By Ruwan M Jayatunge  –

Death is not an adventure to those who stand face to face with it. Erich Mariya Remarque – All Quiet on the Western Front

In the Sri Lankan conflict, the impact of war and extreme stress on civilian population has been highlighted over the years. However, war traumas experienced by the combatants were not adequately shown. Unfortunately some biased and extreme reports had dehumanized the images of the combatants and publicized combat veterans as perpetrators of violence. But a very few realize that the war trauma affected the soldiers in tremendous proportions and they too have become the psychological victims of the Eelam War.

War is particularly traumatic for soldiers because it often involves close violence, including witnessing death through direct combat, viewing the enemy before or after killing them, and watching friends and comrades die (Hendin & Haas, 1984). After exposing to combat trauma soldiers are more likely to have psychological ailments predominantly stress related symptoms, problems with social relationships and various other problems.

Mental health of the soldiers who participated in the Eelam war in Sri Lanka has been severely compromised by the horrendous battle events that they experienced. Many combatants suffered posttraumatic stress and depression. The wounds that they received from war are not confined to the battlefield it frequently transformed to their domestic environment as well. Still we are unaware of what long-term effects the war had on Sri Lankan soldiers. Although studies would be needed to systematically assess the mental health of members of the armed services, a very few studies have been conducted during the last 30 years.

During the US Civil War Dr Mandaz Da Costa had found abnormal cardiac symptoms in soldiers without any physical basis. Subsequent researches have confirmed the correlation between combat exposure and negative health outcome. According to Schnurr & Green (2004) studies have shown the correlation between cancer risk and battle stress. Some studies have found the link between Diabetes Mellitus and stress.  Lloyd et al.  (2005) point out that the evidence suggests that stressful experiences might affect diabetes, in terms of both its onset and its exacerbation. The veterans of the Eelam War are at a health risk. Therefore the health authorities should take appropriate responsive measures to minimize the mental and physical hazards caused by the War.

The dedication and the courage of the armed forces cannot be underestimated, the Sri Lankan combatants fought one of the longest and deadliest armed conflicts in the world, and they were able to gain a decisive victory. Sri Lanka paid an immense price for the military victory. As a result of the three-decade war, many soldiers became physical and psychological casualties. Unfortunately the society is gradually forgetting the scarifies made by the combatants.

Although many see war as a heroic effort, there are thousands of untold traumatic stories in the Eelam War. Some soldiers shared their traumatic stories with us and these stories reveal the magnitude of their suffering. These stories represent the true nature of combat trauma in Sri Lanka.

The psychological casualty of the operation liberation

The Operation Liberation or the Wadamarachi Operation was conducted in 1987. It was the first major military operation in Sri Lanka. Nearly 8,000 soldiers participated in this campaign. The most popular and the famous officer of the Sri Lanka Army the late Gen Denzyl Kobekaduwa commanded this military offensive against the LTTE. Now nearly 25 years have passed and many have forgotten this campaign. Up to date no one has scientifically studied the first military operation of Sri Lanka and its psychological effects.

Corporal Ax36 is one of the psychological casualties of the Operation Liberation. During this battle, he faced many war stresses. He was physically and mentally exhausted. After serving, a number of years in the Army Cpl. Ax36 witnessed countless traumatic events. He suffered nightmares, intrusions, hyperausal, and flashbacks. He was avoiding people and places related to his traumatic experiences and became emotionally numbed. In 2003, Cpl. Ax36 was diagnosed with PTSD.

Corporal Ax36 describes his present emotional and physical ailments as follows:

I was one of the soldiers who took part in the Wadamarachi Operation in 1987. Our main aim was to liberate Jaffna Peninsula and destroy the LTTE positions. When we came near the Thondamanaru Bridge, the LTTE destroyed the bridge using explosives. We had to advance slowly. One of our soldiers died in front of my eyes as a result of a booby trap. I can still recall his face filled with blood. It was a horrific incident.

I should honestly admit that I was terrified by this dreadful event, because I am a human although I wore a military uniform. I was deeply shaken by the death and demolition. Even after many years, I still see these events in my dreams. To evade the nightmares associated with the Wadamarachi Operation I used to take alcohol and go to sleep. I cannot stand any loud noises, I become frightened and my heart starts pounding. Often I try not to think about past battle events. When watching TV if I see any combat related story or pictures, I disconnect myself with it. I hate to talk about past events especially those related to the war.

I have no strength in my body now. My joints are aching. I cannot even walk a mile. Prematurely I have grown old. My mind is full of melancholic feelings. I am unable to feel happiness. For many years, I never experienced cheerfulness.

I am unable to concentrate and I am very forgetful. I have forgotten the names of my fellow soldiers who served with me in the same unit. Sometimes I feel that I have no reason to live. My family members avoid me because of my hot temper. Unlike early days, I cannot control my anger. I have been turned in to an irritable cold person. Several times, I thought of disappearing from this world. However, according to my religion it is a sin. Therefore, I have resisted the idea of committing suicide.

Private K and Survivor Guilt

There is a higher incidence of depression in veterans who had been in combat and lost a friend. Survivor guilt is an especially guilt invoking symptom. “Survivor guilt” is the term used to describe the feelings of those who, fortunately, emerge from a disaster, which mortally engulfs others. On an irrational level, these individuals wince at their privileged escape from death’s clutches. (Aaron Hass).

Private K is a soldier who was severely troubled by the Survivor guilt. He joined the Army in 1992 and served in the North. While serving in combat his buddy was shot in front of his eyes near the Punani station (in Batticaloa District). He fell down and lost his consciousness. Although Private K wanted to help his friend, he could not reach the friend due to heavy fire. Along with the other soldiers, he attacked the enemy and eventually went near his friend. But he was dead. This incident made him so upset. He felt guilty that he could not help the friend.

By 1997, he frequently experienced headaches, intrusions about his dead friend and showed marked symptoms of depression. He became irritable and gave a startling reaction to any slightest sound. Private K felt uneasy with the military duties and wanted to avoid military situations. In 2003, he was referred to the Military Hospital Colombo and diagnosed as having PTSD. Private K’s condition improved following drug therapy (SSRI) and psychotherapy (CBT and EMDR). By 2005, he was free of most of the PTSD symptoms. After cognitive restructuring, he got the insight and now Private K knows that he was not responsible for the death of his friend.

