Addressing
the psychosocial problems of women in a war ravaged society
People’s
Forum
“Integration
of women in the peace process”
University
of Jaffna
8-9th
Feb., 2003
-- Daya
Somasundaram
Effects of war
War can have effects not only on individual
women, but also on their family, extended family, group, community,
village and wider society.
Individuals
An
increased vulnerability in women to develop psychiatric problems
during war and civil violence has been reported. In London General
practices during World War 11, their was a preponderance of
women in the ratio of 2:1 (Female to Male) for neurotic illness
(Lewis, 1942). In Belfast, N. Ireland, a ratio of 3:1 (Female
to Male) was found for all psychiatric disorders and significantly
the stress of civil violence was the major or contributing factor
in all patients (Lyons, 1979).
In
Northern Sri Lanka the male to female ratio for admission remained
close to 1:1 from before the war upto 1986. In developing countries
of Asia and Africa preponderance of males in the ratio of 1:2
(female to Male) is usual (Ihezue, 1986) while the reverse is
true of developed countries (Shepard et al, 1966). As discussed
by Prof. Ganesvaran and Rajarajeswaran (1983), the high rate
of literacy (85%), maybe an important factor influencing sex
ratio in Jaffna, leading to an awareness, acceptance and understanding
of mental illness in females. It may also reflect the sex ratio
of the resident population due to the absence of young males
in the age group where mental illness is common (70% of the
mentally ill are from the 20- 44 year group). Some in this age
group left seeking jobs and other opportunities abroad. It
was also this age group that joined the militants, were killed,
migrated or left the area out of fear, seeking asylum in foreign
countries.
For
all these reasons the women were left behind to shoulder the
responsibility of family, home and keep the society functioning
during this critical period (Sivachandran, 1994). While men
left their wives and children behind, women did not leave their
children or husband to emigrate or flee the area (with few
exceptions in cases of Middle East housemaid jobs). They were
left to face the trauma of war all alone. They looked after
their families single-handedly (19,000 women headed households),
filling in for the absent male in what had been upto then, traditional
male roles. They rode bicycles in greater numbers, went to the
shops, met and argued with authorities, took their children
to schools and temples, and generally ‘kept the home fires burning’
during this crisis in our society. They were thus under considerable
stress and more vulnerable to breakdown. The sex ratio of admission
tilted even further towards female preponderance as the war
continued, due to accentuation of this process (for example
by 1991 the ratio of female to male was 1.2:1 ). In the final
analysis this may have been the price women had to pay to save
our society from collapse.
Of
the types of war related psychiatric problems manifested by
women, the commonest is somatization. Often the physical complaints
of heaviness in the head, pressure on the chest, difficulty
in breathing (“perumuchu”), inability (“elamai”)
appear to be cultural idioms of distress reflecting the excessive
burden of responsibilities and work the women face. Other problems
are depression following loss of loved ones (Grief), property,
dignity, virginity etc.; anxiety and PTSD.
Due to close and strong bonds and
cohesiveness in nuclear and extended families in our cultures,
the families tend to function and respond to external threat
or trauma as a unit rather than as individual members. Thus
the family tends to think, feel, experience and respond together.
When an event happens, the family faces it together as a unit.
They share the experience and perceive the event in a particular
way. Thus it may be more appropriate to talk in terms of family
dynamics in our culture rather than of individual personalities.
During times of traumatic experiences,
the family will come together with solidarity to face the threat
as a unit and provide mutual support and protection. In time
the family will act to define and interpret the traumatic event,
give it structure and assign a common meaning, as well as evolve
strategies to cope with the stress. Due to the ongoing war,
the extended and nuclear family systems have been weakened or
shattered due to displacement, separation, migration, death,
detention, disappearance etc. of the members. The traditional
family unit as the basic social institution has barely survived
but its function has been irrevocably changed by the chronic
conflict. The cohesiveness and traditional relationships are
no longer the same. The role of the mother has undergone momentous
change with increasing non-traditional responsibilities, activities
and "liberation".
