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.   

Family

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,, 191111   ) 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.

Community

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.

General Awareness

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

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.

Vocational Training

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.

 

Reconciliation

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.