International Journal of Mental Health Systems BioMed Central Research Open Access Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study Daya Somasundaram1,2,3 Address: 1Department of Psychiatry, University of Adelaide, Australia, 2Scholar Rescue Fund, Institute of International Education, New York, USA and 3University of Jaffna, Sri Lanka Email: Daya Somasundaram - [email protected] Published: 4 October 2007 Received: 16 March 2007 Accepted: 4 October 2007 International Journal of Mental Health Systems 2007, 1:5 doi:10.1186/1752-4458-1-5 This article is available from: http://www.ijmhs.com/content/1/1/5 © 2007 Somasundaram; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Complex situations that follow war and natural disasters have a psychosocial impact on not only the individual but also on the family, community and society. Just as the mental health effects on the individual psyche can result in non pathological distress as well as a variety of psychiatric disorders; massive and widespread trauma and loss can impact on family and social processes causing changes at the family, community and societal levels. Method: This qualitative, ecological study is a naturalistic, psychosocial ethnography in Northern Sri Lanka, while actively involved in psychosocial and community mental health programmes among the Tamil community. Participatory observation, key informant interviews and focus group discussion with community level relief and rehabilitation workers and government and non- governmental officials were used to gather data. The effects on the community of the chronic, man- made disaster, war, in Northern Sri Lanka were compared with the contexts found before the war and after the tsunami. Results: Fundamental changes in the functioning of the family and the community were observed. While the changes after the tsunami were not so prominent, the chronic war situation caused more fundamental social transformations. At the family level, the dynamics of single parent families, lack of trust among members, and changes in significant relationships, and child rearing practices were seen. Communities tended to be more dependent, passive, silent, without leadership, mistrustful, and suspicious. Additional adverse effects included the breakdown in traditional structures, institutions and familiar ways of life, and deterioration in social norms and ethics. A variety of community level interventions were tried. Conclusion: Exposure to conflict, war and disaster situations impact on fundamental family and community dynamics resulting in changes at a collective level. Relief, rehabilitation and development programmes to be effective will need to address the problem of collective trauma, particularly using integrated multi-level approaches. Background sequelae. These could range from adaptive and construc- Disasters, whether natural or man made, are now well tive coping responses in the face of catastrophic events to known to cause a variety of psychological and psychiatric understandable non-pathological distress as well as a Page 1 of 27 (page number not for citation purposes) International Journal of Mental Health Systems 2007, 1:5 http://www.ijmhs.com/content/1/1/5 number of recognizable psychiatric disorders. Conditions [7,11]. Collective events and consequences may have like Acute Stress Reaction (ASR, the old disaster syn- more significance in collectivistic communities than in drome), Posttraumatic Stress Disorder (PTSD), depres- individualistic societies like the US and Australia. It may sion, anxiety, somatoform disorders, alcohol and drug also be important to bear in mind that societies are in flux, abuse [1,2], and in the long term, complex PTSD [3], changing. With modernization and globalization, collec- enduring personality changes or Disorders of Extreme tivistic societies are also increasingly becoming individu- Stress Not Otherwise Specified (DESNOS) have been alistic and consumer oriented. There may also be shown to occur after disasters [4]. Evidence based and traditional subcultures within the bigger, individualistic effective, modern treatments like Cognitive Behaviour culture. In collectivist societies, The individual becomes Therapy (CBT) and pharmacotherapy for PTSD to help embedded within the family and community so much so individuals affected by the trauma of disasters to recover that traumatic events are experienced through the larger are now available in western countries [5]. unit and the impact will also manifest at that level. The family and community are part of the self, their identity However, there is less recognition or understanding of the and consciousness. The demarcation or boundary effects disasters have at the supra-individual levels as well between the individual self and the outside becomes as about appropriate interventions at these levels. There blurred. For example Tamil families, due to close and are many reasons for this relative deficiency. First, the field strong bonds and cohesiveness in nuclear and extended of disaster studies is itself rather recent. For example the families, tend to function and respond to external threat diagnosis of PTSD was accepted only in 1980 with the or trauma as a unit rather than as individual members. American DSM III [6]. They share the experience and perceive the event in a par- ticular way. During times of traumatic experiences, the Secondly, modern psychology and psychiatry have had a family will come together with solidarity to face the threat western medical illness model perspective that is prima- as a unit and provide mutual support and protection. In rily individualistic in orientation[7]. Geertz describes the time the family will act to define and interpret the trau- Western concept of self as "...a bounded, unique, more or less matic event, give it structure and assign a common mean- integrated motivational and cognitive universe, a dynamic cen- ing, as well as evolve strategies to cope with the stress. tre of awareness, emotion, judgement, and action organized Thus it may be more appropriate to talk in terms of family into a distinctive whole and set contrastively both against other dynamics rather than of individual personalities. There such wholes and against its social and cultural background....is maybe some individual variation in manifestation, a peculiar idea within the context of world cultures" [8]. The depending on their responsibilities and roles within the 'Kantian concept of an autonomous self' [9] and 'Enlight- family and personal characteristics, while some may enment values of individualism' [10] has come to mould become the scapegoat in the family dynamics that ensues western ways of experiencing the self, the world and (see family case histories [12]). Similarly, in the Tamil events. PTSD is clearly a condition that exclusively afflicts communities, the village and its people, way of life and the individual self, the traumatic event impacting on the environment provided organic roots, a sustaining support individual psyche to produce the PTSD. However, it is system, nourishing environment and network of relation- being increasingly recognized generally that we need to go ships. The village traditions, structures and institutions beyond to the family, group, village, community and were the foundations and framework for their daily life. In social levels if we are to more fully understand what is the Tamil tradition, a person's identity was defined to a going on in the individual, whether it be his/her develop- large extent by their village or uur of origin [13]. Their uur ment, behaviour, emotion, cognition or responses to more or less placed the person in a particular socio-cul- stress and trauma as well as design effective interventions tural matrix. to help in the recovery and rehabilitation of not only the affected individuals but also their families and commu- A word of caution is necessary in trying to romanticize or nity. For when the family and/or community regained idealize the family, neighbourhood, village, collective and their healthy functioning, there was often improvement community which in reality are vague, amorphous terms, in the individual member's wellbeing as well. The sense of and which include within it considerable variation among community appears to be a vital protective factor for the members as well as negative dynamics like scapegoating, individual and their families and important in their recov- marginalization, exclusion, ostracism and hegemonic ten- ery. dencies. It would also prove very difficult to define com- munity and collective very precisely, as the borders will This broader, holistic perspective becomes paramount in invariably breakdown [14]. However for this paper, the non-western, 'collectivist' cultures which have tradition- discussion addresses cataclysmic forces impacting on ally been family and community oriented, the individual these structures and as such consideration of some of tending to become submerged in the wider concerns Page 2 of 27 (page number not for citation purposes) International Journal of Mental Health Systems 2007, 1:5 http://www.ijmhs.com/content/1/1/5 these important internal difficulties can be temporarily arose among family members