War Trauma in Sri Lanka

War Trauma in Sri Lanka
Dr Ruwan M Jayatunge M.D.

The 30 year armed conflict in Sri Lanka has produced a new generation of veterans at risk for the chronic mental health problems that resulted following prolonged exposure to the war. Over 200,000 members of the Sri Lanka armed forces and police had been directly or indirectly exposed to combat situations during these years. There had been nearly 20 major military operations conducted by the Armed Forces from 1987 to 2009. A large number of combatants from the Sri Lanka armed forces were exposed to hostile battle conditions and many soldiers underwent traumatic battle events outside the range of usual human experience. These experiences include seeing fellow soldiers being killed or wounded and sight of unburied decomposing bodies, of hearing screams for help from the wounded, and of helplessly watching the wounded die without the possibility of being rescued. Following the combat trauma in Sri Lanka, a significant number of combatants were diagnosed with Post Traumatic Stress Disorder (PTSD).
The combat operations in the North and East had involved military personnel in major ground combat and hazardous security duty. A significant number of combatants had posttraumatic reactions soon after the traumatic combat events. Majority of these reactions were undetected and untreated.
The deaths include 27,639 LTTE carders, 23,327 Sri Lankan soldiers and police officers, 1,155 Indian soldiers, and tens of thousands of civilians. The last phase of the war resulted 280,000 internally displaced persons.
Combat Trauma Experienced by the Soldiers
War is particularly traumatic for soldiers because it often involves close violence, including witnessing death through direct combat, viewing the enemy before or after killing them, and watching friends and comrades die (Hendin & Haas, 1984). After exposing to combat trauma soldiers are more likely to have psychological ailments predominantly stress related symptoms, problems with social relationships and various other problems.
The wounds that they received from war are not confined to the battlefield it frequently transformed to their domestic environment as well. Although studies are needed to systematically assess the mental health of members of the armed services, a very few studies were conducted during the last 30 years.
The most common mental health issue for soldiers is post-traumatic stress disorder and related symptoms of depression, anxiety, inattention, sleeping difficulties, nightmares, and survival guilt.
The dedication and the courage of the armed forces cannot be underestimated and the Sri Lankan combatants fought one of the longest and deadliest armed conflicts in the world and they were able to gain a clear victory. Sri Lanka paid an immense price for the victory. As a result of the three-decade war, many soldiers became physical and psychological casualties. Unfortunately the society is gradually forgetting the scarifies made by these people.
Although many see war as a heroic effort, there are thousands of untold traumatic stories in the Eelam War. Some soldiers shared their traumatic stories with us and these stories reveal the magnitude of their suffering. These stories represent the true nature of combat trauma in Sri Lanka.
The psychological casualty of the operation liberation
The Operation Liberation or Wadamarachi Operation was conducted in 1987. It was the first major military operation in Sri Lanka. Nearly 8,000 soldiers participated in this campaign. The most popular and the famous officer of the Sri Lanka Army the late Gen Denzyl Kobekaduwa commanded this military offensive against the LTTE.
Corporal Ax36 is one of the psychological casualties of Operation Liberation. During this battle, he faced many battle stresses. He was physically and mentally exhausted. After serving, a number of years in the Army Cpl Ax36 witnessed many traumatic events. He suffered nightmares, intrusions, hyperarousal, and flashbacks. He was avoiding people and places related to his traumatic experiences and became emotionally numbed. In 2003, Cpl Ax36 was diagnosed with PTSD.
Corporal Ax36 describes his present emotional and physical ailments as follows.
I was one of the soldiers who took part in the Wadamarachi Operation in 1987. Our main aim was to liberate Jaffna Peninsula and destroy the LTTE positions. When we came near the Thondamanaru Bridge, the LTTE destroyed the bridge using explosives. We had to advance slowly. One of our soldiers died in front of my eyes as a result of a booby trap. I can still recall his face filled with blood. It was a horrific incident.
Needless to say that I was terrified by this event. Because I am a human although I wore a military uniform. I was shaken by the death and demolition. Even after many years, I still see these events in my dreams. To evade the nightmares I used to take alcohol and go to sleep. I cannot stand any loud noises, I become frightened and my heart started pounding. Often I try not to think about past events. When I see the TV if I see any combat related story or a pictures I disconnect myself with it. I hate to talk about past events especially those related to the war.
I have no strength in my body now. My joints are aching. I cannot even walk a mile. Prematurely I have grown old. My mind is full of melancholic feelings. I am unable to feel happiness. For many years, I never experienced cheerfulness.
I am unable to concentrate and I am very forgetful. I have forgotten the names of my fellow soldiers who served with me in the same unit. Sometimes I feel that I have no reason to live. My family members avoid me because of my hot temper. Unlike early days, I cannot control my anger. I have been turned in to an irritable cold person. Several times, I thought of disappearing from this world. But according to my religion it is a sin. Therefore, I have resisted the idea of committing suicide.
Private K and Survival Guilt
There is a higher incidence of depression in veterans who had been in combat and lost a friend. Survival guilt is an especially guilt invoking symptom.
