The Easter Bombings that left 253 people dead and at least 500 others injured, is making psychological ripple effects, with sporadic incidents of violence reported from areas such as Negombo, Chilaw, Kuliyapitiya, Bingiriya and Dummalasuriya, intermittent banning of social media and a call to boycotting Muslim business establishments. Counterpoint spoke to an expert on the psychological impact of a tragedy of national scale.
And who is better to talk about armed conflict and its psychological repercussions than a person who has been in the thick of it? He was abducted and tortured for subscribing to JVP views, in 1988, and subsequently released.
Prof. Athula Sumathipala was trained in Sri Lanka as a family physician. He migrated to the UK, in 1992 and re-trained as a psychiatrist at the Maudesley and Bethlem Royal Hospitals, considered one of the centres of excellence in the field. He then obtained the MRCPsych and completed the specialist training as a Liaison psychiatrist. He followed an academic career and obtained a PhD from University of London.
Sumathipala is a Professor of Psychiatry, Research Institute for Primary Care and Health Sciences, Keele University, Emeritus Professor in Global Mental Health, King’s College, London and Honorary Consultant at the Midland Partnership of the National Health Service (NHS) Foundation Trust. He is also the Honorary Director of the Institute for Research and Development.
Q: What are the psychological effects of calamities such as the Easter bombings on survivors?
A: The psychological repercussions will not only be on the directly affected survivors but also on anybody indirectly affected through hearing or seeing such events on television or even being front-line service providers. However, the dose response will definitely vary between the directly affected and the indirectly affected.
The consequences may also be different if they have faced a serious traumatic event before (like being a survivor of a previous blast or tsunami) or already have a mental illness.
The immediate psychological consequences are a normal reaction to an abnormal event.
In the immediate few hours most will be numbed, not being able to comprehend what has happened at an unexpected time, horror, terror, panic, anger, etc. It will take a few hours or days to sink in and they will go through a range of emotions, mainly grief arising from death. They will weep, cry, may even want to know why only they survived, feel guilty, angry, frightened, reliving the experience. ALL these are very normal and not signs of weakness or illness. Certainly, any of those are not symptoms of mental illness. It is extremely important not to medicalise this distress. None of them need compulsory counselling.
Q: What is psychological first aid and how is it administered?
A: ‘Psychological first aid’ was first introduced conceptually in the mid-Twentieth Century; in the post-9/11 era, psychological first aid has emerged as a mainstay for early psychological intervention with survivors of disasters and extreme events. Providing psychological first aid (PFA) is generally considered to be an important element in preliminary care of disaster victims.
Five practice guidelines were included which were found to vary in the development process and evidence base used. None of them provides solid evidence concerning the effectiveness of PFA practices. Additionally, two systematic reviews (a scientific method of synthesising existing research/knowledge) of PFA were found, both a lack of studies on PFA was noted. A complementary search for individual studies, using a more sensitive search strategy, identified 11,237 references, of which 102 were included for further full-text examination; none of which ultimately provides solid evidence concerning the effectiveness of PFA practices. The scientific literature on psychological first aid available to date does not provide any evidence about the effectiveness of PFA interventions.
Currently, it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims. Thus, the best available ‘evidence’ is currently restricted to peer-reviewed consensus statements and guidelines.
In the first few moments and hours after a disaster, survivors may have medical, material, social, and emotional needs. After the traditional steps to guarantee physical safety, it became common practice to also offer immediate psychosocial support.
A contemporary definition of psychosocial support is given by the International Federation Reference Centre for Psychosocial Support of the Red Cross and Red Crescent Societies (2011) as “a process of facilitating resilience within individuals, families and communities.”
PFA is not a new intervention. Rather, it is better conceptualized as documenting and operationalizing good common sense – those activities that sensible, caring human beings would do for each other anyway. It is underpinned by five ‘essential elements’ generated from the available research literature by a consensus conference of disaster mental health experts convened in 2004 and later summarized in a landmark publication by Hobfoll and 19 co-authors.