Absence of members of the family due
to death, ‘disappearance, injury or displacement will create
infallible gaps in the functioning of the family unit. The uncertainty
or grief about the missing member will add to the maladaptive
family dynamics that will ensue. The loss of the essential unifying
role of the missing member can cause disruption and disharmony
within the family. A common situation is where the father has been
detained, ‘disappeared’ or killed but the family members are
not sure of his fate. They are caught in a `conspiracy of silence'
where further inquiries may lead to more problems for the father
were he still alive and the mother may not be able to share
the truth with the child. The mother has to adapt to all the
negative implications of being a 'widow' in this society. Having
the mother share her fears and feelings with the child can be
helpful. This is particularly difficult for a family where the
male has been ‘disappeared’ by the Tamil militants. Here the
social situation compels the remaining members to keep silent
and makes it extremely difficult for them to receive social
support. They often have to suppress the memory of the person
altogether.
In
the Jaffna peninsula, there are currently, 19,090 female-headed
households. The effect on the family, the widow (Kumerandran
et al., 1998) and the children has been immense. A study assessed
the impact of displacement in the North on functioning of the
family system (Jeyanthy et al., 1993). Psychological disturbances
particularly depressive symptoms were much more common in displaced
families than in those living in their own homes. Disturbances
in family dynamics particularly disputes and quarreling between
father and mother were attributed to economic stress, lack of
privacy and interference of others in over crowded camps.
Some
women have also joined the militants. One factor inducing them
to leave society, was the tight control, domestic life and
bleak future they faced. Joining the militants was a liberating
act, promising them more freedom and power (Trawick, 1999; Balasingham,
2001). In some cases, the family actively encouraged their daughter(s)
to join when their poor socio-economic state did not allow them
to put by a good dowry for their daughters.
Tamil society had always suppressed
women into a subservient position. Modern education starting
in the colonial period had loosened this to some extent and
some women managed to get free. However, it was the war that
has had a liberating role for women.
The war has had a tremendous impact
on the community or village. During the current war whole communities
or villages have been targeted, destroying whole village and
its way of life and environment. The village traditions, structures
and institutions that were the foundations and framework for
the their daily life have been irrevocably changed (Council
of NGO’s, 1998; National Peace Council & Marga, 2001).
One can mention the systemic attacks
on all the Tamil villages in the Trincomalee District which
eventually displaced all of them into the city or to other districts.
Another example is the Moslems of the North. Apart from direct
attacks, whole villages of all three communities have been disrupted,
displaced and uprooted due to the ongoing conflict. One terrible
example is the fishing community, another the farmers.
In the various rural communities,
the village and its people, provided organic roots, a sustaining
support system, nourishing environment and network of relationships.
The village traditions, structures and institutions were the
foundations and framework for the their daily life. In the Tamil
tradition, a person’s identity was defined to a large extent
by their village or uur of origin (Daniel, 1984). Their
uur more or less placed the person in a particular matrix.
All this has been destroyed by the war. Some villages have
ceased to exist. Due to dislocation people have been separated
so that the network of relationships, structures and institutions
have been lost. Kai Erikson ( 1976) described it as a “loss
of communality”. A very good example of the collective
effect of displacement was the mass exodus from Valikamam in
1995. Even when people have returned to their villages, as
it has happened in Jaffna in 1996, the village was not the same.
Many were complete newcomers. The old structures and institutions
were no longer functioning. Thus the protective environment
provided by the uur is no longer there.
Collective
Trauma
The cumulative effect on the community
can be described as collective trauma, which goes beyond the
individual. In fact, given the widespread nature of the traumatization
due to war, the psychosocial reactions in the women may have
come to be accepted as a normal part of life. But at the community
level, manifestations of the trauma can be seen in the social
processes and structures. This can be seen in the prevailing
cultural coping strategies. Women have learned to survive under
extraordinarily stressful conditions.
