when Tutsis were murdered by Hutus in what is now known as the Rwandan genocide. There is ongoing international advocacy to include other recent conflicts such as

Sudan, Sri Lanka, Islamic State targeting Christian, Yazidi and Shia minorities, and Myanmar under the term of genocide. For the purposes of this chapter, a number of historical and more recent armed conflicts, civil wars and massacres will be examined to understand the impact of traumatic events, how the experience of trauma events has led to PTSD diagnosis and how trauma narratives as well as PTSD symptoms may be transmitted across generations. This will be discussed in the context of The Armenian Genocide, The Holocaust, The Vietnam War, The

Cambodian Genocide, The Rwandan Genocide, The Srebrenica Genocide, Australian

Aboriginal community’s experiences of historical and collective trauma, and Sri Lanka’s 30 year civil war and Tamils’ persecution experiences.

Over the years, researchers have tried to understand the impact of human suffering due to war and armed conflicts on the individual and family, as well as the community. We understand that traumatic experiences that overwhelm an individual’s capacity may lead to a diagnosis of mental health disorders. Trauma events linked to war have the highest conditional risk for the development of PTSD (Carmassi et al., 2014). Transgenerational trauma transmission describes the passing down of trauma from the first generation of survivors to the second or third generation offspring. Following the aftermath of the Holocaust and the Vietnam War, there has been growing research interest on human suffering and coping mechanisms

(Pedersen, 2002). Over the years, other communities affected by war have also been included in this research.

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6.1.1 The Armenian Genocide

Gevorg Akhpar was seven or eight years old during the Armenian Genocide, and now

he remembered quite well how they took away his father, how they kidnapped his

sister (my grandmother), Verzhin Hazarian, from the exile caravan. He remembered

so many atrocities, plunder, pillage, crying, and wailing. He remembered the corpses

of Armenians on the roadside on which carnivorous birds were feeding.

The Armenian Genocide: Testimonies of the Eyewitness Survivors (Svazlia, 2011)

The destruction of the Christian Armenian population by the Ottoman Turkish government is now widely considered as an act of genocide for many Armenians around the world. It is considered by scholars as the first genocide of the 20th century. On 24th April 1915, several hundred Armenian intellectuals were rounded up, arrested and later executed as the start of the

Armenian Genocide. There were also massacres of Armenians in previous years such as 1894,

1895, 1896, and 1909. The policy of Pan-Turkism hoped to save the remains of the weakened

Ottoman Empire after World War 1. However, the Turks saw Armenians as an obstacle in achieving this policy goal as they were one of the only Christian cultures in the Muslim

Ottoman Empire. Armenians were treated as second class citizens and experienced discrimination in the form of being banned from speaking their native language. They risked the punishment of having their tongue cut out if caught speaking the language outside of prayers (Cooper & Akcam, 2005). The Armenians living in Anatolia were ousted from their homes and sent to the Syrian Desert where many died. Their land and property were confiscated. Many women and children died along the death march across Syrian Desert towards the concentration camps. It is estimated that up to 1.5 million Armenians were killed and many more were displaced and persecuted. Many who survived the death march were raped

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University of Sydney and mutilated. Others died of widespread diseases. Tens of thousands of Armenians were also forcibly converted to Islam. This culminated during the period of 1915-1918.

In 2019, the Turkish leader stated that the country’s House of Representatives had no moral standing to adjudicate on the murder of 1.5 million Armenians. The Turkish government’s denial of the genocide has further intensified Armenians’ emotional reactions to the suffering their ancestors experienced (Cooper & Akcam, 2005). On the 30th October 2019, the US House of Representatives voted to recognise the Armenian Genocide. Research began to be published in the 1980s exploring the transgenerational transmission of the genocide trauma of the

Armenians. The legacy of the Armenian Genocide continues to impact future generations through survivor narratives, through sharing of rituals and the sense of collective victimisation due to identification with the victim group. However, the literature exploring transgenerational transmission is limited within the Armenian population.

Trauma can be transmitted through survivor narratives. Narrative scholars over the years have explored the passing down of narratives in families to maintain collective identity (Baquadano-

Lopez, 1997). However, the transgenerational transmission of narratives shared to maintain ethnic identity has been less explored (Azarian-Ceccato, 2010). Sharing a story can assist the process of socialisation of a child from a young age. Following the Armenian Genocide, stories were shared within families and the community through commemorations and remembrances.

Dan Bar-On (1995) also identified ritual practices with Holocaust survivors as contributing to the transfer of trauma. The stories were shared by survivors with other generations in pursuit of recognition (Azarian-Ceccato, 2010). The experiences of the traumatised parents are internalised by the offspring through the practice of storytelling. Trauma symptoms can be caused by both direct and indirect experiences of trauma. This indirect trauma can be

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University of Sydney transmitted either at a personal level or collectively in a community (Yehuda et al., 1998). At a personal level, this can through the experience of storytelling. At a community level, the trauma may be shared through a ritual practice of mourning the dead. The lack of research exploring transgenerational transmission of trauma narratives with refugees may be due researchers’ ambivalence about risks of further traumatisation as a result of sharing their story and re-telling their trauma history. Furthermore, another barrier may also include the lack of safety established in a host country that allows a survivor to finally share their story.

Armenians identify the genocide as the most historically and psychologically significant event in their history and development of the Armenian collective identity. Transgenerational transmission of trauma was explored in the Kupelian et al. (1998) study of PTSD symptoms among Armenian survivors of the Turkish genocide. They found that the third generation of survivors exhibited more pathological symptoms than the second generation of survivors.

Karenian et al. (2011) explored transgenerational trauma in 689 Armenians living in Greece and Cyprus using a PTSD self-rating scale. The researchers hypothesised that the older, second generation Armenians with a close relative or family member killed may present with characteristics of PTSD symptoms. They also explored if any contemporary Armenians were presenting with any mental schemas (patterns of thought and behaviour) or feelings related to the genocide events. The results of the study showed increased symptoms of PTSD among the offspring of the Armenian Genocide, but these symptoms had in fact decreased over subsequent generations. This contradicts Kupelian et al.’s (1998) study where third generation offspring were exhibiting trauma symptoms. Karenian et al.’s (2011) findings of reduced traumatisation in subsequent generations may be explained through increased access to social support over the years that may have provided a safe space to share and process past trauma. The thirteen years gap between the two studies also resulted in significant changes in how the Armenian

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Genocide was perceived by the global community. The recognition likely enabled survivors to feel heard and validated in their experience of suffering. The study also found that women who had stronger connections to the Armenian community presented with increased trauma symptoms. These women had greater exposure to trauma narratives as a result of greater connection to their community.

Historical trauma was initially introduced to describe the experience of children of Holocaust survivors (Kellermann, 2001a). Historical trauma is both cumulative and collective

(Braveheart, 2011). It refers to complex and collective trauma experienced over time and across generations within a particular cultural group who share an identity, affiliation, or circumstance. It is marked by complex layers of multiple trauma experiences that include war, grief and loss, displacement and poverty (Gone, 2013). Azarian-Ceccato (2010) explored how memory of the Armenian community’s collective suffering continues to impact lived experiences and identity of fourth generation offspring of the Genocide survivors. The study found that historical and collective memory connected the past and the present with participants using Genocide narratives to strengthen their connection to their family history. Azarian-

Ceccato (2010, p.108) explained her own reflections as an offspring of a survivor:

For as long as I can remember, as the descendant of Armenian Genocide survivors, I

grew up listening to the stories. My grandfather told and retold his mother’s story in an

effort to make sure that we didn’t forget. I began to remark that anytime I was in an

Armenian milieu and someone would speak of the Armenian Genocide, others would

organically chime in with their own ancestrally anchored stories of familial

displacement. I listened as a collective “we” was often referred, as in “we” the

descendants of Eastern Anatolian deportees who were marched into the desert. This

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“we” was dichotomously drawn up against a collective “they.” The “they” referred to

the Turks, as they were often referred. (p.108).

Although trauma narratives were shared in some families openly, some individuals found it difficult to disclose their past experiences. Kalayjian et al. (1996) found that seventy five percent of those interviewed had not spoken to anyone about their experiences of the Genocide.

They chose not to speak due to the fear of further persecution of self and their loved ones. This is common fear that is faced by many minority persecuted communities as the process of remembrance and memorialisation is banned. Governments may engage in this practice to control how a community mourns their dead and the narratives of heroism. This is undertaken with the intention of influencing how events are remembered. Collective remembrance, mourning and memorials allow dignity for the persecuted community. Communities that are able to share narratives through stories have reported both positive and negative emotions.

However, in the Kalayjian & Weisberg (2002) study of children and grandchildren of survivors of the Armenian Genocide, participants recounted loss of family members, traumatisation of parents as well as feelings of helplessness, being overwhelmed, confusion and curiosity. It is understood that collective memory is not destroyed with the death of the last survivor. Some participants identified feeling resentment towards carrying the burden of past trauma memories of their ancestors. Other participants reported that they were expressing unexpressed emotions of their parents such as sadness and rage. Here, the participants express their reaction to hearing the trauma narratives as having been predominantly overwhelming. This may be due to a number of factors, including when the trauma events were shared, how many details were disclosed and the capacity of the individual to receive and make meaning from the content of the shared narrative. In asylum seeker and refugee communities, the sharing of trauma narratives may be further complicated by the immigration asylum process that requires the

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University of Sydney narrative to be shared regardless of the readiness of the individual and the fear of further persecution as a result of identifying with a particular cultural or racial group in the host country. One of the limitations of Kalayjian & Weisberg’s (2002) study was the small sample size of eight participants. However, it also highlights the need to have small group opportunities where sensitive conversations can be facilitated to understand the impact of trauma on future generations and strategies required for healing. Groups provide an opportunity to bear witness to the horrors of war and suffering. They allow for a space where assumptive world can be restored and trust re-established.

6.1.2 The Holocaust

Like many other survivors, I feel an obligation to tell my story again and again. The

Holocaust was the scientifically designed, state-sponsored murder of the Jewish

people by Nazi Germany and its allies. The Holocaust should never be forgotten and

should never happen again.

Rena Finder (2019)

My Survival: A Girl on Schindler’s List

In the Greek language, Holocaust means sacrifice by fire. The Holocaust refers to the systemic and state sponsored murder of more than six million Jews by the Nazi regime and its collaborators from 1933-1945. During this period, up to 72% percent of European Jews were killed (Kahane-Nissenbaum, 2011). The Nazis believed that Germans were racially superior and that the Jews were a threat to the German community. Millions of Jews, along with other minorities such as Roma gypsies, the disabled, homosexuals and Soviet prisoners were brutally killed. They were killed by the Nazi regime through starvation, disease, gassing, beatings, exhaustion, death marches and shootings (Clarke et al. 1996). The killing was justified as the

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University of Sydney final solution to the Jewish problem to maintain the purity of the Aryan blood. In addition to the physical genocide that took place, Nazi Germany also utilised psychological warfare to dehumanise (Jews were labelled as rats and parasites) and humiliate (Nazi medical experiments on prisoners that amounted to medical torture) the Jewish people whilst destroying their sense of individualism and identity (Krell, 1993). Holocaust survivors who were interviewed almost fifty years later identified the Holocaust as one of the most significant stressors of their lifetime

(Rosen et al. 1989). Following the Holocaust, many survivors found shelter in displacement camps administered by Allied powers. Between 1948 and 1951, almost 700,000 Jews fled to

Israel, including 136,000 Jewish displaced persons from Europe. Other Jewish displaced persons emigrated to the United States and other nations. The last of these displacement camps closed in 1957. Crimes committed during the Holocaust devastated European Jewish communities. It resulted in direct and indirect trauma experiences.

Holocaust survivors have been studied extensively to understand and evaluate the impact of trauma that has resulted in PTSD symptoms. PTSD symptoms in Holocaust survivors have been found to intensify in older age (Kuch & Cox, 1992) due to loneliness, retirement, and physical ill health (Macleod, 1994). This study re-examined the files of 124 Holocaust survivors who had applied to the West German compensation board. The study found that up to 78% of the participants reported that their first degree relatives were killed. Sixty three percent of participants reported that they had been detained in a concentration camp. Forty six percent of the individuals met PTSD criteria in DSM-III-R with reported symptoms of recurrent nightmares and intense distress over reminders of their trauma. Nadler & Ben-Nadler &

Shushan’s study (1989) explored the long-term consequences of mass traumatisation in

Holocaust survivors, in particular looking at survivor’s syndrome that described their emotional health, relationships with others and their functioning as spouses and parents. This

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University of Sydney group was compared with a control group who were not survivors of the Holocaust. The

Clinical Analysis Questionnaire and the Tennessee Self-Concept Scale were translated to

Hebrew and utilised to measure symptoms of clinical depression and self-esteem. The findings were that survivors scored significantly lower when compared to the control group on concepts of self (self-worth, self-control, and self-discipline), energy, and assertiveness. The survivors reported greater difficulties in their emotional expression, trust in others and independence.

These reactions are common following a severe trauma event that affects an individual’s worldview, self, and trust. The shattering of the assumptive world and the impact of this on an individual’s world view has been explored in literature (Janoff-Bulman, 1992). Survivors who have changed world views, who are traumatised, and who struggle with their emotional regulation as well as expression may find it difficult to be emotionally available to their offspring. This is likely to impact the style of attachment relationship between the parent and child (discussed in chapter 5).

Fossion et al. (2015) explored the impact of direct trauma experiences in Jewish children who survived by hiding. They were Jewish youths who spent World War two hiding in shelters across Nazi-occupied Europe. Studies have found that hiding for prolonged periods of time in order to avoid captivity can contribute to risk of psychological disorders. Yehuda and colleagues (Yehuda et al. 1995) studied Holocaust survivors fifty years later and found that those who had lived in hiding continued to experience high levels of psychopathology and disturbances. One survival strategy that children use when hiding for prolonged periods of time is to cut themselves off from any emotion (Herman, 1997) so they can continue with the everyday demands needed for survival rather than continue to feel helplessness and despair.

Herman (1997) states that when children are powerless to change a situation and no support is available, they surrender and “the system of self-defence shuts down entirely. The helpless

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University of Sydney person escapes from her situation not by action in the real world, but rather by altering her state of consciousness” (p.42). These children experienced prolonged exposure to trauma that resulted in feelings of helplessness and powerlessness. Hiding meant that the children needed to leave behind family and their home. This process causes a disruption to their attachment to caregivers. They also were at risk of punishment if caught and as a result likely experienced hyper vigilance and a constant state of danger. These children likely altered their worldview in order to survive the long periods spent in hiding. The world was likely perceived by them as an unsafe, unpredictable and unjust environment. Their adaptations of their behaviour correspond to their world view and crucially supported their survival. However, these behaviours often became maladaptive when survivors continued to practice them years later.

The horrors of the Holocaust resulted in severe traumatisation that led to the PTSD diagnosis of many individuals. The individuals as well as their families continued to struggle many years later with other mental health and social challenges related to their psychological wellbeing.

Research exploring transgenerational trauma has studied the offspring of the Holocaust survivors (Bergmann & Jucovy, 1982; Epstein, 1979). The trauma symptoms found in the offspring of trauma survivors has been linked to their knowledge of their parents’ past trauma experiences. The offspring may have learnt of their parents’ past trauma as a result of observing the trauma symptoms in their parents or through the narratives shared by the parents. This has been described by some researchers as secondary traumatisation. Others have described this as transgenerational trauma. The differences between the terms as well as how the terms are understood for the purposes of the current research questions are further discussed in Chapter

5. Transgenerational trauma was first studied in the context of how the Nazi Holocaust survivors’ children were impacted by the stories and behaviours of their parents. Kellerman’s

(2001b) integrative review exploring transmission of Holocaust trauma includes an excerpt of

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University of Sydney a man reporting fragments of his dreams. He recounted the following during a psychotherapy session:

I am hiding in the cellar from soldiers who are searching for me. Overwhelmed by

anxiety, I know that if they find me they will kill me on the spot… Then, I am standing

in line for selection; the smell of burning flesh is in the air and I can hear shots fired.

Faceless and undernourished people with striped uniforms march away to the

crematoriums. Then, I am in a pit full of dead, skeletal bodies. I struggle desperately to

bury the cadavers in the mud, but limbs keep sticking up from the wet soil and keep

floating up to the surface. I feel guilty for what has happened, though I do not know

why. I wake up in a sweat and immediately remember that these were the kinds of

nightmares I had ever since I was a child. During a lifelong journey of mourning, I have

been travelling back to the dead; to the corpses and graveyards of the Second World

War with a prevailing sense of numb grief for all those anonymously gone.

Kellerman (2001b) argues that from the content of this recount of his dreams, he can be considered as a direct survivor of the Holocaust. However, this excerpt is from the son of a survivor who had no direct experience of the Holocaust. Kellerman accepts that it is difficult to assess how manifestations of trauma are passed onto offspring or how this is observed in the offspring (Kellerman, 1999). Individuals can be directly or indirectly affected by trauma. In the phenomenological-thematic analysis by Scharf and Mayseless (2010), they found that three major themes of difficult experiences that could have had disorganising effects on the second generation: survival issues, lack of emotional resources, and coercion of the child to please the parents and satisfy their needs. The second generation of those who survived experienced their world view as (a) the world is an unpredictable place where (b) threats to survival can surface at any moment, and (c) one needs to prepare, to be on the alert and ready for such unpredictable

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University of Sydney but somewhat probable occurrences (Scharf and Mayseless, 2010). The assumptive world appears to be shattered due to the trauma experiences of the parents. Some participants also expressed their own feelings of unmodulated fear:

I think I fear that something will happen to him [father]. I was afraid that something

would happen to him, as if this whole family would collapse, and many times my

mother would go down with me, and I really remember these events. She would wander

around the street. It was Friday noon. There were hardly any cars. “Why doesn’t he

come?” And I remember her eyes, how she grabbed me, and my fear that something

would happen to him— that perhaps something had really happened to him. She was

afraid. She also said, “Probably something happened to him.” I remember her grip, her

eyes, her fast walk, all along the street, back and forth. I remember it pretty well, so it

probably instilled fear inside me. (Scharf and Mayseless, 2010).

This example supports the idea that the children of traumatised parents often grew up in an environment that evoked a sense of danger. This was demonstrated through the behaviours of their parents who were unable to establish a sense of safety for themselves. Only when a parent establishes their own safety, are they then able to support their children to create their own safe and predictable world. Refugees and migrants struggle to establish safety in their new homes.

This can be both physical and psychological safety. The survivors struggle to manage their trauma symptoms combined with resettlement and cultural challenges.

The Holocaust has had continuing psychological, social, and cultural effect on first, second and third generation offspring of survivors. Despite the vast amount of research that has been done on Holocaust survivors and their offspring, there has not been significant research undertaken to explore when, why and how surviving generations begin to move past pathological symptoms (Kahane-Nissenbaum, 2011). Kahane-Nissenbaum’s study (2011) explored the

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University of Sydney impact the Holocaust had on third generation offspring of survivors through administering an eight item semi-structured questionnaire called, The Third Generation Questionnaire, which was created for the purpose of this study. Participants reported both positive and negative feelings about their perception of their surviving grandparents. The study found that 19 out of the 30 third generation participants viewed their grandparents as heroes. Most were in awe of their capacity to overcome something so horrific. The participants also identified survivor strength within their grandparents that had helped some battle health concerns such as cancer.

A participant reported the following “When my grandmother had breast cancer, she felt that if the Nazis couldn't kill her neither could cancer, and she beat it”. The study examined the trauma transmission from survivors to the third generation participants. Participants identified feelings of anger and regret, the duty to never forget the Holocaust, and some psychopathology symptoms as being transmitted across generations. Seven participants expressed anger at what had happened to members of their family as well as regret that they had not asked questions to find out further from their grandparents while they were alive. The lack of communication between the generations appears to have resulted in feelings of regret at not knowing the family’s trauma narrative.

The duty to never forget the horrors of the Holocaust was also identified as being passed on from their grandparents. Participants identified the pressure and emotional pain of keeping the stories alive so it may never happen to another Jew or another human again. Two participants who completed a telephone call following the questionnaire reported symptoms of anxiety and depression. One participant disclosed that her grandfather had told her his story of survival.

Following this, she continued to have nightmares of someone coming to take her or her parents away from the ages of eight to twelve. The traumatic recount of survival from the grandparent appears to have impacted the safety of the young child’s world.

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The third generations’ emotional responses could be argued as appropriate reactions to the horrific experiences of their grandparents. However, these reactions are as a result of the sharing of trauma events between the survivors and the third generation offspring. The sharing of trauma events that elicit a strong response in offspring could be argued as an example of trauma transmission. The survivor, without intention, may be contributing to the indirect traumatisation of the third generation offspring by sharing horrific details of a trauma event.

Their intention of sharing their trauma experiences is not to harm but rather to pass on their survival stories to their family members

Some participants also recounted physical reactions being in places where their parents or grandparents had been during the Holocaust. Below is an excerpt from a participant who visited one of the camps:

My husband convinced me (and it was not easy) to visit Dachau. It was absolutely

horrifying. I froze thinking how my grandmother walked the same path so many years

ago, but not as a free woman like I am. I cried and couldn't breathe while we were there.

Even thinking about it now brings tears to my eyes. As we visited Germany, the people

were all so nice but I couldn't help but think "What were you doing while my

grandparents were being tortured? Did you know? Did you care?" I try not to hold Hitler

and the SS's actions against all Germans. But I also can't help but feel some resentment

toward them for what happened in their country. (Kahane-Nissenbaum, 2011).

In follow up phone calls following the study, a few participants reported dealing with symptoms of anxiety and depression but could not specify whether it was attributed to their own struggles or that of their parents. This highlights that their emotions attached to their

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University of Sydney surviving family member’s experiences go beyond merely an individual reaction to hearing another individual’s trauma event. There appears to be some distinction that it is not solely a personal struggle but perhaps the struggle of others manifested in their own trauma reactions.

One participant stated that they were not sure whether their feelings were directly related to having survived the Holocaust or because they were raised by a father who was a Holocaust survivor. However, over all the third generation offspring of Holocaust survivors have reported the transmission of survivor strength, survivor legacy, pride and resilience as part of this study.

Some participants acknowledged that their newfound value of family was passed down from their surviving grandparents who ‘treasured whatever relationship they had left’. This study highlights that unlike Kellerman’s study (2001b), not all that is transmitted across generations following a tragedy is traumatic (Kahane-Nissenbaum, 2011).

The trauma response of Holocaust survivors’ offspring to present day impact of terror was further investigated by researchers. Hoffman and Shrira (2017) explored anxiety surrounding

ISIL (Islamic State of Iraq and Levant) in Israeli participants whose grandparents were

Holocaust survivors. In particular, they wanted to look at conditions in which the anxiety regarding ISIL was the greatest. The study found that the greatest anxiety was observed in participants when all four grandparents were survivors of the Holocaust. They also found that the transmission of trauma is observed more when facing another threat reminiscent of ancestral threat, that they may be re-triggered or activated by the current threat (Hoffman &

Shrira, 2017). Yehuda at al. (1998) examined stress and trauma exposure and current and lifetime PTSD in adult children of Holocaust survivors using the Trauma History Questionnaire

(measuring traumatic life events) and The Antonovsky Life Crises Scale (measuring cumulative life events). This study utilised a comparison group of demographically equivalent

Jewish men and women in the same age group with no family member affected by the

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Holocaust. One hundred participants were recruited from Mount Sinai specialised treatment program who had at least one parent who was a survivor of the Holocaust. The results showed that the offspring of Holocaust survivors ranked higher in severity of trauma events meeting the DSM-IV criteria for PTSD. The adult children also experienced a greater degree of lifetime cumulative stress. PTSD prevalence was also higher in the offspring group (15%) when compared to the comparison group (2%). Other trauma studies have also described Holocaust survivors presenting with high levels of emotional disorders, psycho-social symptoms, and post-traumatic symptoms and this impacting their parent child relationships (Cohen et al., 2001,

Fossion et al., 2003). As a result of parents’ presenting with high levels of emotional disorders, they were unable to provide adequate nurturing and parenting (Kellerman, 2001b). This is supported by attachment theory principles of traumatised parents unable to provide a nurturing relationship to their offspring. These studies shows evidence of increased prevalence of trauma resulting in both anxiety and PTSD prevalence in the offspring of survivors. However, there is a need to further understand the mechanisms that may be responsible for the transmission of trauma across generations.

6.1.3 The Vietnam War

No event in American history is more misunderstood than the Vietnam War. It was

misreported then, and it is misremembered now.

Richard M. Nixon

The Vietnam War from 1959 – 1975 has been often described as costly, controversial and divisive. The Vietnam War was also known as the Second Indochina War or the American

War. It was the longest and most opposed war in American history. The war was officially fought between the North (the communist regime led by Ho Chi Minh) and the South (the

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University of Sydney government led by Ngo Dinh Diem). South Vietnam was supported by anti-communist allies such as the USA, Australia and South Korea. More than 500,000 US military personnel were involved in the Vietnam War at the height of United States’ involvement. After the growing opposition to the war in the United States, President Richard Nixon ordered the withdrawal of the US military in 1973. On January 27, 1974, a peace accord was signed in Paris officially ending the war. The war resulted in a large number of casualties from the United States of

America, South Vietnam and North Vietnam. Australian military personnel were also involved in the Vietnam conflict from 1962 to 1973 (National Centre for War-Related Post-Traumatic

Stress Disorder: 1999). Although, it was an extensively reported war, the experience of the

Vietnam War is still misunderstood.

The psychological cost of the Vietnam War has never been wholly established and the ongoing psychological impact of this war has been the focus of much research (Fontana & Rosenheck

1994; Haley, 1984; Westerink, & Giarratano, 1999). There are estimated figures of more than two million Vietnam War veterans still living in Vietnam but further details are not clear as the country lacks epidemiological data on mental illnesses. There may be many that continue to suffer in silence due to the country’s lack of resources to support mental health education, counselling, assessment, treatment and support.