The reviewers were unable to find any randomized trials, nor any non-randomized or even large descriptive studies.
These five elements are: safety, calming, connectedness, self-efficacy, and hope.
Q: Who needs psychological first aid and who can offer it? Where can it be offered?
A: Everyone needs it. In simple terms, PFA includes the provision of information, comfort, emotional care, and instrumental support to those exposed to an extreme event, with assistance provided in a step-wise fashion tailored to the person’s needs. It should be administered by a multiplicity of lay providers, ranging from professional disaster responders (emergency services personnel, medical emergency teams) through to teachers, clergy, and PFA trained disaster volunteers.
Q: Psychologically speaking, what factors drive people to resort to terrorism?
A: Terrorism is one of the most complex social problems of our time and it is difficult to talk about terrorism without defining it, and is too often an issue that is so divisive.
It is also challenging to even discuss it and also talk about psychological basis of terrorism exclusively based on a psychological approach as terrorism has a clear link to a myriad of social, political, religious, and other factors that cause terrorism
Ironically despite the extraordinary social and political consequences often associated with terrorist violence, as well as our responses to it, psychological research on terrorist behaviour is conspicuously underdeveloped. Limited research showcases new conceptual, theoretical, and empirical advances in our understanding of terrorism.
Defining terrorism is difficult as there are hundreds of definitions, but none dominate. Terrorism is a special kind of strategy that uses public violence intended to effect social or political change (wrongfully), but for an act to be reliably categorized as terrorism or terroristic in nature, it must feature the proximate victimization of non-combatants (e.g., civilians) to influence far-more-distant actors (e.g., governments) and agendas.
The general consensus is that psychology cannot currently explain why some people become involved in terrorism when most do not. Reviews of the existing scientific literature would suggest this is not likely to change any time soon. Whether it is realistic to expect satisfactory answers to such a complex question, our collective failure (which extend beyond psychology) to provide a good answer to this question has led some to conclude that the study of terrorism more broadly has become stagnant.
Q: What’s the psychology of a suicide bomber like?
A: This is also a difficult one to answer as their psychology has not been accessed especially as they complete their mission.
However, an article in CONVERSASION; what science can reveal about the psychological profiles of terrorists, May 27, 2017 (https://theconversation.com/what-science-can-reveal-about-the-psychological-profiles-of-terrorists-7830) provide a reasonable narrative about it.
According to the article ‘ We often dismiss terrorists as non-humans, monsters, at first. But when we learn that they were seemingly normal individuals with families and jobs, it’s hard not to wonder how their minds really work’.
A new study published in Nature Human Behaviour, which assessed the cognitive and psychological profiles of 66 Colombian paramilitaries imprisoned for committing terrorist acts, now argues that poor moral reasoning is what defines terrorists.
‘The idea behind such research is obvious – it’s to identify stable, predictive traits or ‘markers’ of terrorist personalities. If we could do that, we may be able to predict who will become a terrorist – and perhaps prevent it. But this type of research is viewed by many psychologists, with extreme caution. Researchers carrying out such studies typically use a myriad of psychometric measures, personality and IQ tests in various contexts. But there’s no consensus on how useful these tests are’.
According to the article ‘the researchers found terrorists had higher levels of aggression and lower levels of emotion recognition than non-criminals. However, no differences were found between the groups for IQ or executive functioning. The biggest difference between the terrorists and the other group was seen in moral cognition – they found that terrorists are guided by an abnormal over-reliance on outcomes. The authors argue that this distorted moral reasoning – that the ends justify the means – is the ‘hallmark’ of a terrorist mindset. They assessed moral judgement by asking participants to rate various stories according to levels of unjustified aggression’.
Accordingly, ‘Many psychologists believe that the events which occur in the years before a terrorist attack, referred to as radicalisation, offer most in terms of trying to answer why a person might turn to political violence. However, the psychology of terrorism is not well advanced. There is little empirical evidence to support existing conceptual models – and they are often limited to particular extremist groups and ideologies. More and more psychologists are now beginning to believe that a number of key psychological components are fundamental to the radicalisation process. These include motivation, group ideologies and social processes that encourage progressive distancing from former friends.