However, some coping strategies that
may have had survival value during intense conflict may become
maladaptive during reconstruction and peace. For example, the
Tamil community had learned to be silent, non involved and stay
in the background. They have developed a deep suspicion
and mistrust. People have learned to simply attend
to their immediate needs and survive to the next day. Gradually
people have been made very passive and submissive.
The repeated displacements, disruption
of livelihood have made people dependent on handouts. People
have lost their self-reliance, earlier the hallmark of the Tamil.
They have lost their motivation for advancement, progress or
betterment. There is a general sense of resignation to fate.
They have developed dependence on help from outside sources,
on relief, on handouts. Further they have lost their trust in
their fellow human beings as well as the world order. For example
the Tamil people no longer trust the security forces, including
the police. Their recent experiences have taught them otherwise.
Thus instead of trust, respect for law and order, a belief
in their legitimacy; there is fear, even terror. Women particularly
face ill treatment at the hands of the law enforcing agencies
like the police.
There has been a breakdown in social
ethics and morals. Particularly marked is the increase in child
sexual abuse in females. Even adult females have faced rape
and other forms of sexual violence and harassment. There is
a noticeable increase in domestic violence, seen in other post
conflict situations around the world.
Community
level approaches
As described above, the wide spread
problem of collective traumatization is best approached through
community level interventions. Further, Community based approaches
will enable one to reach a larger population as well as undertake
preventive and promotional public mental health activities
at the same time(Somasundaram,1998). In these circumstances
it may be more meaningful to look at how the community as a
whole has responded, how the community coped, and what we can
do at the collective level (Somasundaram, 1996). For example,
it may be more beneficial to consider strengthening and rebuilding
the family and village structures, as well as finding a common
meaning for the immense suffering than to treat individual traumatization
per se.
Psychoeducation about trauma and special
problems for women for the general public can be done through
the media, pamphlets and popular lectures. A pamphlet for
this purpose has been prepared in Tamil by Shantiam.
Training of grass root community level
workers in basic mental health knowledge and skills is the easiest
way of reaching a large population. They in turn would increase
general awareness and disseminate the knowledge as well as do
preventive and promotional work. The majority of minor mental
health problems in women could be managed by community level
workers and others referred to mental health professionals.
Primary Health Workers including doctors, medical assistants,
nurses, Family Health Workers; school teachers; village resources
like the village headman (G.S.), elder, traditional healer,
priests, monks and nuns; Governmental, Non Governmental Organization
(NGO), volunteer relief and refugee camp workers are ideal community
level workers for training. Trauma and mental health should
become part of the normal curricula of health staff and teachers.
A manual based on the WHO/UNHCR (1996) booklet, “Mental Health
of Refugees”, adapted to the Tamil cultural context (Mental
Health in the Tamil Community) with a special chapter devoted
to problems in women, is being used to train a group of trainers
(TOT). They will in turn train community level workers. In this
way the necessary knowledge and skill can be spread to a wide
population. A referral system where more severe problems can
be referred for more specialized care with a multidisciplinary
team consisting of female counsellors, clinical psychologists,
psychiatrists, social workers, relaxation and massage therapists;
drama, art etc. , has been established. Teaching of the culturally
appropriate relaxation exercises like yoga to large groups in
the community and as part of the curricula in schools can be
both preventive and promotive of mental health.
Indigenous
coping strategies
Indigenous coping strategies that
have helped the local population to survive should be encouraged.
Culturally mediated protective factors like rituals and ceremonies
should be strengthened.
Social attitudes can influence how
traumatized women are treated, their response and eventual recovery.
