Featured image courtesy New York Times

If only political leaders knew the horrors of war first hand, they might find other ways to solve differences, to meet threats – perhaps go to the root causes of the conflicts that  stem from crucial conversations about identity, rights and privileges – listen, seek to understand and compromise in the common interest – anything to stop the guns from coming out.

Then again, war has become an economic machine – run by the Military Industrial Complex, as US President Dwight Eisenhower warned in his January 17, 1961 farewell address to the nation.   President Eisenhower knew a thing or two about the horrors of war, having served as the Supreme Commander of the Allied Forces to see the end of World War II in Europe. Eisenhower expressed his concerns about the dangers of massive military spending, particularly deficit spending and government contracts to private military manufacturers.

The world has not heeded his wise words to date, as even the modern day leader’s minds have not evolved from the hunter gatherer days, it seems, as the only way to solve a conflict is to pick up a stick – just that our modern day weaponry is much more lethal.

It is indeed these modern day weapons, the powerful blasts, then the mayhem it creates, that seems to be causing the Post Trauma Stress Disorder (PTSD) for soldiers and civilians, apart from the human misery and trauma of war. PTSD is catching the attention of the public, especially in North America, as it is impacting society as a whole and families in particular.

Canadian Broadcasting Corporation (CBC) program – IDEAS hosted by Paul Kennedy and produced by Mary O’Connell showcased a story called All In The Family, Part 3 (April 21st 2016) to highlight people who suffer trauma growing up in violent and abusive families and how it impacts their entire lives and the people around them.

The CBC website on the program stated;

Trauma is not a story about the past – it lives in the present: in both the mind and body. Left untreated, it has no expiration date, whether it’s trauma arising from childhood abuse or PTSD suffered as an adult. In recent years we’ve heard a lot about how resilience and character can mitigate the effects of trauma.

I was interested in the work showcased by Dr. Bessel van der Kolk – a Clinical Psychiatrist who works to integrate mind, brain, body and social connections to understand trauma. I was especially excited when he spoke of Yoga, Martial Arts, Dance, Meditation and Eye Movement Desensitization and Reprocessing (EMDR) – a simple eye exercise used in integrative psychotherapy.

In the dominant Western culture where better living is prescribed through Chemistry, van der Volk offers an alternative solution based on Eastern practices through an inward journey of the body and mind, with breath and movement to cultivate insight and awareness, as he believes this trauma is physical and lives in the body.

Sri Lanka having been through its 30 year war is certain to have Post Traumatic Stress Disorder (PTSD) victims.

Dr. Ruwan Jayatunga MD, a Sri Lankan Psychiatrist has written many articles including How PTSD Impacted Sri Lankan Society (May 17th 2016), in news papers and web blogs. He highlights that the entire duration of the war, from 1983 to 2009, the military did not have any medical teams to treat, evaluate or assess the seeming mental health problems of the soldiers who may suffer from trauma.

He also states that the clinical community was divided on PTSD. However, family members and the medical community started noticing certain abnormal behavioural patterns among ex combatants. Reports of nightmares, flashbacks, feelings of fear and uncertainty were being reported in these incidents. Some have even resorted to violence both at the domestic level and in public, and many reports of suicides have brought the issue of PTSD to the public view.

Dr. Jayatunga estimates about 8 – 12 percent of combatants may be severely affected by combat stress and many of them are not under any type of treatment.

Similarly, the civilian population of Northern Sri Lanka witnessed the war firsthand and many are victims of the collateral damage. Prof Daya Somasundaram estimates in the Journal of Mental Health Systems 2007 that  14% of the Tamil population living in Northern Sri Lanka suffer from PTSD.

Van der Kolk stated in the CBC interview that 25% of returning American soldiers will develop PTSD – leading to dysfunctional home lives, sometimes full of rage or becoming distant and separated at worst – resulting in more trauma for their partners, children and the community.

This is what is at stake for Sri Lanka too, as trouble begins at home and spreads outward creating a socio-cultural issue that is a national concern. Van der Kolk calls the resulting trauma the “cultural feedback loop”.

Latest research is beginning to show that PTSD is also physical.

A New York Times Magazine article by Robert F. Worth June 10, 2018, titled, What if PTSD is more physical than psychological?, describes a new study that supports what a small group of US military researchers have suspected for decades: that modern warfare destroys the brain.

Neuropathologist Dr. Daniel Perl’s research is realizing that war trauma during World War I known as shell shock, then termed combat fatigue and now PTSD stems from also being subjected to powerful blasts which scars the brain.   As such, what was just deemed emotional trauma can be deemed a physical affliction too.

This makes it easier, especially for a macho soldier to accept there is a problem and rise to deal with it.

Physical and Emotional Balance

We also realize that a physical impact has an emotional response as we are interconnected holistic beings. Trauma separates us from our humanity as the mind moves away from the body, as that separation is the way we cope in the short term.

War also creates emotional trauma, as deep down we are driven by a primal need to do good, be caring and giving, to live meaningful lives, to honour each other and nature that we are a part of. These get compromised, especially when we are forced to harm, in the name of duty, other humans, especially “enemy” children.

According to van der Kolk, people with PTSD, with the separation of mind and body, loses touch with physical sensations and have trouble taking care of themselves. This is because the rational-limbic part of the brain, while good at making connections and relationships, is not good at managing emotions and impulses when under threat. Then the reptilian brain kicks in with a primal survival response, which can lead to inner or outer violence.