The term Post Vietnam Syndrome was used to describe returning soldiers who were experiencing trauma and grief symptoms prior to the inclusion of the term post-traumatic stress disorder under the label of Anxiety disorders in DSM-III that was published in 1980. The condition was previously understood as a response to stress. These responses included combat related nightmares, anxiety, anger, depression, and alcohol and/or drug dependence. This followed the works of psychiatrist Robert Jay Lifton (1973) and psychoanalyst Chaim Shatan

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(1973), who conducted extensive interviews with Vietnam veterans suffering from what is currently known as PTSD symptoms such as flashbacks as well as paranoia. There are a number of studies that also suggest that many Vietnam veterans with PTSD show high levels of social anxiety (Escobar et al., 1983; Kulka et al., 1990; Orsillo et al., 1996). The psychological and emotional impact of the Vietnam War has been significant. The ongoing impact of the Vietnam

War on future generations has been studied closely in recent literature (Davidson & Mellor,

2001; O’Toole et al. 2015). Figley (1983) describes individuals living in close proximity to victims of violent trauma as experiencing secondary traumatisation, becoming indirect victims of that trauma. Literature shows that veterans' PTSD following exposure to combat violence also affects veterans' familial relationships and impacts the psychological adjustment of family members (Rosenheck, 1986). President Jimmy Carter’s President’s Commission on Mental

Health Report (1978) found that 38% of the marriages of Vietnam veterans ended within six months of their return from duty in South East Asia.

Literature reviews have emphasised the recurring theme of violence in the home following diagnosis of PTSD for war veterans (Galovski & Lyons, 2004). Frederikson, Chamberlain, and

Long (1996) interviewed wives of five Vietnam War veterans who had been diagnosed with

PTSD following their return from South East Asia. These women described their households as filled with anger and violence, a description of a hostile family environment. The wives disclosed that they would often control their environments and manage potential triggers to maintain calm and order in their families. They also reported problems in their marriage and family. A study by O’Toole et al (2015) endeavoured to establish the prevalence of suicidality amongst Vietnam War veterans living in Australia, as well as their partners. They examined lifetime suicidality amongst 448 ageing Australian Vietnam War veterans and 237 female partners and compared the results to the Australian population statistics. They found that the

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University of Sydney relative risks for suicidal ideation, suicide plans and suicide attempts were 7.9, 9.7, & 13.8 times higher for Vietnam War veterans when compared to the general Australian population.

Their partners also scored higher on all three aspects compared to the general population (6.2,

3.5, and 6.0). Similarly, the Australian Institute of Health and Welfare (2000) also conducted a study into the risk of suicide for children of Australian Vietnam War veterans. The study found that the highest at risk groups were those aged 15-29 at the time of the study and that children of war veterans were at least three times more likely to commit suicide than the general

Australian population. These studies support the notion that Vietnam War Veterans returned home psychologically impacted by the atrocities and violence they had witnessed during the war. When they returned home, their symptoms of trauma likely contributed to long term consequences for their family’s psychological states in the form of further traumatisation.

The National Vietnam Veterans' Readjustment Study (NVVRS) explored Posttraumatic Stress

Disorder (PTSD) and other post war psychological concerns among Vietnam War

Veterans. Price (2007) summarised the findings of the re-adjustment study and stated that across 100 life-adjustment indices, the majority of Vietnam Veterans appeared to have successfully re-adjusted to post war life and were not experiencing any symptoms of psychological disorders. But the study also revealed that a minority of these veterans were still suffering psychologically and experiencing problems in other aspects of their life such as relationship, marital and work difficulties. Furthermore, Price highlighted that these veterans also showed increased violent behaviour that had then resulted in their children having higher risk of behavioural, academic and interpersonal problems (Price, 2007).

Struggling with trauma symptoms can impact parent child relationships. Rosenheck and

Fontana (1998) studied the transgenerational transmission of trauma in Vietnam War veterans

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University of Sydney and their offspring. They interviewed partners of Vietnam War veterans to learn more about their children’s behaviour. They found that the children of these veterans who had engaged in violence scored higher on the Child Behavioural Checklist Score. This is a 122 item questionnaire exploring child behaviour and adaptation. A higher score indicated clinical range severe problem behaviour in children. Children may manifest adjustment problems related to their father’s traumatic experiences. Fathers who have engaged in violence have been identified as having greater difficulty establishing trusting and intimate relationships. This may lead to difficulties in maintaining parent-child relationships, problems with substance use, and increased family violence (Reeve, 2010). It is acknowledged that forming a close, intimate bond between a parent and child contributes to secure attachment. Bosquet Enlow et al.

(2014)’s study found an association between a mother’s trauma and PTSD diagnosis to mother- infant attachment relationship. Although this is a non-war trauma sample, the study found that increased maternal PTSD symptoms at six months was associated with increased risk of insecure and partially disorganised mother-infant attachment style at thirteen months. The study also found that insecure mother-infant attachment relationship increased the offspring’s vulnerability to developing PTSD later in life.

Rosenheck and Fontana (1998) hypothesised that fathers in this study may have struggled to form close relationships with their children as they may have harmed other children in Vietnam during the war. They also hypothesised that these fathers may have struggled in making emotional connections and being empathic, firm and consistent with their children due to their own discomfort. The study outlines a connection between parental trauma due to war and combat and the impact this has on offspring. In the Castro-Vale (2019) study, similar findings were identified. Offspring of Portuguese war veterans scored higher on the Brief Symptom

Inventory (BSI), which measures general psychopathology. They showed increased suffering

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University of Sydney associated with their father’s exposure to war. The study additionally found an association between father’s exposure to war and offspring physical neglect. This is similar to Yehuda et al (2001)’s findings of increased levels of offspring childhood trauma including physical neglect. However, the findings were not related to the fathers’ diagnosis of PTSD. The researchers encouraged mental health support for veterans’ offspring based on fathers’ war exposure intensity rather than just psychopathology.

Mechanisms of trauma transmission are not captured clearly in either of these studies discussed above. This further identifies the current gaps in our understanding of how exactly the trauma is transmitted between generations. The transmission of trauma through parenting pattern is more clearly explored in the study by Zerach & Solomon (2016). The researchers explored the impact of captivity trauma and secondary traumatisation with Israeli fathers and their adult offspring. The study found that war captivity increased the fathers’ PTSD, in particular the avoidance symptoms (withdrawing from relationships, emotional numbing, and increased isolation). These symptoms can result in parents struggling to be physically and emotionally in close proximity to their children. The increase in avoidance symptoms decreases parent-child relationship as it restricts a parent’s capacity to form meaningful, close relationships with their offspring and support their growth. This is in line with theoretical literature that suggests that traumatised parents are less able to be emotionally available and more likely to perceive their children negatively. The experience of secondary traumatisation described above can be considered as an example of transgenerational trauma. The trauma symptoms experienced by the survivor is passed onto the offspring through the parent-child relationship.

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6.1.4 Cambodia’s Killing Fields

To keep you is no benefit; to destroy you is no loss

A popular slogan of the Khmer Rouge

The Khmer Rouge came to power in 1975 when they militarily defeated the government forces following a coup that began in 1970. Their aim was to create an agrarian utopia under the leadership of Pol Pot. Up to two million Cambodians, one fifth of the population, were killed through execution, starvation, torture, beatings, disease and overwork (Chandler, 2008). The

Khmer Rouge can be traced back to the 1960s as the armed wing of the Communist Party of

Kampuchea (Kampuchea was name given to Cambodia by the communists). The regime was characterised with brutality, oppression, control and violence. In 1979, The Khmer Rouge was overthrown by invading Vietnamese troops. Pol Pot was sentenced to house arrest in 1997 and was never charged with genocide. In 2006, the United Nations established a special tribunal to try surviving Khmer Rouge leaders. In November 2018, the tribunal found the three leaders guilty of genocide and two of them guilty of crimes against humanity. The phenomenon of collective trauma was observed when working in the post war recovery and rehabilitation context in Cambodia (Somasundaram et al., 1999). Overnight, the regime abolished the Khmer religion, Khmer art, Khmer familiar relations, and the Khmer social class structure. This significantly undermined deeply-held societal values and practices and contributed to the breakdown of structure and community cohesion. During the Khmer Rouge era, the Cambodian community’s social structures, institutions, family, educational and religious orders were deliberately destroyed (Vickery, 1984). Cambodia did not have the resources to adequately support the mental health needs of the survivors following the mass trauma. Western psychological treatment modalities were introduced in the nineties to manage the impact of trauma (Mollica, Brooks, Tor, Lopez-Cardozo, & Silove, 2014). However, our understanding

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University of Sydney of trauma, its impact and how trauma symptoms are transmitted is limited due to lack of large- scale population-based research on transgenerational effects in post-conflict settings.

Sonis et al. (2009) conducted a national study of 1017 adult Cambodians to explore prevalence of PTSD during the joint United Nations-Cambodian tribunal that was also called The Khmer

Rouge trials. The study found that 11.2% of adult Cambodians living in Cambodia had current probable PTSD and this was significantly associated with mental disability. The study also found that the younger generation who were approximately three years old during the Khmer

Rouge era had a higher prevalence rate of 14.2% of probable PTSD. Those that felt they received justice showed lower levels of probable PTSD. The psychological distress that individuals develop after traumatic events is linked to feelings of reduced control over their personal safety and physical environment. Seeking justice for those who have been wronged allows a society to recognise their suffering. Trauma disrupts an individual’s sense of justice

(Silove, 2013). Pursuing justice is a crucial component of healing for many refugees. Mollica

(2015) has identified justice as the third pillar in his H5 model of refugee trauma to examine the mental and physical health issues attributed to trauma in refugees (discussed further in chapter 5).

In another Cambodian study, Marshall at al. (2005) study looked at symptoms of PTSD within

586 Cambodian refugees aged between thirty five and seventy five who had lived during the

Khmer Rouge era and had migrated to the United States prior to 1993. The study found that

99% (n = 483) experienced near-death due to starvation and 90% (n = 437) had a family member or friend murdered by the Khmer reign. High prevalence of PTSD (62%) as well as

Major Depression Disorder (51%) was also found in this population, with scores high for traumatic exposure and number of traumatic events witnessed. With older participants,

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University of Sydney additional stresses such as poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty also resulted in higher prevalence of PTSD and depression symptoms. It is acknowledged that multiple trauma experiences can result in increased sense of helplessness and hopelessness. It also results in changes to an individual’s system of meaning that leads to a loss of trust and safety in the world (Janoff-Bulman, 1992; Herman,

1997). This, combined with barriers that reduce participation in society, appear to be vulnerabilities associated with increased trauma symptoms that lead to higher prevalence of both PTSD and depression.

Transmission of trauma symptoms from one generation to the next can result in transgenerational traumatisation (discussed further in chapter 5). Burchert, Stammel &

Knaevelsrud (2017) explored the transmission of trauma in Cambodian families, focusing on symptoms of post-traumatic stress and levels of trauma exposure. They interviewed

Cambodian offspring born after the genocidal Khmer Rouge Regime. A randomised cross sectional study interviewed both mothers as well as their eldest child. Traumatic exposure was measured using the Posttraumatic Diagnostic Scale (Foa et al., 1997) and the Harvard Trauma

Questionnaire (Mollica, et al., 1992) and PTSD symptoms were measured using the PTSD checklist civilian version. The mothers surveyed reported a number of traumatic events, including deportation, forced labour and combat situations. The study found possibility of

PTSD diagnosis in 21.7% of the mothers and 8.5% of their offspring. The mothers’ post trauma stress symptoms were positively associated with traumatic exposure in their offspring. The study also found that lifetime traumatic exposure of the mother increased the vulnerability to

PTSD symptoms in daughters specifically. This may be the result of the mother and daughter culturally and traditionally growing up in a close relationship that constitutes increased parental expectations and pressure. Another explanation suggested is that daughters may assume the

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University of Sydney parent role in the mother-child relationship in some cultures more than others. The daughters may experience anxiety symptoms relating to this role reversal (Burchert, Stammel &

Knaevelsrud, 2017).

There is a need to explore the role of culture and its impact in how trauma is experienced at an individual and community level. Reactions to adversity are shaped by culture (Kroll, 2003).

The study discussed above highlights the role of culture in how a trauma event is experienced by acknowledging the cultural differences in the parent-child relationship. However, Burchert et al’s (2017) study fails to utilise culturally appropriate measures. This may be due to the difficulties in establishing the reliability and validity of culturally appropriate measures due to limited research undertaken using these tools. Eisenbruch (1991) argued that Western psychological and psychiatric frameworks may not be appropriate for the Cambodian population who have been diagnosed with PTSD, depression and anxiety. This is as a result of

Western concepts of distress being attributed to the Cambodian population without recognition of the impact of culture on meaning. Eisenbruch proposed that there is a need to further understand how individuals attribute meaning to trauma, how distress is communicated culturally and what strategies enable coping. Similarly, Hinton et al. (2013) found that the questionnaires used to assess psychological health did not adequately capture the way

Cambodians understand and experience distress. The questionnaires were also not culturally sensitive. In response, Hinton and colleagues developed the Cambodian Somatic Symptom and

Syndrome Inventory (CSSI) which included cultural terms and causal explanations of distress such as “wind attack,” “thinking too much,” “sleep paralysis,” and “weak heart”. Those who scored high for PTSD symptoms also scored high on the CSSI. However, the individuals voiced greater concern regarding CSSI descriptions of distress that were culturally and somatically familiar when compared to the Western framework of PTSD symptoms (Hilton et al. 2013).

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Lin and Suyemoto’s study (2016) explored the social phenomenon of intergenerational communication of trauma (IGCT) in the American Cambodian population. IGCT is defined as the ‘communication that is voiced or silent, intended or unintended, in which information about the older generation’s trauma experiences is expressed, received, and interpreted between generations of a family’ (Lin & Suyemoto, 2016 p.401). Here, Lin and Suyemoto acknowledge both silence and disclosure as two mechanisms that can transmit trauma. Disclosure captures the communication of trauma content that is intended from survivor to offspring. Silence captures the unspoken and unintended transfer of trauma content. Current literature suggests that those who are traumatised often maintain their silence and not share their trauma narratives even with their loved ones. Their communication style may be marked by long silences and avoidance of direct account of trauma events. Other studies have found that silence deflected distress and resulted in detrimental behaviours such as scapegoating children and being violent in relationships (Ancharoff et al., 1998). The severity of trauma symptoms experienced by

Khmer Rouge survivors likely disrupted their parenting capacity. The parent, transformed through the experience of trauma, engages in traumatising child-rearing practices that may lead to the distress of their children. A parent who is severely traumatised will find it difficult to be emotionally available to their child, resulting in an insecure style of attachment with their caregiver (discussed further in Chapter 5).

Lin and Suyemoto (2016) suggest that family trauma history may alter cultural rules and influence communication between two or more generations. We understand that trauma can influence and transform cultural norms and practices. Lin and Suyemoto (2016) recruited thirteen participants between the ages of 18 and 25 who were all offspring of survivors of the

Khmer Rouge. The researchers conducted a semi structured interview addressing five areas of exploration: (a) family history and dynamics, (b) experiences growing up in the United States,

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(c) knowledge of and experience learning about the older generation’s refugee history, (d) knowledge of and experience learning about the older generation’s lives in Cambodia, and (e) reactions to the interview process. The study found that the participants identified opportunities for learning, interpersonal connection and emotional reactivity as motivating factors to have meaningful conversations about family trauma. The participants’ motivation also encouraged survivors to share more of their trauma history resulting in increased feelings of interconnectedness between the generations. Research suggests that both practices of silence and over disclosure can be harmful to the offspring. There is evidence that parents’ over disclosure of trauma events may result in the traumatisation of offspring (Baranowsky et al.,

1998; Fossion et al., 2003). This is evident in Kahane-Nissenbaum’s study (2011) of third generation offspring of Holocaust survivors in which a participant recounted the impact of her grandfather’s disclosure of survival narrative on her own mental health. She stated that she had continued to have nightmares of someone coming to take her or her parents away from the ages of eight to twelve. The disclosure of the survival narrative from the grandparent appears to have impacted the safety of the young child’s world. There is also conflicting evidence some disclosure can reduce the prevalence of trauma symptoms in the second generation of offspring

(Fargas-Malet & Dillenburger, 2016) The model of modulated disclosure that is age appropriate is encouraged to minimise traumatisation in offspring. Some participants in this study reported that they had stopped IGCT previously as they were too young to understand or became too emotional when hearing of the trauma narrative. This highlights that age may be an important factor in the emotional capacity of an offspring to be able to process the account of their parents’ trauma. Increased age also allows for a child to create appropriate meaning of the trauma content and not be consumed by helplessness and despair.

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6.1.5 The Rwandan Genocide

I was raped several times by two men who were guarding with the military. I didn’t

know them beforehand and I don’t know where they are now. They told me that I was

also old enough to be raped like the other Tutsi girls who were there. In fact, I was

the youngest of all of them. They told us that our time was up, that we should give in

to their desires. These men hurt me. They were violent.

Solange, Survivor of the Rwandan genocide

Outreach program on the Rwandan Genocide and the United Nations

On the 6th April 1994, a plane carrying Rwandan President Juvenal Habyarimana was shot down. This became the catalyst for the Rwandan genocide. Following this incident, nearly one million Tutsis were killed in Rwanda by the ethnic Hutu militia extremists within a period of about a hundred days. Political opponents, friends, relatives and wives who identified as Tutsis were also slaughtered. The Hutu extremists set up radio stations and newspapers that broadcasted hate propaganda. These messages urged people to weed out the ‘cockroaches’ from the community. The names of those to be killed were printed and handed out as well as read out aloud on radio. Even priests and nuns were complicit in killing people, including those who sought safety and shelter inside churches. The UN estimated that 250,000 ‐ 500,000 women and girls were raped, while countless children witnessed the slaughter of their parents.

Twenty six years after the Rwandan Genocide, studies have looked at PTSD and other trauma symptomology within the Rwandan population who were directly impacted by the Genocide.

In 1994 following the Genocide, de Jong (2000) et al examined the prevalence of mental health concerns among 854 Rwandan and Burundian refugees in three separate refugee camps. The participants were over the age of fourteen. As a result of the refugee camp conditions, the study

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University of Sydney was limited to utilising the 28 item General Health Questionnaire. Two samples were studied, one a random population sample consisting of 854 participants and the other a specific sample of twenty three participants consisting of clients in a psycho-social support program within the refugee camp. The study found that over fifty participants in the random sample showed signs of mental health problems which had started to impact their coping capacity and general functioning. The study also recommended the implementation of psycho-social programs for large refugee populations in order to strengthen community structures. The recommendations also included the need to support large groups in addition to the provision of individual support

(de Jong, 2000).

Direct trauma impact is further explored in Schaal et al.’s (2011) study of trauma exposure and prevalence of mental health disorders in Rwandan widows and orphans who had survived the

Rwandan genocide. Trained local psychologists conducted interviews with the orphan children as well as the widows using three assessment questionnaires. These included the PTSD

Symptom Scale – Interview (PSS-I) to assess posttraumatic stress disorder (PTSD), the

Hopkins Symptom Checklist to assess depression and anxiety symptoms, and the Mini-

International Neuropsychiatric Interview to assess risk of suicidality. The study found that 29% of orphan children living in child headed households met criteria for diagnosis of PTSD.

Furthermore, those interviewed had high exposure to trauma with a mean of eleven types of lifetime traumatic events for both groups (widows and orphans) from a possible total of twenty five.

The impact of direct experiences of trauma is further explored in the Dyregrov et al. (2000) study of 8-19 year old Rwandan children and young people as part of The National Trauma

Survey (NTS). The 1547 children and young people who were surveyed experienced multiple exposures to trauma events. The study’s results showed that over 90% of respondents reported exposure to life threat and witnessed killings, and 35% lost immediate family members. When

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University of Sydney looking at symptomology, 95% of respondents reported one or more re-experiencing symptom and three or more avoidance/blunting symptoms. These children are exhibited trauma symptomology that is consistent with other studies exploring survivor symptoms following the aftermath of a traumatic event that overwhelms one’s emotional capacity.

There have also been a number of research studies with second generation Rwandan children and young adults exploring the impact of witnessing violence (Dyregrov et al., 2000;

Neugebauer et al., 2009; Schaal & Elbert, 2006). Most children witnessed the violence that took place even if they were not the victims of the trauma itself. Schaal and Elbert’s (2006) interviews of sixty eight Rwandan orphans (aged 13-23) showed that many were exposed to high levels of violence and trauma. Nearly all those interviewed (91%) needed to hide in order to survive and most expected to be killed at some point (88%). The study revealed that up to seventy seven percent of these young people had witnessed someone being killed and up to 41

% had witnessed a parent murdered. Within the interviewed sample, 44% met criteria for

PTSD. These findings provide evidence of significant direct trauma events experienced by

Rwandan youth during the genocide. The Rwandan genocide contributed to the direct traumatisation of both parents and their children across two generations.

Witnessing a trauma event is considered a direct experience of trauma. However, indirect experiences of trauma have also been studied in second generation offspring following the

Rwandan genocide. The genocide against the Tutsi community resulted in the rape of thousands of Tutsi women. Sexual violence is said to be a common experience for many women during civil war, armed conflict and military occupation. Bijleveld and colleagues

(2009) estimate that up to 350,000 Rwandan women were raped during the genocide and out of this an estimated 50,000 may have survived. The qualitative study by Kagoyirie & Richters

(2018) involved focus group discussions and semi structured interviews with the offspring of

Rwandan women who were raped, to understand their trauma experiences. This study explored

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University of Sydney the parents’ trauma experiences and the impact of this on their offspring, parent-child communication in the family, the meaning of being born a rape survivor’s child, and the indirect impact on offspring as a result of their mothers’ participation in a Sociotherapy program. Sociotherapy is a group based therapeutic program that has been delivered in Rwanda following the principles of interest in people, equality, democracy, here and now, responsibility, participation and learning by doing. The participants reported growing up in a home where they experienced physical and emotional abuse from their mothers. When a woman was raped, her offspring became the symbol of her rapist. This likely contributed to a mother’s emotional and physical abuse of her child. The offspring identified being a witness to their mother’s trauma symptoms such as howling, screaming and nightmares. As a result of witnessing these symptoms, some learnt about their mother’s rape for the first time. The mothers were likely suffering their own symptoms of trauma and struggling to hide this pain from their children. Those who were born out of rape faced particularly difficult challenges.

This included increased verbal abuse and avoidance behaviour by their mothers. In response, the children also withdrew from their mothers.

Other participants reported that they felt a sense of helplessness as they did not know how to help their struggling mothers. Role reversal was also experienced as participants comforted their distressed mothers, taking on the role of a caregiver in the relationship. This shows that offspring were exposed to their mother’s trauma symptoms growing up in the same household.

When exposed to the mother’s trauma symptoms as well as knowledge of the trauma event, the participants felt helpless and overwhelmed. Several participants identified being given the same name as a deceased relative, often becoming a symbol or memory representation of a loved one to their family. The memory of a past trauma appears to be unintentionally passed down to the future generation through practices of maintaining their legacy.

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The participants reported silence, intimidation, and fragmented narratives when asking their mothers about the Rwandan genocide and how this had impacted their family. Children born out of rape asked about the whereabouts of their fathers. When asked these questions, the offspring reported changes in their mothers’ mood as well as silence. The lack of information resulted in the offspring feeling angry, confused, and sad. The children born out of rape, when hearing more about their fathers, distanced themselves from them and over-identified with their mothers. Other participants asked about their family members who had died. Those who were able to find further information reported both positive and negative feelings. Some reported feeling relieved and others reported feeling troubled. Those who felt troubled identified feelings of hate towards perpetrators; they also reported symptoms of headaches, stomach aches, loss of concentration, and sadness. Those who heard their mother’s ‘full story’ stated that they were finally able to see that their mother was not immoral or wicked. Hearing the full story appears to have allowed the offspring to create a new meaning of the traumatic event and replace the perspective of his or her mother as immoral and wicked to someone who was vulnerable and needing empathy. After the mothers’ participation in the Sociotherapy program, the participants identified that their mothers’ interaction with them had changed to one of hope, joy and improved communication. Mothers’ changes resulted in the participants feeling increased self-confidence and resilience, both factors transmitted from the mother.

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6.1.6 Srebrenica Genocide

Thousands of men executed and buried in mass graves, hundreds of men buried alive,

men and women mutilated and slaughtered, children killed before their mothers' eyes,

a grandfather forced to eat the liver of his own grandson. These are truly scenes from

hell, written on the darkest pages of human history.

International Criminal Tribunal judge Fouad Riad’s statement after confirming the

Srebrenica indictment of Bosnian military commander Ratko Mladic and Bosnian

Serb wartime leader Radovan Karadzic, 16 November 1995.

Srebrenica is a town in Eastern Bosnia Herzegovina. It has traditionally been home to Bosnian

Muslims. Beginning in 1992, the Serb forces were tasked with seizing control of a block of territory in Eastern Bosnia and Herzegovina to annex it to the Republic of Serbia. The war raged between 1992 and 1995 and non-Serbs were attacked in their homes and villages across the country. By 1993, Srebrenica housed up to 40,000 Muslim refugees. The United Nations declared the nearby town of Potocari as a safe zone, allowing it to be protected by international peacekeepers (Honig, 1997). However, the Serb military attacked the town that was assigned as a safe space. The Srebrenica Genocide was the mass murder of more than 7000 Bosnian

Muslim boys and men by the Bosnian Serb forces in Srebrenica in July 1995. This was considered as Europe’s worst atrocity since World War 2.

Goldstein & Wampler (1997) suggest that over 1.3 million civilians were displaced within the country and 800,000 became refugees having fled the country. There are estimates that up to

200,000 civilians were killed during the war. The expulsion of Bosniak civilians from the area was considered as ethnic cleansing. The International Criminal Tribunal for the former

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Yugoslavia found that the massacre at Srebrenica, along with the expulsion of Bosniak civilians, amounted to crimes of genocide. The United Nations also took partial responsibility for the crimes due to the inability of the peacekeepers to provide protection for those who fled.

The Bosnian Serb military leader Ratko Mladic was captured in 2011 and extradited to The

Hague to face trial. In November 2017, he was found guilty on charges of genocide, war crimes and crimes against humanity. The Bosnian War uprooted up to 2 million people (Mollica et al. 1999). It resulted in mass atrocities of murder, rape and torture. Survivors of the genocide, along with their children and grandchildren, continue to live in refugee camps today that were once considered a temporary solution. Many families continue to report feeling abandoned

(Tondo, 2020).

The Genocide of Srebrenica resulted in a community struggling to comprehend loss, persecution and displacement. Australia is home to Bosnian refugees who migrated following the Genocide. Momartin et al. (2004) explored the prevalence of comorbidity of PTSD and depression in Muslim Bosnian refugees resettled in Australia. The study sampled one hundred and twenty six Bosnian Muslims using the Clinician Administered PTSD Scale (CAPS) and

Structured Clinical Interview (SCID) for DSM-IV. Results showed that although the participants had experienced a stressor five years prior, they still exhibited symptoms of both

PTSD and depression. Fifty participants were diagnosed with comorbid depression and PTSD and twenty nine participants with diagnosis of PTSD only (Momartin, et al. 2004). The traumatic antecedent threat to life was found to be a sole predictor for PTSD. The study found no gender difference in rates of PTSD or depression. Mollica et al. (1999) found similar results in their study of 534 Bosnian refugees a year after the Genocide in 1996. Their findings were that 20% of participants met symptoms for PTSD diagnosis and 46% met symptoms for both depression and PTSD. Momartin et al. (2004) argued that the similar findings across both

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University of Sydney studies with a five year gap in between suggest that the impact of PTSD may persist over prolonged periods of time.