“Survivor guilt” is the term used to describe the feelings of those who, fortunately, emerge from a disaster, which mortally engulfs others. On an irrational level, these individuals wince at their privileged escape from death’s clutches(Harvery, 2007).
Private K is a soldier who was severely troubled by the survival guilt. He joined the Army in 1992 and served in the North. While serving in the combat his buddy was shot in front of his eyes near the Punani station. He fell down and lost his consciousness. Although Private K wanted to help his friend, he could not reach the friend due to heavy fire. Along with the other soldiers, he attacked the enemy and eventually went near his friend. But he was dead. This incident made him so upset. He felt guilty that he could not help the buddy.
By 1997, he often experienced headaches, intrusions about his dead friend and showed a marked depression. He became irritable and gave a startling reaction to any slightest sound. Private K felt uneasy with the military duties and wanted to avoid military situations. In 2003, he was referred to the Military Hospital Colombo and diagnosed as having PTSD. Private K’s condition improved following drug therapy (SSRI) and psychotherapy (CBT and EMDR). By 2005, he was free of most of the PTSD symptoms. After cognitive restructuring, he got the insight and now Private K knows that he was not responsible for the death of his friend.
Did I bury him alive?
Private Lx26 became pitiful when he witnessed the death of his fellow soldier who got killed by a sniper shot. The troops had no means to bring the body back. After confirmation of death, Private Lx26 was ordered to bury the body. When he touched his friend’s body, he could feel the body warmth may be due to the hot Northern climate. Private Lx26 dug a pit and buried his friend’s body in the mist of sorrow. Then they advanced towards Omanthai. After a several days, Private Lx26 had an irrational and guilty feeling that he had buried his friend alive. He suppressed this painful feeling for a long time. Gradually it became a distressing thought, which he could not bear anymore. In 2003, he experienced a severe depressive reaction following survival guilt. He had full-blown symptoms of clinical depression. He was treated with Rational Emotive Therapy in which his irrational and illogical ideas were confronted via a friendly and therapeutic mediation. After the therapeutic intervention, Private Lx26 was free from devastating psychological burden that he had carried for long years.
My Sergeant died in my arms: says Private RS
I was born in a small village in Pollonarwa and often our village became the LTTE target. Several times the LTTE attacked our village slaughtering men women and little children. We had mass funerals after these attacks and most of the villagers felt utterly sad and insecure. As a child, I saw these horrendous things around me. At night, we did not sleep in houses, for security we slept in the jungle. I did not see a way out for these tremendous problems except joining the military. So I was determined to join the Army.
Our family had to face many financial hardships and that affected my education. I could not study further and I joined the Army. After my basic training, I served in Welioya and Vavunia.
In 1997, I participated in Jayasikuru (Victory Assured) operation and we were given a task to capture the Mankulam highway. We fought the enemy face to face. The gunfire lasted for nearly 3 hours. A commando unit came for our support and we were able to advance further. Sergeant L who was my senor NCO and my mentor was behind me. He taught me many combat skills. We always fought the enemy together. He used to cover me and I used to cover him. Both were lucky for many years. However in Mankulam he was hit by a bullet. Sergeant L was bleeding profusely. I helped to evacuate him. I carried him while praying for his life. His breathing became shallow. I could not reach the medics, half way he died in my arms.
After his death, my conscience blamed me for not saving him. I felt guilty. I wish I could have taken him to the Medical Point on time. If I had done that, it could have saved his life. But I was late and Sergeant L died. I was troubled by this guilty feeling and combat related nightmares and various intrusions. My life became to a standstill. I was filled with sorrow and repulsion of combat events. I was disgusted with all these issues and once I wanted to shoot myself and end the suffering. Somebody or some power saved me from self-harm and showed the way towards life. Again, I saw light.
(Private RS was found with PTSD comorbid with depression. Following intensive treatment, he was able to recover. He became free of survival guilt that had troubled him for a long time. Now he is serving in his unit without firearms and doing light duty. )
Rifleman Sn34 and Baptism of Fire
I became a psychological casualty at the Yal Devi operation says Rifleman Sn34 revealing his story thus.
…Operation Yal Devi was my first combat experience. We faced the enemy with courage. I witnessed a lot of traumatic incidents there. Our fellow soldiers died in front of my eyes leaving us in sorrow. On one occasion, the enemy gave us a surprised attack and we were scattered. I jumped in to a pit and waited all night long. It was a dark night. I saw the enemy collecting weapons from our bunkers. I was alone and feared for my life because I knew, the enemy had no mercy. I had seen dead bodies mutilated by the enemy. I thought they would do the same thing to me if they could capture me. It was an awful idea. I had vivid mental pictures of my funeral and I saw my parents were crying. I did not want to be captured by the enemy and let them mutilate my body.
The entire night I was praying for my life and by dawn the reinforcements came and they rescued me. I was taken to the hospital. Although I had no physical injuries, my mind was deeply wounded. Nevertheless, doctors said I was ok. I felt something was wrong with me. I was sent to the battlefield again. I had fear feelings and every night I saw the same horrible dream. I saw myself trapped in a pit and the enemies were all over. Despite the fear and resentment, I did the duty that was requested from a soldier. My mental health was deteriorating and I had no salvage. Finally, I decided to become AWOL.