A Holistic Approach

It is time we take a holistic view to these findings, as if we go through the traditional Western route alone, we will again seek only Allopathic Chemical methods to reverse the physical affliction – the lesions that are found in the brain of PTSD victims, and leave out the emotional fall out.

Western psychotherapy also has scarcely paid attention to the experience and interpretation of disturbed physical sensations and action patterns. That is why a balance is important to also consider seeking the holistic Eastern mind-body approaches to help victims, as this is both, a mind and body trauma.

That is why Van der Kolk and Perl should be speaking to find that middle ground.

Quieting the Mind and Finding Space

This physical and emotional combination is required to quiet the mind to reflect and learn to control bodily reflexes. Memory is important here, as PTSD victims store the past at a sensory level and the body keeps relaying the past trauma like a broken record.

According to van der Volk, yoga and mindfulness breaks this ruminative cycle and helps to reintegrate body and mind. It makes it easier to discern the past from the present, real or perceived threats, when the mind is clearer – even if there is a physical affliction.

Yoga offers a way to reprogram automatic physical responses, as it helps reintegrate body and mind.  Mindfulness – through a patient practice of meditation to become present and aware rather than being influenced by thought (thought is driven by the past and the future), helps to observe the ebb and flow of internal experience.

That is why yoga combines the physical movement with a focus on the breath too. This brings awareness to thoughts, feelings, body sensations and impulses that are important components in healing PTSD. Only by learning to control the bodily reflexes can one heal from PTSD.

How Yoga and Mindfulness Works

Yoga helps regulate emotional and physiological states. It enables the body to regain its natural movement and to modulate the breath for self-regulation.

Van der Volk states, “what is beautiful about Yoga is that it teaches us—and this is a critical point for those who feel trapped in their memory sensations—that things come to an end. While doing certain asanas, uncomfortable sensations may be evoked. But, by keeping time as they stay in a posture for a limited amount of time, they get to observe that discomfort can be tolerated until they shift into a different posture.”

Becoming integrated with our own bodies helps us to feel safer in the present and staying with whatever sensations that emerge and seeing how they come to an end is a positive imprinting process. It teaches impermanence – the notion that, this too shall pass.

For PTSD victims, yoga helps to befriend their bodies that have betrayed them by failing to guarantee safety, as trauma lives in the body. It helps one to become present to the safety of now with their family, in their homes, rather than be stuck in the dangerous past.

Hope for Sri Lankan PTSD Victims

I am excited about all this, as integrating these approaches of Yoga and Mindfulness is easier for us in Sri Lanka, as it is a part of our culture and tradition.

Western culture and education does not have any approaches to master our own physiology – mind and body. Western traditions teach to analyse and think critically to seek solutions from outside, starting with relationships, and if those fail, drugs are prescribed.

Why should we succumb to that when the neurobiology of meditation shows that the brain can grow new cells and reshape itself. It is called neuro-plasticity.

A recent Scientific American guest blog written by Tom Ireland (12 June 2014) stated that –

MRI Scans show after an eight-week course of mindfulness practice, the brain’s “fight or flight” center, the amygdale, appears to shrink. As the amygdale shrinks, the pre-frontal cortex – associated with higher order brain functions such as awareness, concentration and decision-making – becomes thicker.

Amygdala is the part of the brain that keeps us alert to danger.   Yoga and mindfulness enables to change our brainstem arousal process, our sympathetic and parasympathetic nervous systems and to quiet the brain. Meditating regularly can modulate the fear center and help us be more focused to separate and discern real and perceived threats.

Gaining this space to differentiate threats as real and not real can enable us to take personal responsibility, so we can take the steps to heal through a disciplined practice.

A Considered Approach

However, Yoga and Mindfulness is not a panacea. All this requires a holistic, well thought out approach with well qualified teachers and practitioners and most importantly to work in tandem with the allopathic medical system. According to van der Volk, “if you are traumatized, being in silence may be terrifying. Memory of trauma is stored, so when you are stilled, demons may come out. That is why in healing it is important to regulate the body and mind with breath, postures and relaxation and work toward meditation.” Hence, psychotherapy and even medication may be required as a part of the healing process.

As such, we have to approach this very carefully. The most important first step is for this holistic approach to be accepted by the allopathic medical community in Sri Lanka, who may be on one end of the spectrum on evidence based responses. Yoga and mindfulness community may be on the other end of the spectrum, with anecdotal evidence.

That is why it is imperative to follow people like van der Volk, therapist Dr. Ronald Siegel (Author of Mindfulness Solution) and other experts including leading universities in North America – UCLA, University of Toronto, University of Wisconsin, Stanford, some who are aligned with the Dalai Lama and Neuroscientist and Buddhist monk, Mathieu Ricard to do practical research to prove the benefits of mind-body practices such as yoga and meditation.

This way, Sri Lanka can take a measured and a thoughtful approach to bring about a holistic way of healing from PTSD. If we can facilitate them to become present to the here and now, they may discern and recognize the safety and security of their home and loved ones, far away from the terrors of the past. Helping them to differentiate that will be the healing they need, both physically and emotionally, to get back to a normal life.