THE PSYCHOLOGICAL ASPECTS OF THE INDIAN MILITARY ACTION
(Jaffna, The End Of 1987)
Throughout history, the cost of war in terms of deaths, mutilation, torture, grief, destruction of material resources, privation, social disorganisation and psychological trauma, as been enormous and, in recent times, war has become increasingly costly and ever more destructive. The continued occurrence of war, accompanied by the presence of standing armies and the manufacture and stockpiling of costly weapons of limitless destructive power, shows man's incompetence in solving his problems in peaceful ways and his drive to struggle for power by violence and aggression. Woe unto a population caught in such a war!
During the months of October and November, 1987, Jaffna witnessed death and destruction on a scale unprecedented in its history. Military operations have been going on full scale in Eastern Sri Lanka and to a limited extent in the North, as part of the chronic civil war being waged in the last few years. The so called Operation Liberation, in the middle of 1987 in the Vadamaratchi area brought the action into the heartland of the Tamils of Sri Lanka. A similar fate for the rest of the Jaffna peninsula had been in the offing and frequently threatened. It is a tragic irony that it was left to the Indians who had all along been championing the Tamil cause and had been looked upon as their saviours and protectors, to complete this task. A comparable number of deaths has been claimed by epidemics in the past but in terms of the agony, destruction, terror and mayhem of complete war and the duration of continued action, the Indian military action far surpassed anything Jaffna had ever experienced. In the final analysis, it is perhaps the psychological trauma to the civilian population, even more than the deaths, the physical hardships and destruction of property, that is most poignant. Though not by any means a new or unique experience in the annals of the history of war, an attempt is made here to record the psychological impact of this acute war, from the perspective of a participant-observer. It is based on an earlier, more detailed, clinical study, "The psychological sequelae to the chronic civil war in Northern Sri Lanka," during the period 1983 - 1987.
Psychodynamically war is a form of severe stress that can cause, even in previously stable personalities, temporary personality decompensation, leading to transient stress reaction. The decompensation can be acute and sudden as in the case of an individual exposed to an overwhelming experience of death and destruction; or chronic and gradual as in the case of a person who has been subjected to being a refugee or living under conditions of unpredictable and irregular shelling. Usually the individual shows good recoverability once the stress situation is withdrawn, although in some cases there is residual, permanent damage to the personality and an increased vulnerability to stress. In the case of individuals who are marginally adjusted to begin with, or who are predisposed to mental illness, the situational stress may precipitate more serious psychopathology and neurotic or psychotic illness. It is not possible to predict with absolute certainty what form the reaction to stress will take in a particular individual, though the premorbid personality, previous reaction patterns to stress, family history of mental illness and the specific meaning and severity of stress in the unique life situation of the individual are good indicators. Indeed in some, stress may lead to adaptation and provide the impetus for personality development and increased stress tolerance. Common symptoms of what has been called "war neurosis" are dejection, weariness, tension, irritability, hypersensitivity, startled reaction, sleep disturbance and tremors; or more specifically, anxiety, phobias and depression. In clinics held at refugee camps, the majority of cases, apart from skin conditions (like scabies), gastrointestinal disturbances (like diarrhoea and peptic ulcer) and upper respiratory tract infections, were suffering from transient stress relations, reactive depression and anxiety. They manifested somatic symptoms, of which the following were common: headache, dizziness, dyspepsia, backache, palpitation, chest pain, paresthesias and other multiple complaints for which no obvious organic cause could be found. On questioning, symptoms of sleep disturbance, irritability, dejection, loss of appetite and "worries" were discovered. It has been found that patients from developing countries, who lack psychological awareness, 'Somatise' their mental and emotional problems in terms of physical complaints. This could explain the common finding of multiple bodily complaints as a reaction to the chronic stress of being displaced.
During the military operation several factors contributed to the inducement of stress in the civilian population. A significant phenomenon during those days was the large number of refugees. More than 75% of the civilians from affected areas were displaced at one time or another, the figure reaching 100% in some areas. 'Fight or flight' is the normal neurophysiological response of an organism to threatening stimuli. Flight is the more common response particularly when the threat is overwhelming. Chronic flight due to continuing danger leads to one fleeing his home as a refugee to a safer place. The status of being a refugee creates in one a feeling of homelessness and loss of traditional support, with the collapse of the world one knew and the regular routine that was the framework of one's daily life. Many civilians sought refuge at temples and schools as advised by the Indian Army. These same temples and schools were shelled, resulting in a large number of civilian deaths. It was a tragedy that even refugee camps such as Kokuvil Hindu College, Chundikuli Girls' College, Jaffna Railway station, Inuvil Pillayar Kovil and the Karamban Roman Catholic Church turned out to be death traps. No place was safe. In some refugee centres, people were marched in front of masked "nodders". Some youths were shot, others were taken away. At Manipay Hindu Ladies' College, women were raped. Decomposing bodies were not allowed to be burnt or buried. It was reported that a mother had to look on, while dogs ate her dead son a few yards away. Large numbers were confined in small spaces for long periods of time, sometimes 2 to 3 days. They were without food and water, with perhaps kanchy1 in some places. They had to relieve themselves within the rooms they were in. The children and the old were badly affected. Appeals to the Indian Army fell on deaf ears or were answered with threats of being shot.
As the army advanced behind them, the refugees trekked over long distances seeking alternative refugee shelters. The old and the disabled had to be left behind. A large number fled from one part of the peninsula to another until, eventually, there was no place left. The more enterprising and affluent ones fled to Singapore, the U.K., Canada, Australia, France, West Germany and so on.
