Gaithri A. Fernando, PhD, who presented two papers at the ISTSS 2004 annual meeting, is assistant professor of psychology at California State University, Los Angeles, and a clinical psychologist. Fernando was born in Sri Lanka and, under a Fulbright Fellowship in 2000, conducted research at the Family Rehabilitation Centre to provide mental health services to torture survivors. When the tsunami struck South Asia in December, Fernando was visiting family in Sri Lanka, inland from the coastal areas directly affected. She also had been in India to begin research on whether there is a differential response to trauma that is human-made as opposed to trauma caused by natural forces.
According to CNN News, 12 days after the ravaging destruction caused by the tsunami waves, more than 100,000 Sri Lankan victims of the disaster decided to leave the refugee camps and either return home or depend on their family and friends to try to pick up the pieces of their lives. This decision seemed incomprehensible to Westerners reporting the news; words such as “indomitable” were used to describe the villagers who preferred to go home rather than depend on the aid pouring in to the camps (CNN report, Jan. 7, 2005).
The decision probably was not surprising to most Sri Lankans. In my own clinical practice and research in Sri Lanka, I find that most Sri Lankans need little support and encouragement to get back on their feet and face life after tremendous hardship (Fernando, 2003, 2004b). In addition, psychosocial consequences such as social isolation and difficulty performing family roles are among some of the greatest concerns for survivors of trauma, compared with psychological symptoms such as flashbacks (Fernando, 2003, 2004b). The same study found that most clients who sought mental health treatment wanted socioeconomic aid (specifically, employment) rather than relief from psychological symptoms (Fernando, 2003, 2004b).
Though not symptom-free, clients with employment and/or short-term economic and housing aid were better able to integrate their painful experiences into their lives and identities. Most were able to return to acceptable levels of functioning, the goal of mental rehabilitation. Religio-cultural beliefs and practices may account for the way in which the majority of Sri Lankans adjust to adversity. Most Sri Lankans are Sinhalese Buddhist (approximately 70%), with a minority being Tamil Hindu (approximately 12%). A far smaller minority are Muslim (approximately 8%), or of Roman Catholic and Protestant Christian denominations (8%–10%). In research conducted with ordinary (non-clinical sample) school-going children, Fernando and colleagues (Fernando, 2004a; Goldbeck, Rodriguez, Gevorkian, & Fernando, 2004; Sanchez, Giniel, Leung, & Fernando, 2004) found that Buddhist and Hindu children were less vulnerable to depression compared with Christian children, even though they reported more exposure to violent events such as bomb blasts. There may be protective factors in the Buddhist and Hindu philosophies (e.g., active acceptance of pain and suffering, an understanding that the future can provide relief through rebirth) which may be utilized to maximize recovery for survivors.
Current reactions of Sri Lankans to the disaster are similar to reactions of people in Western cultures: horror, avoidance, reexperiencing the trauma, numbing, grief and survivor guilt, among others. However, longer-term adjustment may differ in this population compared with disaster survivors in Western cultures. Researchers and clinicians alike agree that survivors of trauma are better able to function after a traumatic event if they can integrate the traumatic experience into their identity and find meaning in the experience. For example, in the West, survivors of interpersonal violence may have difficulty functioning in a society where humans demonstrate extreme cruelty to other humans, as these behaviors shatter assumptions of a just and humane world (Janof-Bulman, 1992). The shattered assumptions theory may be more valid for Judeo-Christians and may be inadequate to explain the reactions of Hindus and Buddhists. Concepts of fatalism and acceptance may have more predictive utility, but such research has yet to be conducted in a systematic and methodologically sound manner.
The concept of social capital—mutual benefit and restrictions arising from social cohesion, trust and informal social control—(Coleman, 1988; Lin, 2001) also may be particularly relevant in the Sri Lankan context. Social capital theory predicts that social bonding occurs among people who share similar demographic characteristics and through whom information is disseminated and cultural and social norms established. Steury, Spencer and Parkinson (2004) further argue that bonding and affinity determine levels of social trust, and should be taken into account when considering psychological interventions. Thus social capital theory may have some explanatory power in understanding how people who are bonded together, not only by shared cultural and religious traditions but also by shared adversity and extreme suffering, can utilize their interdependence to find new or modified identities and meaning in life despite experiencing extremely traumatic events.
On the other hand, Sri Lankans have never experienced this particular type of adversity before. As in people from other collectivistic cultures, Sri Lankans find meaning and identity in social roles, particularly those of family (Durvasula & Mylvaganam, 1994). While trauma such as torture may have been overcome in the past as survivors found meaning in family roles, the tsunami disaster left hundreds of thousands of people bereft of their roles as mothers, fathers, daughters, sons, grandparents, uncles and aunts. It remains to be seen whether such tragedy has overtaxed the resilience of the typical Sri Lankan, and whether the tragic loss of family role and identity is so traumatic that recovery from it will take much longer and is less successful than recovery from the wounds of war. The story reported by CNN is encouraging in that it seems Sri Lankans already are trying to integrate back to their family roles, whether in the nuclear or extended family; but the wounds from traumatic loss and grief is likely to take many painful years to recover from, and both socioeconomic and psychosocial interventions must take this into account.
References
Coleman, J.S. (1988). Social capital in the creation of human capital. American Journal of Sociology , 94: 95-120.
Durvasula, R., & Mylvaganam, G. (1994). Mental health of Asian Indians: Relevant issues and community implications. Journal of Community Psychology, 22 (2) [Special Issue: Asian American Mental Health], 97-108.
Fernando, G., (2004a, November). Mental health of school children exposed to violence in Sri Lanka. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, New Orleans, Louisiana.
Fernando, G. (2004b, November). Torture in Sri Lanka: Psychosocial and Psychological Issues. Poster presented at the annual meeting of the International Society for Traumatic Stress Studies, New Orleans.
Fernando, G. (2003, August). Psychophysiological, psychological, and psychosocial impact of torture on survivors. Paper presented at the annual meeting of the American Psychological Association, Toronto, Canada.
Goldbeck, J.P., Rodriguez, C.A., Gevorkian, M., & Fernando, G. (2004, August). Personal control and trauma-induced depression in Sri Lankan Youth. Poster presented at the annual meeting of the American Psychological Association, Honolulu, Hawaii.
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free press.
Lin, N. (2001). Social Capital. Cambridge, MA: Cambridge University Press.
Sanchez, S., Giniel, A., Leung, D., & Fernando, G (2004, August). Violence exposure, religion, guilt, and anxiety among children in Sri Lanka. Paper presented at the annual meeting of the American Psychological Association, Honolulu, Hawaii.
Steury, S., Spencer, S., & Parkinson, G.W. (2004). The social context of recovery. Commentary on “A National Longitudinal Study of the Psychological Consequences of the September 11, 2001, Terrorist Attacks: Reactions, Impairment, and Help-Seeking.” Psychiatry: Interpersonal & Biological Processes, 67 (2), 158-163.