Restoring the mental health of conflict-hit soldiers

Dr Ruwan M Jayatunge

So hard to express how that mental duress
Played especially torturous role
Like the termites that fed on the boards in my bed,
It was gnawing away at my soul...

Against horrors so chilling, the spirit was willing
But the flesh was too weak to withstand.
Was it really a sin for a man to give in?
Could I better resist each demand?

Edward Alan Brudno, American security forces
victim captured by the North Vietnamese in 1965

Former security forces victims of the conflict undergo a range of mental health problems. The Eelam war which lasted for about 20 years in Northern Sri Lanka has caused numerous physical and mental health ailments among the survivors. The LTTE or the Liberation Tigers of Tamil Eelam had captured a considerable number of servicemen during the war and some of them were executed. The remaining victims were handed over to the ICRC (International Red Cross) and now they are free. Many former victims have dreaded memories. Most of them suffer from PTSD.

To become a victim is a traumatic experience although the Geneva Conventions protect security forces victims from maltreatment and assure them of certain basic needs. The words can hardly explain the physical and mental agony experienced by former security forces victims. They are like the living dead.

Physical and mental trauma

The psychological impact of being taken as a victim of war is devastating. Security forces victims cope with utter difficulty. Although they are free they constantly live of fearful intrusions and spend their lives in despair.

Following case studies reveal the physical and mental trauma experienced by former security forces victims of the Elam war. Among them Lance Corporal P's story is horrendous. Even though he is a free man today he is still suffering from the ramifications of security forces victim's experience. Lance Corporal P was captured by the LTTE in 1993 and endured the next five and half years in victim camps. He was deeply traumatized and his psychological wounds were a direct result of his being in the LTTE prison camp. He is a casualty of war, strained by the emotions that had haunted since 1993. When he came home guilt and anger and helplessness built up. He struggled with depression.

Prison cell

Lance Corporal P joined the Sri Lanka Army in 1991 as a signalman. After his basic training he was sent to the operational area. In 1993 he was posted to Welioya Senapura camp. He was working in the signal room. During this period the LTTE launched a massive attack against the Senapura camp. He was wounded and captured as a prisoner. This is how he describes the horrific events of his life.

"When the LTTE attacked our camp I was in the signal room with a Lieutenant. We wanted to send a message and ask for reinforcement. The signal room was attacked with a RPG. Our radio and other equipment were destroyed by the attack. Then a group of LTTE members broke into our signal room.

They grabbed the lieutenant and killed him with a mammoty. His eyes were taken out. I was wounded and lost consciousness. When I opened my eyes I was in a LTTE vehicle blindfolded and my arms and legs were tightened. Then I realized that I was a victim. I was anxious about my future. A number of times I asked from myself are they going to kill me? I could not escape and I was helpless."

"First few weeks they interrogated me. They thought I was an officer in disguise. They wanted to get our classified signal codes. They tortured me and threatened to kill me. The first few months I was unbreakable and told them nothing. Then they put me in isolation. For seven months I was in a small dark room. My biological clock was disrupted. I did not know it was daytime or night. I was given food three times a day. That was the only time I saw somebody. I was sleeping in a dirty rough prison cell fearfully waiting for my tormentors. This was the worst part of my experience. That was a frightening and disorienting event.

"After seven months I was daily taken for interrogations and everyday they asked same set of questions. For any slightest incompatibility I was savagely beaten and sometimes electrocuted. They crushed my genitals, also used to put chillie powder into my foreskin. I was in pain and agony. No one was there to save me. I was abandoned by my people and I knew this was my end."

Troubled by nightmares

"They threatened to kill me a number of times. Each time I was oozing with fear and helplessness. Once they took me to a deserted area where they execute victims. They shot an EPRLF prisoner who belonged to a different militant group. But they did not kill me that day perhaps they wanted to bargain for my freedom with the government."

The guards were extremely brutal in their handling of victims of war. Interrogators as well as the prison guards administered the torture. He was tied up for interminable periods into painful positions. He was not able to resist the torture without cooperating with his captors. He was subjected to psychological manipulation and blackmail. Following the long-term repressive conditions, the torture and degradation under which Corporal P suffered resulted PTSD. Lance Corporal P further explains his horrendous experience thus.

"I was a victim for nearly five years. All these years I was tortured and humiliated. Every single day I prayed for my life. Finally freedom came to me unexpectedly. I was released in 1998 September after the intervention of the ICRC. I came home. There was no welcome ceremony. I went on leave for few weeks. My family members were happy to see me. But I could not feel the happiness. I was always on guard. I had the fear that the LTTE might capture me again. Some nights I was troubled by nightmares and I could not sleep."

"After my brief leave I went to my unit. People were suspicious about me. They thought I was collaborating with the enemy. Only if they knew what I underwent they would have realized the trauma that I experienced. What do you expect from a victim when you are surrounded by the enemy? Perhaps they expected me to act like Rambo.