I went home as a completely changed person. The innocence of youth and affection towards the family members had gone away. They saw me as a frightened cold soul. My parents thought that some evil spirit had got in to my body and they did Thovilaya, the ancient ritual to chase dark spirits to heal me. But it did not help. My memory was fading and I couldn’t sleep. Nightmares ruined me to the end.
My family arranged a marriage for me thinking that it would help me to get away from alienation. After my marriage, again I went back for duty. But I was a lost soldier. I was anxious performing military duties. I had intense fear of enemy attacks. The noise of the gunfire made me startle.
I went home after several months serving in the North. I had no happy feelings that I got a vacation after so many months fighting in the jungle. My emotions became numbed and I was no longer interested in marital life. I became more and more hostile and physically abused my wife. Since I couldn’t have a sound sleep, I started indulging in alcohol. Practically day and night, I was drinking secretly. But it made me worse. It made me a monster. My wife was afraid of me. When I came home, she was shivering in fear. When I was angry, I destroyed the house property. Nothing gave me relief.
Eventually I decided to talk to one of my senior officers whom we trusted. The officer listened to my grief and helped me to get psychological therapies. I was treated at the Psychotherapeutic unit at the Military Hospital Colombo for nearly 3 weeks as an inward patient. Then they got down me to the clinic and treated me. Counseling and medication helped me to get away from the trauma that I experienced for a long time. Today I am a new man who is not abusing alcohol and I love my family. I enjoy life and do not live in past memories.
The soldier who did not like to attend military funerals
I hate to participate in Military Funerals says Lance Corporal S who described his military life in the following account.
In 1987, I was posted to Kurumbasevadi camp near the Palali Base Camp. There I faced the baptism of fire. In that camp, I served nearly one and half years and was then sent to Welioya camp. I was at the forward defense line. At the Welioya camp, I witnessed many horrendous combat events. The enemy attacked us with heavy weapons killing my fellow soldiers. I saw how they were lying on the ground with bullet or shrapnel wounds. I collected the dead bodies and put them in to body bags. I was utterly devastated when collecting human remains.
In 1991, I served in a non-operational area but my official duty was to participate in funerals of our soldiers who died in action. When I was at these military funerals, I had various intrusions about the battlefield and my dead buddies. My heart was broken when I heard the mourning and wailing of the relatives. At one funeral, I saw a mother was crying for her dead son. He was a good soldier whom I knew. Her weeping reverberated in my ear. I recalled the dead soldiers at Welioya, how they were lying on the sand. Some with opened eyes. Many weeks I could not sleep.
I hated to participate in these depressing military funerals. However, my duty required such participations. In each funeral, I had flashbacks and deep sensation of sadness.
By 1998, I got a transfer to Mannar District. There while I was traveling by bus I met with a land mine explosion. I was wounded and treated at the hospital. Although my physical wounds healed, the fear I experienced at that event was re-occurring. My mind was full of various battle events, military funerals and the land mine explosion, which I met in Mannar. I had nightmares and fear feelings. I became more irritable and sexually inactive.
My body became a source of pain. Every joint in my body started aching. When I experienced an unbearable headache, I could not stand noises. After the land mine explosion, I was again posted to the former camp in the non-operational area to fulfill funeral duties, which I hated. Regrettably, the senior officers gave no ear to my grievances. I was there for another one and a half years. During that time my illness progressed rapidly and once I decided to commit suicide inside the camp. My unsuccessful suicide attempt alarmed the platoon officer and I was sent to the hospital. At the hospital, I was treated and given medication and psychological support. After months of treatment, my condition improved. Today I am doing light military duty in a non-operational area. But still I cannot see the dead and war memorials.
(Lance Corporal S was diagnosed with PTSD treated with SSRI and EMDR. After intense therapy, his anxiety based symptoms were reduced to a significant level)
In my dreams I see the enemy is attacking my bunker says Private Rx68 (A known PTSD patient)
….My memories are still filled with the events that took place on the 24th of August 1993. Now for many years I still live with these horrendous memories. Practically every day I recall these events and it gives me pain and anguish.
On that doomsday at 12 o’clock midnight I was at the bunker. Two of my buddies who were with me had a rest while I was on guard. Suddenly I heard gunshots and one of our corporals shouted that the enemy is attacking the Janakapura North Camp. I awakened two of my buddies and asked them to be on alert. Within a few moments, a group of LTTE attacked our bunker.
I heard the scream at the adjacent bunker. The enemy attacked them with a hand grenade and I presumed that they had captured that bunker. So we were on our own and fighting the enemy. Three of us fired at the enemy from three different directions and we never wanted to surrender.
The enemy came towards us like an unceasing wave. I attacked the enemy with my LMG killing a dozen of them. One of my buddies near me sustained a gun shot and fell down. Hence, two of us had to face them.
We fired at them without giving any break. Suddenly they attacked my bunker with a RPG and the bunker collapsed. A large Palmyra log fell on to my head and I was semi-conscious. My ears became blocked and I felt bleeding from my head. I knew if we stayed there, we would be killed. Therefore, we came out from the wreck and crawled towards the center of the camp. While we were moving several LTTE carders came to capture us alive and I threw a grenade to escape.
