Easter commemorates the resurrection of Jesus Christ. It is widely celebrated in Sri Lanka mainly by the Catholic and Christian communities. Christianity is an integral part of the Sri Lankan culture with its centuries-old ties to its former colonial rulers, the Portuguese, Dutch, and the British.
The situation
Sri Lanka experienced deadly attacks on churches and high-end hotels on Easter Sunday, April 21. According to international media reports, it is believed that more than 250 people have lost their lives and about 500 are injured. Among the dead are several foreign tourists as well. The impact of these deadly blasts in eight places in the country is felt by all Sri Lankans.
First and foremost, we would like to express our sincere condolences to the families of the dead and the injured. At present, they are experiencing unbearable grief, and hopefully, they would be supported by religious and social organisations in our society. Apart from the families who are directly affected, all Sri Lankans would be feeling a sense of loss, disbelief, and insecurity.
Sri Lanka, being a geographically-small nation with secure cultural connections between communities, has experienced disbelief and shock in all its regions and communities. Sri Lanka has been traumatised once more after a relatively peaceful decade following the end of the armed conflict that lasted nearly 30 years. Many of us thought that violence of this nature was behind us. Us having to experience such trauma once again could lead to significant frustration and anger as well.
Potential impact
Mass trauma events; such as wars, political violence, bomb blasts, mass shootings, and natural disasters; raise important psychological, human rights, and sociopolitical issues. Firstly, many mental health studies in the past have reported a significant increase in psychological morbidity after the occurrence of mass trauma. Increased prevalence of major depressive disorder, post-traumatic stress disorder, as well as anxiety disorders, have been reported following mass-casualty incidents.
Sri Lanka has experienced several large-scale man-made and natural disasters in the recent past. The 2004 Tsunami, which destroyed the Southern and Eastern Sri Lankan coast, left thousands of people dead, millions displaced, and the country mourning for over a decade. Various psychological problems were reported in those affected in the aftermath of this massive disaster. The studies in Sri Lanka detected a higher prevalence of depression, anxiety, and post-traumatic stress in the affected regions of the country.
People who experience violence, or witness it happening to their loved ones, would potentially experience significant psychological trauma. Also, almost all Sri Lankans are exposed to this unexpected and devastating news through electronic media and rumours. Studies show that persons who are indirectly exposed to mass trauma could develop anger and intrusive thoughts as well, leading to the development of post-traumatic symptoms. Apart from adults, children are highly likely to develop post-traumatic symptoms after witnessing violent blasts. This has been found after psychological studies conducted after bombings in other countries.
Psychological first-aid
Psychological first-aid is considered as a humane, supportive response, in a time of crisis, to a fellow human being who is suffering and requires support. Psychological first-aid is not ‘debriefing’, which is considered harmful.
This help includes providing effective care and support, including safety. This should not intrude on the survivors’ privacy and autonomy. Furthermore, assessing needs and concerns—as well as listening to the traumatised individuals and communities but not pressuring them to divulge sensitive information—are components of psychological first-aid. It is also essential to comfort people and help them feel calm, as well as to protect them from further harm during the recovery phase.
Our people have lived through many disasters during the past few decades. Therefore, as a nation, we have adapted to specific ways of coping after a traumatic event. Psychological first-aid does not mean implementing en bloc Western psychotherapeutic interventions to heal the minds of the affected Sri Lankans.
In contrast, support in Sri Lanka involves the facilitation of culturally-sensitive mourning in the context of social and spiritual rituals in a more organised manner. Nevertheless, appropriate professional help should be obtained for any person requiring more than mere psychological support and those who may benefit from structured psychiatric care.
The importance of mental health in the overall well-being of individuals is being increasingly recognised around the world. Among all age categories, adolescents and youth appear to have the highest prevalence of psychological problems. However, children, adolescents, and youths are the age groups with the least access to mental health services, probably due to a lack of specialised services catering to the developmental and cultural needs of this group.
Children of Sri Lanka
As Sri Lankans, we have experienced mass violence on many occasions during the past few decades. Parents today, were exposed to the cruelty of the war as children in real life and through media. However, today’s children in Sri Lanka may never have experienced such atrocities due to the relatively stable and peaceful past decade. Therefore, many Sri Lankan children watching images and videos of blasts could be significantly affected by them.
Your child could either be exposed to the violence that happened in the country directly, or they may be exposed to it via media, conversations with friends, or family members. In today’s world, it is highly likely that a child would be exposed to violent events. Furthermore, research has shown that children could be significantly traumatised even when they are exposed to violence indirectly. Studies have shown that they may develop anger and intrusive thoughts related to the events. Hopefully, many children could be supported by understanding parents and caring teachers.
How to support children?
Children have different temperament styles. Some children may be easily affected by these violent events while others may not. Psychological support should be appropriate to the age and the cognitive developmental stage of the child. A general guide is shown below, however, it needs to be catered to the understanding and temperament of your child.
Toddlers and preschoolers (aged 2 to 6)
Try your best not to expose these young children to news of these events. It may be better to discuss these violent events after they have gone to sleep. If they are not aware of these, you may not have to introduce new information to them. If they are aware and inquisitive, you need to tell them that they are safe; that the family is safe and you would do your best to protect them. Observe their sleeping patterns; a change may indicate possible anxiety. Encourage them to engage in their usual play activities.
Primary and middle-schoolers (aged 7 to 12)
Parents need to be vigilant whether their child has the aforementioned symptoms of psychological trauma. Please check their understanding of the violent events prior to explaining to them. You would have to decide and choose wisely the information you provide them. You would have to exclude many gruesome details and listen carefully to them.
If you listen, they may have a lot to say. Please be honest when you give them information as you don’t want to lose their trust in you. Clearly tell them that the culprits are never heroes and discuss potential sensationalism. However, be careful not to encourage stereotypes. Spending time with them and listening to their concerns is very important.
Adolescents (above 12 years)
They may already know a lot, however, their sources of information may be unreliable (social media, as well as rumours from peers and certain websites). Listen to what they know and explain kindly. Help them understand that there is a deeper socio-cultural meaning to these events. Support older adolescents to look beyond what is shown on the news.
Do not encourage pessimism and negativity about the country. For example, do not say things such as “this country will never be safe”. Instill hope for a stable country and a safer society instead. Depending on the security status of the country allows them to return to their usual routines quickly. A new onset of irritability could be a sign of underlying psychological distress in adolescents.
Where to get help from?
On most occasions, parents and teachers would be able to provide the necessary psychological support and safety for their children. However, you might have to consider professional help, if your child is demonstrating significant symptoms of psychological trauma as depicted above. Your closest teaching hospital, general hospital or base hospital would have a child and adolescent guidance clinic or a psychiatric clinic. You could obtain support and guidance from these units.
The writer works as a child and adolescent psychiatrist attached to the Colombo North Teaching Hospital in Ragama. A significant proportion of the community living close to the hospital has been affected by these tragic events. Experts in children’s mental health have been receiving many requests for psychological support around the country. This article was prepared for the benefit of Sri Lankan children. Hopefully, it may provide some guidance to parents and teachers, to support their children in order to prevent potential acute and long-term psychological consequences of these tragic events.
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