SRI LANKAN TAMIL DIASPORA: CONTEXTUALIZING PRE-MIGRATION AND POST- MIGRATION TRAUMATIC EVENTS AND PSYCHOLOGICAL DISTRESS By Miriam George A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Faculty of Social Work University of Toronto © Copyright by Miriam George (2009) ABSTRACT Title: Sri Lankan Tamil Diaspora: Contextualizing Pre-Migration and Post- Migration Traumatic Events and Psychological Distress Degree: Doctor of Philosophy Year: 2009 Author: Miriam George School: Faculty of Social Work, University Of Toronto The objective of this study was to generate a deeper understanding of the influence of pre- and post-migration traumatic experiences on refugees’ psychological distress, including historical, political and social factors. This dissertation used a multi-method design to examine the impact of trauma on the psychological well-being of refugees. Further, the design included a quatitative component to provide a contextual framework for understanding refugee psychological distress that is not limited to an analysis of a disease model alone but by also making connections to important historical, social and political events. Post-Colonial, Refugee, Trauma and Feminist theories are used as analytic lenses to explain the social structures and events contributing to refugees’ pre- and post-migration traumatic events, and psychological distress. This was an international study that spanned two continents. Sampling included 50 Sri Lankan Tamil refugee participants who lived in Chennai, India and 50 Sri Lankan refugees in Toronto, Canada. Inclusion criteria included a residency period of the last 12 months in either of the sampling sites, and participants 18 years of age or older. Participants from Toronto were recruited through social service agencies and associations, and participants from Chennai were recruited from refugee camps, and the Organization for Elam Refugee Rehabilitation. Tamil versions of the Harvard Trauma Questionnaire, the Post-Migration Living Difficulties Questionnaire, and the ii Symptoms Check List – 90R were utilized to measure participants’ pre- and post-migration traumatic events and psychological distress. The Harvard Trauma Questionnaire contained qualitative open-ended questions to triangulate the quantitative data in identifying and exploring the impact of contextual influences. Results showed that post-migration traumatic event scores positively predicted psychological distress, and refugee claimants living in Canada had the highest scores on pre-migration and post- migration scores. The qualitative analysis revealed themes related to civil war and resettlement as significant issues. Implications of these findings support the development and incorporation of a multi-level approach within social work practice which emphasizes contextual issues, focuses on individuals, and promotes social advocacy. The advocacy role of social workers suggests that better integration of micro and macro systems should be aimed for more consistently since internal and external factors interact to effect psychological functioning. Recommendations for future research point to conducting longitudinal studies to assess the cumulative effects of historical, social and political factors on refugees and identify resiliencies that mobilize their capacity to survive. iii ACKNOWLEDGEMENTS For the memory of the Tamils who fought for their rights during the Sri Lankan Genocide......... Completing a doctoral dissertation is a great accomplishment in anyone’s life. By completing this international scientific study, I am bringing to life the urgency of recognizing the unique voices of the Sri Lankan Tamil community that can enlighten and inspire readers to work towards social justice in Sri Lanka. The more I thought about writing this acknowledgement section, the more I realized that the people I have known throughout my life journey in India and Canada have contributed in creating this work. The Indian village of Koratty, where I was born and brought up, gave me the space to cultivate and expand my creativity -starting from the Little Flower Girls School where I started my education, to the Koratty Muthi Church where my life moved forward. It’s all about Koratty, the place I was born and brought up, and the people in Koratty who encouraged my carefree spirit. Wherever I go, my memories of Koratty are my constant companion. I am stumbling now to find the right words to express my gratitude to my hometown. However, I believe that acknowledging my deepest connection to my village and its people, even after I left the village 20 years ago, proves my true feelings to my home town. Canada brought a great deal of new experiences for me. My memories include individuals who inspired me to transform my previous experiences into hope and purpose. Two organizations: the University of Toronto and the Centre for Addiction and Mental Health (CAMH) played a huge role in who I am today. The University of Toronto is truly a home away from my real home. The