Post-Traumatic Stress: the Sri Lankan experience

Abstract

Few countries in the world have experienced the myriad traumas that Sri Lanka has faced over the past three decades. The 30 year civil war was perhaps the most traumatic and disabling. It was not only the people in the north and the combatants and their families that suffered, but many in the south as well. Of note is the quelling of the dissent by Sinhala youth in the south by the government during the late 1980s which resulted in many young people going missing with no records as to their whereabouts, accepted now as dead. However, the tsunami of 2004 eclipsed all the others in terms of its magnitude and ability to wreak havoc within a few minutes, 15 leaving thousands dead and many others deprived of their families, friends, livelihoods and lifetime earnings. In the midst of these major traumas, the day to day traumas that are seen in middle income countries with limited resources are often ignored. Snake bite related trauma among farmers, accidental injuries such as spinal cord transections and even suicide. These and other traumas and their psychological impact is the thrust of this oration. The following studies will be discussed: delayed psychological morbidity associated with snakebite envenoming and possible psychological interventions to reduce the adverse outcomes; the role of religiosity and cultural perception as predictors of depression in relation to a spinal cord injury patient population; suicidal trends and their relationship to trauma in post-war Sri Lanka. Also discussed are the high prevalence of depressive disorder and post- traumatic stress disorder (PTSD) in war affected females and elders, andfinally, the persisting psychological issues in families of missing individuals from the war, youth unrest in the 1980s and the tsunami. The wider issues in achieving ‘closure’ in those with unresolved grief, and the need for an appropriate national response is highlighted.