Cultures and villages have their own rituals and traditional
functions to deal with trauma. Funeral rites like eddu chelavu,
anthyetty, andu thuvasam, thuvasam and similar anniversary
observance are powerful social mechanisms to deal with grief
and loss. The gathering together of relations, friends and the
community is an important social process to share, work through
and release deep emotions, define and come to terms with what
has happened and finally integrate the traumatic experience
into social reality. In addition to funerals, religious and
temple rites, cultural festivals, dramas, musical fares, exhibitions
and other programs, meetings and social gatherings provide the
opportunity for people to discuss, construct meaning, share
and assimilate traumatic events. In war, when due to the disturbed
situation these rituals are not possible or improperly performed,
the trauma is never fully accepted or put to rest, as in the
cases of "disappearances” where there is no finality about
death. Patricia Lawrence (1998) has brought out the psychosocial
value of the traditional oracle practice of “vakuu choluthal”
in Batticaloa, particularly in cases of disappearances,
where the families are told what has happened to the disappeared
person in a socially supportive environment. In cases of detention
by the security forces the relatives may take vows (nethi
kadan)at Temples to various Gods which they will fulfill
if the person is released. Religious festivals, folk singing
and dancing as well as leisure activities can be ways of meeting,
finding support and expressing emotions. Ideally the social
processes should work to promote feelings of belonging and participation,
where the group is able to give meaning to what has happened,
adapt to the new situation, and determine
their future.
Women need rest from their increased
responsibilities. Community support should be mobilized to relieve
women and give them rest , even for few hours. For example younger
girls and women can help with the household chores and child
rearing responsibilities. In view of the added responsibilities
women face, they should be given preference in government and
public institutions, transport etc.
Rehabilitation
The dangers of 'imposing aid' from outside has
been well documented (Harrel-Bond, 1988). The prospect of the
complex machinery and politics of international aid agencies,
UN organizations, donors, NGO's, etc., descending on the helpless
Tamil community to swamp and trample all over her traditional
beliefs and life, with western ideas of 'aggressive development'
and 'progress' would appear inevitable. In the long-term this
'invasion' and imposition of 'modern' socio-economic processes
may prove more deadly to the community than the war itself!
In developing an overall integrated scheme for
rehabilitation of the Tamil community, a systems oriented approach,
taking into account the many interacting subsystems like the
individual, family, community, cultural ethos, socio-economic
conditions, ecological balance, political forces, available
resources, existing structures, and sources of help from outside
would be best. What needs to be stressed here is that such a
design include due consideration for the psychological processes
that promote individual, family and social healing , recovery
and integration. Special attention has to be given to the needs
of women, be made gender sensitive. It is important that any
such programme take into account the wishes of the local women
concerned, that they be give an active and deciding role rather
than a dependent, ‘victims’ role, as it promotes their overall
sense of participation and thus their eventual psychological
recovery. For without mental health being established first
or concurrently, development and reconstruction efforts may
not be of much benefit, except for the political and business
interests as it will merely be for passive recipients with
no motivation or interest in their own destiny.
To avoid this , emergent self-help groups and local
leadership should be encouraged to resume traditional and habitual
patterns of behaviour, re-establish social networks and community
functioning at the grass root level (Raphael, 1986). The local
skills and resources have to be tapped and utilized, if the
community is to gain a sense of accomplishment and fulfillment
in the reconstruction process. The constriction in cognitive
functioning under the oppressive circumstances of war noted
above will have to be released. The creative spirit within the
community will have to be rekindled if this community is to
rise from the ashes. New solutions, paradigms, inspirations
and enthusiasm will have to be encouraged. Under the present
totalitarian political culture, creative thinking will be suppressed.
Rather we will see stereotyped, rigid and uniform ways of thinking
and looking at the world. Avenues for expression of ideas, for
the independent and not the engineered voice of people to be
heard, an atmosphere conducive to open and free discussion will
have to be created. We have seen some women from Jaffna University
and elsewhere writing poetry and creating other forms of artistic
expression, but soon suppressed. For example Selvy from the
University of Jaffna won a International award for her poetry
but was killed. Similarly Rajani Thiranagama was killed thought
she wrote and portrayed in Drama the problems of women during
this war.
Provision for the non-partisan cultural working
through of the shared traumatic experience in the form of periodic
reminders of the loss and reiteration of its meaning, and of
the heroism of those who suffered expressed in media, arts,
public works, monuments, special museums & occasions of
public mourning have been found to be useful in countries ravaged
by civil war (Kinston & Rosser,1974). For example the destroyed
Jaffna library should have been left as a historic monument
to what happened, while a new, modern one could have been built
close by. Community gatherings, meetings and religious ceremonies
will allow for communal release of feeling; review and coming
to terms with the collective trauma; socially define
and interpret their experiences, as well as re-establishing
social links and planning for the future.
