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Complex Cases of PTSD: Importance of Sociocultural Factors in the Sri Lankan Context

  • Daya Somasundaram
  • T. Umaharan
Chapter

Abstract

Complex trauma that follow man-made and natural disasters has a psychosocial impact on not only the individual but also on the family, community, and society. Just as the mental health effects on the individual psyche can result in non-pathological distress as well as a variety of psychiatric disorders, massive and widespread trauma and loss can impact on family and social processes causing changes at the family, community, and societal levels. This qualitative study was done in postwar Northern Sri Lanka while actively involved in mental health programs among the Tamil community during 2009–2014. The methodology used case studies to inquire into the variety of factors complicating PTSD. This chapter reports on the sociocultural factors. It was found that sociocultural factors such as ostracization, social isolation, economical status, belief systems, and collective bereavement influenced the impact, manifestation, course, and recovery process of PTSD. Sociocultural factors helping in recovery were social support system, normalization in friendly environments, practice of routine coping strategies, and rituals, customs, and other traditional measures and opportunities for healthy, supportive expression of grief. It was evident that exposure to conflict, war, and disaster situations impact on fundamental family and community dynamics resulting in changes at a collective level. Relief, rehabilitation, and development programs to be effective will need to address sociocultural factors, particularly using integrated multilevel approaches.