When two of us went further, we met a group of our soldiers. We regrouped and attacked the enemy. The assault went for a long time, by dawn the enemy withdrew from the camp leaving many casualties. Although I was injured and tired, I fought with my guys without dropping my weapon. In the morning, I was sent to the hospital for treatment.
I still recall how my friend at the bunker fell like a log after being hit by a bullet to the head. We fought while he was gasping and we had no time to pay attention to him. He must have died within a few minutes. These memories hound me at nights. When I am half a sleep I see shadows, and I become vigilant. I always get a feeling that the enemy is crawling towards me. I fear that the enemy would attack with a RPG. Then I open my eyes and my heart starts to beat like an accelerated machine. Afterward for several hours, I am unable to sleep. Awake at night I am thinking about my friends who died in the battle. Then I feel that it was so unfair that I am alive and they are no more.
Sometimes I see battle events in my dreams. Often when the enemy attacks I am unable to return fire, my gun is jammed. Since I am unable to shoot the enemies, they are approaching me little by little. I can hear their voices scolding us in Tamil Punde Army, Punde Army. I become helpless. I hear someone throw a grenade. My fear increases and I shout. Then I realize that it was another nightmare.
My family members are now used to my screenings at night. My great fear is when I am sleeping I might harm someone who is near me. Therefore, I often tell my wife and children not to be near me when I am sleeping. My life has changed dramatically and I am not the same person anymore. My emotions are numbed and I cannot cry for my dead friends.
The Story of Private UG
Private UG met with a blast injury in 1997 near the Thaladi camp. He was wounded and psychologically shattered by the blast. After several months of the injury he complained of severe headache, insomnia and fear feelings. Gradually he developed PTSD symptoms. Private UG found it difficult to sleep and experienced nightmares related to the blast injury. He had fright feelings and always wanted to avoid the places and conversations related to the blast injury. Any slightest sound made him jumpy. He became irritated and could not control his anger. Often he experienced sexual dysfunctions and as a result of family turmoil, his wife left him. Following family problems and overwhelming anxiety, he tried to commit suicide.
When Private UG was referred for psychological therapies, he was treated with CBT and EMDR which minimized his PTSD symptoms. Today he is able to sleep without nightmares and intrusions hardly bother him. He does not get excessively angry as early. He has learnt to manage his anger without destructive behavior. The final follow up revealed that his wife had returned and Private UG is leading a productive life.
I was hiding in a hole in the ground: Rifleman Mx38
The night of the 27th of September 1998 was the most terrible hours of darkness of my life. I was at the FDL in the Paranthan area. The LTTE attacked my bunker and they managed to come very close. My friends had thought that I was dead and the enemy had captured my bunker. Then they too attacked the bunker with their weapons. I was trapped facing enemy fire as well as friendly fire. Without many options, I decided to abandon the bunker. I crawled and moved away from the FDL. Then I found a pit and I was hiding in there. I heard the enemy’s movements and lot of gunfire. I thought this would be the end. Within a few moments, they would discover me and they would not think twice to kill me. I saw child soldiers moving towards the FDL with heavy weapons, then the LTTE female carders with AK 47 in their hands. Luckily, no one saw me or not expected me to be in a hole in the ground. I could hear heavy fighting and I decided to stay inside the pit. I was trapped there for several days. I had no food and my water bottle finished by the second day. On the third day, I was thirsty and I was compelled to dink my urine. By the fourth day, I had no alternative. I decided to move towards the FDL. I noticed the defeated enemy retreating group by group. I took cover and avoided them. It was a dark night and I made no noise. I was without food and water with severe exhaustion. I moved slowly.
When I came near the FDL I had to be vigilant not to attract friendly fire. I shouted at our soldiers. I told them my name, unit and my serial number. Then they recognized me with a surprise. They had thought that I was killed or captured by the enemy. I was taken to the C/O and he admired my courage. I evaded death like a miracle. I was lucky to come alive. But this happiness lasted for few days. Often the fear and isolation that I experienced inside the ditch bothered me. I could not rest, every time I had to be on guard anticipating an invisible enemy. Days went by, I was still feeling fear. When I went to an ambush I became restless, I was looking at the front, then my inner feeling said the enemy is behind you, I looked back, and no one was there. I could not concentrate my mind. It was a terrible mess and became an obsessive ritual to watch every direction for the enemy.
My head started aching and often I forgot things. Several times, I was warned by senior NCOs and Officers for leaving my weapon elsewhere. I could not concentrate or remember things. At nights, I was practically awake. A slightest sound made my heart ooze with fear. My heart started pounding giving me aches and pains. I had terrible nightmares. In my dreams, I saw I was trapped in a hole in the ground and surrounded by the enemy. I hated to go to sleep.