Literature has explored the trauma impact of the Srebrenica Genocide on Bosnian children following resettlement. Goldstein and Wampler (1997) study found that two thirds of Bosnian children reported that a significant person in their life was killed by the war. Similar youth trauma was also reported in the Weine et al. (1995) clinical interviews with twelve Bosnian adolescents within the first year of resettlement in the United States of America. The PTSD

Symptom Scale (Foa et al., 1993), as well as the Communal Traumatic Experiences Inventory

(CTEI) questionnaire, were used to assess trauma experiences. The CTEI is a 36-item clinician administered questionnaire that was developed for the purpose of this study to capture the traumatic events experienced by survivors of communal trauma. The adolescents reported intense memories of their past trauma experiences including destruction of property, violence, disappearance of family members, lack of food and shelter, and detainment in camps.

Furthermore, 25% of the adolescents displayed symptoms consistent with PTSD criteria and

17% displayed depression symptoms that justified a diagnosis of depression. The study found that these adolescents often took over the parenting role within their families due to parental trauma and reduced language capacity of the parents. The adolescents also acknowledged traumatisation due to parents’ recounting of their direct experiences of the massacre (Weine et al., 1995). In this example, the children had both direct and indirect experiences of trauma. The children reported direct trauma experiences of losing a significant person in their lives. They were likely to have experienced persecution, violence and displacement on their migration journey. However, they also provided evidence of transgenerational traumatisation as a result of being exposed to the recounting of trauma narratives through their parents.

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The transmission of trauma narratives was further explored by Jordanova (2012) in interviews with thirty war survivor families from Bosnia Herzegovina. The parents had experienced direct war trauma such as torture, rape, forced displacement, imprisonment and mock executions. The children were born after the war and as such were not exposed to direct trauma experiences.

The study found that children learnt about parents’ trauma experiences through disclosures from parents as well as from what they observed on television, newspapers, film and their peer groups. In this particular example, the children can be argued as only experiencing indirect trauma as a result of being born years after the massacre. The findings are similar to the

Holocaust study where trauma symptoms were reported by the third generation of survivor offspring who were born after the genocide (Kellerman, 2001b). Through the parents’ recounting, the children were indirectly exposed to the direct traumatic experiences of the parents. Contrastingly, some parents’ reluctance to share narratives also had a negative impact on the children’s mental health. Parents’ reluctance to share narratives led to children observing concerning behaviours of parents, such as anxiety filled silences, and matching this to a created narrative in their imagination. Here, there are two possible factors that may be facilitating the transfer of trauma. One is the parent’s behaviour as a result of their own trauma experiences that results in feelings of anxiety for the parents. Anxiety symptoms can reduce a parent’s capacity to be present in the moment and be emotionally available to the child. This anxious behaviour is observed by the children and they attempt to make sense of it by filling in the gaps of their imagined narrative. Secondly, it also highlights the role of silence in contributing to feelings of confusion and being overwhelmed for the child. This study identifies two potential mechanisms of trauma transfer.

The study further supported a gender difference in how narratives were shared across generations with fathers having more fragmented and violent narratives, often linked to their

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University of Sydney active roles in the war. Men shared the narrative through jokes about the war. Jokes may be argued as a more acceptable way to share a difficult topic with a younger generation. This form of sharing may also alleviate psychological distress for the individual. The women on the other hand found it easier to talk about the war as they had clear roles of looking after the home, their children and the elderly. The study found that a mother’s narrative was transmitted to the next generation as she felt more comfortable in sharing this with her child (Jordanova, 2012). There are many ways in which trauma narratives may be passed from one generation to another. A variety of trauma transfer mechanisms may be identified within the one family. These gender differences are also important to acknowledge in collectivist cultures where stories are shared predominantly through mothers and grandmothers who may be identified as culture and tradition custodians in keeping with tradition.

6.1.7 Australian Aboriginal Community: Historical and Collective Trauma

As the car disappeared down the road, old Granny Frinda lay crumpled on the red

dirt calling for her granddaughters and cursing the people responsible for their

abduction. In their grief the women asked why their children should be taken from

them. Their anguished cries echoed across the flats, carried by the wind. But no one

listened to them, no one heard them.

Doris Pilkington, Rabbit-Proof Fence: The True Story of One

of the Greatest Escapes of All Time

The Australian Aboriginal community has called Australia their home for approximately

60,000 years. The Torres Strait Islander community has been in Australia for at least 2500 years. To these communities, their land is central to their identity (Atkinson, 2002).

Historically, both Aboriginal and Torres Strait Islander community, have been subjected to

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University of Sydney government policies that have displaced them from their traditional lands, culture and community (Westerman & Wettinger 1997). The Bringing Them Home report (Human Rights and Equal Opportunity Commission, 1997) found that between 1910 and 1970, between one in three and one in ten Indigenous children were forcibly removed from their families and communities by churches, governments and welfare agencies. The children were forcibly assimilated and fostered into white families. These children became known as the Stolen

Generation. The process that resulted in the Stolen Generation destroyed the cultural, spiritual and familial ties of communities. Children of the Stolen Generation suffered sexual, physical and psychological abuse and neglect in institutions in addition to the trauma of being removed from their families (Atkinson, 2002). For Aboriginal and Torres Strait Islander communities, colonisation was not a single trauma event. The communities continue to suffer the ongoing impact of colonisation and invasion as well as continuous trauma in the form of discrimination, racism, disadvantage, violence, over representation in the justice system and deaths in custody.

Erikson (1976) defined collective trauma as ‘‘a blow to the tissues of social life that damages the bonds linking people together ... realisation that the community no longer exists as a source of nurturance and that part of the self has disappeared (p. 302). He identified the need to explore collective trauma events in fragmented and disconnected communities as individuals rely on these communities for their own healing and recovery. Addressing collective trauma can also lead to collective healing within communities (Atkinson, 2002) and healing the community can often lead to individual healing (Silove, 2005). Atkinson argues that an adult who does not feel safe in the world, cannot pass feelings of safety to the child. Safe places need to be established for healing to occur.

Although there may be similarities in symptoms experienced by Aboriginal and Torres Strait

Islander Australians as well as migrants and refugees following trauma, it is important to acknowledge that Indigenous trauma experiences vary significantly to the war and persecution

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University of Sydney experiences. The Aboriginal and Torres Strait Islander communities have experienced nearly two centuries of systematic racism and discrimination. They also suffered due to the introduction of diseases, forced removal from their traditional lands, destruction of their culture, and forced separation from their families and communities over generations. The

Indigenous community continues to experience racism, social marginalisation, and social disadvantage.

The trauma experiences of the Aboriginal community have been captured in studies in the past two decades. The Western Australian Aboriginal Child Health Survey (Zubrick et al., 2006) identified that poor mental health of carers, economic deprivation, poor family functioning relating to communication and parenting challenges, and exposure to racism and discrimination, increased the risk of children experiencing distress. Professor Milroy (2018), an Indigenous psychiatrist specialising in child and adolescent psychiatry, explained the impact of transgenerational trauma as:

The transgenerational effects of trauma occur via a variety of mechanisms including

the impact of attachment relationships with care givers; the impact on parenting and

family functioning; the association with parental physical and mental illness;

disconnection and alienation from the extended family, culture and society. These

effects are exacerbated by exposure to continuing high levels of stress and trauma

including multiple bereavements and other losses, the process of vicarious

traumatisation where children witness the on-going effects of the original trauma which

a parent or care giver has experienced. Even where children are protected from the

traumatic stories of their ancestors, the effects of past traumas still impact on children

in the form of ill health, family dysfunction, community violence, psychological

morbidity and early mortality. (p. 11)

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Historical trauma refers to collective trauma experiences (trauma wounds) of a group of people who share an identity and culture with symptoms that span multiple generations. Atkinson

(2002) linked historical events such as massacres, removal of people in reserves and the process of colonisation to increases in family violence and child sexual abuse. The introduction of historical trauma helped to understand the experiences of Holocaust survivor children and the secondary impact of trauma, and researchers have described historical trauma as transgenerational (Kellermann, 2001b). Nadew’s study (2012) explored the prevalence of depression, PTSD, and alcohol and drug abuse within the Aboriginal community living in

Western Australia. Participants reported a rate of 97.3% for lifetime exposure to traumatic events. A total of 55.2% (n=122) participants also met the criteria for PTSD in DSM-IV.

Nadew’s study identified PTSD as an important public concern as more than half of the participants, who were not seeking treatment, met the criteria for PTSD. There is a need to better understand the impact of historical events on communities to recognise the psychological impact of lost history. The historical trauma experienced by the Indigenous population over generations is significantly more prolonged than what other communities faced in their experiences of persecution. Establishing safety is made more difficult when a community has not felt safe for multiple generations in their traditional lands. However, the process of being uprooted, the experiences of racism, the denial of identity, culture and religion as well as the forced separation from family can resonate with multiple communities’ experiences of persecution.

Trauma can be transmitted from the first generation of survivors to their descendants (Atkinson et al., 2010). Atkinson (2002) has highlighted the value of understanding trauma within a colonised population using both a historical and sociological approach. Duran and Duran

(1995) stated that historical trauma can become normalised within a culture because it becomes rooted in the collective and cultural memory of a people and a community. In particular, the

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University of Sydney collective memory of historical trauma that is constructed socially and culturally may be passed on through trauma narratives shared by each generation with each other. Trauma narratives are an interplay of stories and culture (Kienzler, 2008). The stories can be shared both in the private space and in the public space as public narratives. Stories are shaped by narrative elements such as characters, actions, places, and time (Wertsch, 2008). Cultural continuity may be a motivating factor when public narratives of post traumatic growth, resilience and survival after mass trauma are shared. Public narratives around trauma, struggles and survival can be found around the world and these trauma narratives may include how a community struggles through war or how a family survived through a shelling (Young, 2004). Refugees and migrants also pro-actively engage in cultural continuity to preserve their identity in their newfound places of safety. They prioritise their children learning their language, traditions, and cultural rituals. It is a common experience for refugees to experience cultural bereavement, a reaction of grief to the loss of culture. Eisenbruch (1991), an Australian psychiatrist and medical anthropologist, coined the term of cultural bereavement as:

The experience of the uprooted person - or group - resulting from loss of social

structures, cultural values and self-identity: the person - or group - continues to live in

the past, is visited by supernatural forces from the past while asleep or awake, suffers

feelings of guilt over abandoning culture and homeland, feels pain if memories of the

past begin to fade, but finds constant images of the past (including traumatic images)

intruding into daily life, yearns to complete obligations to the dead, and feels stricken

by anxieties, morbid thoughts, and anger that mar the ability to get on with daily life".

This description can be used to describe both an Indigenous Australian and a refugee’s

grieving process. (p.674).

Stories of adversity and resilience are commonly shared to identify resilience in a community and to encourage participation by its members. An example is the positive nature of a group

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2009). Wexler et al. (2009) also argued that stories when told, received, interpreted and re-told, the trauma narratives are shaped and conveyed through multiple generations. Trauma impacts the stories families tell each other. Trauma shared amongst family members includes not just the trauma events but also the emotional state of the storyteller, this may include the anger placed with the aggressor and the guilt placed within self. These emotional states may also be transmitted along with the story with children too feeling anger towards the aggressor. Trauma may become the dominant narrative that connects the family together and dictates how they perceive the world and each other. These stories can also restrict the family from seeing the possibilities of their future (Dallos, 2004).

Survival stories are shared in refugee families for the purpose of maintaining cultural identity.

Refugee communities have often experienced the oppression of their culture in their homeland.

This is often carried out in a systemic manner by government bodies with the help of the military and police. Through the narratives shared, parents pass on details of persecution experiences so that children are aware of their roots, where they were born and why they had to leave. Sharing stories also reduces the chance that their cultural heritage will be assimilated into the host country’s dominant cultural group. The re-telling of survival and war narratives likely facilitates the trauma transfer from one generation to another. The intentions of disclosure may differ in individuals: to safeguard their children, to pass on cultural knowledge, and to highlight their historical roots. However, through the re-telling process children become aware of their parents’ trauma history. The two key elements for potential trauma transmission appear to be too much and too little re-telling.

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6.1.8 Sri Lankan Tamils: Persecution, Discrimination and the Civil War

The two young girls, crying hysterically in a fragile bunker of sandbags in the

immediate aftermath of a shelling. They want to rush from their shelter to help the

injured, but a woman is holding them back – because one shell is almost inevitably

followed by another. The girls are weeping as they look at the carnage in front of

them. And then, in a chilling moment, one of them recognises someone, and her

hysterical cries turn to anguished screams: "Amma!"

No Fire Zone documentary, Channel 4.

Sri Lanka’s civil war is one of the leading causes for the increase mental health concerns in Sri

Lanka. The war experienced by multiple generations of Sri Lankans has uprooted families, communities and social institutions. Although there are a significant number of individuals with mental health concerns within the Sri Lankan population, the stigma relating to being mentally unwell is still very current. The term ‘mental’ locally implies what locals consider as

‘crazy’. The beginnings of Sri Lanka’s civil war and the socio-political history of the country have been discussed in Chapter four. Somasundaram (1998) identifies a central factor in any ethnic conflict to be group identity. He further describes that the claim of Sinhala Buddihist identity by the majority led to the reaction to save the Tamil identity. War trauma is complex and there are individual differences in how trauma impacts upon their day to day lives. War survivors experience the loss of status, family, home, community, work, and money (Weine et al., 1995). Continuous war also disrupts healing and a return to normalcy (Somasundaram,

1998). Tamil refugees may face further trauma as they navigate their journey through asylum process following the loss of home. Although Sri Lanka’s 30 year civil war has ended, the long term effects of trauma and trauma symptoms need to be explored in order to better support a migrant population in a newly settled country.

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It is common for traumatic events to be associated with severe negative consequences for those who were directly exposed to them as well as family members who were not directly exposed to the event (Figley, 1995). Many Sri Lankan families who now call Australia home lived through a number of traumatic experiences. This includes the loss of family and friends, loss of livelihood, incarceration, interrogation, torture and daily threats to one’s life. A significant number of these individuals witnessed direct trauma in the form of shelling and bombings whilst escaping the civil war. Events that are a result of fellow humans, such as wars, rapes, and assaults yield a higher percentage of PTSD victims when compared to natural disasters.

This may be explained through the acceptance that they could not have prevented natural disasters, yet when they are traumatised at the hands of a fellow human being, it is more a personal attack on the individual (Solomon, 1995).

Direct exposure as well as proximity to extreme events can lead to post traumatic stress.

Somasundaram (1996) administered the Stress Impact Questionnaire to 43 participants who had just witnessed and escaped an aerial bombing in North East of Sri Lanka. The participants were part of the 101 individuals seeking safety in a local school when bombings began. The study found that immediately after the bombings, the participants were dazed and experienced shock. This acute stress reaction consisted of anxiety, aimless wandering, confused behaviour, anger, hyperactivity, depression, and withdrawal. Out of this study sample, 63% were diagnosed with PTSD as per ICD 10 diagnostic guidelines, and 44% met the stricter DSM criteria. Somasundaram (1996) identified changes in religious beliefs, interpersonal relationship problems and social withdrawal in participants. These changes may be evidence of the shattering of an individual’s assumptive world following a traumatic event. Here, the participant describes reactions that fit into the thinking pattern of: the world is unsafe and

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In their study of Tamil refugees and asylum seekers, Steel et al. (1999) found that trauma experiences were multiple, involving at least three dimensions of trauma, namely detention and abuse, traumatic loss of loved ones, and exposure to general conditions of war. Those suspected of being linked to Liberation Tigers of Tamil Eelam spent a number of years hiding in order to protect not only themselves but also their families. The families of those affected may also experience physical and psychological health concerns. The study found that Tamil women took on greater responsibility due to the breakdown of society during the war. As a result, the women were more vulnerable to stress (Steel et al., 1999). Figley (1983) stated that being a member of a family who is traumatised makes other members emotionally vulnerable due to the emotional connection to the victimized family member. This can be due to the empathy one feels for the family member who is important to them. The other reason is that the family member may be exposed to the victim’s distress over a prolonged period of time and this can become a chronic stressor resulting in mental health detriments for the family members.

At times of distress, Tamils have often relied on their religious roots for support. Patricia

Lawrence’s ethnographic account of the experiences of Batticalo Tamils is captured through her field work. Lawrence (1997) describes the Eastern Tamils’ experiences of violence and the subsequent shift towards the community’s religious spaces. She describes the local Amman

(divine mother) temples as symbols of both strength and protection. Tamils have traditionally prayed to the goddess Amman to bless them with prosperity, good health, and plentiful harvest.

However in times of violence and civil unrest, these prayers have been transformed into pleas to return missing family members and to protect the local community from harm (Lawrence,

1997). Somasundaram (2014) also encourages culturally mediated rituals and ceremonies. He

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Studies exploring trauma symptoms in the second generation of Sri Lankan Tamils are limited.

The second generation of Sri Lankan Tamils may have experienced traumatic grief having grown up in families and communities who have experienced the civil war trauma.

Somasundaram (2014) also argues that there has been a concerted effort to suppress the collective memory and change the collective narrative of what had happened during the war years. He states that the Tamil community needs acknowledgement of their suffering and losses in order to move forward with their lives. This can be through the retelling of stories that heals collective trauma and creates collective catharsis (Somasundaram, 2014). In Wijeyasuriyar’s

(2018) study, exploring trauma transmission in second generation Canadian Tamils, found that family members wanted to remain strong and protect each other and as a result allowed for feelings of sadness only when alone. The youth stated that they wished their parents communicated more in regard to how they felt, where they had come from, why their left and why they cannot return. When the first generation of parents who were survivors were interviewed, they disclosed that they detached from their ethnic identities for fear of being seen supporting the LTTE as they were labelled a terrorist organisation in the West. The parents also believed that if their children became too involved after knowing their stories, it might disadvantage their future opportunities in Canada or stigmatise them. Both survivors and offspring appear to act protectively with each other to not disturb each other. However, through the conspiracy of silence (Somasundaram, 2007) the second generation of Tamils felt that they were robbed of understanding their parents’ story of where they came from, what they lost and how they survived.

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6.2 Summary

Armed conflicts, civil wars and genocides result in mass trauma, persecution, discrimination and displacement of families and communities around the world. The most significant cost of war is the mental health of civilians. War disrupts the development of the social and economic fabric of communities and nations. Our understanding of war trauma began with American civil war veterans. Over the years, human suffering as a result of war and genocide has led to greater understanding of humans’ psychological reactions to trauma. The direct correlation between the severity of trauma and the extent of the psychological problems is consistent across a number of war trauma studies. Although we now have a robust understanding of trauma and how severe trauma events can result in PTSD, there continues to be scarce data available to more thoroughly understand how trauma is passed on from one generation to another and what mechanisms support this process to occur. We understand through current limited literature that trauma transfer mechanisms include silence, over disclosure, identification, and re- enactment. Through examining the Shattered Assumption Theory, Attachment Theory and

Family Systems and Communication Theory, we also understand that parenting practices can contribute to trauma narratives and trauma symptoms being passed onto the offspring.

A greater understanding of trauma transmission in the context of different cultures is also needed to better support migrant and refugee communities. These communities may lack access to mental health support and face increased stigma due to their mental health struggles. As a result, many may continue to suffer in silence. There is very little known about the transgenerational transmission of trauma experiences in the Sri Lankan Tamil community following the civil war. The review of trauma transmission mechanisms in chapter 5, and the review of previous atrocities in this chapter, provide evidence that transgenerational transmission of trauma is likely to occur. The manner, in which transgenerational trauma

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Chapter 7

Aims and Objectives

7.1 Overview

Although there have been increased numbers of migrants and refugees worldwide in recent years, insufficient attention has been paid to addressing their mental health needs. Migrants and refugees are often a forgotten population in health policies and strategies (Matlin et al.,

2018). In particular, refugees experience trauma events that are profound, long-lasting, and shattering to both their inner and outer selves (Steel et al., 2006). The traumatic events experienced in their country of origin, the long and hazardous journey to reach safety, and the complexities of resettlement increase the risk of mental health issues for asylum seekers and refugees (discussed in Chapter 1 and Chapter 3). The objective of this study is to explore the trauma experiences of the Tamil community living in Sydney, New South Wales, Australia

(discussed in Chapter 2). This study investigates the trauma experiences of the first and second generation of Sri Lankan Tamils who have been directly or indirectly impacted by Sri Lanka’s thirty-year civil war. The study hopes to explore the first generation Tamils’ experiences of trauma events and whether they meet the probable PTSD score of 14 or above. The study particularly seeks to answer whether trauma experienced by the survivors may be passed on to another generation in the form of PTSD symptoms.

7.2 Guiding Concepts

Trauma theories have provided a basis for understanding how traumatic events impact an individual’s psychological health. Judith Herman (1997, p.33) states that ‘traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life’ (discussed in Chapter 5). The complexity of trauma symptoms has

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The Holocaust, The Vietnam War, The Cambodian Genocide, The Rwandan Genocide, The

Srebrenica Genocide, Australian Aboriginal community’s experiences of historical and collective trauma, and Sri Lanka’s 30 year civil war and Tamils’ persecution experiences

(discussed in Chapter 6).

Sri Lankan Tamils have experienced years of discrimination, persecution, and the violence of the thirty-year civil war (discussed in Chapter 4). PTSD symptoms were common amongst Sri

Lankans affected by the civil war (Somasundaram and Jamunantha, 2002; Somasundaram,

2007). Sri Lanka is a country that has struggled to provide adequate mental health support to those affected. In 2012, the suicide rates in Sri Lanka were 17.1 per 100,000 citizens, making

Sri Lanka the country with the 22nd highest suicide rate in the world (Knipe, Metcalfe, &

Gunnell, 2015). It is estimated that between 5-10% of Sri Lankans may be suffering from mental health challenges requiring psychological support (Castillo, 2009). The impact of trauma on the mental health of Tamils has been explored in limited studies both in Sri Lanka and abroad.

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Sri Lankan Tamils have migrated to Australia over the years, some have migrated on skilled visa programs and others have reached Australian shores as asylum seekers (discussed in

Chapter 3). Their experiences of traumatic events may differ depending on when they fled Sri

Lanka, the trauma events they were exposed in Sri Lanka and during their journey as well as the level of social support that was available. The first and second generation Sri Lankan Tamils likely experienced the traumatic events differently. The first generation of Tamils likely experienced their traumatic events directly as a result of living in Sri Lankan for at least 18 years and having greater exposure to war and persecution. The second generation of Tamils likely experienced their traumatic events indirectly through their parents’ experiences of persecution and war. The participants in generation 2 may have spent limited time living in Sri

Lanka or were born in Australia. As a result, they were less exposed to the direct experiences of trauma events. There may be evidence of both direct and indirect traumatic experiences reported by some Sri Lankan Tamil participants in this study.

7.3 Current Gaps

PTSD has been identified as the most common psychological response to trauma. Over the years, PTSD symptoms have been labelled as hysteria, war neurosis, railway spine, and shell shock. Our understanding of PTSD symptoms has expanded since the Vietnam War. In Sri

Lanka, PTSD became a familiar term as a response to supporting survivors of the civil war.

Although war trauma and PTSD have been studied widely in both veterans and civilians, the study of trauma transmission from survivor to offspring, which has been referred to as secondary traumatisation in some literature, is a more recent line of inquiry (Samper, Taft,

King, & King, 2004).

Transgenerational trauma is described as the transfer of trauma symptoms from one generation to another. Research began in this field following the Holocaust with first generation survivors

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University of Sydney and second generation offspring. Studies have found evidence of trauma narratives and trauma symptoms being transmitted from survivor parents to their offspring following the Holocaust, the Vietnam War as well as the Rwandan Genocide. Although this phenomenon has been studied for many years, there is limited studies to understand how much trauma is passed onto the offspring and if particular trauma events are likely to have a greater impact on another generation. A review of the literature suggests that current studies on the transgenerational transmission of trauma are not conclusive (discussed in Chapter 5). However, three theories have been reviewed to explore the impact of trauma experiences on survivors and their parenting approaches. Shattered Assumptions Theory, Attachment Theory, and Family

Systems and Communication Theory provide a greater understanding of survivor’s trauma narratives and symptoms that may play a role in impairing their parenting capacity and parenting practices. This study hopes to explore if there is evidence of PTSD symptoms in the second generation of Tamils living in Sydney. The open ended questions contained within the study questionnaire may offer further insight into the factors that may contribute to the transmission of trauma in the second generation participants.

Although war trauma and PTSD literature have increased with recent world events resulting in increased asylum seeker movements across borders and applying for refugee status, fewer studies currently exist that examines how much trauma may be passed from one generation to another, from survivors to their offspring. Evans-Campbell (2008) has criticised the current

PTSD criteria as it does not allow for transgenerational trauma to be captured. The original

PTSD Symptom Scale Self-Report (PSS-SR) questionnaire included two tick boxes of yes and no to identify self-experiences of traumatic events. Research has captured the impact of self- experiences of trauma on an individual’s psychological health. The amended PSS-SR questionnaire utilised in the current study included additional tick boxes to explore a possible relationship between symptomology and family experiences of trauma. The additional tick

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University of Sydney boxes of self and household allowed for individual as well as the family’s experiences of trauma events to be captured in the data. Additionally, there is also a gap in our current understanding of how trauma manifests in the offspring of survivors in a relatively safe environment. As this study recruited participants from the Australian community in Sydney, the physical environment would be considered safer than the post-war environment of Sri Lanka. However, trauma literature suggests that physical safety is only one factor that supports healing. There is a need to establish emotional and psychological safety in the post-war environments.

Furthermore, the meaning attributed by survivors to their trauma experiences as well as the likelihood of survivors sharing narratives with their offspring may explain some aspects of symptomology even after physical safety has been established. Over the years, trauma researchers have advanced their understanding of single-episode present-life trauma. However, significantly less is known about the impact of transgenerational trauma. The current study hopes to expand on the current understanding of transgenerational trauma and the factors that may be facilitating the transfer of trauma from one generation to another.