Women can benefit from being taught basic social skills and specific crafts
to help them find employment and integrate themselves back into
society . In addition, occupational training, by structuring
time and channeling physical activity into satisfying goals
helps the individual regain her sense of control and mastery,
her worthiness and usefulness and thus establish her self-respect
and self-esteem. In the long-term, occupational skills are empowering
and produce self-sufficiency. Such training can be particularly
useful for poor widows whose husbands had been killed in the
war.
Special programmes
Special programmes will have to be
developed for women, landmine victims, and so on. Women, particularly
widows will benefit from group sessions, individual counselling
when necessary, rehabilitation programmes that should include
education, vocational training, income generating projects,
loans, housing etc. that is tailored to their needs. Networking
with other NGO’s and government will help to offer integrated
and holistic help. One such successful ul group for widows has
been developed the PsychoSocial trainers from Shantiam at Savalkaddu.
Thus an important aspect of the treatment is to plan for the final rehabilitation
of the women and of the family. The plan will have to be individually
tailored to the needs of the woman and be therapeutic. Financial
resources to help an individual re-establish herself in society
may be an essential step to her regaining her self-esteem and
self-respect. It may also be necessary to provide an initial
incentives for women to come forward for treatment. The Canadian
funded programme, “Kappaham”, seeks to holistically
help women affected by violence including domestic violence.
Expressive Therapy
Artistic expression
of emotions and trauma can be cathartic for women and the community
as a whole. Art, drama, story telling, writing poetry or novels
(testimony), singing, dancing, clay modeling, sculpturing etc.
are very useful emotive methods.
Psychological and socio-dramas can go a long way in creating awareness about
trauma among the public and help traumatized women to ventilate
their emotions or seek treatment. A few such dramas like annai
idda thee have been produced in the North. The drama called
Velvi thee looks at the problem of rape by soldiers.
The recent dance-drama, Yar Kollo Sathurar, brings out
the ethos of women caught in the ravages of war.
Obviously the best way to ensure
social recovery will be to stop the conflict altogether. The
current peace process gives hope. The international practice
of introducing processes favouring conflict reduction, resolution
and if possible, reconciliation into rehabilitation programmes
and donor policy is a positive step in this direction.
One way to reverse (or sidestep)
the processes that led to the conflict, favoured by the international
community, is to initiate socio-economic development that does
not discriminate against the Tamils or any other minority. In
fact, initially there may have to be “assertive action” or positive
discrimination in favour of the minorities to set the balance
right. Unfortunately, the Sri Lankan majoritarian political
developments have led to dominance by the Sinhalese in the State
and other sectors. Thus all rehabilitation and development efforts
even by international organizations such as the UN tend to perpetuate
the same discriminatory structures that led to the conflict
in the first place as they have always chosen and have been
required to work through state structures. This is clearly evident
in the recent exercise to develop the Jaffna district after
its re-capture by the state forces in 1996. However, meaningful
development did not take place (Council of NGOO Jaffna District,
1998). This in turn has impaired psychosocial healing. A completely
radical restructuring of all developmental and other national
activities will have to take place if the way out of the ethnic
conflict is to be through socio-economic development. Fundamentally
there will have be a change of attitude towards a more ready
acceptance of the equality of the ethnic groups, particularly
among the ruling elite. Sadly this is still to take place and
thus the continuation of the problem. However, many Tamils would
feel that under the existing circumstances, it may not be possible,
to effect these attitudinal changes and then the structural
re-arrangements (inability or rather unwillingness to implement
the ‘official’ use of the Tamil language, constitutional reforms,
equal opportunity bill or the gross inequality in the development
of the South compared to North East) and only through a measure
of autonomy or separation can the Tamils regain equal opportunities
to development.