Q: Would you say that terrorism arise out of fear of cultural annihilation and particularly in the case of Islamic fundamentalism, a fear of fundamentalist way of life being under attack?
A: According to the same article it is clear that a number of complicated factors are directly and indirectly related to radicalisation. Personality and cognitive performance may change over time and therefore seem irrelevant for prediction purposes. But it is important to note that many in society are vulnerable to being manipulated and managed by terrorist groups to perform terrorist acts because of a cognitive impairment, disability or mental illness.
Q: Having been the medical advisor to JVP founder, Rohana Wijeweera, you may be able to analyse the psychology of armed conflict. What causes a group of people to take up arms?
A: Well, I do have some background professionally and also due to my past political experience.
The reasons the JVP took up arms are very different to why the LTTE did and now these Muslim extremists groups are doing. I am not saying any of those are correct but we can only compare like with like.
The 1971 uprising by the JVP in my opinion was inspired by Cuban revolution and Vietnam patriotic struggle. We should know that armed struggle had legitimacy in that era for independence from Colonial ruling. One such example in Sri Lanka was 1817–18, also known as the 1818 Uva–Wellassa uprising, or simply the Uva rebellion.
As Wijeweera said, they were not terrorists but people fighting against a government or invading force; they were rebels or revolutionaries.
In 1971, neither side was involved in brutality. Thousands were given the opportunity to be rehabilitated. After the emergency was lifted in 1977, the JVP was wedded to democratic means of coming to power. In fact, they contested the District Development Council even though the SLFP boycotted it.
However, the then government resorted to repression, state violence against all the Opposition political parties, taking away the civic rights of Sirimavo Bandaranaike, imprisoning of Vijaya Kumaratunga and postponing the parliamentary elections via a notorious referendum, which then was extended to ruthless violence in Jaffna and 1983 riots finally proscribing several parities including the JVP. In my opinion, this injustice compelled the JVP/Patriotic National Front to take up arms.
On this occasion, both JVP/Patriotic National Front and the government exhibited much more brutality than in 1971 but did not resort to indiscriminate bombing of innocent civilians unlike the LTTE.
The psychology behind that violence was fighting against undemocratic forces for their rights and also against Indian invasion of Sri Lanka. It was a local insurrection without any support from outside.
The LTTE psychology was fighting for a so-called homeland. In this, beyond any doubt the outside forces were very active and the combatants’ psychology was manipulated to achieve ulterior ends.
As regards the current wave of violence, I have no clue what they are demanding, but certainly the ruthless terrorist psychology is beyond any doubt whatsoever is manipulated to achieve ulterior ends. Extremists are hiding behind Islam but certainly manipulated by imperialist reactionary forces who want to destabilise counties for political gains.
Q: Would you say that terrorism is resorted to by those who are politically disadvantaged to gain political leverage?
A: There could be a range reasons for armed struggles ranging from pure political motive to terrorism. In my opinion, the historical progressive role an armed struggle played as a freedom fight had for emancipation is no more. The armed struggle amounting to terrorism now serves the interests of the reactionary forces dividing nations, countries on every possible front be it language or religion, ironically even within the same faith (Shia and Sunni)
Q: Do you think that violence is an effective measure to achieve a political end?
A: No, not at all! But ironically the big powers foster it to achieve their own ends.
Q: How should a government react to terrorism, without helping violent outfits garner more support from the minority group they claim to represent?
A: National security should never be compromised whatever the pressures from outside.
No indirect benefits should be left open through negative rewards offered through positive discrimination to ethnic minority groups.
All those responsible directly or indirectly should be brought to justice irrespective of their positions.
These unfortunate events should be used as a window of opportunity to unite the nation.
The community rights should be respected over individual rights concepts that are opportunistically used to divide nations.