The Sri Lankan civil war led to the displacement of thousands of Tamils. However, their experiences of marginalisation and discrimination preceded the civil war (discussed in chapter

4). The Tamils sought refuge in countries such as the UK, the USA, Canada, and neighbouring countries such as Malaysia and India. Today, many Tamils call Australia home after arriving through skilled migration pathways. In the last decade, Tamils have also reached Australian shores as asylum seekers arriving by boat (discussed in chapter 3). To thoroughly understand the impact of traumatic events on the Sri Lankan Tamil community in Australia, there is a need to examine their experiences before their asylum journey.

The current study hopes to improve the theoretical understanding of trauma, Post-Traumatic

Stress Disorder, and transgenerational trauma within the Sri Lankan community. There are limited Australian studies on the Sri Lankan Tamil migrant and refugee population although a

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University of Sydney large Sri Lankan Tamil Diaspora resides in Australia. This study will also provide greater insight into the mental health needs of the Sri Lankan Tamil community. Although the civil war ended in 2009, the experiences of torture and trauma are not just specific to the masses that are claiming asylum today. Those who migrated to Australia in the 1980s and 1990s may also have been exposed to traumatic events. Currently, there is limited research exploring the impact of trauma across generations. Greater awareness of the impact of intergenerational consequences of trauma can lead to early recognition and improved diagnosis and response from the mental health sector.

Finally, the interchangeable nature of trauma terms in trauma research has been identified as contributing to a gap in our understanding. The current study acknowledges that the terms secondary traumatisation, vicarious traumatisation, generational traumatisation, and transgenerational traumatisation has been used interchangeably in literature. For the purpose of this study, transgenerational trauma is defined as the transmission of trauma symptoms from survivor to offspring. The survivor, who has experienced a direct trauma event, transmits the trauma symptoms to the offspring. This process of transmission is facilitated through a number of mechanisms. These include parenting styles of the survivors, the exchanges of trauma narratives across generations, and the offspring’s experience of living with parents who may be traumatised.

7.4 Summary

A review of the current empirical and theoretical literature identifies two major gaps that this study hopes to contribute to:

1. Although there is significant literature exploring the impact of war trauma on survivors,

less is known about the subsequent generations and how they may be impacted.

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2. There are limited studies exploring the mental health needs of the Sri Lankan Tamil

community in Australia.

7.5 Research Questions: An Overview

Please find below a brief overview of the current study’s research questions. The research questions are further detailed in the next chapter.

1. What level of exposure to trauma has the first generation of Tamils experienced?

2. Is there evidence that the first generation Tamils’ experiences of trauma events are

associated with psychological distress?

3. What level of exposure to trauma has the second generation of Tamils experienced?

4. Is there evidence that the second generation Tamils’ experiences of trauma events are

associated with psychological distress?

5. Are there additional trauma events reported by generation 1 or generation 2

participants?

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Chapter 8

Methodology

8.1 Overview

The current study explores the trauma experiences of two generations of Tamils living in

Sydney, Australia. This chapter provides a detailed account of the research questions, research design, sampling and data collection procedures, and methods of data analysis used to undertake this study. Having resided in Sydney for the past twenty-four years and identifying as a migrant Tamil, my family and I have built a strong community network around us. This was mostly due to living within a close-knit Sri Lankan Tamil community once we moved to

Sydney in the mid-nineties at the height of Sri Lanka’s civil war. The small but resourceful Sri

Lankan Tamil community rallied around each other as it attempted to establish a sense of safety and normalcy in a relatively new home.

At the time of data collection, I worked at the NSW Service for the Rehabilitation and

Treatment of Torture and Trauma Survivors (STARTTS). In my role, I provided psychological support for individuals and families who had survived the civil war, systematic discrimination, and oppression in their home country. I particularly worked with Tamil asylum seekers and forged a strong community network. This enabled me to understand the experiences of refugee trauma further as well as learn greater cultural sensitivity although I too identified from the same community. Previous to this role, I had worked intermittently as a Tamil interpreter in detention centres on Christmas Island, Port Augusta (South Australia), Leonora (Western

Australia), and Villawood (Sydney) between 2009 and 2012. This enabled me to see and hear first-hand accounts of persecution, discrimination as well as the violence of the Sri Lankan civil war and why many Tamils were scared to return home.

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8.2 Research Questions

8.2.1 Research Question 1

What level of exposure to trauma has the first generation of Tamils experienced?

a) What type of trauma events have they experienced?

b) Are these experiences direct, indirect or combined?

c) What are the most common trauma events experienced by participants in

generation 1 either directly, indirectly or combined?

d) Is there evidence of secondary trauma experiences in generation 1 participants?

8.2.2 Research Question 2

Is there evidence that the first generation Tamils’ experiences of trauma events are associated with psychological distress?

8.2.2.1 Probable PTSD

a) Is there evidence that the first generation participants’ trauma symptoms meet

the threshold for probable PTSD?

8.2.2.2 Self and Household Only Experiences of Trauma Type

b) Is there evidence that the self experiences of trauma events are associated with

a higher PTSD score?

c) Is there evidence that self experiences of trauma events are associated with a

specific PTSD subscale?

d) Is there evidence that household only experiences of trauma events are

associated with a higher PTSD score?

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e) Is there evidence that household only experiences of trauma events are

associated with a specific PTSD subscale?

8.2.2.3 Severity of Trauma Type

f) Is the experience of severe types of trauma, defined as the experience of torture

and sexual assault, associated with a higher PTSD score?

i. Is the self experience of torture and sexual assault associated with a

higher PTSD score?

ii. Is the self experience of torture and sexual assault associated with a

specific PTSD subscale?

iii. Is the household only experience of torture and sexual assault associated

with a higher PTSD score?

iv. Is the household experience of torture and sexual assault associated

with a specific PTSD subscale?

8.2.2.4 Complexity of Trauma Type

g) Is trauma complexity, as measured by the type of traumatic events experienced,

associated with a higher PTSD score?

8.2.2.5 Complexity of Interference of Trauma on Everyday Life Events

h) Is complexity of interference of trauma on everyday life events, as measured by

number of yes responses to the life areas affected, associated with a higher

PTSD score?

a. Is complexity of interference associated with a probable PTSD score?

i) Is complexity of interference associated with complexity of trauma?

j) Is complexity of interference associated with self experiences of trauma events?

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k) Is complexity of interference associated with household only experiences of

trauma events?

l) Is complexity of interference associated with a self experience of sexual assault

and torture?

m) Is complexity of interference associated with a household only experience of

sexual assault and torture?

8.2.3 Research Question 3

What level of exposure to trauma has the second generation of Tamils experienced?

a) What type of trauma events have they experienced?

b) Are these experiences direct or indirect or both?

c) What are the most common trauma events experienced by participants either

directly, indirectly or both?

d) Is there evidence of transgenerational trauma experiences in generation 2

participants?

8.2.4 Research Question 4

Is there evidence that the second generation Tamils’ experiences of trauma events are associated with psychological distress?

8.2.4.1 Probable PTSD

a) Is there evidence that the second generation participants’ trauma symptoms

meet the threshold for probable PTSD?

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b) Is there evidence of a PTSD score above zero for participants in generation 2

who only report household only trauma experiences?

8.2.4.2 Self and Household Only Experiences of Trauma Type

c) Is there evidence that the self experiences of trauma event types are associated

with a higher PTSD score?

d) Is there evidence that self experiences of trauma event types are associated with

a PTSD subscale?

e) Is there evidence that household only experiences of trauma event types are

associated with a higher PTSD score?

f) Is there evidence that household only experiences of trauma event types are

associated with a PTSD subscale?

8.2.4.3 Severity of Trauma Type

g) Is the experience of severe types of trauma, defined as the experience of torture

and sexual assault, associated with a higher PTSD score?

i. Is the self experience of torture and sexual assault associated with a

higher PTSD score?

ii. Is the self experience of torture and sexual assault associated with a

specific PTSD subscale?

iii. Is the household only experience of torture and sexual assault associated

with a higher PTSD score?

iv. Is the household experience of torture and sexual assault associated

with a specific PTSD subscale?

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8.2.4.4 Complexity of Trauma Type

h) Is trauma complexity, as measured by the type of traumatic events experienced,

associated with a higher PTSD score?

8.2.4.5 Complexity of Interference of Trauma on Everyday Life Events

i) Is complexity of interference of trauma on everyday life events, as measured by

number of yes responses to the life areas affected, associated with a higher

PTSD score?

j) Is complexity of interference associated with complexity of trauma?

k) Is complexity of interference associated with self experiences of trauma events?

l) Is complexity of interference associated with household only experiences of

trauma events?

m) Is complexity of interference associated with a self experience of sexual assault

and torture?

n) Is complexity of interference associated with a household only experience of

sexual assault and torture?

8.2.5 Research Question 5

Are there additional trauma events reported by generation 1 or generation 2 participants?

a. What trauma events are reported by generation 1 and generation 2 participants? b. Is there evidence of trauma narratives being shared across the generation groups? c. What factors appear to play a role in the transmission of trauma narratives across the two generations?

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8.3 Research Design

The goal of this research study was to learn more about the larger migrant Sri Lankan Tamil population living in Sydney, New South Wales by surveying a smaller sample within the population. A cross-sectional approach was chosen to compare two groups of participants.

Cross-sectional designs are used for population-based surveys to assess the prevalence and identify associations (Creshwell & Plano Clark, 2011). Both quantitative and qualitative approaches were taken to answer the research questions. The impact of trauma symptoms and the association between PTSD symptom score and trauma events with both generations of participants were analysed through quantitative data methods. The mechanisms that may facilitate the transfer of trauma narratives and symptoms were analysed using both quantitative and qualitative methods. In the quantitative approach, the independent variables included: generation, gender, age, marital status, employment status, educational level, country of birth, number of years spent in Sri Lanka, the year of migration, and mental health support previously sought. The dependent variable was the symptom severity score on the PTSD questionnaire.

Inclusion criteria included the participant identifying as Sri Lankan Tamil, being 18 years of age or older, currently living in Sydney, and consenting to participation.

8.4 Sampling

The participants included forty-six male and forty-nine female participants between eighteen and sixty-seven years old from the Sri Lankan Tamil community living in Sydney, Australia.

The unit of analysis was individual respondents. In total there were 200 surveys distributed to the community and 112 participants returned the surveys, a response rate of 56%. Of this total,

95 participants completed the survey in its entirety (85%) and these surveys were included in the analysis. The participants included representatives of two generations of Sri Lankan Tamils residing in New South Wales, Australia. 200

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Generation 1 participants were defined as those who had migrated to Australia after the age of

18. Generation 2 participants were defined as those who migrated to Australia as a child or young person aged under 18 or who were born in Australia. Generation 1 participants lived their formative years in Sri Lanka experiencing greater exposure to persecution while generation 2 participants lived their formative years in Australia. There were fifty one generation 1 participants and forty-four generation 2 participants. In Holocaust studies exploring transgenerational trauma, Jews who had been in a concentration camp, forced labour camp, or an extermination camp in Europe during World War 2 were classified as generation

1. Generation 2 were the offspring with a parent who had survived the Holocaust (Baider et al.,

2000). For this study, it was difficult to identify survivors of Sri Lanka’s civil war with experiences of civil war, combat, torture, and imprisonment experiences prior to the study due to existing mental health stigma within the community. As a result, generation 1 was identified as individuals living in Sri Lanka until they had reached adulthood as they were likely to have experienced greater direct trauma events and it was appropriate to define these individuals as survivors.

8.5 Data Collection Instruments

The strategy of this research study was to learn more about the larger migrant Sri Lankan Tamil population living in Sydney, New South Wales (NSW) by surveying a smaller sample within the population. As Sri Lankan Tamils are a culturally and linguistically diverse community, the option of a culturally appropriate trauma measure was explored. Jayawickreme et al. (2012) examined whether the psychometric instruments incorporating local idioms of distress were better able to assess functional impairment in a war-affected Sri Lankan population than the existing translations of established instruments. Jayawickreme and colleagues created a new questionnaire based on qualitative data collected from open ended questions with those living 201

University of Sydney in the north and east of Sri Lanka affected by the civil war. This questionnaire included three preliminary group of concepts that included trauma events, war related general problems, and war related psychological and behavioural problems. Each of these groups had sub clusters identifying further reported problems within the qualitative data collected. Under the group of war related psychological and behavioural problems, idioms of distress were identified. These included ‘heart pain’, ‘broken mind’, ‘extreme fear’, and ‘being in a panic situation’.

Jayawickreme et al.’s study (2012) identified that locally developed instruments better assess trauma symptoms that predict functional impairment than gold standard self-report measures of PTSD and depression that are translated into other languages. One of these gold standard measures identified was the PSS-SR. A culturally adjusted scale has clear benefits as outlined by Jayawickreme et al.’s study, however it also limits comparisons with studies of other populations which have used standard scales. The PSS-SR was also selected as the trauma measure for the current study due to its validity and reliability in research undertaken with refugees.

Data collection for the current study combined the quantitative and qualitative components in a questionnaire instrument. The questionnaire gathered demographic information about participants, their exposure to direct and indirect traumatic experiences, their level of posttraumatic symptoms, and interference in daily life events attributable to trauma. The participants received the following: 1) Demographic questionnaire; 2) Participant information sheet; and 3) The PTSD Symptom Scale Self-Report (PSS-SR) as a single document in both

Tamil and English.

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8.5.1 Demographic Questionnaire

The demographic questionnaire included questions regarding the participants’ gender, age, religion, marital status, current employment and occupation, highest education level attained, place of birth, number of years spent living in Sri Lanka, the year of migration to Australia, and whether they had previously sought support for mental health. To provide follow up emotional and psychological support, the participant information sheet included contact details of STARTTS, the Australian Psychological Society as well as Multicultural Mental Health

Australia. This questionnaire is reproduced in Appendix B and Appendix C.

8.5.2 Post-Traumatic Stress Disorder Symptom Scale Self-Report

The Posttraumatic Stress Symptom Scale Self Report questionnaire (PSS-SR; Foa, Riggs,

Dancu, & Rothbaum, 1993) is a 17-item, self-report, Likert-type scale that asks participants to refer to a specific traumatic event and rate how much they were distressed in the past week by each of the PTSD symptoms specified in the DSM-IV (the DSM version current at the time the questionnaire was prepared). The ordinal scale ranges from 0 (never) to 3 (5 times per week or more/very severe/nearly always). The PSS-SR was designed to assess the presence and severity of PTSD symptoms for those with known trauma histories. The 17 items reflect the PTSD symptoms identified in DSM-IV. The statements within the scale are categorised into three symptom clusters identified in DSM IV: re-experiencing, avoidance, and hyperarousal (Foa,

Riggs, Dancu, & Rothbaum, 1993). The first cluster involves intrusive symptoms of re- experiencing of the traumatic event through nightmares, flashbacks, and recollection of images and thoughts. This is captured in the PSS-SR in symptoms 1-5. The second cluster involves avoidance symptoms such as avoidance of places, social withdrawal, detachment, diminished interest, and emotional numbing. This is captured in the PSS-SR in symptoms 6-12. The third cluster involves hyperarousal symptoms including hypervigilance, difficulty with sleep, 203

University of Sydney concentration, and an exaggerated startle response (American Psychiatric Association, 2000).

This is captured in the PSS-SR in symptoms 13-17.

The first part of the PSS-SR lists traumatic events or situations that a participant may have experienced. These questions are numbered 1-12. The questionnaire asks the participant to identify whether they have experienced or witnessed the trauma event by choosing the yes or no tick box. There are three open ended questions in the PSS-SR. Question 13 asks the individual to identify what the other traumatic event is that is identified in the previous question and question 14 asks the individual to choose the worst event identified. The final question 15 asks the individual to identify which of the above identified incidences as the reason for which they are currently seeking treatment. The PTSD symptoms were assessed using the DSM-IV

PTSD diagnostic criteria (American Psychiatric Association, 2000) because the most recent edition of DSM (DSM 5) (American Psychiatric Association, 2013) was introduced following the commencement of this Ph.D. study in 2012.

Foa et al. (1993) examined the psychometric properties of the PSS interview version as well as the self-report version (PSS-SR). She administered the two versions of the questionnaires to

118 recent rape and non-sexual assault survivors. The findings established that both versions of the PSS questionnaires had satisfactory internal consistency (α = .91), good concurrent validity (sensitivity = 62%), high test-retest reliability (r = .74), positive predictive value

(100%), and negative predictive value (82%). (Foa et al., 1993). In another study Stieglitz, et al. (2001) explored PTSD symptoms in severely injured inpatients following an accident using

PSS-SR. The study examined the psychometric properties of the PSS-SR and the results showed satisfactory internal reliability and externality validity. The PSS-SR is a reliable and consistent tool to measure trauma experiences. One of the concerns of PSS-SR is its lack of 204

University of Sydney reverse-scored questions which may increase the likelihood of individuals over-reporting symptoms. Scores on the PSS-SR has also strongly correlated with war trauma studies undertaken with Vietnamese and Kurdish refugees living in the USA (Hollifield et al., 2006).

8.5.3 Amendment of PSS-SR

The PSS-SR was amended to acquire data for research questions 3, 4, 5, and 6 exploring transgenerational trauma in the second generation participants. The amendment included the addition of three tick boxes to the right of each of the stated trauma events. This was a step taken to identify whether the trauma event was experienced by self, household, both or none.

The original PSS-SR questionnaire contained only two tick boxes, yes and no as potential responses. This was an important amendment to collect symptomology information that was not attributed to a direct experience of trauma by the individual. It allowed the researcher to examine whether a second-generation participant reported trauma symptoms and if their symptoms were linked to a household experience of trauma. Question 15 of the PSS-SR was amended from Which of the above incidences is the reason as to why you are currently seeking treatment? to Which of the above incidences has the most significant impact in your day to day life? Question 16 was added: Is there anything else you’d like to tell us? This open ended question allowed any information to be shared by the participant. The amended PSS-SR is included in Appendix G and Appendix H.

8.5.4 Probable PTSD

Probable PTSD can be measured in three ways: an algorithm method (Foa et al., 1993), a continuous scoring method (Coffey, 2006), and a combination of algorithm and continuous scoring methods (Dunmore, Clark, & Ehlers, 1999). The algorithm method requires a participant to meet at least one re-experiencing, three avoidance/numbing, and two 205

University of Sydney hyperarousal symptoms are identified with a score of 1 or greater on the measure (Foa et al.,

1993). The continuous scoring method states that a PTSD score of 14 or greater is indicative of probable PTSD. A combination method would utilise both these requirements together. The

PSS-SR produces scores ranging from 0 to 51. For this study, probable PTSD was assessed using the continuous scoring method where the total PSS-SR score ≥14. A total score of 14 or higher would indicate probable PTSD in generation 1 and generation 2 participants answering research questions 2 and 6. Coffey (2016) calculated the cut off score of 14 following research undertaken with survivors of motor vehicle accidents. The continuous scoring method has a sensitivity and specificity of .90 in classifying PTSD diagnoses based on the Composite

International Diagnostic Interview (CIDI) (Wohlfarth, van der Brink, & Smitten, 2003). As the

PSS-SR did not measure the DSM IV event criteria (Criteria A1 and A2), duration of symptoms

(Criterion E), and impaired functioning (Criterion F), a formal diagnosis of PTSD was not established in any of the participants in this study.

8.6 Procedure

8.6.1 Ethics Approval

Ethics approval was granted by the Sydney University Human Ethics Committee on the 26th of August 2013 to begin collecting data for the research study (Project number 2013/365). The approval letter is included in Appendix A. Initially, the Ethics committee had concerns about the researcher reading distressing content within the completed surveys and requested formal debrief following receipt of each 25 questionnaires. This was agreed as an appropriate self- care strategy between the research student and the primary supervisor.

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8.6.2 Recruitment

There were discussions held between the researcher and the primary supervisor, Dr. Sitharthan, to upload the questionnaire online. However, a decision was made that online data collection may be complicated due to participants’ access to computers, internet connection difficulties, and potential worry about how information was going to be protected online. This decision was confirmed after reviewing media coverage and the Tamil community’s reaction following an incident of a data breach in 2014. In February, 2014, the Guardian Australia (Laughland et al.,

2014) reported that up to 10,000 asylum seekers’ personal information had been inadvertently published on the Department of Immigration and Border Protection’s website. This was thought to be one of the gravest privacy breaches in Australian history. As a result of the increased worry and anxiety within the Tamil refugee community, it was decided that an alternate means of data collection was needed. A decision was made between the research team that the best method of reaching the community and encouraging the sharing of trauma narratives was through trusted individuals as well as community organisations.

As a result, no posters or advertisements were used to locate participants. Individuals within the community as well as professional organisations that were assisting the newly arrived asylum seekers and refugees were helpful both directly and indirectly in providing contact with potential participants, via snowball sampling. The researcher contacted three Tamil community grassroots organisations. Community volunteers, who were acknowledged to be public figures in supporting migrants and refugees, were identified through community organisations. They were contacted through email, Facebook, or by telephone. The researcher contacted six community volunteers to explain the research goals and provide the background to the study.

The community members were asked to share the survey with interested participants and their families and friends. The community member provided the participant with a participant sheet, 207

University of Sydney the demographic questionnaire as well as the PTSD symptom scale with a yellow envelope to return the completed survey. The study was acknowledged by the Australian Tamil Congress as a positive step to support the Tamil community residing in Sydney, NSW (Appendix J).

Eight different NSW suburbs were identified where Tamil migrants were known to reside in large numbers. The decision to focus on particular areas enabled the research questionnaire to reach those in geographical areas with higher numbers of prospective suitable participants. The community members were asked to contact potential participants within these suburbs to complete the research study questionnaire. However, it is likely that participants who resided outside these suburbs also participated. This was not an inclusion criterion, but a step taken to target interested participants in suburbs with an increase Sri Lankan Tamil population. It was the community member’s responsibility to gather the completed questionnaires and return them to the researcher. Purposeful sampling (Patton, 2002) was utilised through the snowballing technique to recruit participants who could complete the required survey and provide information about their war trauma experiences and the impact this has had on their psychological health (discussed further in procedures). Although the participant was asked to post the completed survey directly to the researcher, many individuals chose to return it to the community member. The final study sample consisted of both Sri Lankan Tamil migrants as well as recently arrived refugees and asylum seekers who were currently living in Sydney,

NSW.

8.6.3 Confidentiality

All the information provided by participants for this research study continues to remain confidential. Participants were provided with a participant sheet explaining that none of the participants will be identified individually as part of the study. It also outlined that the results will be published appropriately. Confidentiality was given the utmost importance and surveys 208

University of Sydney were handed out to participants in envelopes that they later sealed and returned to their community support person. The community support person returned the surveys sealed in the envelopes to the researcher maintaining the confidentiality of the participant at all times.

8.6.4 Risks and Participant Withdrawal

Some participants may have found recalling parts of their trauma narrative upsetting. To provide support, the participant information sheet (Appendix D and Appendix E) included contact details of STARTTS (NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors), Australian Psychological Society as well as Multicultural Mental

Health Australia. Participation in this research study was completely voluntary. This is outlined within the participant information sheet. Participants were provided an opportunity to complete the survey in their own time; they were able to withdraw at any time during the process.

Returning of surveys was considered as providing consent by the individual to participate in the study. There were no negative consequences as a result of withdrawing from the study.

8.6.5 Benefits

The participants did not have a tangible benefit as a result of participating in this research study.

However, the researcher believes that the sharing of traumatic experiences may be beneficial for some individuals as it may lead to an acknowledgment of their past trauma and its impact.

Furthermore, the participants may have felt included in a process to advocate for others in similar situations to have greater access to mental health support. Participants also had the opportunity to speak further with organisations to seek further support if required. This included the following organisations: STARTTS, Australian Psychological Society, and

Multicultural Mental Health Australia.

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8.7 Data Management and Data Analysis

The participants were assigned identification numbers and separated into either a generation 1 or a generation 2 group. The returned questionnaires were analysed both quantitatively and qualitatively.

8.7.1 Quantitative Data Analysis

The quantitative data collected was entered into an excel document. The quantitative data was analysed using descriptive and inferential statistics; this was undertaken with R version 3.4.4 software using the JASP version 0.9.0.1 interface. Experiences of trauma events were coded into four categories; self, household, both and no. Using descriptive statistics, research questions one and three were explored. The descriptive statistics summarises the trauma experiences of generation 1 and generation 2 participants. In particular, the findings describe the type of trauma events reported, whether a specific trauma event was more frequently reported by the generation group, and whether the trauma event was directly, indirectly or both directly and indirectly experienced by the individual.

Research questions two and four were analysed using descriptive and inferential statistics to understand how many participants within a generation group met the threshold for probable

PTSD, if multiple trauma events are associated with a higher PSS-SR score, if specific trauma events are associated with a higher PSS-SR score, and if specific trauma events are associated with differences in PTSD subscales of re-experiencing, avoidance and arousal. Research question five, exploring transmission of trauma across the two generation, was analysed using descriptive and inferential statistics. Due to concerns about levels of measurement and non- normality of distributions, the preferred analyses were nonparametric correlations. Spearman correlations were used to compare continuous measures, while nonparametric point-biserial 210

University of Sydney correlations were used to compare dichotomous variables, such as generation, to continuous variables. Using Cohen’s standard criteria for size of effect, rpbs = 0.1 is a weak effect, 0.3 a moderate effect, and 0.5 or greater a strong effect. In particular, research question five explored the associations between multiple indirect trauma events and the PSS-SR score, and if the indirect exposure of individual trauma events is associated with higher scores on the PTSD subscales of re-experiencing, avoidance and arousal. Finally, the question explores if there is a

PTSD score difference between generation 1 and generation 2 participants following the disclosure of indirect trauma events. A PTSD score above zero in generation 2 participants with only a disclosure of indirect trauma experience may be associated with the likelihood of trauma transfer across generations.

8.7.2 Qualitative Data Analysis

The qualitative from the open-ended question was entered into a Microsoft Word document to be further analysed. Qualitative data was collected in written form from three open-ended questions in the amended PSS-SR (Q13 If “other traumatic event” is checked YES above; please write what the event was and who it happened to; Q15 Which of the above incidences has the most significant impact in your day to day life?; Q16 Is there anything else you’d like to tell us?). Fifty-two participants answered the open-ended questions. Qualitative data can be used as a tool to understand the human experience. The study’s qualitative analysis aimed to understand the mechanisms that may be facilitating the transfer of trauma narratives and symptoms across generations. The raw qualitative data was separated from the study and thematically analysed. Thematic analysis was undertaken using content analysis. Content analysis is described as an interpretive and naturalistic approach. It is both observational and narrative and relies less on the experimental fundamentals normally associated with scientific research including reliability, validity, and generalisability. Content analysis requires a 211

University of Sydney reflective process that does not have a linear model. The subjective experience of the Sri

Lankan civil war was captured in questions 13, 15 and 16 of the PTSD questionnaire.