Did I bury him alive?

Private Lx26 became pitiful when he witnessed the death of his fellow soldier who got killed by a sniper shot. The troops had no means to bring the body back. After confirmation of death, Private Lx26 was ordered to bury the body. When he touched his friend’s body, he could feel the body warmth may be due to the hot Northern climate. Private Lx26 dug a pit and buried his friend’s body in the midst of sorrow. Then they advanced towards Eluthumaduwal.

After several days, Private Lx26 had an irrational and guilty feeling that he had buried his friend alive. He suppressed this painful feeling for a long time. Gradually it became a distressing intrusive recurrent thought, which he could not bear anymore. In 2003, he experienced a severe depressive reaction following survival guilt. He had full-blown symptoms of clinical depression. He was treated with Rational Emotive Therapy in which his irrational and illogical ideas were confronted via a friendly and therapeutic mediation. After the therapeutic intervention, Private Lx26 was free from devastating psychological burden that he carried for long years.

My Sergeant died in my arms: says Private RS

Private RS is an experienced combatant who became a psychological casualty of the Eelam War. This is his story:

I was born in a small village in Pollonarwa and often our village became the LTTE target. Several times the LTTE attacked our village slaughtering men women and children. We had mass funerals after these attacks and most of the villagers felt utterly sad and insecure. As a child, I saw these atrocious events around me. At night, we did not sleep in our houses, for security we slept in the jungle. I did not see a way out for these fathomless problems except joining the military. So I was determined to join the Army.

Our family had to face many financial hardships and that affected my education. I could not study further and I joined the Army. After my basic training, I served in Welioya and Vavunia. In 1997, I participated in Jayasikuru (Victory Assured) operation and we were given a task to capture the Maankulam highway. We fought the enemy face to face. The gunfire lasted for nearly 3 hours. A commando unit came for our support and we were able to advance further. Sergeant L who was my senor NCO and my mentor was behind me. He taught me many combat skills. We always fought the enemy together. He used to cover me and I used to cover him. Both were lucky for many years. However in Maankulam he was hit by a bullet. My heart sank when I saw he became wounded. Sergeant L was bleeding profusely. I helped to evacuate him. I carried him while praying for his life. His breathing became shallow. I could not reach the medics, half way he died in my arms.

After his death, my conscience blamed me for not saving him. I felt guilty. I wish I could have taken him to the Medical Point on time. If I had done that, it could have saved his life. But I was too late and Sergeant L died. I was troubled by this guilty feeling and combat related nightmares and various intrusions. My life was at a standstill. I was filled with sorrow and repulsion of combat events. I was disgusted with all these issues and once I wanted to shoot myself and end the suffering. Somebody or some power saved me from self-harm and showed the way towards life. Again, I saw light.

(Private RS was found with PTSD comorbid with depression. Following intensive treatment, he was able to recover. He became free of survivor guilt that troubled him for a long time. Now he is serving in his unit without firearms and doing light duty)

Rifleman Sn34 and Baptism of Fire

I became a psychological casualty at the Yale Devi operation says Rifleman Sn34 revealing his story thus.

..…Operation Yale Devi was my first combat experience. We faced the enemy with courage. I witnessed a lot of traumatic incidents there. Our fellow soldiers died in front of my very eyes leaving us in extreme sorrow.

On one occasion, the enemy gave us a surprised attack and we were scatted. I jumped in to a pit and waited all night long. It was a dark night. I saw the enemy collecting weapons from our bunkers. I was alone and feared for my life. I knew, the enemy had no mercy and knew it very well. I had seen dead bodies mutilated by the enemy.  I thought they would do the same thing to me if they could capture me. It was an awful idea. I had vivid mental pictures of my funeral and I saw my parents were crying. I did not want to be captured by the enemy, then kill me and let them mutilate my body.

The entire night I was praying for my life and by dawn the reinforcements came and they rescued me. I was taken to the hospital. Although I had no physical injuries, my mind was deeply wounded. Nevertheless, doctors said I was ok. I felt something was wrong with me. I was sent to the battlefield again. I had fear feelings and every night I saw the same horrible dream. I saw myself trapped in a pit and the enemies were all over. Despite the fear and resentment, I did the duty that was requested from a soldier. My mental health was deteriorating and I had no salvage. Finally, I decided to become AWOL.

I went home as a completely changed person. The innocence of youth and love and affection to the family members had gone away. They saw me as a frightened cold soul. My parents thought that some evil spirit had got in to my body and they did Thovilaya (traditional healing ceremony) to chase dark spirits and to heal me. But it did not help. My memory was fading and I couldn’t sleep. Nightmares ruined me to the end.

My family arranged a marriage for me thinking that it would help me to get away from alienation. After my marriage, again I went back to the Army. But I was a lost soldier. I was anxious performing military duties. I had intense fear of enemy attacks. The noise of the gunfire, artillery sounds made me startle.

I went home after several months serving in the North. I had no happy feelings that I got a vacation after so many months fighting in the jungle. My emotions became numbed and no longer, I was interested in marital life. I became more and more hostile and physically abused my wife. Since I couldn’t have a sound sleep, I started indulging in alcohol. Practically day and night, I was drinking secretly. But it made me worst. It made me a monster. My wife was afraid of me. When I came home, she was shivering in fear. When I was angry, I destroyed the house property. Nothing gave me a relief.

Eventually I decided to talk to one of my senior officers whom we trusted. The officer listened to my grief and helped me to get psychological therapies. I was treated at the Psychotherapeutic unit at the Military Hospital Colombo for nearly 3 weeks as an inward patient. Then they got down me to the clinic and treated me. Counseling and medication helped me to get away from the trauma that I experienced for a long time. Today I am a new man who is not abusing alcohol and I love my family. I enjoy life and do not live in past memories.

The soldier who did not like to attain military funerals

I hate to participate in Military Funerals says Lance Corporal S who described his military life in following account.

In 1987, I was posted to Kurumbasevadi camp near the Palali Base Camp. There I faced the baptism of fire. In that camp, I served nearly one and half years and then sent to Welioya camp. I was at the forward defense line. At the Welioya camp, I witnessed many horrendous combat events. The enemy attacked us with heavy weapons killing my fellow soldiers. I saw how they were laying on the ground with bullet or shrapnel wounds. I collected the dead bodies and put it in to body bags. I was utterly devastated when collecting human remains.