(Rifleman Mx38 was diagnosed with PTSD treated with SSRI and Psychotherapy –CBT& EMDR. According to the 12th April 2005 follow up he experienced no major PTSD symptoms. His sleep became normal and the startle reactions became minimal. No intrusions or flashbacks troubled him)
The story of Lance Corporal AS – The soldier who was living in isolation
I was happily married but things changed when I became wounded. In 1990, I was at the Thaladi Camp, Mannar. There I saw fierce battles. The LTTE attacked us with heavy weapons killing nearly 40 soldiers. With utmost difficulty, we were able to defeat the enemy. My heart cried when I saw the dead bodies of our fellow soldiers. We were like one large family. Prior to the attack we had meals together and made jokes about odd things. They have gone forever. When I put their bloodstained bodies in to the body bags, I cursed the enemy.
After this event I became more isolated and had intrusive memories. There was no one to speak about my anguish. I became alienated. When I came home, my wife often asked what was wrong with me. However, I did not tell anything to her. Because it was a pointless effort to tell my sorrow to her and she would never understand what happened in the battlefield. Therefore, I silently lived with my grief. But I became more and more irritable.
In 1996 we went to Kodikamam and ambushed the enemy. There was no proper camp for us. We lived in abandon houses, which were ruined by the shellfire. It was a hostile ground. The enemy was everywhere. If you do a stupid mistake, you would sleep in a body bag. I was uncertain of my life. We lived day-by-day avoiding enemy fire and booby traps.
One day we accidentally walked to an ambush and the enemy fired at us in close range. Eight of our men died in this attack and they died in front of my eyes. We too attacked the enemy and eventually managed to escape. But we had to leave the bodies due to the advancing hostile forces. I still feel guilty for leaving their bodies. Indeed it was a terrible time. During these years, I saw many dead soldiers as well as the members of the LTTE. Some bodies were decomposed or mutilated. I saw large monsters eating dead bodies. The things I have seen confirmed me that there is no glory in death for sure. Once I saw a dead body of a staff sergeant (he was known to me), the enemy had shot his eyes. It was a horrible image to see, a dead body without eyes and instead of the eyeballs, I could see the deep bullet wounds. For many years, that image was deposited in my mind. I even had bad dreams.
When I came home these battle events started roaming around my mind. I wanted to be left alone. But my wife wanted to know what’s wrong with me. I was not interested in sex life. I was avoiding my wife. She thought I was having an illegal affair. I could not stand her accusations. I became depressed and could not tolerate noise. When my children played and shouted I became extremely angry. I punished them severely. When my wife protested, I used to beat her too. One day I smashed the TV and chased everybody out of the house.
My family was suffering with me. When I came home, I used to physically abuse my wife for a slightest argument. She felt uneasy during my presence. Even the children feared me as if I am a monster. Little by little, I was losing my family. When the physical abuse escalated, my wife went to her parent’s house with the children. I was all alone and I started abusing alcohol.
My nights became more and more disturbed. I experienced battle events in my dreams and relived painful moments. Sometimes I could hear gunshots, artillery fire and helicopter sounds. I was trapped in reality and illusion. I had a deep loathe when I saw military vehicles and uniforms. I was afraid of going back to the battlefield. I never knew what fear was but now my body shivers even for a slightest sound like a firecracker.
My wife refused to come back then I became more depressed. I wanted to end suffering by shooting myself. Once when I was on duty at the Army camp, I took a weapon to take my life. A senior NCO jumped and grabbed the weapon. Then I was produced before my Officer in Command. I thought I had to face charges violating military discipline. Instead of punishing me, they sent me to the Military Hospital. There I was treated and the doctors were kind enough to arrange an open interview with my family. The doctors convinced my wife to come back and finally she agreed.
With treatment, I was able to control my anger. My intrusions and nightmares diminished and gradually I became a productive person. Now for over two years, I live with my family and I do not abuse them.
I lost my voice in the height of the battle – Lance Corporal W
Psychogenic dysphonia refers to loss of voice where there is insufficient structural or neurological pathology to account for the nature and severity of the dysphonia, and where loss of volitional control over phonation seems to be related to psychological processes such as anxiety, depression, or dissociative reaction. Psychogenic aphonia is a conversion symptom, which arises following an unconscious psychological conflict. There were many soldiers who lost their voices without any organic factors in the Eelam War. These soldiers mainly had overwhelming combat stress factors, which led to their aphonic condition. Lance Corporal W who is a known PTSD patient described how he lost his voice in the midst of the war.
I joined the military in 1995 and faced many battle events. In 2000, I went to serve in the Pallai camp where the LTTE attacked us with mortars. I was shattered by the sound of this mortar fire. I felt a profound breakdown inside my body. Every time I took cover to incoming mortars. I could feel the shockwave. I saw how our soldiers sustained injuries. I still recall one event in which a soldier succumbed to a mortar blast. His bowels came out and blood splashed all over. It was a cruel and painful death. I was always on guard for incoming mortars. When that ‘zooooo’…..noise comes I always took cover. I knew what was going to happen in the next moment. Mortar come with that sound and gives a terrible blast. If you don’t go down you would be hit by shrapnels. Although I was extra careful, I was not lucky. Once I sustained minor injuries as a result of a mortar attack. Shrapnel pierced my thigh. I was hospitalized and treated for a few days.