Content analysis requires a researcher to be open to the complexity of the data, be mindful of personal bias, be creative in the approach, and to always maintain the core meaning of the data

(Erlingsson & Brysiewicz, 2017). The following steps were undertaken to complete the content analysis.

1. The researcher was mindful of her assumptions, biases, professional background, and

previous experience and knowledge. Content analysis requires the researcher to uphold

openness and a non-judgemental perspective to engage in new learning (Erlingsson &

Brysiewicz, 2017). The researcher read the raw qualitative data multiple times to gain

a general understanding of the whole picture. The research aims and questions were

kept in focus. The researcher considered the following questions regarding initial

impressions:

a) What is the text talking about?

b) What stands out?

c) Reactions to reading the text?

d) What message did the text leave the researcher with?

2. The researcher returned to read the data again and divide the text into smaller parts to

create meaning units.

3. The researcher condensed the meaning units further with another read of the data. The

researcher attempted to constantly protect the core meaning of the data during this

process.

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4. The researcher labelled condensed meaning units into codes. This allows the researcher

to identify connections between meaning units. The codes were highlighted in different

colours.

5. The data was re-read to whether the condensed units and codes still fitted each other

and maintained the core meaning of the data. When there was not a good fit identified,

amendments were made.

6. The researcher then separated the codes into categories.

7. The categories were then collated under themes. The identified themes were considered

as the highest level of abstraction.

8. The researcher returned to her notes on initial impression and compared these notes to

the final themes to confirm that the core meaning was always maintained. This is

referred to as the hermeneutic spiral or hermeneutic circle.

9. The primary supervisor reviewed the data and provided feedback. This feedback was

reviewed by the researcher and a new theme was identified. The researcher re-read the

data and searched for exceptions that contradicted the identified themes.

The findings of this research study are presented in the next chapter.

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Chapter 9

Results

9.1 Overview

This chapter describes the findings from this study. The quantitative data is analysed using descriptive and inferential statistics. The qualitative data is analysed using content analysis.

The findings of this study are separated into three parts: 1) Demographic characteristics of the sample; 2) Research question findings; 3) Additional findings. The complete content analysis table is included in Appendix I.

9.2 Demographic Characteristics of the Sample

Ninety five (N=95) Sri Lankan Tamils participated in this study. Characteristics of the 95 participants are reported in Table 2. Although there was a wide age range, 18 to 67 years, nearly three quarters of the participants were under 39 years. Most identified as Hindus.

Approximately equal numbers were married, and single, with very few divorcees. More than a third of participants had lived in Sri Lanka for more than 20 years of their life. For the purposes of this study, generation 1 participants were those who migrated to Australia after the age of 18 and generation 2 were those who migrated to Australia prior to the age of 18 or those who were born in Australia. There were approximately equal numbers of generation 1 and generation 2 respondents, with almost half the generation 2 respondents being born in

Australia. Those in the sample who had migrated mostly did so after 1995. Seeking mental health support was uncommon.

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Table 2- Demographic characteristics of the sample (N=95)

Variables Number of Percentage (%) Participants (N=95) Gender Male 46 48.42 Female 49 51.58 Age Group 18-28 33 34.74 29-38 38 40.00 39-48 13 13.68 49-58 7 7.37 59-68 6 6.32 69 and over 0 0 Minimum age 18 Maximum age 67

Religion Hindu 85 89.47 Catholic 4 4.21 Christian 3 3.16 Muslim 2 2.11 Nil 1 1.05

Marital Status Married 46 48.42 Single 45 47.37 Divorced 4 4.21

Employed Yes 34 35.79 No 61 64.21

Education Completed University 16 16.84 Completed High School 25 26.32 Did not complete High School 53 55.79 No response 1 1.05

Birthplace Australia 21 22.11 Sri Lanka 74 77.89

Number of years spent in SL >20 years 31 18.95 10-20 years 18 32.63 <10 years 25 26.32 215

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Never a resident in SL 21 22.11

Generation 1 51 53.68 Generation 2 44 46.32

Migration to Australia No data entered 2 2.10 1983 - 1988 1 1.05 1989 - 1994 13 13.68 1995 - 2000 22 23.16 2001 - 2006 5 5.26 2007 - 2012 15 15.79 2013 - 2018 16 16.84 Not applicable 21 22.10

Sought mental health support sought Yes 21 22.11 No 74 77.89

9.3 Research Question Findings

9.3.1 Research Question 1

9.3.1.1 Generation 1 Trauma Experiences

Past traumatic experiences were assessed using the first part of the PTSD Symptom Scale Self

Report questionnaire which provided participants with a list of 12 traumatic events. The participants identified if an event had happened to them or their household or as a combined trauma event (experienced by self and household together). The table below lists the trauma events reported by the first generation Tamils either as experienced directly (self only), indirectly (household only), or combined (directly and indirectly).

The first generation participants identified most of the 12 trauma events contained within the

PTSD Symptom Scale Self Report questionnaire. All reported trauma events were experienced directly, indirectly and combined with the exceptions of life-threatening illness, sexual assault by stranger, and sexual contact before the age of 18 which were not experienced as a combined

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86.27%), torture (n=35, 68.63%), and imprisonment (n=28, 54.90%). Military combat or war zone was commonly experienced by participants in generation 1 as a combined trauma event affecting them as well as their household (n=39, 76.47%). Sexual assault by a family member or someone they know was the least identified trauma event in this generation group (n=1,

1.96%). Please see Table 3.

Table 3 - Trauma events experienced by generation 1 participants

Trauma events Number of Direct (self Indirect Combined (self responses only) (household only) & household) n, % n, % n, % n, %

Military combat or a 44 (86.27) 3 (5.88) 2 (3.92) 39 (76.47) war zone Torture 35 (68.63) 16 (31.37) 10 (16.61) 9 (16.65) Imprisonment 28 (54.90) 9 (17.65) 13 (25.49) 6 (11.76) Serious accident fire 25 (49.02) 8 (15.69) 6 (11.76) 11 (21.57) or explosion Non sexual assault by 23 (45.10) 14 (27.45) 4 (7.84) 5 (9.80) a stranger Non sexual assault by 22 (43.14) 8 (15.69) 10 (19.61) 4 (7.84) someone you know Other traumatic event 20 (39.21) 12 (23.53) 6 (11.76) 2 (3.92) Natural disaster 14 (27.45) 2 (3.92) 9 (17.65) 3 (5.88) Life threatening 9 (17.65) 5 (9.80) 4 (7.84) 0.0 illness Sexual assault by a 7 (13.73) 5 (9.80) 2 (3.92) 0.0 stranger Sexual contact before 4 (7.84) 1 (1.96) 3 (5.88) 0.0 you were age 18 Sexual assault by a 1 (1.96) 0.0 1 (1.96) 0.0 family member or someone you know

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Table 4 below presents information about whether the trauma events were experienced directly or indirectly by the first generation participants by separating them into two categories: directness and indirectness of trauma events. The directness of trauma events included at a minimum a self experience of trauma. As a result, the self experiences (direct) and combined experiences (self and household) of trauma were both added to create a single category of

‘direct trauma experiences’. The indirect experiences remained as household only and this was labelled as ‘indirect trauma experiences’.

The first generation participants overwhelming reported greater direct experiences of trauma than indirect experiences of trauma. However, the following trauma events were experienced as household only by more than 10% of the participants in this generation: torture (n=10), imprisonment (n=13), serious accident, fire or explosion (n=6), non sexual assault by someone you know (n=10), and natural disaster (n=9). The 51 participants (n=51) reported a total of 64 responses to household only trauma events. This accounts for nearly a third of trauma events experienced by generation 1 participants. These responses show evidence that the first generation of participants were also additionally exposed to secondary trauma events as a result of a household member’s experience of trauma. Please see below Table 4.

Table 4 – Generation 1 direct and indirect trauma experiences

Trauma event Direct trauma Indirect trauma

experience (self only, experience (household

self and household) only)

n, % n, %

Military combat or a war zone 42 (82.35) 2 (3.92)

Torture 25 (49.02) 10 (19.61)

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Imprisonment 15 (29.41) 13 (25.49)

Serious accident fire or explosion 19 (37.25) 6 (11.76)

Non sexual assault by a stranger 19 (37.25) 4 (7.84)

Other traumatic event 14 (27.45) 6 (11.76)

Non sexual assault by someone you know 12 (23.53) 10 (19.61)

Natural disaster 5 (9.80) 9 (17.65)

Life threatening illness 5 (9.80) 4 (7.84)

Sexual assault by a stranger 5 (9.80) 2 (3.92)

Sexual contact before you were age 18 1 (1.96) 3 (5.88)

Sexual assault by a family member or 0 1 (1.96) someone you know

9.3.2 Research Question 2

9.3.2.1 Probable PTSD The participants in this study completed the PTSD Symptom Scale Self Report questionnaire

(PSS-SR) with a possible range of 0-51. The mean PTSD score was 21.16 and median 23 (SD

= 11.61, IQR = 16.5, range 1-51). Of the 51 generation 1 participants in this study, a total of

35 participants (68.63%) reported a PTSD score of 14 or above in the PSS-SR, meeting the threshold for probable PTSD. Gender was not associated with PTSD scores in generation 1 participants (rpbs = .033, p >.05). Please see Figure 4 highlighting the PTSD score range for generation 1 participants.

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Figure 4 - Histogram of PTSD scores for generation 1 participants

9.3.2.2 Self and Household Only Experiences of Trauma Type

Nonparametric point biserial correlation is a statistical analysis used to compare a dichotomous variable with a continuous ordinal variable. This was used to compare the dichotomous yes/no variables for number of type of trauma events reported by self as well as household only to

PTSD total score and PTSD subscales in generation 1 participants (n = 51). There was no clear association between generation one’s self experiences of trauma types and a higher PTSD score, rpbs =.165, p >.05. This finding does not provide evidence of a relationship between participants’ PTSD score and reported self experiences of different trauma events. However, there appears to be a moderate inverse relationship between types of traumas experienced by self and a higher PTSD score when excluding sexual assault and torture rpbs = - .281, p < .05.

These findings show that the self experiences of trauma events, when excluding torture and sexual assault trauma events, are inversely associated with PTSD scores. This provides further evidence that the severity of trauma type plays a role in an individual’s psychological distress

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University of Sydney as PTSD appears to be associated with the more severe categories of trauma to self. Those who report only less severe trauma event types to self do not appear to be at any more risk of having a higher PTSD score than those who do not report self trauma experiences for the same event types. There was also no clear relationship between household experiences of trauma and a higher PTSD score rpbs =.117, p > .05. This finding shows that although secondary trauma events were reported by generation 1 participants, there appears to be no evidence from these findings of secondary traumatisation in this group.

9.3.2.3 Severity of Trauma Type

A large number of participants reported both self experiences and household only experiences of torture and sexual assault. Trauma literature considers sexual assault and torture as severe trauma type experiences that lead to significant psychological distress (Van Ommeren, 2002.

Nonparametric point biserial correlation was used to compare the dichotomous yes/no variables for sexual assault and torture to PTSD scores and PTSD subscales in generation 1 participants.

A point biserial correlation analysing self experiences of torture and sexual assault produced significant results rpbs = .344, p < .05. Based on this data, it appears that participants who reported self experiences of torture and sexual assault trauma were likely to exhibit greater psychological distress and a higher PTSD score. Self experiences of torture and sexual assault were positively correlated with only the arousal PTSD subscale rpbs = .353, p < .05. However, there appears to be no evidence of any clear relationship between household only experiences of torture and sexual assault trauma and PTSD scores rpbs = -.159, p > .05. These findings support the notion that the self experiences (direct) of torture and sexual assault has a greater impact on the individual’s psychological health. However, there is no evidence from these findings of secondary traumatisation as a result of a participant’s household experience of

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9.3.2.4 Complexity of Trauma Type

Spearman correlation is used to compare the relationship involving ordinal, or rank-ordered variables. In this analysis, Spearman correlation was used to assess the strength and direction of association between PTSD total score and complexity of trauma type (number of trauma event types reported by each participant). Research question one findings above showed that generation 1 participants had experienced a number of trauma event types. In this thesis, complexity of trauma was defined as number of trauma types experienced, inclusive of direct, indirect and combined trauma events. There was a very strong positive association between complexity of trauma and PTSD score rs = .617, p <0.05. Based on this data, we can say that participants who experienced multiple trauma event types either directly, indirectly or combined reported greater psychological distress in the form of a higher PTSD score.

9.3.2.5 Complexity of Interference of Trauma on Everyday Life Events

Complexity of interference was calculated by counting the number of life areas affected as reported by each participant. There was a total of nine life areas with a yes or a no response requested. The nine life areas included work, household duties, friendship, fun/leisure activities, schoolwork, family relationships, sex life, general life satisfaction, and overall functioning. Spearman correlation analysis found that there was a moderate positive association between complexity of interference and the PTSD score rs = .472, p <0.05.

Additionally, there was also a positive but weaker association between complexity of interference and probable PTSD. This provides evidence that an individual who experienced interference in multiple life areas also scored higher on their PTSD score and were likely to meet the probable PTSD score of 14. On the other hand, the complexity of interference appears 222

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not to be associated with complexity of trauma (rs = .257, p >0.05). There is insufficient evidence to conclude that number of interferences reported by participants is related with the number of trauma types experienced. This adds further evidence that the severity of a trauma event matters in how it debilitates an individual’s life.

Nonparametric point biserial analysis found that there was no association between complexity of interference and both self experiences of trauma types (rpbs = -.017, p > .05) as well as household only experiences of trauma types (rpbs = -.008, p > .05). Furthermore, there was also no association between complexity of interference and both self (rpbs =.086, p > .05) and household only (rpbs = -.126, p > .05) experiences of sexual assault and torture. Based on these findings, there is no evidence that self or household only experiences of trauma types or self or household only experiences of torture and sexual assault have a relationship with the number of interferences reported. These findings are consistent with evidence that trauma event types leading to psychological distress and higher PTSD scores may significantly impact on one aspect of an individual’s life and functioning. These findings also show that while secondary trauma experiences were reported, there is no evidence these experiences have resulted in traumatisation.

9.3.3 Research question 3

9.3.3.1 Generation 2 Trauma Experiences

The table below lists the trauma events reported by the second generation participants either as directly (self experiences only), indirectly (household experiences only), and combined

(directly and indirectly, experienced by self as well as household). The generation 2 participants did not identify all trauma event types. Unlike generation 1 participants, there were very few reports of direct trauma. The most common trauma event identified was military 223

University of Sydney combat/ war zone experience with 40 participants reporting this event (90.91%). Imprisonment

(n = 8, 18.18%) and torture (n = 6, 13.4%) were the next two significant trauma events reported by generation 2 participants. The following five trauma events were not identified by any of the participants: natural disaster, sexual assault by a family member or someone you know, sexual contact before you were age 18, life threatening illness, and other traumatic event. Please see below Table 5.

Table 5 Trauma events experienced by generation 2 participants

Trauma events Number of Direct (self Indirect Combined (self responses only) (household & household) n, % n, % only) n, % n, %

Military combat or war 40 (90.91) 0 36 (81.82) 4 (9.09) zone

Imprisonment 8 (18.18) 0 8 (18.18) 0

Torture 6 (13.64) 0 6 (13.64) 0

Serious accident, fire 3 (6.82) 1 (2.27) 2 (4.55) 0 or explosion

Non sexual assault by 1 (2.27) 0 1 (2.27) 0 someone you know

Non sexual assault by 1 (2.27) 0 1 (2.27) 0 a stranger

Sexual assault by a 1 (2.27) 0 1 (2.27) 0 stranger

Natural disaster 0 0 0 0

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Sexual assault by a 0 0 0 0 family member or someone you know

Sexual contact before 0 0 0 0 you were age 18

Life threatening illness 0 0 0 0

Other traumatic event 0 0 0 0

Table 6 shows that all the trauma events reported by generation 2 participants as either an indirect or direct trauma. The generation 2 participants reported a higher number of trauma events experienced by their family (household only) with the exception of military combat or war zone experienced by four participants as a self and household trauma event (combined trauma) and serious accident, fire or explosion which was reported as a self experience (direct trauma) by a single participant. In generation 2 participants, indirect trauma experiences were significant with more than 91.67% responses choosing household only. Indirect trauma experiences in generation 2 are considered as likely evidence of transgenerational trauma experiences.

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Table 6 – Generation 2 direct and indirect trauma experiences

Trauma event Direct trauma Indirect trauma

experience (self only, experience (household

self and household) only)

n, % n, %

Military combat or a war zone 4 (9.09) 36 (81.82)

Torture 0 8 (18.18)

Imprisonment 0 6 (13.64)

Serious accident fire or explosion 1 (2.27) 2 (4.55)

Non sexual assault by a stranger 0 1 (2.27)

Non sexual assault by someone you 0 1 (2.27) know

Natural disaster 0 1 (2.27)

Sexual assault by a family member or 0 0 someone you know

Sexual assault by a stranger 0 0

Sexual contact before you were age 0 0

Life threatening illness 0 0

Other traumatic event 0 0

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9.3.4 Research Question 4

9.3.4.1 Probable PTSD

Of the 44 Generation 2 participants in this study, only two participants (4.55%) reported a

PTSD score of 14 or above meeting the threshold for probable PTSD. The mean PTSD score was 3.36 and median 2 (SD = 3.82, IQR = 4.25, range 0-16) for the generation 2 participants.

Gender was not associated with a higher PTSD score rpbs = .038, p > .05. Please see Figure 5 highlighting the PTSD score range for generation 2 participants.

Figure 5 - Histogram of PTSD scores for generation 2 participants

9.3.4.2 Self and Household Only Experiences of Trauma Type

Nonparametric point biserial correlations were used to compare the dichotomous yes/no variables for self and household only experience of trauma event types to PTSD score and

PTSD subscales in generation 2 participants (n = 44). There was a positive association between self experiences of trauma event types and a higher PTSD score. This finding was statistically significant, rpbs =.407, p < .05. In generation 2 participants, trauma event types experienced by 227

University of Sydney self were likely to be associated with a higher PTSD score. The self experiences of trauma event type were positively associated with all three PTSD subscales: re-experiencing (rpbs

=.463, p < .05, avoidance (rpbs = .340, p < .05) and arousal (rpbs =.435, p < .05). It is important to note here that there were only four participants who reported a self experience of trauma event type in generation 2.

The association between household experiences of trauma event types and a higher PTSD score was also statistically significant rpbs =.314, p < .05. Additionally, household only experiences of trauma was only positively associated with the avoidance subscale (rpbs =.357, p < .05).

Interestingly, when the sexual assault and torture trauma events are excluded from the list of trauma events correlated with PTSD scores, there appears to be an insignificant finding rpbs = -

.033, p >.05. These findings importantly show evidence of transgenerational transmission of trauma with household only experiences including severe trauma event types being positively associated with PTSD scores in the second generation participants. The severe types of trauma events appear to be associated with greater distress even when the trauma events are experienced by the household only. These findings are consistent with evidence that trauma experienced only by household has an impact on an individual’s psychological health.

Although there is evidence of transgenerational transfer of trauma between generations, there is no evidence of transgenerational traumatisation as only two participants in generation 2 met the probable PTSD score of 14.

9.3.4.3 Severity of Trauma Type

Although self experiences of sexual assault and torture were widely reported by generation 1 participants, there were no participants in generation 2 who identified a self experience of torture or sexual assault. However, household only experiences of torture and sexual assault were positively associated with higher PTSD scores in generation 2, and the finding was 228

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statistically significant rpbs =.333, p < .05. The findings are consistent with evidence that the household experiences of torture and sexual assault may have an impact on the second generation participants’ psychological health. This also provides evidence of trauma transmission across the two generations. However, the PTSD scores do not meet the threshold for probable PTSD in generation 2 participants with the exception of two individuals.

Nevertheless, 29 (65.91%) participants reported only household trauma and a PTSD score above 0. It is important to note that the low PTSD scores are associated with the participants not meeting the clinical threshold of probable PTSD. Household only trauma events were also positively correlated with all three PTSD subscales: re-experiencing (rpbs =.396, p < .05), avoidance (rpbs =.312, p < .05), and arousal (rpbs =.334, p < .05).

9.3.4.4 Complexity of Trauma Type

Spearman correlation was used to assess the strength and direction of association between

PTSD score and complexity of trauma in generation 2 participants. Multiple trauma event types were considered as contributing to the complexity of the trauma experience. A total of

44 participants in generation 2 completed the PSS-SR questionnaire and answered questions about their trauma experiences. The findings of research question three showed that generation

2 participants reported trauma events that were mostly experienced by the participants’ household only. There was a strong significant positive association between the complexity of trauma and a higher PTSD score in generation 2 rs = .536, p < .05. This shows that experiencing a greater number of trauma events may be more damaging to an individual’s mental health than the experience of a single trauma event, even though the experience is only through a household member. Based on this data, we can say that participants in generation 2 who experienced multiple trauma event types either directly, indirectly or combined reported greater psychological distress and a higher PTSD score. As a result of generation 2 participants

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9.3.4.5 Complexity of Interference of Trauma on Everyday Life Events

Spearman correlation analysis found a strong positive association between complexity of interference, as measured by counts of life areas affected, and a higher PTSD score rs = .556, p

< .05. This finding provides evidence similar to generation 1 findings in which the participants who reported a greater number of life areas affected also reported higher PTSD scores. The sample size was too small to explore any association between complexity of interference and

PTSD probability with only two participants meeting the probable PTSD score of 14 in generation 2. In this generation group, complexity of interference was also moderately associated with complexity of trauma events rs = .466, p < .05 showing that multiple trauma events were associated with greater number of life areas affected. Nonparametric point biserial analysis found that there was no association between complexity of interference and both self experiences of trauma types (rpbs = .214, p > .05) as well as household only experiences of trauma types (rpbs = .211, p > .05). Based on these findings, there is no evidence that self or household only experiences of trauma types have a relationship with the number of interferences reported.

There was no self experience of sexual assault or torture reported in generation 2 participants.

However, there was a moderate positive association between complexity of interference and household only experience of sexual assault or torture rpbs =.317, p < .05. This finding also provides additional evidence of trauma transfer between the two generations.

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9.3.5 Research question 5

Content analysis was undertaken to analyse the qualitative data and explore possible mechanisms that may facilitate the transfer of trauma between generations. A total of 31 generation 1 participants (61%) provided a response for the open ended questions. The generation 1 participants disclosed a range of direct and indirect trauma experiences within the qualitative data. A total of 30 participants (60%) in generation 1 had lived in Sri Lanka for more than 20 years and as a result their responses were likely related to their experiences of persecution and the civil war. Twenty one generation 2 participants (48%) responded to the open ended questions. The generation 2 participants disclosed significantly more indirect trauma experiences. It should also be noted that 48% of participants in generation 2 were born in Australia and 20 participants (45%) had lived in Sri Lanka ten years or less. Their responses were likely associated with growing up with parents who were exposed to the war and persecution in Sri Lanka. Several key words were identified, including displacement, missing, killing, bombing, shelling, war, friends, community, death, stories and separation. Key words were compared across participants’ responses and their presence (how often they were mentioned), meaning (understanding the context) and relationship (how were they related to other themes identified) was further analysed. The transcripts were re-read by the supervisors for additional input. A further theme was identified during this process. The key words and identified quotes were separated into the following themes:

1. Grief and Loss

2. Violence and Torture

3. Stories and Survival

4. Social Displacement

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The following themes are presented by reporting quotes directly from the participants that exemplify the themes identified. Some of the quotes are repeated as they embody more than one specific theme.

9.3.5.1 Grief and Loss

The experience of grief and loss was identified by generation 1 participants across different sub themes. This included the following:

1. Loss of family

a. Missing family members

“My family members are missing to this day. I have asked ICRC to help us find

them.”

“My husband went missing in the early 90s, he was suspected of being part of the

LTTE”

b. Deceased family members

“My brothers are no more, I am the only survivor. I am happy with my wife and

children now.”

“My son joined the LTTE after his cousin was killed during an air raid, we lost that

son when he joined as well”

c. Family separation

“My wife and children lived in an Indian refugee camp since 1989, I can't forget

being away from them”

2. Loss of childhood

a. Missing childhood

“Memories of missing school, friends going missing”

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3. Loss of home

“We suffered so much at the hands of the government, they took away our land, our

homes and our future.”

“Sense of community has been lost for us, we feel isolated and alone. Our family is

back home still suffering.”

“Left overnight on a bus when we didn't have anywhere else to hide from the Sri Lankan

army. We had been an educated bunch but they targeted us as well on

suspicion.”

4. Loss of human rights

“Couldn't live in Sri Lanka anymore, faced discrimination and had to leave by boat”

The generation 2 participants identified the following grief and loss indirect trauma experiences.

1. Loss of family

a. Deceased family members

“My mum lost her sister when she was young due to the war. She died in an air raid.

I only heard the stories”

b. Family separation

“Father was separated from us for four years during the civil war, difficult for mum

to be a single parent”

2. Loss of childhood

“Missed schooling impacted my attitude to learning. Struggled to adjust to a new

culture and environment.”

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3. Loss of home

“Went back to parents’ villages, felt depressed at their life now and how they lived. I

know they could be happier”

9.3.5.2 Violence and Torture

Generation 1 participants reported the following Violence and Torture experiences.

1. Injury

“I was injured in a bomb blast”

“Injured in a bomb attack”

2. Physical assault

“I was kidnapped by unidentified people and assaulted on my body”

“I spent 4 years in a jail in Boosa, I was tortured and hung upside down”

3. Sexual assault

“Arrested on the suspicion of being an LTTE member and interrogated for 6 days.

Sexually assaulted with pipes”

4. Detention

“My uncle was imprisoned for nine years as a political prisoner”

5. Civil war violence

“Left overnight on a bus when we didn't have anywhere else to hide from the Sri

Lankan army”

“Visa process has been difficult, no certain future here after suffering years of civil war

and persecution”

6. Psychological impact of violence

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“Although the war has ended back home, our emotional wounds and depression has not

ceased. I am still continuing to live fearing death”

“Still scared of death, there is no peace of mind”

Generation 2 participants reported the following Violence and Torture experiences.

1. Sexual assault

“My parents were detained by the IPKF army and my mum was sexually assaulted

when she was pregnant with my sister”

2. Civil war violence

“Grandmother and mum had to move to India in the 80s when the fighting became bad.