The media too has an important role to play in any
reconciliation process. It is no exaggeration to say that the
media from both sides of the ethnic divide have played a decisive
role in creating and sustaining the ethnic conflict by the biased
and inflammatory reporting. The deterioration in journalistic
standards began in the late 50’s when the state started interfering
with freedom of the press. Currently we have the media polarized
into two ethnic camps dishing out very selective and biased,
armchair views (there are few exceptions). A radical change
to investigative and constructive journalism will have a very
powerful positive effect on the ethnic conflict.
A
big problem that has and will impede any reconciliation or rapprochement
from the Tamil side is the existence of very a “closed mind”
among Tamils. Traditionally, the Tamils have had a very tightly
controlled, closed society, whether this is at the family, group,
village or regional level. The social pressures to conform,
consent and speak in one voice have been tremendous. Thus there
is no real tradition of alternative views, dissent, freedom
etc. particularly in relation to sensitive, political and public
issues that affects the group as a whole. The mechanisms are
largely unconscious, the social processes work to internalize
the control. With the advent of violence and the militants these
processes have been intensified. The Tamil organizations and
media also operate towards creating a single view, seeing only
one side of the problem, criticizing only one party (invariably
the state or security forces) with a general paranoia. Somehow
this stifling hold has to be broken and some space created for
alternate views, leadership and initiatives. Only then can the
creative spirit of the Tamils be reawakened to find new solutions.
Difficult as this may be the International community and their
representatives on the ground, the INGO’s and UN bodies, can
foster this process by capacity building, promoting and protecting
emerging local leadership and generally creating a climate for
a more broad based activity and gender equality.
We
have to create a “culture of peace” by social peace building.
Women are ideal for this role as naturally they are more nurturant
than men who are more prone to violence and war. Women know
how to solve problems in a non-violent way. The peace process
is very fragile. If we leave it to the leaders they may break
it as they see fit (according to their perceptions or interests).Women
have been left out of the peace negotiations. In my opinion,
if the negotiations are left entirely to women, there is more
chance that enduring peace will be found.
Obviously
there is a general yearning for peace. This has to come through.
Community level peace building activities have to be begun.
Women can be put in the forefront of these activities. The
mode of thinking and acting has to change from a conflict-habituated
system of suspicions, grievances, ethnocentrism, violent solutions
and confrontation to a peace system with give and take, accommodation,
flexibility, forgiveness, non-violence and a wider world view.
A fixed belligerent posture should not be engineered or orchestrated
but a creative response should to allowed to grow independently
and spontaneously from below. Only then can genuine peace be
sustained.
Healing of memories and truth commissions along the lines done in South
Africa will be very helpful. Many have undergone untold horrors
which have been never accepted or recognized publicly. But before
this can be successful, there has to be a basic change in attitude.
In the South people will have accept the existence of the problem
of minorities and the acknowledge the suffering they have been
through. In the North, opening up of political space, tolerance
of other views, acceptance of plurality and sharing of power
is needed if the Tamil community is to come out of this situation,
grow and develop toward a better future.
Demobilization
In many post-war situations around
the world, the continuing role of combatants have been an immense
social problem. Often they have found it difficult to re-integrate
back into civil society, while others become marginalized from
the mainstream of society. They feel unwanted, rejected and
unappreciated to develop frustration and resentment. Many develop
chronic psychosocial problems like Malignant PTSD or DESNOS,
and hostile or suicidal behaviour. Thus any peace settlement
should give priority to the process of demobilization. Specific
arrangements should be made for the rehabilitation and reintegration
of women militants or soldiers. Particularly the problems they
will face in coming back into a conservative society and marriage
will have to be addressed. They will need appropriate medical
and psychological care. Opportunity structures in the form of
education, vocational training, jobs, positions and function
in society commensurate with their previous roles in the military
or militants as the case may be are needed. They will need social
recognition and respect for the sacrifices they have made.
Prof. Daya Somasundaram teaches at the Faculty of Medicine, University of Jaffna.
