POSTED AT 05:43 PM 14-03-2017
Sri Lankans' unhealthy tough guy act
FrontPage looks into the narratives and interpretations of grief, trauma, and the coping mechanisms Sri Lankans use to deal with them.
Image courtesy : JustGiving
Traumatic incidents are not uncommon to anyone; yet, the manner in which it is dealt with varies from one individual to another. Many attribute this to each individual’s mental stability, susceptibility to cognitive disorders, and biological make up. Although this certainly has a bearing, studies indicate that the prevalence of disorders such as Depression and Posttraumatic Stress are actually more culturally bound than others.
The total number of people living with depression in the world is 322 million, of which, nearly half of these people live in the South-East Asia Region and Western Pacific Region, quotes World Health Organisation. This is perhaps an indication that South Asian countries present greater susceptibility to grief and depression than most other regions, and Sri Lankan statistics contribute a substantial amount to this.
The case of the strangely resistant Sri Lankan
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During the aftermath of 2004’s devastating Tsunami, a team of America-based psychologists came to Sri Lanka in an attempt to help Sri Lankans cope with PTSD (Post-traumatic Stress Disorder). What started as a charitable endeavour, ultimately became a published study into cultural perspectives on grief and coping mechanisms. Whereas in Western countries, people use therapy to talk their way out of traumatic experiences or incidents that brought them grief, the study revealed that Sri Lankans seemed to cope with it by suppressing their emotions and choosing not to talk about it. This cultural clash of coping mechanisms created an emotional barrier that the American psychologists couldn’t seem to fathom, much less, penetrate.
In treating mental illnesses such as depression and post-traumatic stress, even the terminology differs greatly in its association. Sri Lankans who were primary witnesses to the civil war associated grief with phrases such as “feelings of guilt”, “disgust in life”, and “attempted suicide”, and did not respond to phrases that indicated a ‘broken heart’ or a ‘broken mind', which are common terminology in western societies. Such findings are crucial in providing mental health care to victims of post-traumatic stress, whilst also giving unique insight into how a nation of individuals collectively respond to indicators of grief.
At the onset, this could be perceived as Sri Lankans’ ability to move past traumatic incidents and essentially ‘pick up the pieces’. Yet, national statistics imply a significant departure from this hypothesis. Sri Lanka was known to have one of the highest suicide rates among youth males in the world, and recent reports indicate that roughly 14 in every 100,000 persons commit suicide. Statistics of this nature present glaring lacunae in not only Sri Lanka’s mental health policy, but our perceptions of mental illness in general.
An individual’s culture markedly contributes to the manner in which they present their symptoms, and the manner in which they seek care, or if they opt to seek care at all. This is not applicable to only Sri Lanka: numerous studies have suggested that this cultural trend has been noted in citizens from many South Asian countries. Experts suggest that South Asian patients would give greater prominence to physical symptoms, instead of attributing it to the possibility of it being a psychosomatic symptom ( a projection of a mental illness as a physical ailment). The same trajectory of thinking is unfortunately shared by health-care providers of the South Asian region as well (with the exception of mental-health care providers). Patients with both mental and psychosomatic disorders (also known as comorbidity) have faced many issues with regards to receiving treatment, as caregivers pay more attention to treating the physical illness without addressing the mental illness.
Image courtesy: Sri Lanka for 91 Days
Further enforcing the correlation between culture and depression, it was also found that prevalence for mental illnesses such as Schizophrenia and Bipolar Disorder were standard around the globe and were found to be more hereditary (passed down from generations within the family); however, depression was found to be less hereditary and its prevalence varying from country to county.
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A trial conducted by western psychologists also suggested an interesting angle to analysing the cultural underlyings of grief. This study analysed how children from Thailand and America responded to grief, and the results indicated that due to Thailand being a majority Buddhist nation, the children of that country were more introverted with the expression of grief, which compliments Buddhist teachings of self-restraint and self-control. This theory could be further expanded to include primary Buddhist principles of impermeability, and taking Sri Lanka’s majority Buddhist status, could be transcribed to the Sri Lankan context as well.
This theory could potentially explain why majority of Sri Lankans show such resistance to discussing grief. Yet, it would be a misappropriation to state that Buddhist philosophy encourages the tendency to bottle up grief and trauma in the manner Sri Lankans are accustomed to. Whilst Buddhism promotes the ideology that everything is impermanent, it cannot be associated with any form of suppressing emotion. Furthermore, it does not explain how non-buddhists also experience the same symptoms and face grief in the same manner. Many post-war regions of Sri Lanka are in fact areas with less concentration of Buddhists, but with arguably high numbers of PTSD.
Inevitably, the cultural predispositions of coping with grief are rooted in the stigma associated with mental illness in Sri Lanka. Taking the country’s heavy cultural associations, mental illness was (and sometimes is still) largely perceived to be spiritually charged. Although the instances have decreased, a family member displaying signs of Schizophrenia would sooner be rushed to the nearest witch doctor for fear of demonic possession, than a health-care professional. The stigma surrounding the topic is now more commonly rooted in family values and a family’s status in society, where mental illness is considered to be a ‘black mark’ on family status. With such predispositions, it is certainly unsurprising that many opt to suppress their grief or trauma at all. Urbanised cities such as Colombo are also no exception, with studies indicating the socio-demographic associations of depression in Colombo are very similar to that of western countries. This means, Colombo-folk display signs of depression in the same trajectory as high-income earning societies; a cause arguably warranting concern, especially considering how little attention is given to this topic at policymaking levels.
Ultimately, social stigma is the greatest deterrent for people who wish to come forward to discuss their symptoms and receive treatment. What is needed then, is for Sri Lankans to view depression less as a mental ‘disorder’, and more as an issue that needs to be addressed in order to live a healthy life, as any other physical illness would be addressed. If not, Sri Lanka would potentially be looking at a killer far more dangerous than ever predicted.