It was scary to listen to their tales of survival”

“My family lived in an area where there was an important LTTE camp; she still has

nightmares remembering bombings and air raids next to her house”

9.3.5.3 Survival and Stories

The generation 1 participants reported the following accounts of survival narratives. They reported significantly more survival narratives that highlighted their coping mechanisms than the experience of sharing these narratives with others. However, these coping mechanisms may also have been shared as stories with their offspring although not identified here within the qualitative data.

1. Stories

“Grandmother and mum had to move to India in the 80s when the fighting became bad.

It was scary to listen to their tales of survival”

2. Survival

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“Not having a job has been hard. Worked as a teacher at school back home, felt purpose

to my life. Here I just survive day to day. I am thankful but this isn't what I had hoped

for as my future”

“We lived in bunkers during the war years. Barely survived that part of our life. Then

moved to Indonesia to have a future for my children. And then I had the chance to get

on a boat to Australia”

“A solution for my Depression”

“Just like myself, I would like a safe place for my father”

“I am thinking much about my future; sometimes I think about my past happening, I need some counselling.”

The generation 2 participants reported the following stories and survival experiences.

Generation 2 participants reported greater sharing of stories and lesser personal reflections of survival and coping mechanisms. This is consistent with generation 2 participants not having been exposed to the direct experiences of trauma events.

1. Survival

“I was very young when my parents came here, but they continued to worry about their

siblings. My parents tried to help their families back home”

“I have been involved in activism with the Tamil diaspora in Sydney and understand

the trauma felt as a result of what our parents went through”

“Missed schooling impacted my attitude to learning. Struggled to adjust to a new

culture and environment.”

2. Stories

“Friend's parents’ stories were difficult to hear”

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“Born here but heard my parents talking to their friends about the war in the

community”

“My mum lost her sister when she was young due to the war. She died in an air raid. I

only heard the stories”

“Went back to parents’ villages, felt depressed at their life now and how they lived. I

know they could be happier”

“Mum is active in the community, helps other asylum seekers in the community. I know

their stories and visit church with them”

“I teach English classes for newly arrived refugees, I become angry when I hear similar

stories to what my parents described experiencing in the 80s. Nothing has changed it

seems”

“I was very young when I moved here but my parents celebrate anniversaries of my

uncles' deaths, so I know they were caught up in the civil war”

“Hearing stories, going to events (heroes’ day)”

“Born in Australia and feel very lucky that my experiences are different to that of my

ancestors.

9.3.5.4 Social Displacement

The generation 1 participants reported the following experiences of social displacement. Due to the low sample size with only four generation 1 participants and three generation 2 participants identifying social displacement, PTSD sub scale comparison was not undertaken.

“Displacement, lost job due to discrimination”

“Asylum seeker living in the community, fearful of return home and face harassment.

“Brother was part of LTTE.”

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The generation 2 participants reported the following experiences of social displacement.

“Experienced displacement as a child”

“I moved here with my parents in 1996 when the civil war started. I think I was about

8 back then. Only memory is crossing a body of water trying to get away from both

LTTE and the army”

“Escaped civil war with my parents. Vague memories”

9.3.5.5 Reflections

The quantitative data presented found evidence of transgenerational transfer of trauma in generation 2 participants. Both generation 1 and generation 2 participants reported experiences of direct, indirect and combined trauma events within the qualitative data captured above. The reported trauma events were powerful and embodied a variety of themes. They also highlighted the different factors that may be facilitating the transfer of trauma between the two generations as identified by trauma literature. The working model for this study as proposed by Ancharoff et al., (1998) identified four factors that may play a role in trauma transmission. These include silence, over disclosure, identification, and re-enactment. The themes may be closely linked with each of these factors proposed. Grief and loss reactions may have facilitated either silence in the form of avoidant behaviour or over disclosure as a result of not being able to regulate strong emotions. The experience of violence and torture is strongly embedded in a sense of helplessness and lack of control for many survivors. As a result, a survivor may have re-enacted an event in order to work through these difficult feelings and regain a sense of control in their lives. Furthermore, the experience of sexual violence is often buried in families and communities as a result of stigma, this may have led to avoidant behaviours where a survivor maintained their silence for fear of being outcasted by their community.

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The theme of survival and stories described disclosures where a parent had disclosed the death of a family member, the loss of identity, and the harrowing journey to safety to their offspring.

The theme of social displacement may have led to the second generation participants recognising that their sense of home had been lost as well. As a result, they may have consciously identified with the trauma experiences of their racial and cultural group, in this case as a minority Sri Lankan Tamil. The theme of survival and stories has clearly identified that trauma stories were passed down from one generation to another in this study. It is important to emphasise that although trauma narratives were transferred between generations in this sample and there was evidence of transgenerational transfer of trauma symptoms, there are only two participants who meet the probable PTSD score of 14 or over.

9.4 Supplementary Analysis

9.4.1 Complexity of Trauma and PTSD

In the overall study sample (n = 95), there was a very strong positive association between complexity of trauma (number of trauma events) and PTSD score and these findings were statistically significant rs = .763, p < .05. This finding shows that the experience of multiple trauma events is likely to be associated with greater psychological distress and a higher PTSD score. There was also a strong positive correlation between complexity of trauma events and probable PTSD score for the overall sample that was statistically significant rs = .688, p < .05.

The participants in this study who reported multiple trauma events leading to greater trauma complexity were likely to meet the probable PTSD score of 14 or above in the PSS-SR questionnaire.

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9.4.2 Birthplace and PTSD

As shown in Figure 6 and 7, the participants who were born in Sri Lanka reported higher PTSD scores indicative of greater psychological distress when compared to the participants who were born in Australia. The birthplace of a participant appears to be significant in predicting psychological distress among the study sample.

Figure 6 – PTSD score range of participants born in Australia

Figure 7 – PTSD score range of participants born in Sri Lanka

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9.5 Summary

The study found evidence that the first generation of Tamils have experienced significant trauma events resulting in traumatisation with more than half of the participants in the sample

(n=35, 68.63%) meeting the probable PTSD score of 14 or above. They exhibited increased

PTSD symptomatology with a higher PTSD scores on the PSS-SR questionnaire (mean =

21.16, SD 11.61). These participants also reported multiple and severe trauma events.

Generation 1 participants’ self experiences of sexual assault and torture were positively associated with greater psychological distress and a higher PTSD score. Although generation

1 participants reported some secondary trauma experiences, there was no evidence of secondary traumatisation established, with no association found between any household trauma event type and PTSD scores.

On the other hand, generation 2 participants reported a greater number of indirect trauma event types. This is consistent with 47.73% (n=21) of them being born in Australia. Only two participants in the generation 2 sample met the threshold for probable PTSD (n = 2, 4.55%).

There was evidence of transgenerational transfer of trauma in generation 2 participants with household only experiences of sexual assault and torture positively associated with PTSD scores and all three PTSD subscales, re-experiencing, avoidance, and arousal. Furthermore, complexity of interference was positively associated with higher PTSD scores in generation 2 participants. All three PTSD sub scales were also associated with complexity of interference in this generation group. Although there is evidence of trauma transmission, there is no evidence to support transgenerational traumatisation in generation 2 participants with only two participants meeting the probable PTSD score of 14. These findings together with relevant literature will be discussed in the next chapter.

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Chapter 10

Discussion and Conclusion

10.1 Overview

The aim of the study was to explore the trauma experiences of the two generations of Sri

Lankan Tamils living in Sydney and identify any evidence of transgenerational trauma in the second generation of Tamils. The study established evidence of trauma symptoms in the first generation of participants with 68.63% meeting the probable PTSD score of 14 or higher. The findings were also consistent with evidence that there was transgenerational transfer of trauma symptoms in the second generation of participants with household only severe trauma events associated with a higher PTSD score. However, the generation 2 participants’ reported PTSD symptoms did not meet the threshold for probable PTSD with only two participants presenting with a probable PTSD score of 14 or above. This is the first study in Australia that explores the transgenerational impact of Sri Lanka’s civil war experiences on the Tamil migrant community living in Sydney, NSW.

Sri Lankan Tamils are considered as an established and successful migrant community in

Australia. Many Tamils escaped persecution and discrimination in Sri Lanka prior to their migration to Australia. A large part of Sydney’s Tamil community migrated to Australia prior to the civil war’s end in May 2009. Following the end of the civil war in 2009, Tamils also arrived as asylum seekers to Australian shores escaping experiences of persecution and violence. The rates of depression, anxiety and post-traumatic stress disorder were between three and four times higher among Tamil asylum seekers when compared to the rate of Tamil immigrants in Australia (Silove et al., 1998).

This chapter interprets the findings of the current study with references to the relevant trauma literature. The chapter also examines the implications of this study on the current understanding

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Lankan Tamil community. While this was not a primary goal of the investigation, stigma and mental health is a prevalent concern within the Sri Lankan Tamil community that likely impacts the help seeking behaviour of individuals. Finally, the chapter outlines the study’s limitations and identifies future research opportunities before drawing conclusions.

10.2 Interpretation of the Findings

10.2.1 Trauma Experiences and PTSD Prevalence

The Sri Lankan Tamils have been exposed to a significant number of trauma events directly and indirectly as a result of the 30 year civil war as well as other persecution and discriminatory experiences. Trauma is considered as a blow to an individual’s psyche. Kessler et al. (1995) identified that majority of people will experience at least one trauma event in their lifetime. In the current study, the first generation of participants reported greater number of direct trauma events. This is likely associated with the length of time they had spent living in Sri Lanka with more than half of the generation 1 participants (n = 30) disclosing living in Sri Lanka for more than twenty years. Additionally, several participants in generation 1 arrived in Australia following the end of the civil war in 2009 that saw many Tamils arriving on Australian shores in search of asylum. Most were young men with either direct experiences of persecution or those who had witnessed severe violence during the final months of the civil war. The prolonged period that generation 1 participants lived in Sri Lanka is likely to have contributed to greater exposure to experiences of persecution, racism, discrimination and violence. The three most common trauma experiences disclosed by first generation participants were military combat or war zone experience, imprisonment, and torture.

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On the other hand, the second generation participants reported greater indirect trauma events.

This is consistent with almost half of the participants in generation 2 being born in Australia

(n=21) who were not exposed directly to the experiences of persecution and violence that most generation 1 participants reported. The second generation participants also reported the same three trauma events reported by generation 1 as being the most common. These were military combat or war zone, imprisonment, and torture. However, the important difference is that these trauma events were almost always experienced by a member of their household only, with the exception of four participants who reported a direct experience of military combat or war zone.

This can be considered as evidence that the second generation of participants were aware of their parents’ experiences of trauma as per their responses.

The qualitative data additionally identified that generation 2 participants had learnt of their parents’ trauma experiences through a variety of means, including stories from their parents as well as friends, families, documentaries, and attending remembrance events. In Jordanova’s study (2012) conducted through interviews with thirty war survivor families from Bosnia

Herzegovina, the surviving parents had experienced direct war trauma such as torture, rape, and mock executions. The children were born after the war and disclosed that they had learnt about parents’ trauma experiences through disclosures from parents as well as from what they observed on television, newspapers, film and their peer groups. Similarly, Schlenger et al.

(2002) reported that those who watched television coverage of the September 11th attacks in the USA reported symptoms meeting probable PTSD although they had lived outside of the attack sites.

PTSD is the most common psychological response to trauma (Ehlers & Clark, 2000). van der

Kolk (2014) stated that traumatisation occurs when both the internal coping strategies as well

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Self Report questionnaire (PSS-SR) meeting the threshold for probable PTSD. There were only two participants (4.55%) in generation 2 that met the probable PTSD score of 14. As the

PSS-SR did not measure the duration of symptoms (Criterion E), and impaired functioning

(Criterion F), a formal diagnosis of PTSD was not established in any of the participants in this study. The increased rate of probable PTSD within generation 1 participants highlights the severity as well as the complexity of trauma event types experienced. The study by Momartin et al. (2004) explored the prevalence of comorbidity of PTSD and depression in Muslim

Bosnian refugees resettled in Australia. The study showed that although the participants had experienced a stressor five years prior, they still exhibited symptoms of both PTSD and depression. The complexity of the war trauma experience may explain the individuals’ reported

PTSD symptoms years after stressor was experienced.

Transgenerational trauma experiences were identified in generation 2 participants. Figley

(1983) described secondary traumatisation as the psychological impact of trauma on people in close contact with direct trauma survivors. However, transgenerational trauma experiences within a family can also be understood within this definition. Research undertaken by

Woldetsadik (2018), explored the long-term effects of war time sexual violence on women and their families in Uganda. Woldetsadik’s study results showed that the families and siblings of these sexual violence survivors all reported some form of traumatic stress including anger, anxiety, sadness and withdrawal. The first generation participants in the current study reported several trauma events as experienced by their household only. The three most common household only trauma experiences included torture, imprisonment, and non sexual assault by someone you know. These indirect trauma events were considered as evidence of secondary

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This finding shows that although secondary trauma events were reported by generation 1 participants, there appears to be no evidence of secondary traumatisation in this group.

Generation 1 participants reported greater direct trauma events compared to indirect trauma events. It may be possible that the extent of primary traumatisation in the first generation masked any manifestation of secondary traumatisation in this generation sample.

Consequences of trauma are not limited to only those who directly experience the trauma event.

The family also experienced the ripple effects of trauma events (Price, 1997; Kellerman, 2001b;

Sonis et al., 2009; Kagoyirie & Richters, 2018). Generation 2 participants reported transgenerational trauma experiences with most identifying household only experience of military combat or war zone trauma event. There was a large number of generation 2 participants (n=36) who were aware of their household family members’ experiences of the Sri

Lanka’s civil war. As almost half of the generation 2 participants were born in Australia, their awareness of their parents’ experiences were most likely due to shared narratives within their households and the community, the parenting styles of the survivors, or the experience of living with traumatised parents. Kahane-Nissenbaum’s study (2011) of third generation Jewish offspring found that narratives shared by their grandparents had contributed to some positive feelings about their grandparents. Overwhelmingly, 63% of the participants reported being in awe of their grandparent’s capacity to overcome horrific experiences. While Kahane-

Nissenbaum’s study provided evidence of trauma narratives being passed across the generations, it did not provide evidence of trauma symptoms in the third generation offspring as this was not measured. In the current study, it was not possible to find any association between household only experience of trauma events and probable PTSD score in the second

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2 participants were born into a society that provided greater safety for their survival. These participants may have had greater access to education, social support, and emotional support.

They likely felt greater certainty about their future in contrast to the first generation participants in the study. As a result, they may have been able to utilise healthy coping strategies as well as protective factors when exposed to the traumatic narratives from their survivor parents. The lack of participants in the second generation meeting the probable PTSD score is in contrast to

Kellerman’s (2001b) integrative review of a second generation Jewish offspring’s experiences.

In the review, a son of a Holocaust survivor recounted a very vivid dream of life in Nazi

Germany although he was born years after the Holocaust. The reported vivid dream may be associated with the transfer of trauma symptoms such as nightmares from the first generation of survivors to their offspring.

10.2.2 Severity of Trauma Type

There is a need to differentiate the brutality and effect of different events in order to better understand PTSD as a disorder. The type of event that causes the trauma is significant to understanding the consequences that follow the event. However, there is currently limited theory and empirical data available to recommend measures that capture how different severe trauma events may be associated with symptoms of PTSD. As the severity of a trauma event cannot be measured objectively by a third person, trauma research relies on the subjective disclosures from survivors of the meaning attributed to a specific trauma event and the subsequent impact this event has had on their life. Generation 1 participants who had experienced trauma event types other than sexual assault or torture exhibited lower PTSD scores rpbs = - .281, p < .05. These findings show that the self experience of trauma events, when excluding torture and sexual assault trauma events, are inversely associated with PTSD

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Ommeren, 2002). In Sri Lanka, the experience of torture, especially sexual torture, was rampant as reported by Yasmin Sooka (2017) in the International Truth and Justice Project

(ITJP).

Generation 2 participants’ PTSD scores were positively correlated to their household only experiences of all trauma event types (rpbs = .314, p < .05) as well as severe trauma event types such as torture and sexual assault (rpbs = .333, p < .05). However, when sexual assault and torture were removed from the list of trauma events correlated with PTSD scores, there was a statistically insignificant result with a negative correlation value rpbs = - .033, p >.05. In generation 2 participants, it appears that severe indirect trauma events are associated with the

PTSD scores. The above findings show several important insights. Firstly, there is evidence that the direct experiences of severe trauma events are associated with greater PTSD scores in generation 1 participants. Secondly, there is evidence that the indirect experiences of severe trauma events are associated with PTSD scores in the offspring of survivors. Finally, there is evidence of transgenerational transfer of trauma symptoms associated with severe trauma events. These findings are in line with Daud et al.’s study (2005) where the children of torture survivors were more likely to be at risk for PTSD and depression symptoms when compared to children whose parents were not tortured. While there is consistency in the greater risk created by torture, the absence of evidence for effects of other types of trauma is an

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10.2.3 Complexity of Trauma Type and Their Associations

It has been proposed that serious psychological symptoms are likely to occur as a result of prolonged and repeated multiple traumas over the course of a person’s life (Karam et al., 2014;

Wilker et al., 2015). This study did not measure the number of individual trauma events experienced by the participants. Instead the study explored the complexity of trauma event types, measured as the number of trauma events types reported by participants in this study as a self, household or combined trauma event. In generation 1 (rs = .617, p <0.05) and generation

2 (rs = .536, p < .05) samples, there was a very strong positive association between complexity of trauma type and PTSD scores. These finding are consistent with evidence that participants who experienced multiple trauma event types either directly, indirectly or combined, reported greater psychological distress and a higher PTSD score. Bronstein and Montgomery (2011) found that multiple pre migration trauma experiences were positively associated with distress.

The study found evidence of PTSD symptoms, depressive symptoms, and emotional and behavioural problems.

It is important to note that in the second generation sample, the reported trauma events were experienced indirectly as household only trauma events. Within the generation 2 sample, the positive association between complexity of trauma type and PTSD score can be considered as likely evidence of transgenerational transmission of trauma. The complexity of trauma types was described in the Holocaust survivors recounting of their trauma experiences that included death of relatives and detainment in concentration camps (Nadler & Shushan, 1989). Similarly, multiple trauma events were described in the studies of Khmer Rouge survivors. The regime

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University of Sydney was portrayed with brutality, oppression, control and violence. In Marshall et al.’s study (2005) of 586 Cambodian refugees who had migrated to the United States, 99% (n = 484) had experienced severe starvation and near-death circumstances. A further 90% (n = 437) had lost a family member who was murdered. The study found that 62% of participants met the PTSD diagnosis with a further 51% meeting the criteria for Major Depressive Disorder or clinical depression. Although Marshall et al.’s study (2005) did not correlate the complexity of trauma types, it identified that survivors likely experienced multiple trauma event types similar to the findings of the current study.

The current study also found evidence of complexity of interference on daily functioning positively associated with PTSD scores. There was a strong positive association found between the complexity of interference of trauma on everyday life, measured by counts of life areas affected, and PTSD score in generation 1 (rs = .472, p < 0.05) and generation 2 participants (rs

= .556, p < .05). In both generation samples, a higher PTSD score is associated with increased number of interferences in their daily life. The findings of the National Vietnam Veterans'

Readjustment Study (NVVRS) (Price, 2007) showed that although most veterans re-adjusted to post war life on their return to the United States, some continued to experience problems in different aspects of their daily life. These included difficulties in marital relationships, parent- child relationships, and difficulties with work. This is similar to the current study’s findings where both generation samples identified difficulties with family relationships, friendships and overall functioning as the three most common interferences in their daily life. In Price’s study

(2007), the parent-child problematic relationships were found to also have a negative impact on the offspring of the veterans. The veterans’ violent behaviour resulted in the children having a higher risk of behavioural, academic and interpersonal problems. Price’s study (2007) shows evidence of PTSD symptoms affecting the first generation survivors in their daily life

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In contrast to the findings relating complexity of trauma to PTSD symptoms, the current study’s findings differed when correlating the complexity of interference on daily functioning and the complexity of trauma types. The complexity of trauma types was positively associated with complexity of interference in generation 2 participants, with greater number of trauma type exposure associated with greater impact on daily life. This finding varied in generation 1, where the complexity of trauma type was not positively associated with complexity of interference.

This shows conflicting evidence that interference in daily life is not solely associated with the number of trauma event types experienced. Fewer or a single trauma event type may also be associated with greater number of life areas affected. A severe trauma event such as sexual assault or torture may have far more significant impact on daily life. Torture impacts an individual emotionally, physically, and socially (Gurr & Quiroga, 2001). Torture survivors also commonly disclose survivor guilt and shame that may result in them withdrawing from daily life (Carlsson et al., 2006). They also have increased comorbidity to anxiety, depression and adjustment difficulties which may contribute to greater number of life areas affected.

10.3 Trauma Themes Across Generations

The open ended questions included in the PSS-SR questionnaire provided an avenue to further understand the trauma experiences of both generation samples that were not captured by the listed trauma events. A total of four trauma themes were identified following the content analysis of the qualitative data. These included grief and loss, violence and torture, stories and survival, and social displacement. The study’s aim was not to examine the factors that facilitate the trauma transmission process. However, the first three themes were identified as providing

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10.3.1 Grief and Loss

Sri Lankan Tamils lost their livelihoods, relationships, status and traditional homelands when the civil war began. Loss emerged as a key theme in the current study. The experiences of grief and loss identified by the participants in this study vary significantly. For the generation 1 participants, the death of family and friends resulted in disruption of connections to family and greater community. The loss of this community support may have resulted in destruction of social structures that supported women within their households. Even in settled new environments and within the safety of new homes, research participants worried about their families left behind without any community supports, “sense of community has been lost for us, we feel isolated and alone. Our family is back home still suffering.” The generation 2 participants disclosed that they had learnt about these losses through the first generation’s account of their survival, “my mum lost her sister when she was young due to the war. She died in an air raid. I only heard the stories.” The study by Somasundaram (2007) found that

Tamils had lived through the war and experienced repeated displacements resulting in disruptions to livelihoods. Additionally, the Tamils’ experiences of destroyed villages were symbolic of loss beyond the physical structure of buildings. These included the loss of connections, loss of social institutions, and the loss of crucial support systems. Loss is a significant theme in any refugee or migrant’s journey to safety: loss of lives, loss of livelihood, loss of culture, loss of language, loss of identity and loss of homes (Eisenbruch, 1990). Several studies have identified grief and loss in refugee communities around the world (Tay et al.,

2015; Craig et al., 2008). Tay et al.’s (2015) study found that 41% of West Papuans experienced the traumatic loss of a family member and Craig et al. (2008) found up to 54% of

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(PGD).

During periods of unrest and displacement, families who have been lucky enough not to lose anyone may still experience loss of family due to separation from one another. This experience of family separation was reported by a generation 2 participant in this study, “father was separated from us for four years during the civil war, difficult for mum to be a single parent”.

Using an attachment theory lens, we understand that humans are wired to seek proximity to those we love and to those who provide us with safety. Displacement experienced as a child is likely to disrupt the child’s sense of attachment to home as well as parental figures. A separation anxiety response may be created when proximity to attachment figures may be threatened repeatedly in an environment of separation or abandonment (Bowlby, 1969). The need for attachment figures and support networks during civil wars play a key role in securing one’s own survival (Silove et al., 1995). Many Tamil families experienced separation from one another due to the civil war. This was due to the persecution of Tamil males who were often suspected of being an LTTE member. As a result, they often faced restrictions on movement and were in hiding for their own safety as well as the safety of their family. Other families were also separated along the refugee journey to find safety, “My wife and children lived in an Indian refugee camp since 1989, I can't forget being away from them.” In the study of West Papuans

(Tay et al., 2015), it was found that many survivors lost family members in the mass conflict and these early experiences of loss may have increased their ongoing worries about their family members who are still alive. Although loss is experienced first-hand within the first generation participants, the second generation also identifies that sense of loss through visiting the former homes of their parents, “went back to the parents’ village and felt depressed at their life now and how they had lived.” In this example, the trauma becomes a shared experience between two generations.

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10.3.2 Violence and Torture

Sexual violence and torture have been described as a severe type of trauma event. In particular, the impact of sexual assault may be manifested biologically, psychologically, and sociologically. Sexual violence is an example of common violence perpetuated by the military during periods of mass conflict. In 1998, the United Nations released a report identifying sexual violence as a weapon of war. Historically, rape was considered by the military as legitimate spoils of a war. In World War 2, Soviet leader Joseph Stalin encouraged the use of sexual violence against conquered European populations as the Soviet troops fought their way to the

German capital. In 1994, between 250,000 and 500,000 Rwandan women and girls were raped during what is now termed as the Rwandan Genocide.

In the current study, sexual violence was described by both generation 1 and generation 2 participants. A generation 1 participant reported direct experience of sexual violence, where she was “sexually assaulted with pipes”. This is similar to the findings by Sooka (2017) as part of the International Truth and Justice Project report that identified twenty four sworn testimonies of abduction, illegal detention, sexual violence and torture during the period of

2016-2017. Further allegations of sexual violence have been reported in Sri Lanka over the last ten years since the civil war came to a bloody end (Hogg & Human Rights Watch, 2013).

In the current study, the first generation participants who fled Sri Lanka had recalled their horrific experiences to their offspring, “my parents were detained by the IPKF army and my mum was sexually assaulted when she was pregnant with my sister.” However, many men and women find it difficult to disclose sexual violence as a result of the conservative Tamil culture.

Within the Sri Lankan community, the impact of rape can be both emotionally and psychologically devastating because of the strong communal reaction to the violation and the pain endured by families. It becomes not only a weapon of war, but a weapon used to

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University of Sydney intimidate, terrorise and socially isolate a survivor. Not everyone who is a survivor of sexual violence is ready to speak out. Journalist Frances Harrison (2020) states that:

Not all victims want to be survivors’ champions. Those who are brave enough to do

this should be celebrated but not at the cost of those who prefer to remain private, who

don’t want to tell the world how they were brutally gang raped in a dirty cell, after

randomly surviving a death march through the jungle, then being burnt, asphyxiated,

half drowned and beaten.

Research has found that the severity, perceived distress, and uncontrollability of torture are related to poor psychological functioning (Basoglu, 2009). Boosa is a maximum security prison located in the Southwest of Sri Lanka. This was a notorious site for the torture of many Sri

Lankan Tamils. In 2017, Boosa prison was identified in Sooka’s report (2017) as a torture site.

A Human Rights Watch report (2018) titled ‘Locked Up Without Evidence’ recounted 34 stories of detainees who were detained under the Prevention of Terrorism Act (PTA). One of these detainees in the Humans Rights Watch report (2018) disclosed the following.