The accumulated stress of leaving their homes and usual habitat was accentuated by a complete disruption of normal life patterns, together with lack of food, rest, medical attention and a continuing atmosphere of fear and terror. Another important psychological stress the civilian population faced was the sudden change of the role of the Indians. It has been found that an individual is better able to cope if he understands and accepts the necessity for any particular stress. The Tamils coped with the chronic civil war with the Sri Lankan Army and the accompanying atrocities because they believed they were involved in a legitimate struggle for their human rights. For the Tamils of Sri Lanka, the tragedy of the Indian action lay in the fact that India, the source of their culture and traditions, a holy place of pilgrimage, had always been held in the most intimate and revered terms. When the Indian Army suddenly started treating the local population as its enemy and to kill and destroy mercilessly, this metamorphosis from friend and protector to aggressor and enemy was undoubtedly the most shocking and psychologically traumatising factor of the whole war.
The public was unprepared for the sudden onslaught. People had breathed a sigh of relief at the coming of the Indians and even stopped keeping stocks of essential item as was customary at the time of the Sri Lankan Army's activities.
The older generation particularly found this change of role difficult to accept and different psychological defence mechanisms like denial, rationalisation and intellectualisation were resorted to, to cope with this changed situation. Some denied that it was the Indian Army that was shelling and shooting and claimed that it was probably the Sri Lankan Army, that only the militants were being killed and that the civilian had nothing to worry about. Others maintained that the atrocities were perpetuated by the North Indians, while the South Indians were "Good" and trying to stop the North Indians. Still others rationalised saying that this was all necessary and that we will understand only later. According to them, the action would be over in a few days and then there would be permanent peace.
They continued to believe completely the psychological propaganda spewed out by the Indian Radio special programs (Anpuvali and Veti Malai). They continued to have faith and trust in the Indian Army, till they were confronted with the stark reality of seeing their houses shelled or their friendly approaches answered by a hail of bullets. And still some continued to rationalise the consequences as something that happens with any army and held that we would have fared much worse under Sri Lanka Army. And then there were those who looked at it intellectually. For example a doctor compared it to a surgical procedure to excise a cancerous growth, where a certain amount of healthy tissue also has to be removed. (Only here, excessive healthy tissue was removed due to careless surgery, endangering the lives of the patients, while the cancerous cells escaped, leading to widespread matastasis). By these and similar "explanations", people sought to maintain their mental balance, their psychological homeostasis, in the face of the unexpected Indian attack.
It has been found that information facilitates adaptive reaction to stress. Lack of information and breakdown in communication lead to much confusion, apprehension and disorganisation. The local population had no precise information about what was going on; rumours and half-truths circulated from mouth to mouth. The Indian radio's 'local' programs (Anbu vali and Veti Malai) and the Eelamurasu, the local newspaper, gave completely opposing versions. Each side announced victory after victory with heavy casualties inflicted on the enemy. What became increasingly clear was that these casualties referred to civilians and that heavy fighting continued. In mid November, the Eelamurasu was silenced and the Indian radio happily continued to announce the return of normality - the opening of shops, offices and schools, the restoration of services etc., when in actual fact, people were still afraid to walk around in their own compounds as full scale military operations were still in progress. Only two months later, in January 1988, did civilian life really limp back to normality, once the hostility had decreased.
Even those who could communicate in English or Tamil were terse and snappy or threatening. The Indian Army was evidently not interested. Everyone was the enemy. There was nothing to talk about. The civilians, usually leading senior citizens, who tried holding white flags were rebuffed rudely or sent scurrying be a hail of bullets above their heads. The Tellipallai District Hospital was shelled heavily for two and a half hours with 67 shells falling within the compound and injuring members of the staff and damaging many buildings, although there was no resistance or presence of militants in or near the hospital. After the shelling, a delegation of senior staff members in uniform, together with ambulant patients approached the nearby camp, but were stopped about 100 yards away. The sentry was seen to use the telephone and then he shouted at the delegates to get back or be shot. Again on 17 October, troops, while moving on the road in front fired on the hospital and on uniformed staff members. Although the army moved frequently along the hospital road, no attempt was made to establish communication with this big institution. The first contact was made only on Nov. 11, a month later. This lack of communication led to much uncertainty and helplessness in the minds of the public. They did not know what was expected of them or what rules and regulations to follow.
Most stress reactions show spontaneous recovery once the stress is withdrawn as did happen when people started returning to their homes, and communication and contact was established, with clearer information available. The atmosphere of hostility and terror was defused beginning from January 1988. But the fact that the stress had been fairly severe, was shown by the long time people took to recover. The refractory period was prolonged unlike after the Sri Lankan Army operations, where people resumed civil life immediately or had learned to continue despite military activity. A haunting sense of shock, disbelief and disillusionment, fear and terror, loss and sorrow still lingers like a bad taste. The Tamil man will not easily forget this experience.