In 1991, I served in a non-operational area but my official duty was to participate in funerals of our soldiers who died in action. When I was at these military funerals, I had various intrusions about the battlefield and my dead buddies. My heart was broken when I heard the mourning and wailing of the relatives. At one funeral, I saw a mother was crying for her dead son. He was a good soldier whom I knew. Her weep reverberated in my ear. I recalled the dead soldiers at Welioya , how they were laying on the sand some with opened eyes, green uniforms soaked with blood , black smoke , what a horrible scenario. Many weeks I could not sleep. I hated to participate in these depressing military funerals. However, my duty required such participations. In each funeral, I had flashbacks and deep sensation of sadness.

By 1998, I got a transfer to Mannar District. There while I was traveling by bus I met with a land mine explosion. I was wounded and treated at the hospital. Although my physical wounds healed, the fear that I experienced at that event was re occurring. My mind was full of various battle events, military funerals and the land mine explosion, which I met in Mannar. I had nightmares and fear feelings. I became more irritable and sexually inactive.

My body became a source of pain. Every joint in my body started aching. When I experienced an unbearable headache, I could not stand noises. After the land mine explosion, I was again posted to the former camp in the non-operational are to fulfill funeral duties, which I hated. Regrettably, the senior officers gave no ear to my grievances. I was there for another one and a half years. During that time my illness progressed rapidly and once I decided to commit suicide while on duty.

My unsuccessful suicide attempt alarmed the platoon officer and I was sent to the hospital. At the hospital, I was treated and given medication and psychological support. After months of treatment, my condition improved. Today I am doing light military duties in a non-operational area. But still I cannot see dead and war memorials.

(Lance Corporal S was diagnosed with PTSD by Dr Neil Fernando – Consultant Psychiatrist and treated with SSRI and EMDR. After intense therapy, his anxiety based symptoms reduced to a significant level)

In my dreams I often see the enemy is attacking my bunker

In my dreams I often see the enemy is attacking my bunker says Private Rx68 who is a known PTSD patient.

….My memories are still filled with the events that took place on the 24th of August 1993. Now for many years I still live with these horrendous memories. Practically every day I recall these events and it gives me pain and anguish. Frequently I see these events in my dreams. I wake up in the middle of the night with fear and distress.

On that dooms day at 12 o’clock midnight I was at the bunker. Two of my buddies who were with me had a rest while I was on guard. Suddenly I heard gunshots and one of our corporals shouted that the enemy is attacking the Janakapura North Camp. I alerted two of my buddies and asked them to be prepared. Within a few minutes a group of LTTE attacked our bunker.

I heard the scream at the adjacent bunker. The enemy attacked them with a hand grenade and I presumed that they had captured that bunker. So we were on our own and fighting the enemy. Three of us fired at the enemy from three different directions and we never wanted to surrender. The enemy came towards us like an unceasing wave. I attacked the enemy with my LMG killing a dozen of them. One of my buddies near me sustained a gun shot and fell down. Hence, two of us had to face them.

We fired at them without giving any break. Suddenly they attacked my bunker with a RPG and the bunker collapsed. A large Palmyra log fell on my head and I was semi-conscious. My ears became locked and I felt bleeding from my head. I knew if we stayed there, we would be killed. Therefore, we came out from the wreck and crawled towards the center of the camp. While we were crawling in the dark several LTTE carders came to capture us alive and I threw a grenade to escape.

When two of us went further, we met a group of our soldiers. We regrouped and attacked the enemy. The assault went for a long time, by dawn, the enemy withdrew from the camp leaving many casualties. Although I was injured and tired, I fought with my guys without dropping my weapon. In the morning, I was sent to the hospital for treatment.

I still recall how my friend at the bunker fell like a log after hit by a bullet to the head. We fought while he was gasping and we had no time to pay attention to him. He must have died within a few minutes. These memories hounded me at nights. When I am half a sleep I see shadows, and I become vigilant. I always get a feeling that the enemy is crawling towards me. I fear that the enemy would attack with a RPG. Then I open my eyes and my heart starts to beat like an accelerated machine. Afterward for several hours, I am unable to sleep. Awake at night I am thinking about my friends who died in the battle. Then I feel that it was so unfair that I am alive and they are no more.

Sometimes I see battle events in my dreams. Often when the enemy attacks I am unable to return fire, my gun is jammed. Since I am unable to shoot the enemies, they are approaching me little by little. I can hear their voices scolding us in Tamil “Punde Army Punde Army “. I become helpless. I hear someone throws a grenade. My fear increases and I shout. Then I realize that it was another nightmare.

My family members are now used to my screenings at night. My great fear is when I am sleeping I might harm someone who is near me. Therefore, I often tell my wife and children not to be near me when I am sleeping. My life has changed dramatically and I am not the same person anymore. My emotions are numbed and I cannot cry for my dead friends. I live with this burden until I go to my grave.

The Story of Private UG

Private UG met with a blast injury in 1997 near the Thaladi camp. He was wounded and psychologically shattered by the blast. After several months of the injury he complained of severe headache, insomnia and fear feelings. Gradually he developed PTSD symptoms. Private UG found difficult to sleep and experienced nightmares related to the blast injury. He had fright feelings and always wanted to avoid the places and conversations related to the blast injury. Any slightest sound made him jumpy. He became irritated and could not control his anger. Often he experienced sexual dysfunctions and as a result of family turmoil, his wife left him. Following family problems and overwhelming anxiety, he tried to commit suicide.

When Private UG was referred for psychological therapies, he was treated with CBT and EMDR which minimized his PTSD symptoms. Today he is able to sleep without nightmares and intrusions hardly bother him. He does not get excessively angry as early. He has learnt to manage his anger without destructive behavior. The final follow up revealed that his wife had returned and Private UG is leading a productive life.

I was hiding in a hole in the ground : Rifleman Mx38

The night of the 27th of September 1998 was the most terrible hours of my life. I was at the FDL in the Paranthan area. The LTTE attacked my bunker and they managed to come very close. My friends had thought that I was dead and enemy had captured my bunker. Then they too attacked the bunker with their weapons. I was trapped facing enemy fire as well as friendly fire. Without many options, I decided to abandon the bunker. I crawled and moved away from the FDL. Then I found a pit and I was hiding in there.