There should be a strong programme initiated by the youth of different faiths to achieve national harmony.
Q: What are the psychological effects of action against Muslims in the form of boycotting Muslim business establishments?
A: The psychological effects of the current wave of discrimination against Muslims in the form of boycotting their businesses are going to be very negative and counterproductive. I do understand why it is happening and cautious about the word ‘discrimination’. This word is abused. I would say that it is a counterproductive and destructive path that will widen the rift and alienate the Muslim majority. In my opinion, while the Muslims are discriminated against negatively, Muslim political leaders are benefited through positive discrimination which has a very bad impact on other communities (both Sinhala and Tamil).
Yes, people may be angry about the Muslim extremists and that anger should and could be directed against those elements and also against some of the opportunistic Muslim politicians as well as Sinhalese politicians. This type of behaviour will portray Muslims in a ‘victims’ role whereas the real assault was on innocent Christins/Catholics.
Q: There is a widening rift between minorities in Sri Lanka. What psychological conditioning can be adopted to bridge this gap?
A: It’s a very challenging one but the most important thing is national security for everyone to feel safe. While negative discrimination is defeated through all means, positive discrimination should also stop.
There should also be a long-term plan from Grade One to stop segregation of children within the education system, teaching them the significance of national harmony. Easier said than done, but it is a must. History should not be allowed to repeat itself and we do not need another 1983.
Q: Egypt’s largest radical Islamic group, Al-Gama’a al-Islamiyya, renounced bloodshed in 2003, as a result of a deal brokered by a Muslim attorney between the group and the Egyptian government, and a programme where Muslim scholars debated with imprisoned group leaders about the true meaning of Islam. As a result, the leaders wrote 25 volumes arguing for nonviolence, and the group has perpetrated no acts of terrorism since, Kruglanski says. A second major Egyptian group, Al Jihad, renounced violence in 2007, based on a similar programme. There have been five other such initiatives in Northern Ireland, Yemen, Saudi Arabia, Indonesia and Colombia. Will this not work locally?
A: Most definitely it will. It’s like Alcoholic Anonymous (AA). Someone who was dependent on alcohol and drugs knows much better than anyone else the destructive effects of alcohol and such people have a very strong role to play in a therapeutic or preventive role. There is a strong body of research evidence that it can be done. There is also something called group therapy in such situations where the dependent people are treated in a group setting to rehabilitate them.
Some of those terrorists, like alcohol and drug dependants, are victims and they can be won over.
Q: Is Cognitive Behavioural Therapy an effective reconciliation tool, and if so, how?
A: Cognitive Behavioural Therapy (CBT) principles can certainly be used. The central position of the CBT theory is that the way people think determines how they feel and act. For an example, if someone is told that somebody else is going to kill him the resulting thoughts are about safety what to do to save life, etc. These generate fearful emotions but also may generate thoughts of fighting back. So the resulting behaviour is to fight back or run away or surrender. As these are a triad, by manipulating one you can manipulate the other.
CBT plays a pivotal role not only in mental illness but even in physical illnesses like cancer. There is a significant body of research evidence on its effectiveness.
It has been used with people who have violent behaviours including criminals and also Islamic militants.
Q: What’s the relationship between CBT and Buddhism?
A: Even the founder of CBT Aron Beck has acknowledged the link between CBT, and Buddhism.
There is a classic Jathaka story about the grief-stricken Kisa Gothami. When Kisa Gothami’s new-born son died, she did not realize he was dead, so she ran to the Buddha, asking him to cure her son. The Buddha at once knew that the baby was dead but wanted Kisa Gothami to learn about death herself. He asked her to find a handful of mustard seeds from a household where no one had died. She went knocking on all the doors in the village but could not find a single house in which a death had not occurred. Soon she realised the lesson Buddha was trying to teach her; no family is spared the occurrence of death. This is in CBT terms cognitive restructuring. The Buddha has also used analogies to explain death: Life is like a dewdrop on a blade of grass seen in the morning.