On the positive side, some adapted well to the stress and showed hidden strength and leadership qualities. Particularly encouraging was that individuals, considered as trouble makers or administrative headaches during normal times, acted with heroism and initiative. At the Tellipallai District Hospital, a lady doctor, though with child, continued to run the hospital despite heavy shelling and direct firing on the hospital and her quarters. When most of the staff had fled, she stayed on with four nurses and looked after the patients for over two months, doing yeoman service at this critical juncture. The local population as a whole, after some initial panic and disorganisation, learnt to cope with the situation for two months, while fierce battles raged on all fronts, amidst exploding shells and gunfire, a continuous shoot-at-sight curfew and a breakdown of all civil organisations. The usual amenities of civilized life that we had been so used to, were suddenly not there. What are normally considered essential requirements, such as electricity, water, mail, transport and access to main roads, hospital and medical services, banking and circulation of money, jobs and salaries , ceased to exist for over 2 months. People were caught unawares without any stocks. Open shops were scarce. A large number of refugees were on the move. The injured needed medical care. The sick and disabled, infants and pregnant mothers, unfed domestic animals ... the problems were unlimited. The reaction was often inspired and heart warming. People became accommodating, forgot old quarrels and helped complete strangers. Refugees were given shelter and food shared. People came forward to donate bags of rice, flour, milk and vegetables to refugee camps, food for the infants, care for the sick, solace for the grieved, and refugees were fed and clothed for long periods, thus establishing new friendships.
Small acts of heroism such as retrieving the injured and taking them to hospital facing great personal danger, were much in evidence. At St. Anthony's Church at Chunnakam, eleven severely injured persons were kept alive overnight by a nurse and St. John's ambulance volunteers until midday when permission was given by the army to the priest in charge of St. Anthony's Church to take them to hospital. At Sanguveli, when some young girls were taken away by Jawans, a brave, middle-aged woman approached the army camp, a very risky undertaking in those shoot-at-sight days, and raised such a cry that the commanding officer fired some shots into the air and the Jawans returned meekly to camp. The girls escaped being raped.
Communities organised themselves into groups to deal with urgent issues. Enterprising shopkeepers kept the interior areas supplied with essential items at reasonable prices, often taking risks to procure items from neighbouring areas. But as a whole, the community managed to withstand the severe pressure for over two months, completely on their own, with no outside help. They have established their self reliance, self-sufficiency and their ability to live off the land without the modern amenities of civilization. They have lived up to the local palmyrah tradition.
Phobic anxiety is basically the psychological component of a fear reaction that has become incapacitating. Fear was the predominant emotion during this time and phobic anxiety states could be considered almost normal under the circumstances. They usually reported intense apprehension, fear, feeling of impending doom or death, tension, being edgy, irritable, vigilant and easily startled, dyspnoea, palpitation, chest pain, choking sensation, sweating, abdominal pain, loose motions and increased micturation. Some reported frequent panic attacks, particularly during shelling, gunfire or on seeing the army. Children were reported to run and cling on to their parents or hide under beds. Many had sleep disturbances like difficulty in falling asleep, interrupted sleep, anxiety dreams where they see themselves being injured or chased by the army, nightmares and fitful sleep, with fatigue on awakening. Patients with a previous history of angina pectoris, developed anginal pain during these attacks. It was observed that some instinctively resorted to repeating mantras or short prayers which have been shown to work as relaxation techniques to alleviate anxiety.
What has been described as existential anxiety was also observable in some cases. Deaths became a pressing reality and people had to deal with that fear daily. What had been quietly forgotten or submerged in the press and care of daily life, broke into one's awareness, Man was made aware of his existential state, the transience of life that everything born must die one day. As death stalked the land, the veil that separated life form death was rent asunder and one stood face to face with stark reality. An existential fear gripped everyone. An old, experienced man compared the present war to the great destructive forces of nature - famine, epidemics, cyclones... Groping for mythical symbols to express his deep feeling, he said: "Mother Kali with her Asura forces from India have descended on Jaffna!"
Terror, a form of extreme fear, was widely prevalent in the months of October and November. This was not surprising since it was quite evident that there was a deliberate attempt at the time to terrorise the civilian population. The usual uniformity in the behaviour of the Jawans towards the civilians lends support to this assertion. As mentioned earlier, there was no attempt to establish communication or contact with the civilians; rather it was actively discouraged. Where there was conversation, usually during search operations, it was terse, snappy and revealingly similar. "Any sound from this direction and we will flatten your house and shoot you all." This was repeated in different situations, in different places, by different Jawans. Was this a standard order from higher-up? This wall of silence, except for the few belligerent words spoken, caused uncertainty, a feeling of isolation and loneliness, made worse by being cut off from the outside world.
Secondly the Jawans were undoubtedly free to do as they wished. By their words and deeds, the they conveyed the message that they had been given a free hand by the higher-ups. They were not accountable and people felt deserted, alone, without protection and without recourse to justice. An Indian Red Cross doctor told me that this could only have happened here. There was nothing to ask. This never happened in Punjab or or in Bangladesh. The army felt free to destroy, kill, loot, rape... They were allowed to run amok, unchecked for nearly two months. This lack of restraint, the liberty to do as they wished, contributed to the atmosphere of terror. The atmosphere changed gradually from December as the commanders started to apply some constraints, making the Jawans accountable for their actions and took action on complaints. This did ease the situation somewhat and the Jawans showed much more restraint in their behaviour. A third factor contributing to the reign of terror was the inhuman behaviour of the army. The local population was pushed, shoved and beaten with extreme callousness and brutality. Status, age, sex,.... nothing mattered. Lawyers, doctors, engineers; the old, the young; and the sick and the disabled were all shot even after being identified; whole families were pulled out of their houses and shot. The bloody assault on the Jaffna hospital with the massacre of doctors, nurses and patients, described in detail elsewhere, was the epitome of this type of barbarous behaviour that struck terror in the hearts of the people.