I heard the enemy’s movements and lot of gunfire. I thought this would be the end. Within a few moments, they would discover me and they would not think twice to kill me. I saw child solders moving towards the FDL with heavy weapons, then the LTTE female carders with AK 47 in their hands. Luckily, no one saw me or not expected me to be in a hole in the ground. I could hear heavy fighting and I decided to stay inside the pit. I was trapped there for several days. I had no food and my water bottle finished by the second day. On the third day, I was thirsty and I was compelled to dink my urine. By the fourth day, I had no alternative. I decided to move towards the FDL. I noticed that the defeated enemy retreating group by group. I took a cover and avoided them.

It was a dark night and I made no noise. I was without food and water with severe exhaustion. I moved slowly. When I came near the FDL I had to be vigilant not to receive friendly fire. I shouted at our soldiers. I told them my name, unit and my serial number. Then they recognized me with a surprise. They had thought that I was killed or captured by the enemy. I was taken to the Commanding Officer and he admired my courage. I evaded death like a miracle. I was lucky to be alive. But this happiness lasted for few days. Often the fear and isolation that I experienced inside the ditch bothered me. I could not rest, every time I had to be on guard anticipating an invisible enemy. Days went by I was still feeling fear. When I went for an ambush I became restless I was looking at the front then my inner feeling said the enemy is behind you, then I looked back, and no one was there. I could not concentrate. My mind was full of images. It was a terrible mess and it became an obsessive ritual to watch every direction for the enemy.

My head started aching and often I forgot things. Several times, I was warned by senior NCOs and Officers for leaving my weapon elsewhere. I could not concentrate or remember things. At nights, I was practically awake. A slightest sound made my heart oozing with fear. My heart started pounding giving me aches and pains. I had terrible nightmares. In my dreams, I saw I was trapped in a hole in the ground and surrounded by the enemy. I hated to go to sleep.

(Rifleman Mx38 was diagnosed with PTSD by Dr. Neil Fernando – Consultant Psychiatrist of the SL Army in 2001 and treated him with SSRI and Psychotherapy According to the 12th April 2005 follow up he experienced no major PTSD symptoms. His sleep became normal and the startle reactions became minimal. No intrusions or flashbacks troubled him)

The story of Lance Corporal AS – The soldier who was living in isolation

I was happily married but things changed when I became wounded in the battle. . In 1990, I was at the Thaladi Camp Mannar. There I saw fears battle. The LTTE gave us a surprised attack with heavy weapons, killing nearly 40 soldiers. I heard the sound of thunder and saw a black smoke. I felt the vibration and I fell down. I immediately grabbed my T56. Our soldiers too fired several artillery rounds. Within several hours everything became calm. The enemy artillery had been withdrawn.

My heart cried when I saw the dead bodies of our fellow soldiers. We were like one large family. Prior to the attack, we had meals together and made jokes about odd things. I never expected such an unexpected, sudden and cruel death for them. The war had been really cruel to them. They perished with a large awful sound and black smoke. Our friends had gone forever. After the attack I saw disfigured human bodies covered with blood. Some dead soldiers had no arms and legs. When I put their bloodstained bodies in to the body bags, I cursed the enemy.

After this event I became more isolated and had intrusive memories. I had unexplainable fear and I could not stand loud noises. These sounds reminded me the horrible artillery attack. I was in pain both physically and mentally. I had headaches and it did not subside for painkillers. I had mental reflections of the Thaladi Camp in Mannar and the dreadful events. I was feeling angry, sad and tired.

There was no one to speak about my anguish. I became alienated. When I came home, my wife often asked what was wrong with me. However, I did not tell anything to her. Because it was a pointless effort to tell my sorrow to her and she would never understand what happened in the battlefield. Therefore, I silently lived with my grief. But I became more and more irritable.

In 1996, we went to Kodikamam and ambushed the enemy. There was no proper camp for us. We lived in abandon houses, which were ruined by the shellfire. It was a hostile ground. The enemy was everywhere. If you do a stupid mistake, you would sleep in a body bag. I was uncertain of my life. We lived day-by-day avoiding enemy fire and booby traps.

One day we accidentally walked in to an ambush and the enemy fired at us in a close range. Eight of our men died in this attack and they died in front of my eyes. We too attacked the enemy and eventually managed to escape. But we had to leave the bodies due to the advancing hostile forces. I still feel guilty for leaving their bodies. Indeed it was a terrible time. During these years, I saw many dead soldiers as well as the members of the LTTE. Some bodies were decomposed or mutilated. I saw large Monitor lizards eating dead bodies. The things I had seen confirmed me that there is no glory in death for sure.

Once I saw a dead body of a staff sergeant (he was known to me), the enemy had shot his eyes. It was a horrible image to see, a dead body without eyes and instead of the eyeballs, I could see two deep bullet wounds. For many years, that image was deposited in my mind. I even had bad dreams.

When I came home these battle events started roaming around in my mind. I wanted to be left alone. But my wife wanted to know what’s wrong with me. I was not interested in sex life. I was avoiding my wife. She thought that I was having an illegal affair. I could not stand her accusations. I became depressed and could not tolerate noise. When my children played and shouted I became extremely angry. I severely punished them. When my wife protested, I used to beat her too. One day I smashed the TV and chased everybody out of the house.

My family was suffering with me. When I came home, I used to physically abuse my wife for a slightest argument. She felt uneasy during my presence. Even the children feared me as if I am a monster. Little by little, I was losing my family. When the physical abuse escalated, my wife went to her parent’s house with the children. I was all alone and I started abusing alcohol.

My nights became more and more disturbed. I experienced battle events in my dreams and relived painful moments. Sometimes I could hear gunshots, artillery fire and helicopter sounds. I was trapped in reality and illusion. I had a deep loathe when I saw military vehicles and uniforms. I was afraid of going back to the battlefield. I never knew what fear was but now my body shivers even for a slightest sound like a firecracker.