Keywords

Disasters Trauma PTSD Sociocultural factors Psychosocial interventions Recovery 

References

  1. 1.
    Richard AB, Gallagher GC, Lisa G, et al. Mental health and social networks after disaster. Am J Psychiatry. 2017;174:277–85.  https://doi.org/10.1176/appi.ajp.2016.15111403. Accessed 25 Nov 2016.
  2. 2.
    Green B, Friedman M, editors. Trauma, interventions in war and peace: prevention, practice, and policy. New York: Kluwer/Plenum Press; 2003.Google Scholar
  3. 3.
    Green B. Psychosocial research in traumatic stress: an update. J Trauma Stress. 1994;7:341–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Herman H. Trauma and recovery: the aftermath of violence from doemstic abuse to poltical terror. New York: Basic Books; 1992.Google Scholar
  5. 5.
    World Health Organization. Mental disorders: glossary and guide to their classification in accordance with the tenth revision of the international classification of diseases (ICD-10). Geneva: WHO; 1992.Google Scholar
  6. 6.
    De Jong J, Komproe I, et al. DESNOS in four post conflict settings: cross-cultural construct equivalence. J Traum Stress. 2005;18:13–23.CrossRefGoogle Scholar
  7. 7.
    Wilson J. In: Tang CS, editor. Cross cultural assessment of psycholgoical trauma and PTSD, International and cultural psychology series. New York: Springer; 2007.CrossRefGoogle Scholar
  8. 8.
    Wong P, Wong L. Handbook of multicultural perspectives on stress and coping, International and cultural psychology series. New York: Springer; 2006.CrossRefGoogle Scholar
  9. 9.
    Somasundaram D. Collective trauma in northern Sri Lanka: a qualitative psychosocial-ecological study. Int J Mental Health Systems. 2007;1(Suppl 1):5.CrossRefGoogle Scholar
  10. 10.
    Byman D. Keeping the peace: lasting solutions to ethnic conflicts. Baltimore (MD): John Hopkins University Press; 2002.Google Scholar
  11. 11.
    Cordell K, Wolff S. Ethnic conflict. Cambridge, UK: Polity; 2010.Google Scholar
  12. 12.
    Council NP. MARGA: cost of the war. Colombo: National Peace Council; 2001.Google Scholar
  13. 13.
    Eller JD. From culture to ethnicity to conflict: an anthropological perspective on international ethnic conflict. Ann Arbor: University of Michigan Press; 1999.CrossRefGoogle Scholar
  14. 14.
    Esman M. An introduction to ethnic conflict. Cambridge, UK: Polity; 2004.Google Scholar
  15. 15.
    Horowitz D. Ethnic groups in conflict. 2nd ed. Berkeley: University of California; 2000.Google Scholar
  16. 16.
    Jesse N, Williams K. Ethnic conflict: a systematic approach to cases of conflict. Washington, DC: CQ Press; 2011.Google Scholar
  17. 17.
    Ross MH. Cultural contestation in ethnic conflict. Cambridge, UK: Cambridge University Press; 2007.CrossRefGoogle Scholar
  18. 18.
    Smith A. Nationalism and modernism: a critical survey of recent theories of nations and nationalism. London: Routledge; 1998.CrossRefGoogle Scholar
  19. 19.
    Commission of Inquiry. Report of the commission of inquiry on lessons learnt and reconciliation. Colombo: Government of Sri Lanka; 2011. http://www.priu.gov.lk/news_update/Current_Affairs/ca201112/FINAL%20LLRC%20REPORT.pdf. Accessed 22 June 2013Google Scholar
  20. 20.
    Philp C. The hidden massacre: Sri Lanka’s final offensive against Tamil Tigers. In: Times online. London: The Times; 2009. http://www.timesonline.co.uk/tol/news/world/asia/article6383449.ece. Accessed 29 May 2009.
  21. 21.
    Stein G. War stories. In: Segus G, editor. Dateline. Crows Nest, New South Wales: SBS; 2010. http://www.sbs.com.au/dateline/story/watch/id/600331/n/War-Stories. Accessed 22 June 2013.Google Scholar
  22. 22.
    University Teachers for Human Rights- Jaffna (UTHR-J). Let them speak: truth about Sri Lanka’s survivors of war. In: University Teachers for Human Rights-Jaffna (UTHR-J), editor. Special report. Colombo (Sri Lanka): UTHR-J; 2009. http://www.uthr.org/SpecialReports/Special%20rep34/Uthr-sp.rp34.htm. Accessed 22 June 2013.
  23. 23.
    United Nations Secretary General’s Panel of Experts. Accountability in Sri Lanka. New York: United Nations; 2011. http://www.un.org/News/dh/infocus/Sri_Lanka/POE_Report_Full.pdf. Accessed 22 June 2013.
  24. 24.
    United Nations. Report of the secretary General’s internal review panel of the United Nations action in Sri Lanka. New York: UNO; 2012. http://www.un.org/News/dh/infocus/Sri_Lanka/The_Internal_Review_Panel_report_on_Sri_Lanka. pdf. Accessed 22 June 2013Google Scholar
  25. 25.
    Wax E. Fresh reports, imagery contradict Sri Lanka on civilian no-fire zone. In: Washington Post. Washington, DC: Washington Post; 2009. http://www.washingtonpost.com/wp-dyn/content/article/2009/05/29/AR2009052903409.html?nav5emailpage. Retrieved May 30, 2009.
  26. 26.
    Husain F, Anderson M, Cardozo BL, et al. Prevalence of war related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. J Am Med Assoc. 2011;306:522–31.CrossRefGoogle Scholar
  27. 27.
    Somasundaram D, Sivayokan S. War trauma in a civilian population. Br J Psychiatry. 1994;165:524–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Bloom SL. By the crowd they have been broken, by the crowd they shall be healed: the social transformation of trauma. In: Tedeschi RG, Park CL, Calhoun LG, editors. Posttraumatic growth: positive changes in the aftermath of crisis. Mahwah: Lawrence Erlbaum Associates, Inc; 1998. p. 179–213.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Daya Somasundaram
    • 1
    • 2
  • T. Umaharan
    • 3
  1. 1.Department of Psychiatry, Faculty of MedicineUniversity of JaffnaJaffnaSri Lanka
  2. 2.School of Medicine, Faculty of Health SciencesUniversity of AdelaideAdelaideAustralia
  3. 3.Post Graduate Institute of Medicine, University of ColomboColomboSri Lanka

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