Counselling Tamil Sri Lankans
Please note: This article discusses trauma, torture, and sexual assault. If these topics bring up feelings of distress and discomfort, please access the following helplines linked here.
The term “boat people” has become ubiquitous in our everyday language and remains a contentious political issue that has divided the Australian community. The Department of Immigration advises that of the approximately 185,000 migrants accepted in Australia in 2008/2009, 13,000 were accepted on humanitarian grounds. In that year, 1033 people arrived by boats. This has increased to a staggering 4,916 in the 2009/10-year. Behind the faceless and nameless labels of ‘boat people’ or ‘queue jumpers’, are real people with individual stories of survival. One country that has shown increased activity in the last 12 months is Sri Lanka. After enduring months or years in Australian detention centres, a number of predominately ethnic Tamil Sri Lankans are being granted asylum as refugees in Australia. The majority have suffered significant trauma. Rehabilitation organisations such as STARTTS (Service for the Treatment and Rehabilitation of Torture and Trauma Survivors) treat these clients to help them overcome their trauma and lead fulfilling lives, integrated into the Australian community. This article aims to provide an overview of key cultural considerations when working with Tamil Sri Lankans.
The Sri Lankan Tamil Refugee Sri Lanka is a small island in the Indian Ocean, south of the Indian sub-continent, with a population of 21 million. The Sri Lankan people are divided into a number of ethnic groups including Sinhalese 73.8%, Sri Lankan Moors 7.2%, Indian Tamil 4.6%, Sri Lankan Tamil 3.9% and the remainder unspecified. Various religions are practiced: Buddhist 69.1% (mainly the Sinhala), Muslim 7.6%, Hindu 7.1% (mainly Tamils), Christian 6.2% (Tamils or Sinhala) (data from 2001 census provisional data). Historical ethnic tensions and politically motivated violence by the Sinhalese governing majority, and subsequent retaliation by Sri Lankan Tamil rebels (Tamil Tigers), escalated into a bitter civil war that lasted 27 years. This war has had a devastating impact on the Sri Lankan Tamil community. In the final months of the war in May 2009, over 300,000 Tamil civilians were displaced by intense fighting, including a ‘show and awe’ style bombing campaign instigated by the Sri Lankan government. There are current calls by the EU and the UN for these Sri Lankan government actions to be investigated as war crimes against Tamil civilians. With the defeat of the Tamil Tigers and the end of the civil war, the United Nations reported that as of July 19, 2009 Sri Lankan was detaining 281,621 displaced Tamil civilians in 30 military guarded camps. While the Sri Lankan government portrays the war ceased in May 2009, many clients suggest they continue to have no freedom of movement, freedom of expression, and freedom from human rights violations. If anything, the situation for minority Tamils has deteriorated since the end of the conflict. Many individuals fled the country in response to false allegations that linked them to various political and rebel groups and placed them at risk of imprisonment or worse. While most survivors and victims of trauma may have aided or sympathised with the Tamil Tiger rebels, this was not often by choice but rather as a series of consequences and experiences in their lives.
Presenting problems of Tamil clients Tamil clients at STARTTS have reported verbal, physical, sexual and psychological torture, e.g., hot chillies forced into eyes and other bodily orifices, sexual assault on both mend and women (mostly anal rape for men); deprivation of food, water and light; exposure to extreme hot and cold; in general, any activity designed to degrade, dehumanize and break the spirit. If the client did not suffer torture directly in the hands of captors, they were subject to the constant threat of abductions, fear of disappearances in ‘white vans’, the screaming death noise of air raids, and witnessing dismembered bodies lying around openly and in hiding (noticed by the smell of decaying bodies in camps). As a result of these traumatic experiences, Tamil refugees suffer from a range of physical health and psychological difficulties, including post-traumatic stress disorder, anxiety, depression, suicidal ideation and psychosomatic problems. Separation anxiety is not uncommon. Being away from loved ones but wanting to support their families, these refugees seek immediate employment, and give little attention to the healing of their post trauma. The majority of Tamils are well-educated and held respectable jobs in Sri Lanka. Upon re-settlement in Australia, difficulty in obtaining employment similar to previous jobs, developing social networks and obtaining social status are pressing issues for Tamil clients. Many young families also re-unite after a significant period apart. Much energy is expended as they struggle to re-establish their relationships. Tamil clients suffer many symptoms of PTSD (Post Traumatic Stress Disorder), and anger and domestic violence (financial, emotional, psychological and verbal) are prevalent. Models for understanding trauma suggest that people who experience torture and trauma, also experience change in the biology of their brain that limits them from retrieving information and expressing their traumatic experience. In pop culture, ‘multiple personality disorder’ is often portrayed as involving strategic, dramatic and seductive battles among personalities; however in PTSD one symptom may include fragmentation of the trauma memory. The problem is not that there are ‘multiple personalities’ existing on one body, but rather that the brain fails to integrate the different personae. They are the victims, not the authors, of their own fragmentation. Professor Bessel van der Kolk refers to this as a ‘Dissociative Defence Mechanism’, whereby the clever brain has created a mechanism to prevent oneself from re-experiencing the pain caused by the traumatic event. This should not be confused with a lack of disclosure of the details of the actual traumatic event, but rather a disintegrated sense of self. These are some of the myriad and complex reasons why the Tamil Sri Lankans have resorted to handing over their meagre life savings and risking their lives on dangerous boat journeys to Australian shores of safety and freedom.