My wife refused to come back then I became more depressed. I wanted to end suffering by shooting myself. Once I was on duty at the Army camp and I decided to end my suffering. I took a weapon and loaded it to take my life. A senior NCO jumped and grabbed the weapon. Then I was produced before my Office in Command. I thought I had to face charges violating military discipline. Instead of punishing me, they sent me to the Military Hospital. There I was treated and the doctors were kind enough to arrange an open interview with my family. The doctors convinced my wife to come back and finally she agreed. With treatment, I was able to control my anger. My sorrowfulness started to disappear. I was heading towards recovery. My intrusions and nightmares diminished and gradually I became a productive person. Now for over two years, I live with my family and I do not abuse them.

I lost my voice in the height of the battle – Lance Corporal W

Psychogenic dysphonia refers to loss of voice where there is insufficient structural or neurological pathology to account for the nature and severity of the dysphonia, and where loss of volitional control over phonation seems to be related to psychological processes such as anxiety, depression, or dissociative reaction. Psychogenic aphonia is a conversion symptom, which arises following an unconscious psychological conflict. There were many soldiers who lost their voices without any organic factors in the Eelam War. These soldiers mainly had overwhelming combat stress factors, which led to their aphonic condition. Lance Corporal W who is a known PTSD Patient described how he lost his voice in the midst of the war.

I joined the military in 1995 and faced many battle events. In 2000, I went to serve in the Pallei camp where the LTTE attacked us with mortars. I was shattered by the sound of this mortar fire. I felt profound breakdown inside my body. Every time I took cover to incoming mortars. I could feel the shockwave. I saw how our soldiers sustained injuries. I still recall one event in which a soldier succumbed to a mortar blast. His bowels came out and blood splashed all over. It was a cruel and painful death.

I was always on guard for incoming mortars. When that zooooo…..noise comes I always took cover. I knew what was going to happen in next moment. A mortar comes with that sound and gives a terrible blast. If you don’t go down you would be hit by shrapnel. Although I was extra careful, I was not lucky. Once I sustained minor injuries as a result of a mortar attack. Shrapnel pierced my thigh. I was hospitalized and treated for a few days.

Pallei experience was a horrendous experience for me. I was not sure of my life and often lived in uncertain situations. However, I was lucky to be alive and returned from Pallei. Then I served in relatively a favorable environment. In 2003, I re-experienced Pallei events and I frequently had nightmares. My fellow soldiers did not like me because I used to scream at mid night with fear. Some though that I was smoking cannabis. One night when I was sleeping, I saw an incoming mortar I cried for help but there was no sound. I became speechless. . Ever since, I could not speak and I lost my voice.

(Lance Corporal W was aphonic for several weeks and underwent psychotherapy. He was treated with hypnotherapy and continuous speech therapy. After combined therapies, he was able to regain his voice. But Lance Corporal W’s PTSD condition lasted for a long time. Medication and CBT / mindfulness meditation helped him to minimize the prevailing condition)

I had walked to the enemy lines: Private SK

“I was confused and did not know what I was doing. I had walked to the enemy lines. Luckily, a team of Special Forces saved me. When they found me, I had dropped my weapon and wondering towards the enemy lines. I don’t remember how I left my defense point or where I had dropped my T56. I was taken to the camp and produced before Lt Col ….. I was heavily questioned. Later they blamed me for abandoning my post and losing the weapon. I was severely punished for that offence. “

(Private SK had gone in to a psychogenic fugue state following over whelming battle stress. He could not recall what really took place on that day. His illness developed gradually. He served at Nadunkarni and witnessed the death of four soldiers as a result of an artillery fire. He saw how their bodies had been blown in to pieces and he was shocked. After this incident, he gradually became a victim of combat related PTSD which was undiagnosed and untreated. He had dissociative features as well. Several times, he went in to fugue states and in the final event, he had walked to the enemy lines. After he was rescued, Private SK was referred to the Psychological Treatment Center at the Military Hospital Colombo. At the treatment center, he underwent series of psychological assessments and cyber testing method to elicit autonomic arousal. He was diagnosed as having PTSD. Private SK was treated with SSRI and SPDT (Short Term Psychodynamic Therapy). With the treatment, his mental state improved)

POW s with PTSD

There are a number of POWs of the Eelam War who still carry the psychological scars. Most of them suffer from DDD Syndrome which was delineated by Farber Harlow in 1956. The DDD Syndrome consists of debility, dependency and dread. POWs often show depression, apathy suspicion and fear. Some have large memory gaps and still feel guilty about their POW days.

Lance Corporal U has served 17 years in the Sri Lanka Army. During the Balawegaya operation, he sustained a gun short injury to his leg and became immobile. When the enemy advanced, he could not move and hence he became a prisoner of war. When he was captured, he was severely beaten with the rifle butts and one LTTE senior carder pointed his weapon at him. He was subjected to a mock execution. However, one of the LTTE regional stopped the beatings and sent him for medical treatment.

When the medical treatment was over, he had to undergo vigorous interrogations. He was tortured to get information about his Camp and its inner structure, armory and guard points. He was handcuffed and kept in painful positions for long time. Frequently his guards physically assaulted and humiliated him. However, Lance Corporal U admits that there were some LTTE members who were kind to him and brought extra food sometimes.

From July 1991 to March 1995 L/Cpl U spent his life as a POW facing torture, humiliations and uncertainty. He was kept in a very small cell with forty other prisoners. They had no space to move. The prisoners were allowed to take a bath once in two weeks or sometimes longer than that. Many suffered skin infections. Their meals were not served regularly. Following the intolerable conditions, the prisoners launched a hunger strike and eventually he was released in March 1995 after the interference by the International Committee of the Red Cross (ICRC).

Although Lance Corporal U became a free man, he often suffered from an unexplainable fear, sometimes panic attacks. The POW days memories hounded him severely. Some nights he used to wake up with fear thinking that he was still in the LTTE prison cell. He was depressed and surrounded by guilty feelings. In order to avoid nightmares he was consuming large volumes of alcohol. More he used alcohol more he became depressed. He often physically abused his spouse. Lance Corporal U began to avoid everything related to his traumatic experiences.

He was suspicious about the surroundings. He lost the ability to trust and feel intimate. He was affected by emotional anesthesia. He had flashbacks and sometimes he could not distinguish reality from fantasy. His physical strength was weakening and slightest exertion gave him an immense body pain. In 2003, he was diagnosed as having PTSD.