Pallai experience was a horrendous experience for me. I was not sure of my life and often lived in uncertain situations. However, I was lucky to be alive and returned from Pallai. Then I served in a relatively favorable environment. In 2003, I re-experienced Pallai events and I frequently had nightmares. My fellow soldiers did not like me because I used to scream at midnight with fear. Some thought that I was smoking ganga. One night when I was sleeping, I saw an incoming mortar. I cried for help but there was no sound. I became speechless. . Ever since, I could not speak and I lost my voice.
(Lance Corporal W was aphonic for several weeks and underwent psychotherapy. He was treated with hypnotherapy and was able to regain his voice. His PTSD condition lasted for a long time. Medication and CBT helped him to minimize the condition)
I had walked to the enemy lines: Private SK
“I was confused and did not know what I was doing. I had walked to the enemy lines. Luckily, a team of Special Forces saved me. When they found me, I had dropped my weapon and was wondering towards the enemy lines. I don’t remember how I left my defense point or where I dropped my T56. I was taken to the camp and produced before Col ….. I was heavily questioned. Later they blamed me for abandoning my post and losing the weapon. I was severely punished for that offence”.
(Private SK had gone into a psychogenic fugue state following overwhelming battle stress. He could not recall what really took place on that day. He served at Nedunkurni and witnessed the death of four soldiers as a result of an artillery fire. He saw how their bodies had been blown into pieces and instantly he was shocked. After this incident, he gradually became a victim of combat related PTSD which was undiagnosed and untreated. He had dissociative features as well. Several times, he went into fugue states and in the final event, he had walked to the enemy lines. After he was rescued Private SK was referred to the Psychological Treatment Center at the Military Hospital, Colombo. At the center, he underwent a series of psychological assessments and cyber testing method to elicit autonomic arousal. He was diagnosed as having PTSD. Private SK was treated with SSRI and SPDT (Short Term Psychodynamic Therapy). With the treatment, his mental state improved)
POW s with PTSD
There are a number of POWs of the Eelam War who still carry the psychological scars. Most of them suffer from DDD Syndrome which was delineated by Farber Harlow in 1956. The DDD Syndrome consists of Debility, Dependency and Dread. POWs often show depression, apathy, suspicion and fear. Some have large memory gaps and still feel guilty about their POW days.
Lance Corporal U has served 17 years in the Sri Lanka Army. During the Balawegaya operation, he sustained a gun short injury to his leg and became immobile. When the enemy advanced, he could not move and hence he became a prisoner. When he was captured, he was severely beaten and threatened with death. But one of the LTTE regional leaders stopped the beatings and sent him for medical treatment.
When the medical treatment was over, he had to undergo vigorous interrogations. He was tortured to get information about his Camp and its inner structure and guard points. He was handcuffed and kept in painful positions for long time. Frequently his guards physically assaulted and humiliated him. However, Lance Corporal U admits that there were some members who were kind to him and brought food sometimes.
From July 1991 to March 1995 L/Cpl U spent his life as a POW facing torture, humiliations and uncertainty. He was kept in a very small cell with forty other prisoners. They had no space to move. The prisoners were allowed to take a bath once in two weeks or sometimes longer than that. Many suffered skin infections. Their meals were not served regularly. Following the intolerable conditions, the prisoners launched a hunger strike and eventually he was released in March 1995 after the interference by the ICRC.
Although Lance Corporal U became a free man, he often suffered from an unexplainable fear. The POW days memories hounded him severely. Some nights he used to wake up with fear thinking that he is still in the LTTE prison cell. He was depressed and surrounded by guilty feelings. In order to avoid nightmares, he was indulging in alcohol. More he used alcohol more he became depressed. He often physically abused his spouse. Lance Corporal U began to avoid everything related to his traumatic experiences.
He was suspicious about the surroundings. He lost the ability to trust and feel intimate. He was affected by emotional anesthesia. He had flashbacks and sometimes he could not distinguish reality from fantasy. His physical strength was weakening and slightest exertion gave him an immense body pain. In 2003, he was diagnosed as having PTSD.
The Cook of the Poonari Camp
Mr. N -a civilian worked as a cook in the Poonareen Camp. When the LTTE attacked the Poonari camp in 1993, many lost their lives. To evade the enemy he was hiding inside the building complex and was later found by LTTE carders. He was beaten and threatened to be killed on the spot. He was mistakenly identified as an officer in disguise. He was subjected to numerous physical and mental tortures. Eventually the Red Cross intervened and established his correct identity.
For nearly nine and half years, he lived his life as a prisoner under the LTTE. He was homesick and practically every day prayed for his freedom. For long time he lived with uncertainty without knowing what his future would be. When the Air Force attacked the LTTE camps, their guards used to ill-treat them severely. His condition significantly improved when he met another POW – Capt Boyagoda from the Sri Lanka Navy. Captain Ajith Boyagoda became a POW when his naval ship “Sagarawardene,” was attacked by the Sea Tigers in 1994. Capt Boyagoda gave him courage and strength to face the callous conditions. Along with the other POWs, he spent the time discussing their release and writing letters home via ICRC.
He was released on the 30th of September 2002. After his release, he gradually developed stress related physical symptoms like headaches, backaches which did not subside to painkillers. He was unable to sleep. At nights, he was awake and thinking of the past. He often felt melancholic feelings, and troubled by emotional anesthesia. He could not feel the happiness of becoming a free man. His emotions were dead. Mr. N was losing the will to live. Several times, he planned to commit suicide.