Psychiatric Unit

"When you are a victim you have no choice. You become a number or insignificant tool of your tormentors."

"When I was ordered to join the Operation Jayasikuru I had fear feelings. I did not want to go to the battle. I thought I would again become a victim. I remembered my past events. My head started aching and I was fainted. When I regained my consciousness I could not speak. My voice has gone. I have become aphonic. Lance Corporal P was untreated and undiagnosed for many years. When he was finally referred to the Psychiatric Unit in 2000 he had full-blown symptoms of PTSD with psychogenic aphonia. He had a deep suspicion. He believed no one. After treating him for many months finally he started trusting his therapists. Then he opened more.

He had nightmares. Frequently he gets up in the middle of the night, perspiring with a severe heartbeat thinking that he is still among the LTTE. When he realizes he is safe, again he goes back to sleep. But he cannot sleep. All these victims intrusions come to his mind. The rest of the night he is awake. Sometimes he used to get flashbacks. Then he relives the event. His mind is preoccupied with past horrific events; he thinks hours and hours about the past incidents. Then rage comes to his mind. He cannot tolerate any noise. If somebody interrupts or speaks loudly he often gets angry.

Balawegaya Operation

Lance Corporal P exhibited severe avoidance. He was fear of military vehicles, uniforms and conversations regarding the LTTE. He could not feel happiness. He was emotionally numbed. With utter depression several times he tried to take his own life. Once he tried to kill himself by beating his head against the wall.

Lance Corporal P underwent medication and psychotherapy. He was treated with SSRI, Art Therapy, Relaxation Training and EMDR. The Art Therapy was a real catharsis for him. He expressed vivid events of his events life in a form of art. After every session his overwhelming stress has been reduced to a considerable level. It helped to lift his spirits. With the relaxation training he became calmer. His hyper vigilant reaction became minimal. Lance Corporal P underwent eight sessions of EMDR (Eye Movement Desensitization and Reprocessing) or Reprocessing Therapy. Then his improvement was significant. Today he can sleep without night terror. His severe depressive feelings are subsiding. Gradually he started enjoying his life; playing with his sister's little son. Now he has fewer fears about becoming a victim again. Progressively he is regaining his voice. But he knows he would never be the same person again after spending five years in the LTTE prison.

Lance Corporal U is another victim who faced many horrors. He became a victim in July 1991 during the Balawegaya Operation. He was wounded during the battle and taken as a prisoner. Until his release in March 1995 he was subjected to inhuman treatment. He was deprived of sanitation, light and proper medical treatment. He was kept in a small cell with 40 other victims. They had no enough space and practically every victim developed skin infections. The sick and wounded were left in their own excrement for many days. Someday they were given rotten food and while they were having meals the guards used to disturb them with loud noises etc. They were not allowed to take a bath for months. Finally they decided to go on a hunger strike.

He struggled with depression. He had always been angry at his captors. Lance Corporal U often refused to eat the food he received. After continuous interventions by the ICRC the LTTE agreed to release him with a group of other victims.

Irritable person

After coming home Lance Corporal U started to work again. Gradually his sleeping pattern and the appetite have been changed. He felt more alienated. He had loss of interest and pleasure in ordinary activities, multiple somatic complaints, loss of libido and repeated thoughts to commit suicide. He was diagnosed with Depressive Disorder. Although he was treated with medication his condition was aggravating. He subsequently developed intrusive memories, emotional numbing, nightmares, startling reactions and avoidance of reminders. In 2003 he was diagnosed with PTSD.

Lance Corporal U describes his difficulties thus.

"Although I came home I felt my soul is still in that prison cell. My life was wasted. I came home as a sick person. I have fear feelings which I cannot explain. My wife does not understand me. She thinks that I am a cold irritable person. Very rarely I have sexual contacts with her. My interest in sex has been diminished. I have no one to explain my pain. I can work in Colombo, but I cannot go to the North. I am afraid to become a victim again.

Last month I went to the Police Station to get a Police report for my lost identity card. When I went there I saw the cell where they keep people in detention. I had flashbacks. My mind was occupied with victims' events. I had a headache and without finishing my work I came home.

Lance Corporal U was treated with Beck's therapy and EMDR. With the psychotherapy sessions his distress has been reduced to a grater degree. Today he does not experience nightmares, he has no suicidal ideas. He gradually readjusted to life and struggling to live a happy and productive life.

Being a former victim of war often means that one's life has changed sometimes beyond repair although the human spirit is resilient. It is true that many victims of the Elam war never had happy lives after coming home. Many are still hounded by their past memories. In most cases the permanent psychological damage the security forces victims suffered as a result of surviving long-term torture and degradation has never been examined properly. Returned personnel were not treated as war heroes whose patriotism is beyond question. After many years of torture former victims, are openly questioning whether or not they can really forgive and forget.