The Cook of the Poonareen Camp

Mr. N -a civilian worked as a cook in the Poonareen Camp. When the LTTE attacked the Poonareen camp in 1993, many lost their lives. To avoid the enemy he was hiding inside the building complex and later found by the LTTE carders. He was beaten and threatened to kill on the spot. He was mistakenly identified as an officer in disguise. He was subjected to numerous physical and mental tortures. Eventually the Red Cross intervened and established his correct identity.

For nearly nine and half years, he lived his life a prisoner under the LTTE. He was homesick and practically every day prayed for his freedom. For long time he lived with uncertainty without knowing what his future would be. When the Air Force attacked the LTTE camps, their guards used to ill-treat them severely. His condition significantly improved when he met another POW – Capt. Boyagoda from the Sri Lanka Navy. (Captain Ajith Boyagoda became a POW when his naval ship “Sagarawardene,” was attacked by the Sea Tigers in 1994). Capt. Boyagoda gave him courage and strength to face the callous conditions. Along with the other POWs, he spent the time discussing their release and writing letters home via ICRC. (After his release in a press conference Capt. Boyagodaa admitted that he was well treated by the LTTE except at the beginning when he was kept in solitary confinement. But his other inmate were not lucky)

Mr. N was released on the 30th of September 2002. After his release, he gradually developed stress related physical symptoms such as headaches, backaches which did not subside to painkillers. He was unable to sleep. At nights, he was awake and thinking of the past. He often felt melancholic feelings, and troubled by emotional anesthesia. He could not feel the happiness of becoming a free man. His emotions were dead. Mr. N was losing the will to live. Several times, he planned to commit suicide.

His Physician Col. Dr. Nimalka Ariyarathne of the SLA referred him for psychological therapies. During the Psychological assessment, many anxiety based somatoform features were found in him. Despite the traumatic symptoms, he positively responded to psychological and drug therapies. Gradually he was able to get away from his melancholic feelings, intrusions and psycho- somatic pains. He was lucky to receive a lot of psychosocial support, even a house donated by the Ceylinco Group. Today Mr. N is very much symptoms free and living a productive life.

Combatants with Partial PTSD

According to the researcher -Kulka, partial PTSD is a sub diagnostic constellation of symptoms that was associated with significant impairment. They have sufficient features of re-experiencing and hyperarousal with insufficient features of avoidance and numbing and comorbid alcohol abuse or dependence.

Cpl. Tx3 was a member of the Army Special Forces engaged in a number of military operations. He often worked with the long-range reconnaissance patrols (LRPP). Cpl. Tx3 met with numerous hostile enemy conditions, which affected him psychologically. Many days they used to hide in the jungle and attacked the enemy supply lines. Often they lived with danger risking their lives.

On one occasion, Cpl. Tx3 and his five man team deeply penetrated the hostile territory. They operated silently without alerting the enemy. Suddenly he met with two LTTE female carders face to face and none of them fired. Cpl. Tx3 was in a dilemma situation if he had fired at the two LTTE female carders his team would have been in a great danger. Unbelievably two women despaired in to the jungle. He was confused and dazed for a while and was able to return safely.

For many years, this incident stuck in his mind. He always questioned himself “why didn’t they shoot? With these intrusive thoughts, he re-experienced combat events that occurred in the North. He would give a startling reaction to any loud noise and became vigilant all the time. Despite the posttraumatic features, he was not avoiding combat situations. Therefore, the avoidance feature was not seen in Cpl. Tx3. There was supportive evidence to prove that Cpl. Tx3 suffered from partial PTSD.

Lance Corporal Ax4

Lance Corporal Ax4 who was diagnosed as having partial PTSD, expresses his combat experience thus.

“In 1992 I was posted to Kites Island in Jaffna. My own brother served with me in the same unit and I was not comfortable with it. Therefore, I requested for a transfer and I was asked to serve in Kajuwatta Mannar. While I was serving in Kajuwatta camp one day I got a message saying that my brother was killed in action at Keramalei. Although I was given leave to attain my brother’s funeral when I went home, the funeral was over. But I attained religious ceremonies after his funeral.

When my leave was over, I had to report back to the camp. My mother was devastated over my brother’s death. When I went to say goodbye to her she asked me to stay with her. It was impossible and I had to report to duty. So I left home. While I was traveling to the camp, again I got a message near Puttalam stating that I should report home immediately. My inner mind told me that some bad thing had occurred. When I went home, I met with another tragedy. My mother had committed suicide. I was relentlessly shattered. I lost my brother and now my mother. This time after her funeral, I did not report to work and became AWOL. After several months, I decided report to duty and this time I was posted to a rescue mission at Poonareen. In this mission I sustained a mortar blast injury and taken to the hospital.

“After I was discharged from the hospital I participated in Rivirasa operation. We walked up to Kilinochi facing hostile enemy attacks. A lot of buddies died in front of my eyes. At Kilinochi the enemy attacked us with mortars. I sustained injuries and I was bleeding. I asked others to help me. No one came to help me and I felt fear. Then I saw a sergeant passing near me and I asked him to help me. But he left me just giving a glance. I was helpless and in pain. I gathered my entire energy and scrolled towards Elephant Pass. On the half way, a group of soldiers helped me. They put me in a cab and took me to the nearest Med Aid Point. There I lost my consciousness and when I opened my eyes I was at the Anuradapura hospital.”

“I was treated at the hospital for several weeks and then discharged. I realized that I was experiencing some distressing past events and these intrusive memories troubled me. I could not tolerate sudden noises. My mind was full of traumatic events that I experienced in the resent past. Some nights I could not sleep and I was having a severe headache. When I am with physical and emotional pain, I become restless. I am not afraid of the battle. As a soldier, I can go to the war front at any time. The war does not scare me anymore“

My commanding officer was hit in front of my eyes: Private SN

Private SN who was shattered by war stress expresses his past experience in the following manner……

At Mallakam (1995) the LTTE attacked us with RPG. I stood near my commanding officer. I fired at the enemy with my T56, killing two of them, then a mortar exploded near us. I saw my commanding officer got wounded and was bleeding heavily. His uniform was soaked with blood. I expected help form our buddies. When I looked at the right flank, I saw no one. I shouted for help. Then another mortar exploded near me. I too sustained injuries. Blood came from my left ear. I had no strength to help my commanding officer. While he was lying on the ground with fatal wounds, I crawled towards the rear side. I had severe guilty feelings for abandoning him on a hostile ground. But I had no option. When I was crawling, I met some of our soldiers. Then I shouted at them “the CO is wounded get him soon”

So they went to rescue him. I went further. I could not crawl anymore. I lost my energy. The world was trembling in front of my eyes. I could hear the gunfire artillery explosions and the incoming mortar sounds. My eyes were covered with a dark strip. I lost consciousness. When I opened my eyes, I was at the Palali Hospital.