Concept of counselling: A first step is to discuss the concept of counselling and the benefits of such a process. The popularity of counselling amongst Tamil Sri Lankans grew rapidly after the 2004 Boxing Day Tsunami. However, this was limited to the specific geographic locations that were affected. It is important to appreciate that Tamils (like many other Eastern cultures) derive from a collective culture, where seeking ‘advice’ for difficulties is usually confined to elderly members of their family. This is often the case, as many extended Tamil families live together in Sri Lanka. The problems are kept within the family and rarely discussed with others to prevent any shame to the family. Second, in the Tamil community, sometimes there is no alternative language for the symptomology and concept of PTSD other than that you are ‘mad. Survivors’ fears of going mad may prevent them from talking and they may retreat into a fearful silence. Reinforcing that their experience is just ‘a normal reaction to an abnormal experience’ allows clients to normalise their feelings. According to Herman’s (1992) model of trauma and recovery, the creation of a safe environment and the development of trust is the first stage in the recovery process. To facilitate the establishment of safety. It is critical to ensure the client is empowered through the re-establishment of inner strengths, including family/community, education and religious beliefs. As psychoeducation, the counsellor could provide information about settlement in Australia and the nature of trauma recovery. Many Tamils look-up to counsellors as ‘doctors’ who will provide a more directive role. At this stage, it is possible to contract with the Tamil client that, based on your professional assessment, the client would benefit from six to eight sessions of counselling.
Working with interpreters As part of building safety and rapport with clients, we often use interpreters to ensure effective communication. While STARTTS only uses accredited interpreters, some Tamil clients are reluctant to engage with interpreters (lack of trust or feelings of shame). At the first meeting with clients, it is helpful to not only explain the notion of “confidentiality” between the counsellor and client (many refugees are unfamiliar with this in their home country), but also explain that interpreters are legally bound by confidentially.
Gender roles: It is often the case that Tamil husbands prefer to accompany their wives into their counselling sessions, as they would traditionally when visiting their family doctor. On these occasions, the men tend to do most of the talking, while the women respectfully, look down and nod occasionally, smile or cry in silence. It is important to be aware of gender roles and identity as this may have implications on the individual rapport you are able to build with female Tamil clients. As counselling is not a familiar concept for most Tamils, it is beneficial to educate the family together to avoid any misunderstandings and encourage the individual to attend counselling. In Herman’s model, the next stage is the reconstruction of the story, whereby remembrance and mourning can occur. In a counselling situation, many Tamils may take a number of sessions to reach this stage. The length of time could be a function of the factors influencing settlement in Australia, interaction of cultural and religious beliefs, suppressed emotions, as well as the severity of trauma. Some clients never feel comfortable going through this stage and leave counselling prematurely. However, if the counsellor understands and is successful in integrating the first stage of Herman’s model, and the time is right, they willingly explore the depth of their suffering. It is a significant milestone for a Tamil client to be able to talk about traumatic events, as the pieces of their life stories are put together for the first time. By acknowledging and validating their problems and feelings the individual has the opportunity to remember and mourn. As these intense feelings lessen over time, the healing and recovery can begin.
Communication Style To assist in the reconstruction of a client’s traumatic story, it is important to understand that many Tamils have a unique style of communication. Tamils tend to be passive, less demanding, non-confrontation and focus on portraying a positive image of themselves and their family, despite their hardships and psychological needs. Nonverbal messages and gestures may be as important as what is said. Status and identity may be communicated nonverbally and require appropriate acknowledgement. Building a good relationship can contribute to effectiveness over time; and indirect discussions of settlement needs are important means to identify the current issues at stake. Some Tamils are good at smiling when talking about their deepest fears and traumatic memory, a reflection of their own fear of entering sadness and not knowing how to gain relief from it. A lack of disclosure from Tamil clients may involve being too traumatised to speak, a lack of trust with the counsellor, and cultural taboos. Many Tamils are prohibited from open discussion of abuses or human rights violations in Sri Lanka. Most have been programmed to supress the unfathomable depravities experienced or witnessed due to the sever consequences they can expect with disclosure. By disclosing past experiences, especially those related to political persecution, many Tamils believe that it may have a negative impact on their eligibility for Centrelink benefits, housing, employment or even future citizenship.
Sexual assault Some Tamil women have been kidnapped, endured brutality, escaped army camps and risked their lives in seeking sanctuary via boat passage. Counsellors at STARTTS recognise that each individual will be ready to disclose events such as rape and sexual assault when the time is right. It is respectful to provide a space to grieve or just be in silence, as is openly recognising these women have enormous strength and resilience. While we cannot assume all refugee women have been sexually assaulted, statistics indicate the likelihood is high. Amongst Tamils, the disgrace is not only to oneself but also to the family, and fears of rejection by the community is usually enough to enforce silence. A further difficulty for women in dealing with the effects of sexual assault is the content of overwhelming tragedy in which their personal trauma is situated. How, in the face of the disintegration and destruction of entire Tamil homes, communities and societies, and multiple disappearances and deaths, can women give serious weight to their own experience? How can they feel entitled to take their own pain seriously? To feel entitled to the space to honour their own grief and pain?
Religion and spirituality Although worthy of discussion in its own right, the role of religion and spirituality in the healing and recovery from Tamils is of utmost importance.
Conclusion The human rights violations perpetrated against Tamils in Sri Lanka are significant. Behind the label of ‘boat’ people are Sri Lankan Tamils who have fled their country. Many have suffered significant torture and trauma, and exhibit physical and psychological consequences, ranging from anxiety to PTSD. Counselling is a new but progressive concept for the Tamils. Effective engagement with Tamil Sri Lankan requires familiarisation with their cultural context.
Herman, J. (1992). Trauma and Recovery. New York: Harper Collins Mehraby, N (2002). Counselling Afghanistan Torture and Trauma Survivors. Psychotherapy in Australia, 8(3), 12-18