comfort and support I received from the Faculty of Social Work is unforgettable. No words are enough to express my gratitude for the intense mentorship and brilliant organization skills of Professor Ramona Allagia, my Doctoral supervisor, who guided me to complete my international research in four years. Her support and encouragement for me to complete this dissertation in a short period of time taught me so much about leadership and commitment to social work research. Professor Charmaine Williams - my mentor, my doctoral committee member, a researcher, a social worker, a social activist and an educator - played a significant role in the last 11 years of my Canadian life. Her activism for the rights of people with severe mental illness and her commitment to diversity is a guiding light for any social worker. Her high energy and motivating presence is a blessing for students especially for those who are coming from vulnerable backgrounds. Professor Tahany Gadalla came as a calming presence during my doctoral program. Her patience is her most admirable virtue which is a valuable asset for any educator. I would like to express many thanks to Professor Gadalla for providing me with stress- free statistical analysis lessons to complete my study. I extremely iv appreciate Professor Uzo Anucha’s commitment to my research and her endless support to me as a social researcher from South Asia. The continuous support by many staff from the University of Toronto including Professor Adrienne Chambon, Professor Rupaleem Bhuyan, Professor Michael Saini, Sharon Bewell, Angela Umbrello and Kay Ramdass is also very much appreciated. The Centre for Addiction and Mental Health provided the best research and practice environment for me. My heartfelt thanks to my CAMH colleagues, specifically to Akwatu Khenti; Debbie Thompson; Mahreen Hasan; Dr. Michael Bagby; as well as the Education and Health Promotion program; the Psycho-Geriatric program; the Mood and Anxiety Program and the Pro Act –Schizophrenia program, for accepting and encouraging my dream to be a researcher. To my husband, James George: destiny brought us together from opposite sides of the world. You have been a rock for me in completing this doctoral program. Thank you for believing in my strengths as a social worker and a researcher. To my daughter Amie, you were born in my heart. My activism and passion for women’s rights in the South Asian community are for you to have and live a life of your choice. My only wish for you is to continue my passion in the very best way you can. To my son Varkey: when I look at you, I see the pain you went through with your health issues as a baby and admire the strength and resilience you demonstrated to get through and be the energetic, and charming boy you are today. Thank you for continuing to make me a special person in your life and I hope and wish that you will follow the footsteps of your namesake. To my mother Elizabeth and my brothers Paul and Jojo: I know in my heart that I never followed the traditions you had expected. However, I acknowledge your confidence in my ability to carry my life as an independent working woman and thank you for your immense support during my many challenging and difficult times. A special acknowledgement for Amma, thank you for being a wonderful mother and grandmother to my children during my busy work/school schedule. I hope that your love and values will continue to flourish in their life. The Kuttikat family paved the way for me to become a strong, independent and educated woman with my own opinions. My doctoral dissertation would not be completed without acknowledging one of the most powerful women in my life: my paternal grandmother and my namesake Mariamkutty Maliakkal. Her vision affirmed women’s value in society and continued to keep my spirit strong even after her death 33 years ago. I would also like to express my gratitude to my paternal aunts and uncles who encouraged me to have dreams and dream higher every day. The Erinjery family brought the blessing of laughter into my life. I fondly v remember my maternal aunts and uncles who used laughter to live their lives to their fullest. Sincere appreciation to the Madapallimattam family for their care during many difficult times. Recognizing the contributions of my friends in India and Canada during my personal journey is immeasurable. They were my defense during many rocky times and let me think through many of my creative ideas out loud. Many thanks to Anna Varghese, Preetha Paul, Raji Lakshmi, Shivaranjini, Anita Valliancourt, Steven Solomon, Charlene Cook, Magnus McCarthy, Stephen Willoughby, Cecilia Manicatide, and Betty Gillard, who helped me to be who I am. My deep appreciation to the Tamil Elam Society of Canada, the Canadian Mental Health Association, the Organization for Elam Refugee Rehabilitation, the Refugee authorities in Maviran, Gokulam, the Old refugee camps in Chennai, and to Dr. Mohandas and Dr. Shiva Nambi for making this endeavor successful.