He was referred for psychological therapies and in the assessment, many somatoform features were found in him. Despite the traumatic symptoms, he positively responded to psychological and drug therapies. Gradually he was able to get away from his melancholic feelings, intrusions and psychosomatic troubles. He was lucky to receive a lot of psychosocial support, even a house donated by the Ceylinco Group. Today Mr. N is very much symptoms free and living a productive life.
Combatants with Partial PTSD
According to Kulka partial PTSD is a sub diagnostic constellation of symptoms that was associated with significant impairment. They have sufficient features of re-experiencing and hyperarousal with insufficient features of avoidance and numbing and comorbid alcohol abuse or dependence.
Cpl Tx3 was a member of the Army Special Forces engaged in a number of military operations. He often worked with the long-range reconnaissance patrols (LRPP). Cpl Tx3 met with numerous hostile enemy conditions, which affected him psychologically. On one occasion, they had deeply penetrated the enemy area. He was with a five-man team and they operated silently. Suddenly he met with two LTTE female carders face to face and none of them fired. Cpl Tx3 was in a dilemma situation, if he had fired at the two LTTE female carders his team would have been in a great danger. Unbelievably, the two women disppeared into the jungle. He was confused and dazed for a while but was able to return safely.
For many years, this incident stuck in his mind. He always questioned himself “why didn’t they shoot? With these intrusive thoughts, he re-experienced combat events that occurred in the North. He would have a startle reaction to any loud noise and became vigilant all the time. Despite the posttraumatic features, he was not avoiding combat situations. Therefore, the avoidance feature was not seen in Cpl Tx3.
Lance Corporal Ax4
Lance Corporal Ax4 who was diagnosed as having partial PTSD, expresses his combat experience thus.
“In 1992 I was posted to Kaytes Island. My own brother served with me in the same unit and I was not comfortable with it. Therefore I requested for a transfer and I was asked to serve in Kajuwatta, Mannar. While I was serving in Kajuwatta camp, one day I got a message saying that my brother was killed in action at Keerimalei. Although I was given leave to attend my brother’s funeral, when I went home the funeral was over. But I attended the religious ceremonies after his funeral.
When my leave was over, I had to report back to the camp. My mother was devastated over my brother’s death. When I went to say goodbye to her she asked me to stay with her. But I had to report to duty. So I left home. While I was traveling to the camp, again I got a message near Puttalam stating that I should report home immediately. My inner mind told me that some bad thing had occurred. When I went home, I met with another disaster. My mother had committed suicide. I was relentlessly shattered. I lost my brother and now my mother. This time after her funeral, I did not report to work and became AWOL. After several months, I decided to report for duty and this time I was posted to a rescue mission at Poonary. In this mission I sustained a mortar blast injury and was taken to the hospital.
“After I was discharged from the hospital I participated in Rivirasa operation. We walked up to Killinochchi facing hostile enemy attacks. A lot of buddies died in front of my eyes. At Killinochchi the enemy attacked us with mortars. I sustained injuries and I was bleeding. I asked others to help me. No one came to help me and I felt fear. Then I saw a sergeant passing near me and I asked him to help me. But he left me just giving a glance. I was helpless and in pain. I gathered my entire energy and strolled towards Elephant Pass. Half way, a group of soldiers helped me. They put me in a cab and took me to the nearest Med Aid Point. There I lost my consciousness and when I opened my eyes, I was at Anuradapura hospital.”
“I was treated several weeks at the Anuradapura hospital and then discharged. I realized that I was experiencing some distressing past events and these intrusive memories troubled me. I could not tolerate sudden noises. My mind was full of traumatic events that I had experienced in the recent past. Some nights I could not sleep and I was having a severe headache. When I am with physical and emotional pain, I become restless. I am not afraid of the battle. As a soldier, I can go to the warfront at any time. The war does not scare me anymore”
My commanding officer was hit in front of my eyes: Private SN
Private SN who was shattered by war stress expresses his past experience in the following manner……
At Mallakam (1995) the LTTE attacked us with RPG. I stood near my commanding officer. I fired at the enemy with my T56, killing two of them, then a mortar exploded near us. I saw my commanding officer wounded and bleeding heavily. His uniform was soaked with blood. I expected help form our buddies. When I looked at the right flank, I saw no one. I shouted for help. Then another mortar exploded near me. I too sustained injuries. Blood came from my left ear. I had no strength to help my commanding officer. While he was lying on the ground I crawled towards the rear side. I had severe guilty feelings for abandoning him on a hostile ground. But I had no option. When I was crawling, I met some of our soldiers. Then I shouted at them “the CO is wounded get him soon” .
So they went to rescue him. I went further. I could not crawl anymore. I lost my energy. The world was trembling in front of my eyes. I could hear the gunfire, artillery explosions and the incoming mortar sounds. My eyes were covered with a dark strip. I lost consciousness. When I opened my eyes, I was at the Palali Hospital.