Fourthly the indiscriminate shelling, particularly the its unpredictability and terrific noise, were instruments of psychological terror. It is questionable whether the intense shelling of whole areas achieved any military objective. There were at the most only a few thousand militants among 800,000 civilians in Jaffna, whereas the Indians went about it as if it was conventional war against a large army. One wondered how many of the militants were actually hit by any one of the thousands of shells that fell on Jaffna. As for its psychological effect, the militants could be observed to be nonchalantly moving around in casual conversation, quite unalarmed by the exploding shells.
But the persistent shelling of densely populated areas, even after large scale resistance and mortar shelling ceased, speaks of a more sinister purpose. Sixty shells fell on the Tellipallai hospital on 12 October, when no militants were around. The Christa Seva Ashram with well over a thousand refugees was heavily shelled on 13 October, with a part of the chapel roof collapsing on the incumbent. Again no militants were around. In addition there was the so called "noise" shell which exploded with a thunder-clap effect. This was obviously a psychological weapon used with deadly effect on the civilians. Nights were spent in abject terror, partly due to what has been called the anticipatory anxiety of not knowing when and where a shell would fall. Some died of psychological shock. A mother who had delivered her second child, died suddenly when Chankanai was shelled. Many children have never got over the effect of the noise and remain hypersensitive to any loud noise. Two children who had gone to Colombo as refugees developed severe anxiety and clung to there parents when fire-crackers were lit for the New Year. The animal population too suffered terribly from the noise pollution. Trembling dogs were seen scampering all over, rabbits dropped dead and wild birds vanished from the Jaffna Peninsula. The cry of despair that escaped from an old man in late November reflected the anguish of all living things: "When will this infernal noise stop? When will the shooting cease? Oh, when will peace return to this land?"
Another devastating aspect of the shells was the destruction of property and mutilation of civilians. Residents at Inuvil hospital heard a shell whiz past overhead and in a few moments a Professor Chandrasekaran of Jaffna University was carried over the hospital boundary wall with both legs gone and bleeding profusely. That image was to recur in their minds and send them into panic whenever they heard shells. One has to concede to the credit of the Indians, that neither heavy artillery nor the more lethal fragmenting shells favoured by the Sri Lankan Army was used and heavy bombing was not resorted to. But there was no need at all for artillery fire on a civilian population.
A questionable feature of the heavy destruction due to shelling was that it fell short of Jaffna. There is severe destruction on all roads leading to Jaffna, but stopping just short of the city limits. There was stiff resistance to the army in Jaffna and many civilian deaths but not much destruction of buildings. One wonders why. Could it be the Indians wanted to preserve Jaffna? But subsequent events such as their hurry to establish normality within the Jaffna Town suggest that they wanted the town intact and whole for their conducted tours for foreign journalists. If this is true, then it shows a degree of pre-planning and a deliberate use of the artillery for nonmilitary purposes.
The decision to use terror may have been to wrest control over the civilian population and force them to relinquish their sympathy and support for the L.T.T.E.. Perhaps due to their failure to win a quick victory and their gross underestimation of the L.T.T.E., the Indian Army found itself fighting a desperate battle to save face and take Jaffna at all costs. A second possible reason may have been a reaction to the fighting tactics of the L.T.T.E.'s guerrilla warfare in an urban setting. The civilian population was used for cover. They fought from hospitals, temples and schools. Women and children performed military tasks and allegedly dead bodes were desecrated. These may not have been the norms of war, the Dharma, that the Indian Army expected. If one is to rationalize the behaviour of the Jawans at all, it must be in the context of their being psychologically unprepared for this type of battle and as a rage reaction to the way it was fought.
It has been reported that some sodiers were airlifted over long distances and immediately pressed into battle without adequate rest. Others came with only a change of clothes expecting the action to be a pushover and to be completed in a few days. They were handicapped by fighting an elusive enemy using guerrilla tactics, along with rigid conventional lines, resulting in heavy casualties. For example, at Uduvil on Oct. 13, a convoy of tanks was ambushed by a handful of teenage militants. It was observable that the army kept to the main road or ventured at the most into the road-side houses and compounds leaving the few militants free to move around in the interior, three or four houses deep from the road and in the fields. While setting themselves up as easy targets from all directions, the army allowed the militants to literally run in circles around them. Apparently they had been ordered to take and hold on to the main roads and its main junctions. Indeed, there does not seem to have been any direct fighting during the whole war except at the University grounds and Urumpirai. Few in the Indian Army had any knowledge of the political situation. Put in a completely foreign environment and ignorant of the local language and customs, they may have undergone a paranoid reaction. They were suspicious of everyone, treating the whole local population as the enemy actively supporting the L.T.T.E..
"You L.T.T.E.? ... Where L.T.T.E.?" ... L.T.T.E., L.T.T.E. ...was the one word on their lips. It became an obsession with them. There may have been also an element of inexperience and over-reaction to the situation in some units. It was observable that guns and shells were fired with wild abandon, continually for long periods with little or no provocation. Sometimes one got the impression that they were indulging in using the weapons for the sheer pleasure or experience of it. Late in the night one would hear a shot and then a whole barrage in answer, that would go on and on, and then a few shells for good measure. These men had been pressed into battle mentally unprepared. Expecting a quick finish, but meeting fierce resistance in a foreign environment, they reacted with an uncontrolled frenzy. Later on, a soldier tried to explain their behaviour by saying: "When one of us dies, our blood begins to boil and we do not know what we are doing." But in enlisting in the army, they should have expected battle and death and not taken it out on the civilian population when faced with such grim realities. It may be said that an army is an army and as armies go, they were no worse. But then, we expected something better from India.
