Photo courtesy of Rival Times
It is tragic fact that Sri Lanka is a mentally ill nation. Despite its stunning physical beauty, delicious food and rich history, the country has unaddressed trauma leading to violence, aggression, child abuse, sexual violence, domestic violence, suicide and substance abuse. From ethnic violence beginning in the 1950s to the two JVP uprisings, the tsunami and the 26 year war, people of this country have witnessed unimaginable acts of brutality and horror. Mothers have seen their babies massacred before their eyes, soldiers have tortured and killed their fellow citizens, civilians have borne the brunt of bombs and shells and thousands are still searching for their missing.
Every day the media recount new acts of cruelty and viciousness from grandfathers raping their granddaughters to women stabbed by their lovers, vindictive retaliation over land issues and religious men raping the children they are meant to protect and nurture.
Most government hospitals around the country have clinics where people can go to get treatment for their mental problems. But busy doctors have no time to counsel patients and instead give them calming drugs, leaving the root causes unaddressed. The lingering stigma attached to seeking help means people are reluctant to be seen consulting psychiatrists. Parents pass on the trauma to their children; Sri Lanka is slowly choking on its own poison.
Consultant psychiatrist Dr. Mahesan Ganesan recently retired after ten years at the National Institute for Mental Health. For nine years he worked in Batticaloa. Dr. Ganesan spoke to Groundviews on why Sri Lanka is a sick nation and what should be done about it.
What are the main reasons for psychiatric disorders in Sri Lanka?
The concept of mental health is not understood by the public or by politicians. It is not given the importance that it should be given. Suppressed trauma in society leads to domestic violence, child abuse, suicide and alcohol and drug abuse. All these issues are indicative of the fact that Sri Lanka is not in a good place. Someone in good mental health are not abusive and don’t use substances; they can manage their emotions without resorting to violence. We have a serious mental health crisis overall. It is a country where women are scared to walk on the streets after 7 pm. There are many reasons for mental illness – it could be genetic, produced by environment or bad parenting. In our society, for example, girls are taught to be subservient and boys are made to feel a sense of entitlement. An unhealthy emotional environment in childhood, including schooling, increases the chances of developing disorders. Children have to be taught to take responsibility for their actions and to have a sense of self-worth. What sort of role models, as a society, do we give children? There are no positive role models to aspire to. When they become adults, they feel they are undervalued, not rich enough or under educated.
What are the consequences of unresolved trauma for an individual and for a nation?
Unresolved trauma leads to increased violence levels. In the South there many military personnel who have deserted; they are involved in criminal activities as a result of unresolved trauma. They have no access to mental health services. Trauma shows up in increased domestic violence, substance abuse and many other issues. There are generational effects with abusive parents raising children who become abusive adults. When this has already happened, it is difficult for psychiatrists to intervene. Child abuse is a very serious problems in our society but religious leaders are blocking access to instructing children how to protect themselves by learning the difference between safe touch and bad touch, leave alone sex education. These are simple things that are needed to teach children how to live safely and happily. But some people think it’s against our culture. Before colonialisation we had a relaxed and open culture; Victorian era morals and values were forced on us and now we are stuck with them while other countries have moved on. Education and the law and order situation are the two most important factors for good mental health. We use culture as an excuse not to change the education system, which only teaches memorising and good handwriting without showing children about being responsible citizens and helping others. It is society’s responsibility to make sure laws are implemented and offenders end up behind bars.
What is the situation of mental health services?
Sri Lanka has the best mental health services in South Asia with outreach clinics in all general hospitals. But we can do more to provide better services. Part of the problem is the stigma attached to mental health, which means people are reluctant to access the available services. This is not just the psychiatrist’s or the government’s role; society as a whole has to take responsibility for doing more. If someone has a disorder, we should help them.
What problems did you face in giving mental health support to people in the East?
Batticaloa was affected by the war and the tsunami. The war caused a lot of trauma because people experienced suffering, displacement, death, injuries, child recruitment and seeing people tortured and bombed. The unaddressed trauma has translated into violent behaviour, heavy alcohol consumption and domestic violence. War trauma is not limited to the East. Many soldiers from other parts of the country have been traumatised and return home. We are not good at dealing with war trauma. In Batticaloa, there are two psychiatrist and a few counsellors for 550,000 people. Doctors cannot cope; there has to be a new system where counsellors go and visit people to ascertain their problems. Children sex abuse has very little psycho-social support. Who is monitoring the child and ensuring that the impact is minimised? In Mankulam the first trauma centre has been built with Dutch help but there is no staff to work there so it cannot open.
What more needs to be done to improve the country’s mental health situation?
The problem is that the political will missing. The Ministry of Health doesn’t prioritise mental health. If there were good programme with adequate backing from the government, international agencies would be willing to help. But when there is no interest, they will not come.