I was treated at the hospital for nearly one and half months. When I was discharged from the hospital, I went back to my unit. My Commanding Officer was no more. In addition, some of our unit members had died in that fearsome attack. I began my life again with these miserable memories. I realized that my personality was changing little by little. I was a daring soldier. But the events at Mallakam changed my life. Day and night, my mind was full of these events. Gunfire, black smoke, incoming mortars, images of the enemies and the wounded commanding officer etc were vivid mental pictures that ruminated inside my mind. I became more vigilant. I could not sleep at nights. I used to wake up for a slightest sound. These sounds gave me fear. When I was disturbed by a slightest sound, I felt a burning sensation in my chest.

Many nights I saw the combat events that occurred at Mallakam. I used to get up in the middle of the night with fear and sweat. Gradually I became depressed and felt that my life was wasted. I wanted to commit suicide. One day when I was at the bunker alone, I tried to release the pin of a hand grenade. Then I saw the eyes of my wife. Then I put the grenade aside.

My world was upside down. I did not like to stay in the operational areas. I felt uneasy when I saw weapons, military uniforms and vehicles. I disliked participating in ground operations. But I had no option. I was compelled to fulfill military duties as a soldier. I went with my platoon secretly suppressing my fear and avoidance. My symptoms were aggravating. I was about the explode. I thought of committing suicide every morning. I could not see any future.

Finally, I told my fears to one of my unit leaders. He listened to me for a long time and said “you need medical treatment”. So I went to the military hospital seeking salvage. I was referred to the psychiatric unit and treated for nearly three months. I received drug therapy and psychotherapy. My symptoms reduced little by little. Then I felt much easy. Today I am dong light duty. But I have not completely freed from Malakam events. Occasionally I see the twinge face of my commanding officer.

The Jonny Batta that changed a young life

Private Hx26 became a victim of an anti-personnel mine in Muhamale and underwent B/K (Below-Knee Trans-Tibial) amputation. He became shocked when his foot had blown off from the ankle. At first he did not feel the pain. But he was horrified to see the crushed foot. After a while Private Hx26 felt an unbearable pain. Soon he was evacuated. Even at the hospital and after the discharge Private Hx26 relived this traumatic incident.

After he met with the injury, his life fell apart. The girl who promised to marry Private Hx26 left him. He could not adjust to the life with a prosthetic foot. He became more and more alienated and stopped associating people. His life was limited to clutches. He became angry and hostile. Self-pity gave him no relief. He had no confidence, no ability to cope with his disable condition.

Although he was recommended rehab therapy Private Hx26 did not actively participate in rehabilitation program. Numerous times he thought of ending his life. Once he made an unsuccessful attempt to jump in to the swimming pool at the rehab center with his wheel chair. After his attempted suicide, Private Hx26 was referred for psychological therapies and he was diagnosed with Adjustment Disorder.

Private Hx26’s therapeutic schedule consisted of drug therapy as well as counseling. After 6 weeks of inward treatment, his suicidal ideation changed and he was gradually came to terms with his disable condition. Private Hx26 underwent further psychotherapy and finally he gave his consent to undergo the rehabilitation program with the supervision of the Psychiatrist. He expressed his willingness to take part in vocational training. He selected a handicraft profession- shoe- making and successfully completed the course. Gradually he started accepting his disability and started using his prosthetic foot. He was referred for spiritual therapy and meditation that was conducted by the Ven. Harispaththuwe Ariyawansalankara Thero at the Vipassana Mediation Center Colombo. With the spiritual therapy he was able to see his trauma in a wider perspective. Two year follow-up revealed that Private Hx26 is free of combat related symptoms and facing life with confidence.

The EPS debacle was my worst experience

The Elephant Pass debacle that occurred in 2000 due to poor leadership and inefficient strategic evacuation plan led to loss of many lives. It was a tactical withdrawal of the Elephant Pass camp but it was carried out in the hot sunny afternoon. Many soldiers died of dehydration and heat stroke. During the EPS debacle, 359 military personnel were killed, 349 were listed as Missing in Action and some 2500 were injured. Corporal K described the events that took place between the 21st of April 2000 and 22nd of April 2000.

On the 21 of April 2000, I was at the FDL of the Elephant Pass Camp. We were told that the evacuation order would be given at any moment. The following day at about 10.30 am, the enemy attacked the Elephant Pass camp with heavy artillery. While the enemy was attacking our soldiers withdrew towards Kilali lagoon. There we met Brigadier Percy Fernando who was a brave officer and he tried to re organize us and launch a counter attack then to go for a safe withdrawal. We assaulted the enemy and moved toward Paleii. The LTTE attacked us with mortars and their snipers targeted our offices and signalmen. I saw Brigadier Percy Fernando sustained a gunshot injury. It was a disastrous moment. Brigadier Percy was a brave soldier who did not abandon us. Some cowardly behaved senior officers saved their skin and got away leaving us to the enemy. But Brigadier Percy Fernando stayed with us and gave us leadership until the end. When he fell down, I knew that we were doomed.

We were tired and exhausted. Many of our soldiers could not walk. Hot sun and dry wind absorbed our energy. I felt thirsty but my water bottle was empty. Many of us had no sufficient water. We were walking like zombies on the hot sand. Some drank salty water from the lagoon. Some began to sing songs as they lost their minds. Many fell down with exhaustion and never got up.

While we were moving the enemy attacked us with mortars. Many soldiers were dying without water and facing enemy attacks. We had to walk fast to avoid the enemy fire. There was no air cover for us. Some fainted in front of my eyes. I knew they would never return home. One solder became insane. He was singing and dancing asking for a cup of tea. Wounded soldiers asked us to carry them. But we all were worn out and had no energy to carry a fellow soldier. We were on our own and every man for himself. It was an egoistic moment that I cannot forget until my last day.