In the final analysis, the ultimate responsibility for what ensued, rests with the higher command and more with the political administrators in New Delhi and their representative in Colombo for putting their men in a difficult situation. It was a situation largely of their own making.
The use of terror may have worked to some extent on a society that has learned the language of violence and was used to being ruled by terror. But to continue to rule by the use of terror is costly and impracticable and the Indians have realised this as evidenced by their current efforts to win the hearts and minds of the Tamil by more humane methods. Their recent (February 1988) search operations in Batticaloa were carried out with much more restraint and consideration for the civilians.
The terror of those days still lingers like a persistent bad taste, a recurrent nightmare. The Jaffna man is unlikely to forget that experience in a hurry as can be seen by his lukewarm responses to friendly overtures of army personnel. After all, friendship is not something that can be turned on and off like a switch.
4.4 Grief Reactions
Grief reactions were common during this period. Due to the suddenness and the psychologically traumatising circumstances surrounding the death of loved ones (such as the noise and destruction, the blood, mutilating injuries, pain, lack of medical attention and standing helpless as loved ones died) there was an increased incidence of the more severe reactions and several with atypical features.
A middle aged engineer whose 3 children and mother-in-law had been pulled out of their home and shot dead on the street for no apparent reason, developed a severe grief reaction with secondary alcoholism. He spent his days in deep sorrow with attacks of crying spells, the pangs of grief buffeting him like waves. His mind was preoccupied with thoughts of his children. He complained of loss of purpose in life with suicidal ruminations. His nights were particularly bad with recurrent nightmares about his children and their suffering, especially his pretty daughter. The soldier had lifted up her frock and shot her through the groin. She could not walk and had to drag herself along the road and finally bled to death for lack of adequate medical attention. This picture kept recurring in his mind. He would say: "She was deeply loved and I brought her up without a care. And now she had to suffer like this... It is unbearable," and break into sobs. Hostility, a feature typical of grief reaction, was apparent in his accusations of medical mismanagement, wanting revenge ("I'll personally kill these soldiers,") and his filing a case. His wife too was inconsolable and he expressed a fear that she would cry herself to death. They felt that without their children, life had lost its meaning. Previously an occasional drinker, he had now started drinking heavily and was in a state of intoxication most of the day and night.
A 24 year old farmer from Alaveddy developed an atypical grief reaction when his father and uncle were shot while attending to their cows. He became restless with irrational and incoherent speech and behaved in an abnormal and bizarre way. The picture was that of a psychotic reaction and required electroconvulsion therapy.
In some cases, multiple deaths of close relations precipitated decompensation. A nurse, previously of a jovial personality, developed a severe depressive illness when several of her close relations died. She needed intensive treatment before she gradually recovered.
4.5 Reactive Depression
A large number of patients with depression secondary to the current situation presented to the out-patient clinic and for in-ward treatment. The reactive type of depression is known to be brought on by any type of loss. In addition to the grief reactions, some of which merged into true depressive illness due to loss of loved ones, the other common causes for the development of the illness were loss of house and property due to shelling, loss of employment and other sources of income, loss of dignity and humiliation due to arrest and/or assault and loss of virginity and chastity due to rape.In some cases, wives presented with reactive depression when their husbands were taken in for questioning and assaulted. Conversely, husbands developed loss of libido and other depressive features when their wives were raped.
An Indian Army doctor speaking to me soon after his arrival following the July '87 peace accord, expressed his shock and sorrow at seeing so many houses destroyed. His camp was near Kurumbasiddy, where most houses had been destroyed by the Sri Lankan Army. I agreed, saying that it was built with their life-earnings. To this he replied: "It is not merely the money, it is the love and affection with which they would have built and maintained their homes. To see all that destroyed must be heart rending." I do not know whether he was here to see what happened in October and November and whether he would still be sympathetic.
The straw that broke the camel's back, the loss that proved to be just too much to bear after seeing their houses damaged or destroyed, that which tipped the scale into full blown depressive illness, was the loss of their personal belongings due to looting by the locals. A very unfortunate outcome of the prevailing situation, a state of anarchy without law or order, was the widespread looting that went unchecked. Those vulnerable, those most affected, were the ones who had already suffered much. It was a sad reflection on our community.
4.6 Psychosomatic Disorders
Psychological stress is known to cause physical disorders like eczema, backaches, headaches, bronchial asthma, hypertension, peptic ulcer and mucous colitis. Disorders of this nature were very common during the current period, particularly dyspepsia, tension headaches, backaches, hyperventilation and tachycardia.
In some cases the psychological stress led to more lethal consequences. Psychologically stressful life events are known to precipitate myocardial infection. A middle aged telephone operator at Tellipallai hospital who had been quite healthy, suddenly developed chest discomfort and died when his teenage children were taken in for questioning. A known hypertensive who had been doing quite well had a stroke and died when his area came under intense shelling.
In contrast, some of our patients who had been chronically ill with arthritis, backache and dyspnoea and some of hypochondriacal nature, appeared to get better during this period of stress and led a healthy life even without medication. The complaints returned with the easing of the situation.
4.7 Personality Disorders
It has been found that individuals with abnormal personalities tend to join extreme organisations. Delinquents, aggressive and anti-social personalities may do well in a military set-up, where their energies can be diverted to national ends and their confinement in the army be a protection for the society.
