Psychiatric Morbidity Due to War in Northern Sri Lanka

Abstract

The psychological sequelae to war and other types of civilian violence have not been adequately assessed despite rapid advances is recent years. Admission rates to mental hospitals and suicide rates were reported to have dropped during times of war, as in the Franco-Prussian War of 1870 (Legrand du Saulle, 1871, cited in Lyons, 1971); World War I (Emzlie, 1915; Lyons, 1971; Smith, 1916-1917, cited in Lyons, 1971); the Spanish Civil War (Miru, 1939); and World War II (Dohan, 1966; Lewis, 1942; Odegaard, 1954). However, during World War II, there was a slight increase in the relative incidence of neurotic reactions in England (Lewis, 1942), and a marked increase among males of acute psychotic reactions in Norway (Odegaard, 1954), and of schizophrenia in the United States (Dohan, 1966). With respect to civilian violence, there was no increase in admissions to mental hospitals following the racial riots in Kuala Lumpur during 1979 (Tan & Simmons, 1973) and in the civil war in Lebanon during 1975-1976 (Nasr, Racy, & Flaherty, 1983), but there was a “rebound” increase in outpatient attendance. In reviewing the studies on the effects of civil violence in Northern Ireland, (1988) concluded that “judging from hospital referrals and admission data, suicide and attempted-suicide rates, the practices of psychoactive drug prescriptions, and community based studies, the campaign of terrorist violence does not seem to have resulted in any obvious increase in psychiatric morbidity.” The usual explanation given for this apparent benign effect of war on society as opposed to soldiers is that, in times of war, culture comes together against a common foe and this united purpose and cohesiveness protects against “mental breakdown” (Curran, 1988; Lyons, 1979). Building on Durkheim’s (1951) original observation on the reduction in suicide rates during war, some have postulated that the opportunity to “externalize aggressive behavior” during civilian violence reduces the incidence of suicide and depression, which are believed to be a result of aggression turned inward (Lyons, 1972), and that despite adverse effects on a small minority of unlucky victims, there is a “state of rebound psychological wellbeing in the rest of the community” (Curran, 1988).