My energy was ending. I could not carry the ammunition pack. I had to throw my belongings. Finally, I threw my weapon which was my savior for a long time. I walked in the hot son with other soldiers. All I needed was water. My head was dizzy and I fell down. I saw the hot Sun. There were no clouds in the sky. Many soldiers passed me by but no one helped me. I knew if I stayed there, I would be dead soon. I gathered energy and again, I stated to crawl avoiding enemy attacks. Panicked solders trampled me and ran towards Pallei. On my way, I saw many dead bodies.

One soldier grasped my boots. He was wounded and bleeding. He pleaded me and these very words still echoes in my mind. He said I am dying and I don’t want you to carry me, then he gave his name and address and asked me to convey his death to his parents. I still cannot forget this incident. I didn’t know who he was and by the time I came to Paleii I was unconscious. I too suffered a heat stroke and later recovered. I have forgotten his name and the address. I could not convey the message to his relatives up-to-date. But I still remember his face filled with utter despair. “

The acute PTSD victim of 2005 ceasefire

Signalman Px54 met with a claymore mine explosion in Jaffna in December 2005. He sustained minor injuries to the left hand as a result of this explosion. But 13 of other soldiers died in this incident. Signalman Px54 witnessed the hurtful deaths of two privates and a sergeant. These events change the psychological equilibrium in Signalman Px54 and he was diagnosed with acute PTSD. This is how he describes the event that drastically changed his psyche.

“That was a horrible event indeed. We went to Jaffna town by a truck. I was in the middle and holding my weapon. Suddenly I heard a large noise. The soldiers in front of me fell down. Then I realized that, it was an enemy attack. Despite the ceasefire agreement they attacked us with claymore mines and then with small arms. When the enemy attacked, our driver sustained injuries. But he was able to keep the vehicle steady and we kept going further. There was a large tire inside the truck then I took a cover. While I was lying down two wounded soldiers asked for water from me. But there was no water. We had to travel a few more kilometers to the nearest camp. Another wounded sergeant crawled near me and said something. His mouth was full of blood. Within a minute or two, he became motionless. His eyes were opened and he was dead. When the truck entered the nearest camp, I rushed to help the wounded men. Most of them were dead including two soldiers who asked for water. I felt really sorry for them. I could not help these soldiers even to give a cup of water.”

The soldier who became overwhelmed after killing the enemy

Sergeant Sx78 served nearly ten years in the operational areas experiencing heavy combat. He faced fierce battle events defending the Jaffna Fort in 1993. The Jaffna Fort was under siege and the enemy attacked them with heavy weapons. The operation “Midnight Express” was launched to rescue troops that were trapped inside the Fort. During the confrontation with the LTTE, he killed five of the enemy carders. After some years, he predominantly preoccupied with the thoughts that were related to these killings. Although they came to kill us, they too were human beings says Sergeant Sx78.

“They were poor village boys like us who had no many options in life. They were indoctrinated, poisoned with racial hatred and directed to attack us. We had no alternative except firing at them. I in a war things are intense, either you or the enemy. If you don’t kill him he will kill you. Anyhow, these Tamil youths had parents like us, they too had expectations. All ended very sadly. Someone in somewhere may be still missing them. I know killing is bad. It is a violation of the first Buddhist precept. I was compelled to do that act.

Sergeant Sx78 feels that one day he has to face the Karmic repercussions for these killings in 1993 at the Jaffna Fort. His conscience was shattered and he became more religious. Sergeant Sx78 wishes to be a monk after his retirement from the Army.

The final days of the War

Lt Col …… (This officer wishes to remain anonymous) … is an experienced field officer who participated in many combat operations. He shared his experiences on the final days of the Eelam War.

……….When we liberated Thoppigala I knew we were invincible. Others may have felt that. Therefore, we advanced further. The last days of the Eelam War were hectic. The LTTE built a large sand walls and it was difficult to penetrate it following heavy fire. They were among the civilians creating a human shield. We had to be extra cautious not to harm civilians.

However, in a war civilian casualties are inevitable. For instance, how many civilians died in Iraq and in Afghanistan when the US forces retaliated the enemy? But I remember several events when the enemy attacked, our soldiers did not attack back due to the civilian factor. The outside world would never know about these facts.

I remember when the enemy fired from a bunker, one of our soldiers tried to attack the bunker with a Tomba gun. Another soldier stopped him saying that there were civilians near the bunker. They had to find other means to destroy the bunker without causing civilian casualties.

In another event, I saw soldiers carrying little Tamil children when the civilians broke the sand wall and came towards us. These humane stores were never told and only negative points were highlighted.

I agree, in a war atrocities are often committed and in every army you see people like William Calley who did the My Lai Massacre. I personally think that the media should comment on atrocities as well as humane stores of the war. Otherwise, there will no reconciliation at any point. After all man is not pure evil.

I have been living with the war for many years. I have seen perished soldiers, and dead LTTE carders. All these people were the children of this land. What a waste of human lives.

The final days of the war were traumatic. I saw human suffering. I have seen enough blood. Those who cry for war and glorify the war from Colombo should have been there. Then they would know what the war is really like.

I felt sorry for the Tamil civilians who followed a mirage. . When I first came to the North as a schoolboy at the age of 16, I was touched by the kindness of the Tamil people. The Jaffna people were cultured and educated. They had a great civilization that cherished with non-violence. When the conflict erupted in early Seventies, things changed drastically. Then I had to come to the North in a combat gear.

Tamil people in the North paid an immense price for the war. Their property were destroyed, children were forcibly recruited by the LTTE. They faced deaths and destruction. They lived under poverty. What happened to the millions of dollars that pumped by the NGO s and by the Tamil Diaspora to the North? The people of Wanni had no infrastructure, people were malnourished. If this money was used to develop the North, they could have built a little Singapore.

I am glad that the war is over. We must rebuild the North and work for the ethnic harmony. We must forget our petty racial differences and work for peace with our Tamil brothers. Otherwise, within 20 years there will be another bloody war…………

Conclusion

Many people in Sri Lanka still debate about who should be given credit for ending the war. Is it to MR, or to SF or to Gota? No doubt that all these persons gave their utmost support to end the war. But without the dedication, sacrifice, sweat and the blood of the combatants, it could not have been achieved. Therefore, the Nation has a moral responsibility to look after the well-being of the soldiers who fought in the Eelam War.