It is a well established fact that war provides ample opportunity for sadistic personalities to derive pleasure from acts of violence, cruelty and torture on hapless victims. When the dogs of war were unleashed on Jaffna, one got the impression that a band of raving psychopaths had been let loose on the public. Strangely enough, after the cessation of military activities, the Jawans appeared to be a bunch of innocuous human beings, with the normal variety of personality traits and personal problems. It may be that the war machine itself brings out the darker aspects of one's personality and engenders behaviour bordering on the barbarous, which under normal conditions remained suppressed. To some extent this may have been due to the releasing of the usual restraints and discipline by the higher command. This was quite clear in the behaviour of the Jawans. They acted without any remorse and showed no fear of any disciplinary action from the commanding officers. In fact they indicated that they had been given a free hand. This picture improved by December and more so by the beginning of 1988. By January 1988 the Jawans were much more disciplined and polite and showed fear and uneasiness when indulging in anti-social or illegal activities. By now disciplinary action had been instituted. Identification parades were held and punishment meted out. It is interesting to note that the worst punishment from the point of view of the Jawans, was to be deported home without salary and their pension withdrawn. It is just possible that the officers had been hard put to control the troops after the initial reverses, the heavy casualties and the dirty, "Adharmic" war that erupted. In an attempt to maintain troop morale and retain some control, they may have allowed these indulgences. Indeed the officers themselves, with a few exceptions, were very indignant and belligerent during the actual war. The Indians were quick to realise quite early in the struggle, perhaps to the advantage of the local people, that it is easy to take, but difficult to hold onto an occupied land as shown in Vietnam and Afghanistan. They need the co-operation of the people. Thus the battle for the hearts and minds of the Jaffna men was launched; discipline and order were established, regular classes on public relations were held for the troops, rehabilitation and reconstruction work was commenced, and the popular medical clinics and food distribution were started in every village.
Once the tension eased, one got more insight into the personalities of the officers. As the Jawans started mixing with the public, one perceived the more human side of their character. Despite their metamorphosis during the war, they revealed a simple personality with problems that only the less sophisticated in extended family relationships will take seriously. They lived simply and had simple tastes, likes and dislikes. While in battle they had shown indomitable courage and a remarkable endurance. Another noticeable feature of their character, perhaps not surprising considering their Indian origin, was their extreme religiosity, at least externally. Vibuthis, pottus, pictures and flowers on vehicles, worship and respect at temple were very much in evidence.
At times this took on a tragi-comic aspect, as when a soldier riding on top of a tank that had repeatedly fired on and severely damaged the Christa Seva Ashram and the attached Seminary, folded his hands and bowed his head in prayer as he passed the cross at the entrance! Much more touching were the innocent love affairs that sprang up, despite the language barrier, some even progressing to more permanent relationships. One got a glimpse into their background from the small things they 'lifted' while searching and their expression of awe at the prosperity of Jaffna by such exclamations as: "What do you lack? Everything has been given to you!" (They hardly realised that all that they saw had been earned and built by sweat and toil off a hard and dry land). Evidently they came from the poverty ridden villages of India and the army was an opportunity for their families' advancement. But this did not detract from their straight forwardness and a down-to-earth outlook and an occasional kind word for the locals. When a young farmer in a frustrated outburst shouted: "You beggars you come and occupy our land which we have struggled to develop and order us about and destroy every thing," the soldier merely patted him on the back and said, "I ... I understand, but don't repeat to others."
In contrast, the officers were very sophisticated, polished and suave. The army hierarchy appears to have bred an elite, true to form. They spoke good English with a typical accent, and were all-Indian in out-look, athletic in build and extroverted and social. Their personalities impressed and easily won over the leading local citizens. They appeared well disciplined and in complete control of the men. It was evident that the Indian Army was a historical institution with a long tradition behind it.
The officers made excellent public relations officers when they wanted to. Their main aim in dealing with the public was to reassure with flowery promises that ""everything will be attended to, there will be no problems. It is all a minor matter. Very soon there will be normality and peace. The only problem is the L.T.T.E., please advise them," and so on. An Indian Red Cross doctor complaining of the army's inefficiency said they will promise anything: "Yes, we will get it down form India tomorrow. Don't worry Doctor. No problem." But nothing whatsoever will be done. One got the impression that it was all a show and bluff which had a deep contempt and animosity for the public whose co-operation they nevertheless needed to run the place; an arrogance that broke through the veneer at the slightest frustration. This attitude may have been responsible for the disagreements that arose between the military, the Indian civil administration and Red Cross in Jaffna.
There were exceptions. Major Paramesvaran showed genuine concern for the plight of the civilians and initiated steps towards solving problems. Unfortunately for the Jaffna man, he chose (bravely or brashly) to lead his men into battle and paid the price. His loss was deeply felt by the local population who had come to place their trust and faith in him. One may say of him that despite his army background, he was a genuine person.
In the brief period the Indian Army has been in Jaffna, it appears that they have not as yet adopted the more psychologically damaging methods of torture. Thus we do not see the degree of psychological sophistication and the prolonged systematised torture of victims resorted to by the Sri Lankan security forces, sometimes for no apparent purpose, which resulted in short term and long term neuropsychological symptoms. Torture by the Indian Army has tended to be short term with the specific purpose of gaining information. Although physical damage was sometimes severe such as fractures and even death, psychological sequelae was not common. For example, a foreman at the Paranthan Chemical Factory was taken in due to mistaken identity and tortured by being hung by the legs and beaten on the soles and back. Electrical current was passed into the sensitive tongue and penis causing severe burns and the burning end of a cigarette applied to the atma. On his identity being established the next day, he was released. Despite severe physical damage, he did not appear to have any psychological sequelae.
