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 University of Sydney 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 II 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. III University of Sydney 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 IV 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. V University of Sydney 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. VI University of Sydney 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. VII University of Sydney 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