When they couldn’t find [my brother], they arrested me instead. I was taken to Boosa

and tortured all over again. They asked me to admit that my brother had been in the

LTTE. I was hanged and beaten so badly that I admitted to it even though I don’t know

if it’s true or not. When I was finally produced before a judge in September, the judge

ordered me to be released, saying there was no connection. I was 13 years old when the

war ended. I didn’t even know what the LTTE was. But I’m still being harassed. They

are harassing Tamils.

Two participants in generation 1 disclosed the following similar torture experiences in the same location as identified in the reports by Sooka (2017) and Human Rights Watch (2018).

I spent 4 years in a jail in Boosa, I was tortured and hung upside down.

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Spent time in Boosa camp in early 90s after a bomb went off and they arrested every

Tamil they could find.

Kira et al. (2013) described torture as a complex multilateral trauma that is inclusive of different trauma types designed to humiliate and annihilate an individual’s personal and collective identity. In the current study, there were six second generation participants who identified a household only experience of torture. In comparison, a total of sixteen generation 1 participants identified a direct experience of torture in generation. It appears that there was an under disclosure of torture experiences across generations. This may be due to feelings of shame as identified in studies of torture survivors in Nazi camps (Levi, 1989) as well as more recent studies with refugees where shame has been found to be associated with violence experienced pre-migration and post migration (Hodges-Wu & Zajicek-Farber, 2017). Similarly, sexual violence has also been identified as causing feelings of shame with survivors of rape choosing to give evidence behind a screen before the South African Truth Commission (Hayner, 2001).

It is important to point out that the two generation groups in the current study were not matched to a single household. Therefore, it is possible that generation 2 participants were from households that experienced fewer instances of torture and sexual assault than the generation

1 sample.

10.3.3 Stories and Survival

Kienzler (2008) described trauma narratives as an interplay of stories and culture. These shared stories can be considered as acts of resistance by refugees and migrants to engage in cultural continuity and preserve their identity in their newfound places of safety. Emotions are also shared within the narrative content of a story. For example, the anger placed with the aggressor may be transmitted along with the story with children too feeling anger towards the aggressor.

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In the current study, narratives of survival through loss were shared within families through participation in rituals as well as community activities, “I was very young when I moved here but my parents celebrate anniversaries of my uncles' death, so I know they were caught up in the civil war; Mum is active in the community, helps other asylum seekers in the community.

I know their stories and visit church with them.” This is in contrast to the findings in

Wijeyasuriyar’s (2018) research exploring trauma transmission in second generation Canadian

Tamils, it was found that family members wanted to remain strong and protect each other and as a result allowed for feelings of sadness only when alone. The youth stated that they wished their parents communicated more about how they felt, where they had come from, why their left and why they cannot return.

The current study found that several generation 2 participants reported hearing accounts of past trauma experiences from their surviving parents and extended family. They reported hearing these stories from a safe distance but still identified feeling sadness, helplessness and anger when recounting the events. The second generation participants reported a ‘narrative’, or a

‘story’ told by a mother, father or a grandparent of their family member missing, shot dead or being displaced as a result of the war. Jordanova (2012) identified that gender differences existed in collectivist cultures where stories were shared predominantly through mothers and grandmothers who may be identified as custodians of culture and tradition in keeping with convention. Although Sri Lankan Tamils are collectivist in nature, generation 2 participants did not disclose hearing stories more from maternal family members. This may be due to members of the extended family living in other parts of the world through displacement and migration. As a result, the stories are only able to be shared with those currently living with the second generation participants.

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Stories of loss are often difficult to share for many families. Kahane-Nissenbaum’s findings

(2011) showed that Holocaust survivors’ narratives were passed onto future generations and stories of heroism were shared. Kahane-Nissenbaum’s study did not report on specific trauma symptoms in the third generation participants. A few participants reported dealing with symptoms of anxiety and depression but could not specify whether it was attributed to their own struggles or that of their parents. In the current study, the second generation of participants reported trauma symptoms with their household only severe trauma events positively associated with their PTSD scores. The sharing of trauma narratives across generations appears to play a role in facilitating the transfer of trauma symptoms. However, not all stories are able to be shared. Almqvist & Broberg (1997) identified a strategy of denial and silence within families about previous traumatic experiences. This may be a strategy to protect their children from hearing horrific stories. This mutual silence may become an obstacle in providing professional support for traumatised children when working with survivors of horrific trauma experiences. Nevertheless, heroic or stories of overcoming adversity may be less horrific to share across generations to increase group participation. An example is the positive nature of a group affiliation for Indigenous youth in their political struggle as a collective group (Wexler et al., 2009).

10.4 Transgenerational Trauma

The model by Ancharoff et al. (1998) identified four factors that may be facilitating the transfer of trauma symptoms across generations. These are silence, over-disclosure, identification, and re-enactment. These factors will be discussed in reference to the current study’s findings as well as relevant literature.

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10.4.1 Silence and Over-Disclosure

Silence refers to the process by which surviving parents may not share details of their past trauma experiences with their offspring. A variation of silence is the process of under disclosure in which a parent may not reveal full details of their past trauma. The silence maintained by survivors may lead children to fantasise about the actual events (Daud et al., 2005). Over disclosure refers to the over sharing of trauma narratives in a manner that is not age appropriate.

Over-disclosure is likely to be harmful due to the individual’s lack of capacity to process the horrific nature of the shared information. Under disclosure and over disclosure have been suggested as mechanisms of transgenerational transmission of trauma symptoms.

In the Sri Lankan context, Somasundaram (2007) proposed that the conspiracy of silence is maintained within families for fear of disclosure leading to further persecution. A disclosure from an individual that their family member was taken away by a Tamil militant group as opposed to the Sri Lankan military may result in that family being ostracised and branded as traitors by their very own Tamil community. Similarly, Kalayjian et al. (1996) found that seventy five percent of Armenian Genocide survivors who were interviewed had not spoken to anyone about their trauma experiences for fear of further persecution of self and their loved ones. In the current study, a generation 2 participant reported that they did not know much about the civil war and only found out information through watching a documentary. A second participant disclosed that they had overheard their parents talking about the war with family friends. Although these disclosures do not confirm silence, they indicate under disclosure and the likelihood that parents who were survivors of the Sri Lankan war may not have shared their experiences with their children as openly as others. Research also shows that silence can pass on traumatic messages as powerfully as words even in the absence of them (Ancharoff et al.,

1998).

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Family Systems Communications Theory argues that both the child and the parents protect one another from painful experiences by maintaining silence. Surviving parents may choose to not share painful trauma memories of their past as they do not want to burden their children. In this study, several generation 2 participants disclosed that they were aware of their family member’s experience of sexual assault, displacement, death, and imprisonment. Although the second generation participants in this study identified awareness of several trauma events, torture was not disclosed as commonly as other trauma events. This may be related to the surviving parents not wanting to talk about the severity of this trauma event with their offspring due to feelings of shame as discussed in the above section. The evidence of trauma symptoms in the second generation of participants in this study indicates that under-disclosure by surviving parents may have had an impact on the psychological state of the offspring.

Over-disclosures can also result in the transfer of trauma symptoms. In Kahane-Nissenbaum’s study (2011) of third generation offspring of Holocaust survivors, a participant continued to have nightmares of someone coming to take her or her parents away following her grandfather’s recounting of his survival. The survival narrative of the grandparent appears to have impacted the safety of the young child’s world. When there has been appropriate disclosure of trauma events, offspring have reported fostering a greater connection to the surviving parent. In the current study, a single generation 2 participant identified a sexual assault experience of a parent. It is difficult to assume that a disclosure of a severe trauma event is an over disclosure without knowing the age of the participant when made aware of the trauma event and their subsequent reaction to this knowledge. The generation 2 participant understanding the parent’s full story may have been helpful in creating a new meaning of the trauma event. In Kagoyirie & Richters’ study (2018), those who heard their mother’s ‘full story’ stated that they were finally able to see that their mother was not immoral or wicked.

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When the offspring were able to hear the full narrative from the mother, this allowed for the creation of new meaning of the traumatic event and replace the perspective of his or her mother as immoral and wicked with someone who was vulnerable and needing empathy. The content of the trauma events and how these trauma events are shared may determine the presence or absence of psychological distress in the offspring.

10.4.2 Identification

Identification can be described as both a conscious and unconscious process. Conscious identification is where an offspring of a survivor may identify with who they are and the trauma experiences of their racial and cultural group. Offspring may attempt to make meaning of the parents’ past trauma experiences and additionally share in their experience of pain (Rowland-

Klein & Dunlop, 1998). The qualitative study by Kagoyirie & Richters (2018) involved focus group discussions and semi structured interviews with offspring of Rwandan women. In these homes, the offspring reported being given the same name as a deceased relative, often becoming a symbol or memory representation of a loved one to their family. The memory of a past trauma appears to be unintentionally passed down to the future generation through practices of maintaining their legacy. A second generation participant identified attending heroes day, a commemorative event translated in Tamil as Maveerar Naal where the fallen

LTTE cadres are remembered by the community. Mourning for families and communities is an important step in healing. The process of memorialisation has been restricted in Sri Lanka and as a result many in the diaspora community practice these rituals in host nations such as

Australia. Through the mourning rituals, the past trauma experiences are remembered as a community. The public grieving process allows for past experiences of violence, persecution and loss to be remembered by the first generation survivors and to be acknowledged by the

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10.4.3 Re-enactment

Re-enactment refers to the process of acting out past trauma events to make more sense of what had happened and reduce feelings of helplessness and hopelessness. Re-enactment also offers an opportunity to integrate the experiences of the trauma to the self as part of trauma processing. A generation 2 participant disclosed that their mother continued to have nightmares following years of living next to an LTTE camp which was a target for air raids. Nightmares related to past trauma events are a common symptom of PTSD. Neylan et al. (1998) found that

52% of Vietnam War veterans with a diagnosis of PTSD had reported experiences of nightmares that included the re-enactment of their past trauma experiences in the military. This finding was compared to two other groups, veterans without PTSD (5.7%) and civilians (3.4%), where the experience of nightmares was less common. Re-enactments can be associated with individuals who may be struggling to contain their trauma symptoms. The current study did not find evidence of re-enactment being associated with the transfer of trauma symptoms to the second generation. However, it can be proposed that the trauma narrative is instead shared between the two generations through the acknowledgement of nightmares related to past trauma history.

10.5 Implications of the Findings

10.5.1 Implications for the Understanding of Transgenerational Trauma

The current study found evidence of transgenerational trauma in the second generation of participants. The continued exploration of transgenerational trauma may support trauma clinicians to better understand and treat psychological pain in families. Danieli et al. (2015)

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(those who have difficulty moving on from the original trauma, experience fear of the world and fear of trauma recurring), the numb (those who are emotionally detached, maintain a conspiracy of silence, and isolate from the community), the fighter (those who have intense drive to build and achieve, intolerant of weakness or self-pity, and determination that no-one else should experience what happened to them), and those who made it (those who deny their

Holocaust experiences and distance themselves from the trauma events, and those who are socioeconomically successful).

These four adaptive styles are described as becoming an individual’s integral part of their personality, their world view, and their parenting style (Danieli et al., 2015). In the current study, the first three adaptive styles were observed. A generation 1 participant identified being a victim through their disclosure of ongoing fear of death. A generation 2 participant identified the conspiracy of silence where the parents did not share their trauma experiences with them.

They watched documentaries to further understand the parents’ past trauma. Finally, the fighting spirit is captured in the disclosure from a generation 2 participant ‘Mum is active in the community, helps other asylum seekers in the community. I know their stories and visit church with them’. Although these four adaptive styles described by Danieli and colleagues are based on studies with Holocaust survivors, they are likely to be adapted to other populations who have suffered mass trauma.

10.5.2 Implications for Therapeutic Work

There are several implications for counselling practice following the findings from this research study. The current study adds further support to the existing understanding that trauma can be experienced directly and indirectly. The study shows that it is not just the experience of

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The current study identifies that trauma narratives and symptoms are manifested across generations even when clinical thresholds of PTSD are not be met. The trauma narratives and symptoms also appear to be passed onto offspring even after reaching physical safety in host nations. It would be a worthwhile consideration to explore how therapists can create spaces for individuals to explore their trauma experiences of the self as well as their family members before clinical thresholds are met for psychological disorders. Transgenerational trauma impacts upon the family unit. This can be due to parenting behaviours, emotional attachments, and parent-child relationships. Survivors appear to share their trauma narratives within households. When severe experiences of trauma events are shared, they appear to be associated with the psychological health of the offspring. Family and community based trauma work that bring individuals collectively together can support healing from transgenerational trauma experiences. It is crucial to re-establish safety for both the family and the community in a new environment as a first step towards healing.

Healing from experiences of grief and loss may require participation in mourning practices in the new homes as these were often limited in Sri Lanka due to risk of persecution by the government if those who died had actual or perceived links to the LTTE. The wives of the disappeared men were often unable to perform the required religious rituals due to fear of political retaliation. This transformed traditional religious rituals, considered to heal communities, into stressors (Thiruchandran, 1999). Grief therapy advocates for culturally appropriate trauma informed work to bring closure to those who have lost loved ones. Silove

(2013) advocates for a space where cultural grieving and mourning practices can be practised.

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Culturally appropriate psychological trauma work can be achieved through the use of religious symbolism and folk stories, re-telling trauma experiences through culturally appropriate language, using idioms of distress and explanatory models of mental illness, exploring cultural norms and traditional ways of coping, and providing psycho-education to reduce mental health stigma.

10.5.3 Implications for Trauma Measures

Although this study utilised a Western-centric PTSD measure, it recognises that there may be more accurate results achieved using culturally appropriate measures to assess trauma symptoms. Trauma measures have been developed with a Western-centric approach to suit the needs of populations across Western nations. This is likely due to the large amounts of research conducted with Western populations to assess trauma measures over the years. However, the limitation of this process is that the role of culture has not been considered in the understanding of PTSD symptoms. Although trauma is a global issue (Schnyder, 2013), trauma related disorders may vary across cultures. Culture plays a role in how meaning is attributed to trauma events, how trauma symptoms are manifested, and what treatment modalities may be considered as culturally appropriate to support both the individual and community. It is a possibility that PTSD symptoms in non-Western populations may include symptoms not included in the current trauma measures. Over the years, PTSD rate estimates have varied among trauma affected populations with inconsistency in rates of PTSD reported ranging from

7% to 86% (Fawzi et al., 1997).

Idioms of distress have been identified as a unique way to capture psychopathology in non-

Western population samples. de Jong (2002) identified the use of culturally appropriate measures as an essential step to accurately assess for psychological disorders. Culturally

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University of Sydney specific descriptions of trauma have been identified. Cambodian refugees reported a neck focused panic (Hinton et al., 2006) while the Vietnamese refugees identified with the sensation of a heart being squeezed (Phan, Steel, & Silove, 2004). Further research needs to be undertaken to explore the similarities and differences between the widely-reported Western notions of trauma, and the equivalent conceptions of trauma found in other cultures. This will result is increased cultural competency across the trauma sector.

10.5.4 Implications for Protection Visa Determination Interviews

The current study’s findings show that the severity of trauma experiences, such as sexual violence and torture, is associated with higher PTSD scores in generation 1 participants. These severe trauma experiences have been identified in literature as being associated with shame in survivors. The current study also found evidence of under-disclosure of these severe trauma events across generations. It would be important to acknowledge that war trauma survivors may not always disclose past experiences of torture and sexual violence in the context of asylum interviews as these experiences may be too painful and shameful to share with others.

Bogner, Herlihy, and Brewin (2007) identified the central role of shame in disclosing sexual violence in the asylum process with the UK Home office. The participants with a sexual violence history reported greater feelings of shame than those with a non sexual violence history. Non-disclosure can be commonly perceived as a sign of dishonesty in an individual.

Three participants in the study above identified the need to build confidence and trust before talking about sexual issues as a reason for non-disclosure. A further eight participants identified the gender of the interviewer as a reason for their ability to disclose trauma events. The disclosure of sexual violence for male survivors may be more difficult as a result of sociocultural stereotypes of masculinity and barriers relating to cultural stigma.

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10.6 Additional Consideration

10.6. 1 Mental Health, Stigma, and Help Seeking Behaviour

It is estimated that between 5-10% of Sri Lankans may be suffering from mental health challenges requiring psychological support (Castillo, 2009). Resources and mental health funding have always been low in Sri Lanka. There is only a single psychiatrist for every

500,000 people in Sri Lanka (Siva, 2010). This leaves the burden of caring for the mentally ill individuals on their families. Stigma related to mental illness has been described as the foremost barrier to those seeking help (Sartorius, 2007, p. 810). Although stigma associated with mental health is common, there may be cultural differences in how this is experienced.

Many Sri Lankan families may hide mental illness from their community to avoid discrimination. Families may feel embarrassed, weak and uncomfortable with any disclosures of mental health struggles. Disclosures of sexual violence can be both emotionally and psychologically devastating. Additionally, the disclosure of mental illness in a family member may impact the prospect of marriage or employment opportunity for the same individual or another family member (Lauber & Rösser, 2007; Larson & Corrigan, 2008). Within a Sri

Lankan cultural context, there is significant weight placed on these life events that are affected due to the stigma mental illness.

Literature suggests that women may maintain their traditional roles as nurturers and homemakers within their homes (David, 1991) instead of seeking support for their mental health. Hall (1994) argues that diasporic communities attempt to maintain the culture as they remember it from their country of origin and this burden falls on women, who are seen as biological and cultural reproducers (Anthias & Yuval-Davis, 1989). In the current study, almost three quarters of the surveyed population (77.9%) reported that they had not sought mental health support for themselves. Existing mental health stigma in Sri Lanka may still play a role

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Further barriers to seek help include limited awareness of mental disorders, limited capacity to negotiate the health system, decline in family cohesiveness and fear of rejection and stigma from the community.

10.7 Limitations

This study had several limitations. This study is both a quantitative and qualitative study that relied on voluntary participations from those who wanted to share their trauma experiences.

The study is also a cross sectional study which cautions against drawing causal inferences. One of the limitations of the study was that detailed information was not collected through one-on- one interviews or focus groups. A decision was made to utilise survey method so that a greater number of participants were able to participate in this study. The survey collection method also allowed for the anonymity of participants especially in a community where many struggle with mental health stigma. Those impacted by trauma often find it difficult to talk about their experiences with strangers. This may be due to a lack of safety in sharing information or feelings of overwhelm that may be limiting in how trauma narratives are shared. For many survivors of mass violence, the first step prior to any trauma disclosure is to build trust and rapport. This is labelled as the therapeutic alliance between therapist and client. However, this process may take longer as some clients may need additional time to establish safety. The survey method was intentionally chosen to minimise any further re-traumatisation of the participants. A further limitation of the sampling methodology was that it could not ensure that the study contained generation 1 and generation 2 participants from the same family. As a

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Another limitation of the study was that it did not exclude the possibility that some of the reported symptoms could have been caused by another traumatic experience such as a migration trauma experience or a settlement trauma experience. The first generation participants, many having lived in Sri Lanka for more than twenty years, likely additionally experienced multiple lower level harmful events before civil war began. These lower level yet harmful events are described by Brown (2008) as insidious trauma. It is also possible that the participants were inclined to either exaggerate their symptoms or trauma events (e.g. for reasons of political or ideological condemnation of the Sri Lankan civil war), or minimise it

(e.g. in order to avoid presenting themselves or their community as being psychologically impacted and therefore ‘weak’ or ‘crazy’). Furthermore, Somasundaram (2007) described

Tamils as having a tightly controlled and closed society. The social pressures of the Tamil community to have a single unifying voice was immense. This unifying voice was likely an adaptive response in times of war and persecution. This meant that those who had disagreed or voiced a dissimilar experience were quickly ostracised by the community, some even labelled as a traitor. There may have been participants who were reluctant to share experiences that dissented from the collective and unified voice. The current study may have presented the experiences of the dominant narrative of the trauma experiences shared by the Tamil participants who responded to the study.

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What the study was not able to investigate was the chronic nature of war trauma and potential association to PTSD scores. Prolonged exposure to war and its horrors result in feelings of helplessness, hopelessness and overwhelm. Moreover, research suggests that individuals who experience chronic trauma have lower rates of recovery from PTSD (Famularo et al., 1996;

Altawil et al., 2008). The trauma event, military combat or war zone, was reported as a trauma event by the majority of the participants in generation 1 and 2. This trauma event was likely to have been experienced by generation 1 participants as a prolonged trauma event spanning years if not decades. However, the PSS-SR questionnaire did not measure how often trauma events had happened, or how prolonged the exposure was for a participant. The lack of questions requesting recall of graphic details of how often the trauma event happened and how prolonged the exposure was may have minimised any re-traumatisation for the participants.

The current study’s findings provide evidence of transgenerational trauma in the second generation participants, however the data collected does not illuminate the actual trauma transmission mechanisms that were facilitating the trauma symptoms across generations. It is difficult to conclude whether traumatised parents were struggling with their own mental health challenges psychologically that they simply were not able to provide a healthy nurturing family environment or if they transmitted trauma symptoms by silence or over-disclosure. However, steps required to answer these questions may present with additional barriers of their own.

Participants may have struggled to acknowledge the possibility that their parents were not good parents. Additionally, the information needed may not have been consciously known by participants, and would in any case have required they remember events that occurred over a period of many years, from infancy. More importantly, asking further questions to gather scientific data may have resulted in potential further harm to the participants. The current research study aimed to reach a balance between gathering enough information to illuminate

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10.8 Further Research and Conclusion

It is recommended that further research be undertaken to understand the complexities of transgenerational trauma, displacement and resettlement challenges for both established and emerging migrant communities. Replication of this study involving other refugee and migrant groups is recommended to determine whether these findings are representative of all refugee communities. Research with other migrant communities may show that the experiences of Sri

Lankan Tamils may be similar or different to the experiences other migrant communities who have escaped violence and civil war. It is also important to look more closely at resilience as a protective factor in subsequent generations following migration. Future research is encouraged to have greater representation of women’s voices so that their experiences and narratives can be heard and shared. This is vital to challenge the conventional understandings of women’s experiences during war (Buckley-Zistel & Stanley, 2012; Kent, 2016).

Armed conflicts, civil wars and genocides result in mass trauma, persecution, discrimination and displacement of families and communities around the world. Millions around the globe have been displaced as refugees as a result of war. The current study contributed to the study of PTSD from the wider lens of a transgenerational perspective. This study demonstrated that trauma experiences can be direct, indirect or both. The study also provided further support to the notion that experiences of trauma impacts the individual, family, and the community. The findings of this study have contributed to an increased understanding of direct trauma experiences of the first generation of Sri Lankan Tamils and the transgenerational trauma experiences of the second generation of Sri Lankan Tamils residing in Sydney, Australia. The

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Appendix A – Human Research Ethics Committee Approval Letter

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Appendix B – Demographic Questionnaire in English

DEMOGRAPHICS SHEET

For the following items, please select the one response that is most descriptive of you or fill in the blank as appropriate.

1. Gender: female male

2. Age: _____

3. Religion ______

4. What is your marital status: Single Married Divorced/Separated Widowed

5. Are you currently employed: Yes No

6. Occupation: ______

7. Highest Educational level: Did not complete High School Completed High School Completed University

8. Place of birth: Sri Lanka Australia Other (please specify): ______

9. Number of years spent living in Sri Lanka: <10 years 10-20 years > 20 years

10. The year that you migrated to Australia: ______

11. Have you sought mental health support in the past: Yes for ______No

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Appendix C - Demographic Questionnaire in Tamil and English

DEMOGRAPHICS SHEET

Please do not write your name on this form. It will be stored separately from any other information that you complete during this study and will not be linked with your responses in any way. The information will allow us to provide an accurate description of the sample. உங்க쿁டைய பெயடை இந்த ힿனாக்பகாத்鎿ல் எ폁த வேண்ைாம். உங்கடை அடையாைம் காை்翁ம் ힿெைங்கை் ஆய்ퟁ ힿனாக்பகாத்鎿ல் இ쏁ந்鏁 ꮿைிோக வேை்க்கெ்ெ翁ம்.

For the following items, please select the one response that is most descriptive of you or fill in the blank as appropriate.

1. Gender ொ쮿னம்: female பெண் male ஆண்

2. Age ேய鏁: _____

3. Religion மதம்: ______

4. What is your marital status உங்கை鏁鎿쏁மண நிடல: Single 鎿쏁மணம் ஆகாதேை் Married 鎿쏁மணமானேை் Divorced/Separated மண믁잿ந்தேை் Widowed தாை뮿ழந்தேை்

5. Are you currently employed நீங்கை் தற்பொ폁鏁 வேடல பேய்垿쟀ை்கைா?: Yes ஆம் No இல்டல

6. Occupation பதா펿ல்: ______

7. Highest Educational level கல்ힿநிடல: Did not complete High School உயை்தை ொைோடல 믁羿க்கힿல்டல Completed High School உயை்தை ொைோடல 믁羿த்த鏁 Completed University ெல்கடலக்கழக ெ羿ெ்ꯁ 믁羿த்த鏁

8. Place of birth ꮿறந்த இைம்: Sri Lanka இலங்டக Australia ஆஸ்鎿வை쮿யா Other (please specify) வே쟁 நா翁 : ______

9. Number of years spent living in Sri Lanka இலங்டக뾿ல் ோழ்ந்த காலம்: <10 years (10 ே쏁ைத்鎿ற்க்埁埁டறய) 10-20 years (10-20 ே쏁ைத்鎿ற்க்埁 உை்ை) > 20 years (20 ே쏁ைத்鎿ற்க்埁 வமல்)

10. The year that you migrated to Australia ஆஸ்鎿வை쮿யாힿற்埁 எந்த ஆண்翁 ேந்鏀ை்கை் ?: ______

11. Have you sought mental health support in the past நீங்கை் மன நிடல அ쿁த்தங்க쿁க்埁 ஆதைퟁ/உதힿ பெற்쟁 இ쏁க்垿쟀ங்கைா ?: Yes ஆம் for (என்ன மன நிடல வகாைா쟁க்埁) ______No இல்டல

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Appendix D – Participant Information Sheet in English

Room T419 Discipline of Behavioural and Social Sciences Faculty of Health Sciences

Faculty of Health Sciences Dr Gomathi Sitharthan Cumberland Campus C42 Senior Lecturer in Psychology East Street (PO Box 170)

Lidcombe NSW 1825 Telephone: +61 2 9351 9584 Facsimile: +61 2 9351 9400 Email: [email protected] PARTICIPANT INFORMATION SHEET

Title: Post traumatic stress disorder and Sri Lanka’s 30 year civil war – A study of transgenerational trauma

(1) What is the study about? This study explores the war trauma experience by the first and second generation Sri Lankan Tamils and the impact of this trauma on their day to day lives. This study will also look the second generation of Sri Lankan Tamils living in Australia and if they show symptoms of secondary traumatisation.