In contrast, an engineer going to Peradeniya who was taken in by the Sri Lankan Army about the same time, was tortured systematically for a prolonged period by methods including the regular passage of current through his head. Though physical damage was minimal, he suffered a complete psychological breakdown and was admitted to the psychiatric ward muttering irrationally and irrelevantly, a mental wreck.
What is said about violence in general is applicable to sexual violence. However sexual behaviour has its own unique characteristics. From time immemorial, plunder and rape have been considered the spoils of war. Although the total number of rapes during the Indian Army operation have been exaggerated in the press, it has been verified that quite a large number, ranging from young girls who had just attained age to old women well past their menopause were actually raped.
In our cultural setting, sexual violence takes on a more serious significance and has a severely psychologically traumatising effect on the victim and her close relations, including her husband. Chastity is traditionally considered one of the supreme virtues of women, to be safe guarded with the same diligence as their life. The screams and pleading of a young, attractive girl, whom three soldiers were trying to rape at gun point, still echoes in my ears. She fell at their feet and begged: "Please brother, shoot me, but don't do this..." Fortunately for her, her pleading got through to an officer who took pity and let her go, after slapping her. A young rape victim in Thirunelvely attempted to commit suicide by jumping into a well.
Loss of virginity in a young girl, even if against her will, meant that she could not aspire to marriage in our society and, if already married, there is a good chance that she will be abandoned. All rape victims are socially ostracised, often by the family also. It is not surprising that rape victims were not forthcoming in reporting such incidents and usually swallowed the suffering and injury silently.
Indeed this cultural milieu was quite familiar to the Indians and they took advantage of this silence and fear. In one case a girl had been taken in on suspicion because she had been in a school group-photograph with a known militant and been threatened by the captain with rape, assault, etc. (Perhaps the captain probably meant it only as a threat). Later, when she was released, a couple of Jawans had followed the family to their home, separated the parents and raped the girl. As she had started bleeding after the first had deflowered her, they had left saying they would come back the next day at the same time and that she should be in. It is worthy of note that in two cases where the victims braved both social ostracism and army intimidation to complain, the Indian investigating the case made out that the victims had to have some militant connection to be so bold as to complain. Although there was lack of action initially by the commanders, probably because they had to maintain troop morale in a difficult situation during the first two months, in later incidents disciplinary action was taken with identification parades and punishment, usually in the form of public thrashing and transfer to another unit. After December the Jawans were more discrete and circumspect. By 1988, the higher authorities showed much sensitivity on the issue of rape, probably due to the wide publicity outside Jaffna. They even brought in police-women and paramilitary women to allay the fear of the local women.
The psychological impact on the rape victim and her immediate family is quite severe. Initially, there is a period of shock lasting from a few hours to a day or two during which she is unable to speak and is choking and gasping; later a deep depression sets in with withdrawal, quietness and crying. Usually the incident leaves a permanent scar and she may be unable to rejoin the mainstream of social life. Two girls who later escaped to Colombo, continue to be depressed and dread the thought of returning home. The fear of pregnancy drove many to seek treatment, the mother or some relation insisting on positive assurance of non-pregnancy or requesting an abortion or D. & C., to be sure.
These incidents of rape, the lack of protection for women, and the rumours that spread, created a great fear among the women of Jaffna. The threat to womankind was very real in the months of October and November. Most women experienced sexual anxiety and felt exposed and vulnerable. Many fled to areas they felt were safe, a large exodus reaching Colombo in December when transport became available. Those left behind, started acting with circumspection by following the well meant advice of sympathetic, Tamil speaking Jawans - wearing sarees, putting poddus and staying indoors. It would appear that the Jaffna woman was perceived as more "liberated" and provocative vis-a-vis her Indian counterpart. Further, some of the women took it upon themselves, in a critical situation, to approach and be friendly and to establish communications when the men were rebuffed, assaulted or shot. This may have been misunderstood.
The public outcry and the wide publicity of this aspect of the Indian occupation that gained momentum from December reflected the deep rooted feeling of insecurity and the cultural significance of this threat to our women. A young lady who had fled to Colombo, confessed that when, on her return to Jaffna in January, she saw the Indian Army all over the place, a fear clutched at her heart and her immediate instinct was to get back to Colombo by the same bus. But she sensed, as only a woman can, that the men were now different, better behaved, and more disciplined.
Environmental stress by itself is generally not sufficient to cause the major psychiatric illness called psychosis. But in a predisposed or vulnerable individual, stress may precipitate a psychotic illness or cause a relapse in a healthy individual who has had an attack earlier.
Due to the prevailing situation the psychiatric services did not function for over 2 months, except for the few patients who "got caught" in the psychiatric ward at Tellipallai when the situation suddenly erupted on 10 October. Consequent to the heavy shelling of the Tellipallai Hospital, many patients took flight from the ward. Of these, two are believed to have been shot dead and one who was shot through the thigh and external genitals, was brought back to the hospital for treatment. Many patients on long term maintenance treatment from out-patient clinics relapsed due to lack of drugs as evidenced by the large number of relapsed patients now coming for treatment. A middle aged lady who had been doing well for over a year without drugs, had a relapse when the barrel of a gun was thrust into her mouth. From that time she became restless and paranoid. For some it was the death of a close relation that caused the stress.
