Working with Violence and Trauma in the Tamil community

1
Working with Violence and Trauma in the Tamil
community

• Pushpa Kanagaratnam, PhD.,
• C. Psych. (supervised practice)

2
Themes of focus

• Intimate partner violence (IPV)
• Political violence (PV)

3
Sri Lanka
4
paradise in blood.
5
collective suffering
6
mass exodus
7
Tamil Diaspora

• vast migration following 1983 riots in July
• Toronto has the largest Tamil Diaspora outside
  Southern Asia
• 300,000 Tamils in Canada
• fewer than 10 as independent immigrants
• majority come from rural and war-torn areas
• language is Tamil (accent differs from Tamils
  from other parts of South Asia)

8
Tamil Diaspora contd

• almost one third speak only fair or poor English
• relatively young, well-educated community
• most families are nuclear in structure close
  ties with extended family
• deeply religious community predominantly Hindu
• share norms and values regardless of religion
• belongingness to Ur(village), than Sri Lanka

9
stressors

• unemployed and under-employed
• huge debts and financial obligations
• experiences from back home war, displacement,
  lack of schooling
• gender role expectations
• slowness in re-establishing family ties
• survivor guilt

10
strengths

• ambitious hardworking
• resilient
• family unit as a support system
• religious
• sense of community

11
colonized... now displaced...

• This exile or displacement or whatever it
  is...the way we have been forced to come and
  depend on people (whites) who were actually
  ruling us and oppressing us.. From my point of
  view, this cannot be handled well in the mental
  health field and can never be captured within
  this mental health framework. Because, even we
  who have gone through this, we ourselves, have
  not been able to digest all this. The speed
  around us is such. We do not have the time to
  think and reflect on this. So our experiences
  (for them) to understand this through a different
  tool which is not even developed within us,
  becomes difficult. (key informant, study
  cultural meanings of war trauma)

12
barriers to help seeking for IPV

• definitions and perceptions differ
• norms/values in own community
• help seeking is in itself seen as negative
  least influenced by individual factors

13
IPV different perceptions

• MAINSTREAM COMMUNITY
• legal moral
• minimizing abuse family matter
• separation good for children not good for
  children
• safety important respect important
• move on life is over
• individual determinants community determinants

14
as a woman

• role adherence is a more respectable route to
  fame and admiration than speaking ones mind or
  breaking the mold.

15
quote from IPV study
(Mason, Hyman, Guruge, Berman,
Kanagaratnam Manuel , 2006)

• The saying is, whatever happens is because of
  a woman and whatever perishes is also because of
  a woman. In a family, a woman is important.
  She, if she wants she can lead the family into a
  good life. No matter how much the man hits and
  yells, she needs to be a bit patient and look
  after everything. But if it becomes severely out
  of control, then you leave.

16
quote from IPV study
(Mason, Hyman,
Guruge, Berman, Kanagaratnam Manuel , 2006)

• ostracizing of separated women
• when I asked help from our people because my
  child was sick, they wouldnt help because now
  I am living alone. I cannot drive a car, but even
  in an emergency situation they do not help.
  Because they feel it is a shame or disgrace to
  help us or talk to us.

17
excerpt from IPV study
(Mason, Hyman,
Guruge, Berman, Kanagaratnam Manuel , 2006)

• second generation youth
• Participant 2 I think this (tolerance of abuse)
  will depend on our age. May be in our age we
  will not tolerate. I mean there is a limit to
  what we will tolerate. But, like with our
  parents, or people of that age, they tolerate A
  LOT more.
• Participant 5 I think once you have kids you
  tend to tolerate.
• Participant 4 I mean its easy for me to talk
  like this because I am single. But come back
  to me when I am forty and I am... I dont
  know.

18
quote from IPV study
(Mason, Hyman,
Guruge, Berman, Kanagaratnam Manuel , 2006)

• intergenerational stigma
• When I was receiving many proposals (for
  marriage).... My mom had trouble. They will
  start asking her background. Her family
  background was good but the minute they hear that
  she is a divorcee they are likethey backed out.
  my mother felt really bad, that I am suffering
  because of her. Even myself and my brother
  sometimes I mean he is married now toobut we
  were always like.I was telling my husband that
  if my brother has a problem with his wifeand if
  he ever wants to leave her and carry on with his
  life...if he is unhappy with his married lifehe
  will hesitate to make that decision because it
  will reflect on my mother.

19
quote from IPV study
(Mason, Hyman,
Guruge, Berman, Kanagaratnam Manuel , 2006)

• culture freeze
• I was interpreting for a woman in the shelter.
  The woman wanted to go back, but the shelter
  staff was advising her not to because the
  violence will then again escalate. So I told them
  that due to the children she is willing to go
  back. So we have to be concerned about our
  culture. Otherwise, we have to follow the Western
  culture.

20
IPV assessment/intervention challenges

• assessment
• What is IPV?
• Are you currently in a relationship?
• diagnosis
• Axis I or II?
• intervention
• active vs. passive coping
• safety planning

21
Political Violence
22

• Without setting disease in a context of
  meaning, there is no basis for behavioral
  options, no guide for help-seeking behavior and
  the application of specific therapy.
• - Arthur
  Kleinman

23
expressions of distress resulting from PV
Kanagaratnam Rummens cultural meanings of war
trauma in the Tamil Diaspora

• people becoming more materialistic
• obligations and hurt feelings
• unable to attend funerals/perform rituals
• you know, each community has its own way of
  dealing with distress...we go to temple, go to
  weddings.. sit and talk and the way we through
  crying spells talk through our grief in
  funerals.. We are trying to get over things.
  There is a beauty in these ways. But these are
  all changing. Now, we have to get to a funeral
  back home.. Your mother is dead you go to the
  airport.. You have to smile at the air hostess.
  Only when you approach home (may be after 2 days)
  would you be allowed to show your emotions.

24
I was carrying books. Another one was bringing
his goats. If you see what everyone carries,
everyone has their own story ..
25
relevance /significance of PTS symptoms
Kanagaratnam Rummens cultural meanings of war
trauma in the Tamil Diaspora

• nightmares have different significance
• ... (here) we learn that nightmares are
  related to mental health problems. So if we talk
  about them you might think that all of us are
  mentally affected. In Sri Lanka, you do not take
  these things so seriously. But if you talk about
  having nightmares here, people will think that
  you are depressed or you have a problem and
  that you should see a psychiatrist (female 21)
• emotional numbing recognized collective
  acceptance
• it is as if we are alive.. but dead..
  people.. this life.. why are we born? born as
  Tamils so much sorrow. No happiness. We are
  alive. We are eating. Thats all. Almost all
  Tamils here are alive, but dead (male 65)

26
PV assessment/intervention challenges

• what is traumatic?
• understanding of trauma
• expression of symptoms
• significance of symptoms

27
barriers to providing culturally competent
services

• taking an etic approach
• our value system of the other
• patriarchal
• passive
• lack psychological mindedness
• somatise

28
in search for a homeland..

• that in Toronto and Montreal there are places
  called Little Jaffna. That is enough of a Tamil
  nation for me. Wherever there are enough Tamils,
  there is a Tamil nation.

29
Thank you!

• pushpakanagaratnam_at_yahoo.com