Posted on January 22, 2010 - by David

Crazy Like Us, Part 2: PTSD in Sri Lanka

part 1

Chapter 2 – The Wave that Brought PTSD to Sri Lanka

In chapter 2 of his new book, Crazy Like Us: The Globalization of the American Psyche, Ethan Watters describes the wave of research and treatment professionals that swept in to Sri Lanka in the wake of the 2004 tsunami, hoping to both heal and study the abundance of psychologically scarred people they expected to see.  According to the varying estimates of experts quoted in news articles, anywhere from 15 to 90 percent of the population might be suffering from post traumatic stress disorder.

And did they find this many Sri Lankans suffering from what we call PTSD? The answer seems to be no, but the certainty with which Western professionals entered the supposed psychological disaster zone seems to have made it hard for them to accept what they found. Watters cites the example of a trauma counselor interviewed on BBC radio who was worried by the fact that the children in the village he was working in were more eager to get back to school than to talk about their frightening experiences. His explanation was that they were “clearly in denial.” (77)

Watters is obviously critical of this dogmatic belief that all minds in all cultures are equally susceptible to mental illness. The idea, introduced in the first chapter on anorexia and further developed here, that more traditional cultures do not suffer the way that Westerners do, deserves special attention. By providing meaning and identity through religious beliefs and closely integrated social groups, it seems that traditional cultures avoid the specifically modern forms of mental illness that many in the West assume to be universal.  In her research following the tsunami, Dr. Gaithri Fernando, a psychology professor at Cal State University and a native of Sri Lanka, found that in place of the psychological symptoms westerners would expect to see, many who lost loved ones and homes experienced physical symptoms of aches and muscle pains. Without the Western, dualist conception of mind-body split, it seems Sri Lankans felt the pain of loss in their bodies rather than their minds.

As Watters points out in the first chapter, specifically modern forms of mental illness seem to be related to the importance of individual identity and independence in Western societies. Dr. Fernando’s research suggests this difference is key to understanding the conspicuous absence of PTSD.

… Sri Lankans tended to see the negative consequences of an event like the tsunami in terms of the damage it did to social relationships. Those who continued to suffer long after a horrible experience,  her research showed, were those who had become isolated from their social network or who were not fulfilling their role in kinship groups. In short, they conceived of the damage done by the tsunami as occurring not inside their mind but outside the self, in the social environment. (91)

If social integration and strong cultural beliefs are key to protecting the individual mind from turmoil, then the lack of these would presumably lead to problems. In looking at where the PTSD diagnosis began, Watters goes back to the Vietnam War and the difficulties of many soldiers upon returning home. “Beliefs that had sustained many of their fathers in World War II were suddenly insufficient and meaningless to these soldiers,” he writes (121).  I believe this cultural insufficiency may help to explain why an estimated 300,000 American veterans of the wars in Iraq and Afghanistan are now suffering from PTSD.

In a study published this week in the Journal of Neural Engineering, researchers at the Minneapolis VA Medical Center expressed excitement upon finding that by scanning the brain using magnetoencephalography (MEG), they were able to confirm with 90% accuracy the PTSD diagnoses of 74 American vets. The article that summarizes the findings states that “the ability to objectively diagnose PTSD is the first step towards helping those afflicted with this severe anxiety disorder.” However, all the study did was confirm “objectively” that the “subjective” diagnoses of these soldiers were already fairly accurate. Brain scans do little to explain why veterans today seem to be suffering psychological battle scars at a much higher rate than ever before in U.S history. Could it be the lack of strong cultural belief in what they are doing over there? The ambiguity of the enemy? The possibility that many of these young veterans may have chosen the identity of soldier not merely because of pride and patriotism, but because other paths in life seemed closed to them? The fact that despite the horror of war, the social integration provided during active duty surpasses what they might experience at home? The lesson to be taken out of Watters chapter on PTSD seems to be that the suffering of these veterans cannot be explained by some scientific correspondence between brain malfunction and the horrific events they witnessed and experienced. Is it crazy to think that the inability of American culture to provide a solid identity for soldiers that holds up at home as well as abroad, and the contradictory messages that simultaneously value and vilify the work that they do might be partly to blame for the widespread mental devastation?

A brief article in which Watters highlights some of the main points of this chapter was written in 2007 and is available here.