I was treated at the hospital for nearly one and half months. When I was discharged from the hospital, I went back to my unit. I realized that my personality was changing little by little. I was a daring soldier. But the events at Mallakam changed my life. Day and night, my mind was full of these events. Gunfire, black smoke, incoming mortars, images of the enemies and the wounded commanding officer were vivid mental pictures that were ruminating inside my mind. I became more vigilant. I could not sleep at nights. I used to wake up for a slightest sound. These sounds gave me fear. When I was disturbed by a slightest sound, I felt a burning sensation in my chest. I used to get up in the middle of the night with fear and sweat. Gradually I became depressed and felt that my life was wasted. I wanted to commit suicide. One day when I was at the bunker alone, I tried to release the pin of a hand grenade. Then I saw the eyes of my wife. I put the grenade aside.
My world was upside down. I did not like to stay in the operational areas. I felt uneasy when I saw military uniforms and vehicles. I disliked participating in ground operations. But I had no option. I was compelled to fulfill military duties. I went with my platoon secretly suppressing my fear and avoidance. My symptoms were aggravating. I was about to explode.
Finally, I told my fears to one of my unit leaders. He listened to me for a long time and said “you need medical treatment”. So I went to the military hospital seeking salvage. I was referred to the psychiatric unit and treated for nearly three months. I received drug therapy and psychotherapy. My symptoms reduced little by little. Then I felt much easier. Today I am doing light duty. But I have not been completely freed from the Malakam events. Occasionally I see the face of my commanding officer.
The Johny Batta that changed a young life
Private Hx26 became a victim of an anti-personnel mine in the North and underwent B/K[1] amputation. He became shocked when his foot had blown off from the ankle and for a long period, he relived this traumatic incident. After he met with the injury, his life fell apart. The girl who promised to marry Private Hx26 left him. He could not adjust to the life with a prosthetic foot. He became more and more alienated and stopped associating with people. His life was limited to a wheel chair.
Although he was recommended rehab therapy, Private Hx26 did not actively participate in the rehabilitation program. Once he made an unsuccessful attempt to jump into the pool at the rehab center with his wheel chair. After his attempted suicide, Private Hx26 was referred for psychological therapies and he was diagnosed with PTSD.
Private Hx26 ’s therapeutic schedule consisted of drug therapy as well as counseling. After 6 weeks of inward treatment, his suicidal ideation changed and he was gradually came to terms with his disabled condition. Private Hx26 underwent further psychotherapy and finally he gave his consent to undergo the rehabilitation program with the Psychiatrist’s supervision. He selected a handicraft profession- shoemaking and successfully completed it. Two year follow-up revealed that Private Hx26 is free of PTSD symptoms.
The EPS debacle was my worst experience
The Elephant Pass debacle that occurred in 2000 due to poor leadership and inefficient strategic evacuation plan led to loss of many lives. It was a tactical withdrawal of the Elephant Pass camp but it was carried out in the hot sunny afternoon. Many soldiers died of dehydration and heat stroke. During the EPS debacle, 359 military personnel were killed, 349 were listed as Missing in Action and some 2500 were injured. Corporal K described the events that took place between the 21st and 22nd of April 2000.
On the 21 of April 2000, I was at the FDL of the Elephant Pass Camp. We were told that the evacuation order would be given at any moment. The following day at about 10.30 am, the enemy attacked the Elephant Pass camp with heavy artillery. While the enemy was attacking, our soldiers withdrew towards Kilalli lagoon. There we met Brigadier Percy Fernando who was a brave officer. He tried to reorganize and launch an attack’ then to go for a safe withdrawal. We assaulted the enemy and moved toward Pallai. The LTTE attacked us with mortars and their snipers targeted our officers and signalmen. I saw Brigadier Percy Fernando sustain a gunshot injury. It was a disastrous moment. Brigadier Percy did not abandon us. Some cowardly senior officers saved their skin and got away leaving us to the enemy. But Brigadier Percy Fernando stayed with us and gave us leadership until the end. When he fell down, I knew that we were doomed.
We were tired and exhausted. Many of our soldiers could not walk. Hot sun and dry wind sapped our energy. I felt thirsty but my water bottle was empty. Many of us did not have sufficient water. We were walking like zombies in the hot sand. Some drank salty water from the lagoon. Some began to sing songs as they lost their minds. Many fell down with exhaustion and never got up.
While we were moving enemy attacked us with mortars. Many soldiers were dying without water and facing enemy attacks. We had to walk fast to avoid the enemy fire. There was no air cover for us. Some fainted in front of my eyes. I knew they would never return home. One solder became insane. He was singing and dancing asking for a cup of tea. Wounded soldiers asked us to carry them. But we all were worn out and had no energy to carry a fellow soldier. We were on our own and every man for himself. It was an egoistic moment that I cannot forget until my last day.
My energy was ending. I could not carry the ammunition pack. I had to throw my belongings. Finally, I threw my weapon which was my savior for a long time. I walked in the hot son with other soldiers. All I needed was water. My head was dizzy and I fell down. I saw the hot sun. There were no clouds in the sky. Many soldiers passed me by but no one helped me. I knew if I stayed there, I would be dead soon. I gathered my energy and again started to crawl avoiding enemy attacks. Panicked solders trampled me and ran towards Pallai. On my way, I saw many dead bodies.
One sol