During this period, many of our patients faced special hardships that the mentally ill are normally not exposed to. A very attractive young girl developed a florid schizophrenic illness and was taken in while wandering due to restless behaviour. The truck she was being transported in was blown up by a landmine and she suffered head injury. She was admitted to the Intensive Care Unit at the Teaching hospital, Jaffna which was under army guard. While there, she had been taken to the nurses' changing room, threatened into submission and gang raped on four successive nights. Later she was taken to the K.K.S camp where she was reported to have been raped again. She had jumped from a high window and was readmitted to the Jaffna Hospital. While warded in the neurosurgical ward she had been repeatedly raped, by being taken to the toilet. She was later admitted to the psychiatric ward in a very disturbed state. Due to her mental condition, she manifested an increased libido, and this symptom of her illness may have been misinterpreted by the Jawans.
Some psychotic patients behaved in abnormal and suspicious ways, others wandered around during curfew hours and were taken in or shot. A young patient had been taken in while coming to collect his drugs at the O.A.D. clinic. He was given the so called "helicopter treatment" by being hung by the thumbs and beaten. He was sent to us three days later when, eventually, it was realised that something was mentally wrong with him. To report an incident with a more humorous twist to it, a schizophrenic patient who had earlier been warded at the psychiatric ward, was taken in on suspicion. He had promised to show the Indian Army some L.T.T.E. members. The jubilant army unit, in a convoy of jeeps and trucks was brought by the patient straight to the psychiatric ward! The whole area was cordoned off and security measures taken. The patient then proceeded to point to four patients warded there and said: "He robbed the Durghi Amman Temple; he is a top L.T.T.E. leader etc., etc.." When the psychiatric ward staff tried to explain that he was a mental patient probably acting under a delusion, the commander had indignantly replied: "He was talking quite rationally, how can he be mad?" They finally calmed down and left, leaving instructions to keep the four who had been pointed out, under confinement with no visitors or food, as cyanide capsules may be sneaked in with the food. The staff would be responsible if they escaped, they added.
Interestingly for some psychotic patients who had been handicapped by chronic illness, the period of stress appeared to be therapeutic, similar in effect to shock treatment leading to normal behaviour. There was a young engineer who had become apathetic and withdrawn and was at the time unemployed. He had attempted suicide twice, in deep depression. His area was the scene of heightened military activity with many deaths, refugees and so on. He responded by becoming quite energetic and helpful and undertook a variety of social tasks, even at risk to his life. His relations commented that he was quite normal for the first time in years.
4.11 Childhood Disorders
Children under duress commonly present disturbances in physical function (such as enuresis, functional diarrhoea), emotion (such as crying spells, withdrawal) or behaviour (such as clinging, temper tantrums).
A dental surgeon's eleven month old son developed a chronic diarrhoea which did not respond to the usual medications. Their home had come under heavy shelling and they had fled from place to place as shelling and gunfire started wherever they stayed. The diarrhoea would stop and start again. This continued for 2 months. It suddenly stopped spontaneously when the family returned to their home after some normality and quiet had been established.
Disturbance in sleep with nightmares and night terrors were widely prevalent following traumatic incidents. The relieving of traumatic experience in dreams may serve as a natural abreactive process whereby the child is able to work through and come to terms with the traumatic experience by repeated exposure, which he is unable to cope with awake. Children were found to wake up screaming in the night, drenched in sweat. Parents had to stay with a child when he fell asleep and be by his side whenever he awakened. A doctor's four year old girl who had been sleeping by herself before, now breaks into a panic if her parents are missing when she awakes. She puts out her hand and feels reassured if they are there to her touch.
All children were not uniformly affected by the stress. It was noticed that after showing some initial fear and clinging behaviour due to exploding shells and rattle of machine guns, some were quite undisturbed and took things in their stride. At refugee camps, children were found to be playing, making a big noise and enjoying themselves, despite all the tension the adults were going through. Others reacted badly, showing anxiety and other emotional disturbances even after things had settled down or the family had moved to a safer place such as Colombo. To some extent the child's reaction was dependent on the severity of stress gone through and on the reactions of the parents. Children of parents who were tense and anxious showed anxiety and fear. Although children may show transient behavioural and emotional disturbance under stress, the more permanent effect on the developing personality of the child is difficult to assess. Studies of children born under war conditions or children of parents who survived concentration camp, show permanent scarring. It is likely that exposure during their formative years to insecurity, homelessness and the violent death of loved ones, as well as to other cruel and aggressive action and to the full paraphernalia of war with its instruments of destruction, will permanently influence their development. Indications of this influence are seen in the plethora of war toys and games that our children are so fond of playing with and in their daily vocabulary. When a child was given some building blocks, she immediately proceeded to build a "chain block" (tank) and a helicopter with "guns" sticking out showing clearly how preoccupied children have become with war. This is not helped by the present trend of involving and recruiting younger and younger children into military activities at an age when they cannot quite realise the meaning of their action or its long term consequences. When they act impulsively for kicks and the joy of action, it portends ill for the future. Child psychologists have shown that aggressive behaviour is readily learned by children through observation and imitation of aggressive models and that it can be reinforced and maintained in a variety of rewarding conditions. Thus aggression and violence become a "learned" way of solving problems, when the aggressor is rewarded, for example, by social recognition. This in turn shapes social behaviour where conflicts are solved by aggression and the usual restraints (guilt, conscience) on aggression are reduced and often even morally justified.
This disconcerting development in children in the last few years may prove to be the most far reaching sequelae to the climate of fear and the cult of violence that have been unleashed on this once peace loving society. By all appearances, violence, aggression and non-respect for individual rights is fast becoming part and parcel of our society and a way of life for the next few generations. [Top]
1 The remnant water after boiling rice
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