(2) Who is carrying out the study? The study is being conducted by Dr. Gomathi Sitharthan, Senior Lecturer in Psychology, Discipline of Behavioural and Social Sciences in Health, University of Sydney; and Neeraja Sanmuhanathan, Post Graduate Student, University of Sydney.

(3) What does the study involve? The study invites participants to complete a self-report questionnaire using the Post Traumatic Stress Disorder symptom scale which will take approximately 15-20 minutes to complete. This questionnaire is confidential. This questionnaire will be completed anonymously; no identifiable information will be collected.

(4) Can I withdraw from the study? Being in this study is completely voluntary - you are not under any obligation to participate in the study and you can leave questions unanswered if you feel uncomfortable. If you consent to being part of this study, you will be required to click the “SUBMIT” button or hand in the paper questionnaire. If you decide NOT to consent do not click the “SUBMIT” button or hand in your questionnaire at completion. You can withdraw any time prior to submitting your completed questionnaire/survey by closing the window on the web browser. Once you have submitted your questionnaire/survey anonymously or handed in your paper copy, your responses cannot be withdrawn.

(5) Will anyone else know the results? All aspects of the study, including results, will be strictly confidential and only the researchers will have access to information on participants. A report of the study will be submitted for publication, but individual participants will not be identifiable in such a report. A report will be

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submitted to the community organizations at the completion of the study. This report could be accessed through their web page.

(6) Will the study benefit me? Your participation in filling out the survey will raise your awareness of Post Traumatic Stress Disorder. This is a clinical disorder that may impact on day to day life. The participation will highlight the issue of PTSD experience of some of the participants who have gone through the war experience. This study will provide insight into how the second generation of Sri Lankans may have been impacted indirectly by the war. The findings will shed light into impact of war, raise awareness within the community as well as influence policy makers to develop relevant programs and provide further support to this migrant population.

If you are experiencing some of the symptoms, you may wish to seek treatment. You can do so by liaising with your GP or a mental health practitioner. Please find the contact details under question 9..

(7) Can I tell other people about the study? We would encourage you to discuss this project with others. Any one who is interested in this project can contact Dr Gomathi Sitharthan on (02) 9351 9584 or [email protected] .

(8) What if I require further information? When you have read this information, Dr Gomathi Sitharthan will discuss it with you further and answer any questions you may have. If you would like to know more at any stage, please feel free to contact: Gomathi Sitharthan, University of Sydney; (02) 9351 9584 or [email protected] or Neeraja Sanmuhanathan, University of Sydney on 0433 401 836 or [email protected]

(9) What if I feel distressed during or after completion of the questionnaire? We strongly encourage you to speak with your general practitioner; they may be able to refer you to see a mental health professional. You can also contact STARTTS, who provide counseling and rehabilitation for torture and trauma victims, on 9794 1900. You can also contact Australian Psychological Society on 8662 3300 or Multicultural Mental Health Australia on 1300 136 289.

(10) What if I have a complaint or concerns?

Any person with concerns or complaints about the conduct of a research study can contact the Deputy Manager, Human Ethics Administration, University of Sydney on (02) 8627 8176 (Telephone); (02) 8627 8177 (Facsimile) or [email protected] (Email).

This information sheet is for you to keep

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Appendix E – Participant Information Sheet in Tamil

Dr Gomathi Sitharthan

Senior Lecturer in Psychology

பங்கேற்பாளர்ே쿁ே்ோன தேவல் ப羿வம்

1. இந்த ஆய்ힿல் என்ன நடே்垿ற鏁? வொைி쮿쏁ந்鏁 தெ்ꮿய இலங்டக த뮿ழை்க쿁க்埁 ஏற்ெை்ை காயெ்ெ翁த்鏁ம் அꟁெேங்கடை뿁ம் அக்காயங்கைால் நாைாந்த ோழ்க்டக뾿ல் ஏற்ெ翁ம் தாக்கங்கடை뿁ம் அ잿ய 믁ய쯁ம் ஆய்போன்잿ல் ெங்埁ெற்ற உங்கடை அடழக்垿வறாம். அத்鏁ைன் , அퟁஸ்鎿வை쮿யாힿல் ோ폁ம் இலங்டகயைின் இைண்ைாம் தடல믁டற뾿னடை뿁ம் வொை் அேை்கை鏁 ோழ்ힿல் ஏற்ெ翁த்鎿뿁ை்ை தாக்கத்டத뿁ம் ஆய்வோம்.

2. யார் இந்த ஆய்ퟁே்埁 பபா쟁ப்ꯁ? ஆய்ோைை்கை் : Dr வகாம鎿殿த்தாை்த்தன் (Dr. Gomathi Sitharthan), Senior Lecturer in Psychology, Discipline of Behavioural and Social Sciences in Health, University of Sydney; and நீைஜா ேண்믁கநாதன் (Neeraja Sanmuhanathan), Post Graduate Student, University of Sydney.

3. இந்த ஆய்ퟁே்埁 நான் என்ன பெய்யகவண்翁ம் ? இந்த ஆய்ힿல் நீங்கை் ெங்埁ெற்ற ힿ쏁ம்ꮿனால், தயퟁ பேய்鏁 இந்த ힿனாபகாத்பதான்டற நிைெ்ꯁங்கை் . இந்த ힿனாபகாத்鏁 இைக殿யமாக ொ鏁காக்கெ்ெ翁ம். இந்鏁 15 அல்ல鏁 20 நி뮿ஷங்க쿁க்埁 வமல் எ翁க்கா鏁.

4. நான் இந்த ஆய்ힿல் இ쏁ந்鏁 ힿல垿போள்ளலாமா? இந்த ஆய்ힿல் ெங்வகற்ெ鏁 믁ற்잿쯁ம் உங்கை鏁 ힿ쏁ெ்ெம். ெங்வகற்க வேண்ைாம் என்쟁 நீங்கை் 믁羿ퟁ பேய்தால், உங்க쿁க்埁 எ鏁 ொ鎿ெ்ꯁம் ஏற்ெைமாற்றா鏁. இந்த ힿனாக்பகாத்டத நீங்கை் நிைெ்ꮿ 믁羿ந்鏁ம் நீங்கை் இந்த ஆய்ힿல் இ쏁ந்鏁毁தந்鎿ைமாக ힿல垿பகாை்ைலாம். ஆனால் உங்கை் ힿனாக்பகாத்டத நிைெ்ꮿ அꟁெ்ꮿனால் ꮿற埁 இந்த ஆய்ힿல் இ쏁ந்鏁 ힿல垿க்பகாை்ை 믁羿யா鏁.

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5. இ鏁 இரே殿யமானதா? நான் போ翁ே்埁ம் தேவல்ேள் ோப்பாற்쟁ப்ப翁மா? இந்த ஆய்ힿல் ஆைாய்ே்殿யாைைிைம் நீங்கை் அைிக்埁ம் எந்த ஒ쏁 தகே쯁ம் அந்தைங்கமாகடேக்கெ்ெ翁ம். இந்த ஆய்ힿல் இ쏁ந்鏁 ஒ쏁 அ잿க்டக பேைி뾿ைெ்ெ翁ம், இ鎿ல் ஒ쏁ேைின் அடையாை믁ம் கண்翁ꮿ羿க்க 믁羿யா鏁. இந்த அ잿க்டக ே믂க அடமெ்ꯁக쿁க்埁ம் அꟁெ்ெெ்ெ翁ம், அேை்கைின் website 믂லம் ெ羿த்鏁பகாை்ைலாம்.

6. எதாவ鏁 பயன்ேள் இ쏁ே்垿றதா? இந்த ஆய்ힿல் நீங்கை் ெங்வகற்잿னால் PTSD என்ற மனே쏁த்த வகாைாடறெ்ெற்잿 埂ை ힿெைங்கடை அ잿ய ஒ쏁 ேந்தை்ெம். இந்த வகாைாறால் உங்கை் நாைந்த ோழ்க்டக ொ鎿க்கெ்ெைலாம். நீங்கை் இந்த ஆய்ힿல் ெங்埁ெற்쟁ேதனால், வொை் காைணத்தால் 殿லைின் PTSD வகாைா쟁 அꟁெேங்கடை뿁ம் எ翁த்鏁க்காை்ை 믁羿뿁ம். மற்쟁ம், ஆஸ்鎿வையாힿல் ோ폁ம் இலங்டக뾿னைின் இைண்ைாம் தடல믁டற뾿னடை뿁ம் வொை் அேை்கை鏁 ோழ்ힿல் ஏற்ெ翁த்鎿뿁ை்ை தாக்கத்டத뿁ம் அ잿ந்鏁 பகாை்ைலாம். அத்வதா翁 இந்த ஆய்ힿன் 믁羿ퟁகை் , வொைின் தாக்கங்கடை எ翁த்鏁க்காை்翁ம். மற்쟁ம் இைம்பெயை்ந்鏁 ோ폁ம் மக்கை鏁 மன நிடலக்埁 வதடேயான வேடேகடை ힿைங்垿பகாை்ேதற்埁 உதힿ பேய்뿁ம்.

நீங்கை் வொைால் ொ鎿க்கெ்ெை்翁 மன அ폁த்தங்கடை அꟁெힿத்தால், உங்க쿁டைய GPힿைம் கடதத்鏁க்பகாை்ைퟁம். அேை் மனநிடல ஆவலாேகடை ேந்鎿ெ்ெதற்க்埁 ஒ폁ங்埁கடை பேய்ோை்.

7. நான் இந்த ஆய்வவபற்잿 மற்றவர்ே쿁ே்埁 பொல்லலாமா? நீங்கை் இந்த ஆய்டேெ்ெற்잿 மற்றேை்க쿁க்埁 அ잿ힿக்கலாம். வகை்ힿகை் இ쏁ந்தால் நீங்கை் ஆய்ோைை்கவைா翁 பதாைை்ꯁ பகாை்ைலாம். Dr. வகாம鎿殿த்தாை்த்தன் (Dr Gomathi Sitharthan) பதாடலவெ殿 இலக்கம் 9351 9184, 뮿ன்னஞ்ேல் [email protected]; நீைஜா ேண்믁கநாதன் (Neeraja Sanmuhanathan), University of Sydney பதாடலவெ殿 இலக்கம் 0433 401 836, 뮿ன்னஞ்ேல் [email protected].

8. நான் இந்த ஆய்வப்பற்잿 கவ쟁 தேவல்ேவள யாரிடம் கேட்ேலாம் ? நீங்கை் இந்த தகேடல ோ殿த்தꮿன் வே쟁 ힿெைங்கை் வதடேெ்ெை்ைால் , நீங்கை் ஆய்ோைை்கவைா翁 பதாைை்ꯁ பகாை்ைலாம். Dr. வகாம鎿殿த்தாை்த்தன் (Dr Gomathi Sitharthan) பதாடலவெ殿 இலக்கம் 9351 9184, 뮿ன்னஞ்ேல் [email protected]; நீைஜா ேண்믁கநாதன் (Neeraja Sanmuhanathan), University of Sydney பதாடலவெ殿 இலக்கம் 0433 401 836, 뮿ன்னஞ்ேல் [email protected].

9. இந்த ஆய்ힿல் பங்埁பற்쟁ம் பபா폁鏁 கேள்ힿேள் அல்ல鏁 ேவவலேள் இ쏁ந்தால் நான் யாவர பதாடர்ꯁபோள்垿ற鏁? நீங்கை் வொைால் ொ鎿க்கெ்ெை்翁 மன அ폁த்தங்கடை அꟁெힿத்தால், உங்க쿁டைய ힿைம் கடதத்鏁க்பகாை்ைퟁம். அேை் மனநிடல ஆவலாேகடை ேந்鎿ெ்ெதற்க்埁 ஒ폁ங்埁கடை பேய்ோை். நீங்கை் STARTTS (殿垿ெ்வெ மற்쟁ம்

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殿த்鎿ரவவத மற்쟁ம் அ鎿ர்ퟁ உ뾿ர்தப்ꮿய ꯁனர்வாழ்ퟁ NSW கெவவ) என்ற நி쟁ேனத்வதாடை뿁ம் 9794 1900 பதாடலவெ殿 இலக்கத்鎿ல் பதாைை்ꯁ பகாை்ைலாம். Australian Psychological Society என்ற அடமெ்ꯁைꟁம் 02 8662 3300 பதாடலவெ殿 இலக்கத்鎿ல் அல்ல鏁 Multicultural Mental Health Australia என்ற அடமெ்ꯁைꟁம் 02 1300 136 289 பதாடலவெ殿 இலக்கத்鎿ல் பதாைை்ꯁ பகாை்ைலாம்.

10. நான் இந்த ஆய்வவப்பற்잿 믁வற뿀翁 பெய்யகவண்翁ம் என்றால் யாவர பதாடர்ꯁபோள்ளகவண்翁ம் ? பெயை்: Manager, The Human Ethics Administration

பதாடலவெ殿 இலக்கம்: 02 8627 8176

ொக்ஸ் இலக்கம்: 02 8627 8177

뮿ன்னஞ்ேல்: [email protected]

Any person with concerns or complaints about the conduct of a research study can contact The Manager, Human Ethics Administration, University of Sydney on +61 2 8627 8176 (Telephone); +61 2 8627 8177 (Facsimile) or [email protected] (Email).

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Appendix F – PTSD Symptom Scale Self Report Questionnaire in English

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Appendix G – PTSD Symptom Scale Self Report Questionnaire Amended in English

PTSD Symptom Scale (PSS)

Below is a list of traumatic events or situations. Please mark YES if you AND/OR someone in your household (parents, siblings, extended family) have experienced or witnessed the following events.

Please mark NO if you or someone in your household have NOT had that experience.

1. Serious accident, fire or explosion 2. Natural disaster (tornado, flood, hurricane, major earthquake) 3. Non-sexual assault by someone you know (physically attacked/injured)

4. Non-sexual assault by a stranger 5. Sexual assault by a family member or someone you know 6. Sexual assault by a stranger 7. Military combat or a war zone 8. Sexual contact before you were age 18 with someone who was 5 or more years older than you

9. Imprisonment 10. Torture 11. Life-threatening illness 12. Other traumatic event 13. If “other traumatic event” is checked YES above; please write what the event was and who it happened to ______14. Of the question to which you answered YES, which was the worst ______(Please list the question #) 15. Which of the above incidences has the most significant impact in your day to day life? ______

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(Please list the question #) 16. Is there anything else you’d like to tell us? ______If you answered NO to all of the above questions, STOP If you answered YES to any of the above questions, please complete the rest of the form

(Side Two) Please check YES or NO regarding the event listed in question 15. Were you physically injured? Was someone else physically injured? Did you think your life was in danger? Did you think someone else’s life was in danger? Did you feel helpless? Did you feel terrified?

Please complete all pages of this document if you answered YES to any of the first series of questions (1-14).

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PTSD Symptom Scale (PSS)

Below is a list of problems that people sometimes have after experiencing a traumatic event. Please rate on a scale from 0-3 how much or how often these following things have occurred you in the last two weeks:

0 Not at all 1 Once per week or less/ a little bit/ one in a while 2 2 to 4 times per week/ somewhat/ half the time 3 3 to 5 or more times per week/ very much/ almost always

1. Having upsetting thought or images about the traumatic event that come into your head 0 1 2 3 when you did not want them to 2. Having bad dreams or nightmares about the traumatic event 0 1 2 3 3. Reliving the traumatic event (acting as if it were happening again) 0 1 2 3 4. Feeling emotionally upset when you are reminded of the traumatic event 0 1 2 3 5. Experiencing physical reactions when reminded of the traumatic event (sweating, 0 1 2 3 increased heart rate) 6. Trying not to think or talk about the traumatic event 0 1 2 3 7. Trying to avoid activities or people that remind you of the traumatic event 0 1 2 3 8. Not being able to remember an important part of the traumatic event 0 1 2 3 9. Having much less interest or participating much less often in important activities 0 1 2 3 10. Feeling distant or cut off from the people around you 0 1 2 3 11. Feeling emotionally numb (unable to cry or have loving feelings) 0 1 2 3 12. Feeling as if your future hopes or plans will not come true 0 1 2 3 13. Having trouble falling or staying asleep 0 1 2 3 14. Feeling irritable or having fits of anger 0 1 2 3 15. Having trouble concentrating 0 1 2 3 16. Being overly alert 0 1 2 3 17. Being jumpy or easily startled 0 1 2 3 Please mark YES or NO if the problems above interfered with the following:

1. Work 6. Family relationships 2. Household duties 7. Sex life 3. Friendships 8. General life satisfaction 4. Fun/leisure activities 9. Overall functioning 5. Schoolwork Thank you for participating in this project. You are welcome to contact Dr Sitharthan or Ms Sanmuhanathan if you wish. Dr Sitharthan's phone number is 9351 9584: and Ms Sanmuhanathan may be contacted on: 0433 401 836

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Appendix H – PTSD Symptom Scale Self Report Questionnaire Amended in Tamil

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Appendix I – Content Analysis

Resp Gene Meaning unit Condensed Code Category Final Theme onse ratio meaning unit

n (expressed by the participant)

1 1 My family members Family members Missing family Loss of family Grief & Loss are missing to this day. are missing members E004 I have asked ICRC to help us find them.

2 1 Injured in a bomb Injury as a result Bomb attack Violence Violence and attack of bomb blast Torture E006

3 1 I was injured in a Injury as a result Bomb attack Violence Violence and bomb blast of bomb blast Torture E007

4 1 I was kidnapped by Kidnapped by Physical Violence Violence and unidentified people unidentified Assault Torture E008 and assaulted on my people and body assaulted

5 1 My brothers are no Brothers are Death of Loss of family Grief & Loss more, I am the only dead and I am family E010 survivor. I am happy the only member with my wife and survivor children now.

6 1 I spent 4 years in a jail While in jail, I Experience of Torture Violence and in Boosa, I was was tortured torture Torture E011 tortured and hung upside down

7 1 My wife and children Separated from Separation Loss of family Grief and Loss lived in an Indian wife and from family E012 refugee camp since

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1989, I can't forget children in being away from them refugee camp

8 1 My husband went Husband is Missing family Loss of family Grief & Loss missing in the early missing members E013 90s, he was suspected of being part of the LTTE

9 1 Displacement, lost job Displaced and Civil war Displacement Social due to discrimination discriminated experience Displacement E014 Discrimination

10 1 Memories of missing Missing friends, Missing Loss of friends Grief & Loss school, friends going missing school E016 missing

11 1 My son joined the My son and Death of Loss of family Grief & Loss LTTE after his cousin nephew were family E017 was killed during an killed members air raid, we lost that son when he joined as well

12 1 Arrested on the I was sexually Sexual Assault Violence Violence and suspicion of being an assaulted Torture E031 LTTE member and interrogated for 6 days. Sexually assaulted with pipes

13 1 Couldn't live in Sri I couldn’t live in Displacement Loss of home Grief & Loss Lanka anymore, faced Sri Lanka any Discrimination E033 Loss of discrimination and had more livelihood to leave by boat

14 1 Asylum seeker living I am scared to Civil war Displacement Social in the community, return home experience displacement E034 fearful of return home

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and face harassment. Brother was part of LTTE.

15 1 My uncle was My uncle was Imprisonment Violence Violence and imprisoned for nine imprisoned Torture E040 years as a political prisoner

16 1 Displaced and taken to I was displaced Loss of home Loss of home Grief and Loss a detention centre E045 during 1995 I was taken to a Civil war Displacement Social detention centre experience displacement

17 1 Visa process has been I was persecuted Civil war Violence Violence and difficult, no certain experience Torture E055 future here after

suffering years of civil

war and persecution. Had more hope for

Australia as the land Seeking Stories and that will give me peace I have little to Survival asylum and Survival of mind. no hope refuge

18 1 I can't forget the I can’t forget the Civil war Violence Violence and memories of the war war experience Torture E057 and the final days.

Trying to move past it Seeking Stories and with mental health Survival support Survival I want support support.

Just like myself, I Stories and would like a safe place I want a safe Survival Survival for my father place for all Asylum

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19 1 Shelling, death of My friends and Death of Loss of family Grief and Loss friends and family family died family E068 members. Ongoing

conflict affected family being together.

20 1 Left overnight on a I couldn’t hide Civil war Violence Violence and bus when we didn't from the Sri experience Torture E076 have anywhere else to Lankan army

hide from the Sri Loss of home Lankan army. We had Grief and Loss been an educated bunch but they targeted us as well on suspicion.

21 1 Not having a job has I fled seeking Asylum Survival Stories and been hard. Worked as safety Survival E080 a teacher at school back home, felt purpose to my life. Here I just survive day to day. I am thankful but this isn't what I had hoped for as my future.

22 1 My sister joined the My sister ran Family Loss of family Grief and Loss rebel group when she away to join the separation E083 was 12, my mum tried LTTE to stop her by taking her to the local boarding school. She ran away again and joined them. I was the only child from that day onwards,

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23 1 Spent time in Boosa I was jailed in Experience of Torture Violence and E084 camp in early 90s after Boosa camp torture Torture

a bomb went off and

they arrested every Tamil they could find.

24 1 We lived in bunkers I fled seeking Asylum Survival Stories and E088 during the war years. safety Survival

Barely survived that part of our life. Then moved to Indonesia to have a future for my children. And then I had the chance to get on a boat to Australia.

25 1 My sister's shooting My sister was Death of Loss of family Grief and Loss E091 death by an shot family unidentified individual

26 1 My sister's shooting My sister was Death of Loss of family Grief and Loss death by an shot family E092 unidentified individual

27 1 We suffered so much The government Loss of land, Loss of home Grief and Loss E094 at the hands of the took everything Loss of

government; they took from us livelihoods, away our land, our loss of future homes and our future.

28 1 Sense of community We lost our Loss of Loss of home Grief and Loss has been lost for us, community community E095 Loss of family we feel isolated and

alone. Our family is

back home still suffering.

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Although the war has ended back home, our

emotional wounds and depression has not I am scarred Civil war Violence Violence and ceased. I am still emotionally experiences Torture

continuing to live fearing death.

29 1 A solution for my I feel depressed Depression Survival Stories and Depression Survival E005

30 1 I am thinking much I think about my Asylum Survival Stories and E058 about my future; future Survival sometimes I think about my past happening, I need some counselling.

31 1 Still scared of death, I am scared of Civil war Violence Violence and E090 there is no peace of death experiences Torture mind

Generation 2 participants’ responses

1 2 My parents were Mother was Sexual Torture Violence and detained by the IPKF sexual assaulted assault Torture E018 army and my mum

was sexually assaulted when she

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was pregnant with my sister

2 2 I was very young I saw my parents Witnessing Survival Stories and when my parents being worried survival survival E020 came here, but they about their

continued to worry siblings. about their siblings. My parents tried to help their families back home.

3 2 Experienced I was displaced as Civil war Displacement Social displacement as a a child experience displacement E021 child.

4 2 Friend's parents’ I heard the Sharing of Stories Stories and E023 stories were difficult difficult stories experiences Survival to hear

5 2 I moved here with I escaped both Civil war Displacement Social my parents in 1996 from the LTTE experience displacement E024 when the civil war and the army started. I think I was about 8 back then. Only memory is crossing a body of water trying to get away from both LTTE and the army

6 2 Born here but heard I heard the Sharing of Stories Stories and my parents talking to difficult stories experiences Survival E025 their friends about

the war in the community

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7 2 My mum lost her My aunt died Death of Loss of family Grief and E027 sister when she was family Loss

young due to the

war. She died in an Sharing of Stories and air raid. I only heard I heard the Stories experiences Survival the stories difficult stories

I have been involved

in activism with the Activism Stories and I am an activist Tamil diaspora in Survival Survival Sydney and

understand the trauma felt as a result of what our parents went through.

8 2 Escaped civil war I have memories Civil war Displacement Social E029 with my parents. of the war experience displacement Vague memories

9 2 My family lived in My family lived Civil war Violence Violence and E030 an area where there near LTTE camp experience Torture

was an important

LTTE camp; she still

has nightmares remembering My family Sharing of Stories and Stories bombings and air remembers the experiences Survival raids next to her war. I heard the

house difficult stories

10 2 Went back to I felt depressed Sharing of Stories Stories and E036 parents’ villages, felt returning to experiences Survival Displacement depressed at their life parents’ home Grief and now and how they Loss of home Loss

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lived. I know they could be happier.

11 2 Mum is active in the I heard the Sharing of Stories Stories and E037 community, helps difficult stories experiences Survival other asylum seekers

in the community. I know their stories and visit church with them

12 2 I teach English I heard the Sharing of Stories Stories and E041 classes for newly difficult stories experiences Survival arrived refugees, I

become angry when I hear similar stories to what my parents described experiencing in the 80s. Nothing has changed it seems.

13 2 I don't know much I heard the Sharing of Stories Stories and E042 about the war but difficult stories experiences Survival have seen some

documentaries about it. That probably has been the most traumatising part.

14 2 I was very young I heard the Sharing of Stories Stories and E048 when I moved here difficult stories experiences Survival but my parents

celebrate anniversaries of my uncles' deaths so I know they were

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caught up in the civil war.

15 2 Hearing stories, I heard the Sharing of Stories Stories and E050 going to events difficult stories experiences Survival (heroes’ day)

16 2 Did not experience I heard the Sharing of Stories Stories and E053 the war, parents did difficult stories experiences Survival

PTSD 2

17 2 My dad's family My dad’s family Death of Loss of family Grief and E054 mostly died in the died family Loss war

18 2 Born in Australia and I heard the Sharing of Stories Stories and E059 feel very lucky that difficult stories experiences Survival my experiences are

different to that of my ancestors

19 2 Grandmother and My family moved Civil war Violence Violence and mum had to move to to India because experience Torture E062 India in the 80s when of the war

the fighting became

bad. It was scary to

listen to their tales of Sharing of

survival. I heard the experiences Stories and difficult stories Stories Survival

20 2 Missed schooling My learning was Loss of home Loss of home Grief and impacted my attitude disrupted Loss E063 to learning.

Struggled to adjust to

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a new culture and I fled to seek Asylum Stories and environment. safety Survival Survival

21 2 Father was separated My father was Family Loss of family Grief and E075 from us for four separated from us separation Loss years during the civil war, difficult for mum to be a single parent.

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Appendix J – Australian Tamil Congress Study Support Letter

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