Health and Disability

Scandinavian Journal of Psychology, 2005, 46, 511 –520

Blackwell Publishing, Ltd.

Health and Disability

Ideological commitment and posttraumatic stress in former Tamil child soldiers PUSHPA KANAGARATNAM,1 MAGNE RAUNDALEN2 and ARVE E. ASBJØRNSEN1 1 2

Department of Psychosocial Science, University of Bergen, Norway Center for Crisis Psychology, Bergen, Norway

Kanagaratnam, P., Raundalen, M. & Asbjørnsen, A. E. (2005). Ideological commitment and posttraumatic stress in former Tamil child soldiers. Scandinavian Journal of Psychology, 46, 511–520. This study focuses on the impact of present ideological commitment on posttraumatic stress symptoms in former child soldiers living in exile. Eighteen men and two women (aged 25–37), who had joined different Tamil armed groups in Sri Lanka between the ages of 13 and 17 years, participated. The Impact of Event Scale was used to measure posttraumatic symptoms. Qualitative methods were used to investigate the participants’ ideological commitment. Participants reported being exposed to many potentially traumatizing events, and had high scores on the Impact of Event Scale. Twenty-five percent of the sample showed strong ideological commitment to the “cause”. Ideological commitment at the present seemed to predict better mental health when exposure was less intense and overwhelming. Time had a negative impact on ideological commitment. Key words: Political violence, trauma ideology, child soldiers. Pushpa Kanagaratnam, Department of Psychosocial Sciences, University of Bergen, Christiesgt 12, N-5015 Bergen, Norway. Fax: +47 55589882 ; e-mail: [email protected]

INTRODUCTION Ideological commitment has been defined as a “consistent belief in the justification of the national war and the readiness to participate in it and to interpret its consequences in favorable terms, as well as a defiant stance toward the enemy” (Punamäki, 1996, p. 56). Acknowledging the limitation of employing quantitative methods in studying ideology, Punamäki further operationalized ideological commitment as glorification of war, patriotic involvement, and defiant attitudes toward the enemy. These three categories were based on her Attitudes toward War and Peace Questionnaire, and an open-ended question on attitudes toward the enemy, developed and applied to study ideological commitment in both Israeli and Palestinian children (1987, 1996). A modified version of this questionnaire was used in a Northern Irish context to study ideological commitment among children in Northern Ireland (Muldoon & Wilson, 2001). Ideological commitment can have a significant impact in individuals, even long after their active involvement in political acts. Agger and Jensen (1993) stress the importance of ideological and political issues in influencing a refugee’s life in the host country. They see the loss of personal and ideological consciousness as a major part of the refugee’s psychological problems. An anthropological study focusing on the women guerrilla army, the Frente de Libertacão de Mocambique (FRELIMO), more than 20 years after their serving as combatants, emphasizes on their ideological commitment for the cause as essential for their feeling of being empowered rather than victimized by the war (West, 2000).

Anyhow, there is still a lack of empirical data, showing a protective or destructive role of ideology in the mental health of individuals many years after their active past as child soldiers. Except two studies done on children (Punamäki, 1996; Muldoon & Wilson, 2001) and one study done on adult torture victims (Basoglu et al., 1994), factors like ideological commitment have only been suggested as possible explanations for findings (Allodi & Cowgill, 1982; Allodi, 1989), but have not been directly addressed in empirical studies. Ideology is considered as one of the most equivocal and elusive concepts in the social sciences. Widely varying in significance in daily use and heavily charged with political connotations, a variety of theoretical approaches assign different meanings and functions to it (Larrain, 1992). For our purpose, the concept of ideology could be formulated as political reasoning, which is again a product of both the thinking subject and a determining social environment (Rosenberg, 1988). According to Rosenberg, there are a number of methodological caveats in measuring ideology, as ideology and political thinking have more profound subjective components than is generally recognized. A child soldier is broadly defined as “anyone under the age of 18 years who actively participates in a war situation on behalf of a particular group or ideological position (p. 402, Mendelsohn & Straker, 1998)”. With few exceptions (e.g., Macksoud, Dyregrov & Raundalen, 1993; Dybdahl, 2001; de Silva, Hobbs & Hanks, 2001; Derluyn, Broekaert, Schuyten & Temmerman, 2004), psychological accounts reporting from war-torn areas are scarce. The particular lack of research on child soldiers has been associated with problems

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in getting access to participants, researchers’ reluctance in acknowledging the active role played by children in armed conflict and the theoretical complexity of the area (Mendelsohn & Straker, 1998). De Silva, Hobbs and Hanks (2001) claim that children are easily recruited into armed groups because of their influential and idealistic minds. Ideological commitment has been suggested to have the most important mediating effect on the mental wellbeing of children affected by political violence (Boyden, 1994), but there have been concerns regarding the limited cognitive capacity among younger people to think rationally about concepts like ideology and nation (Garbarino, Kostelny, & Dubrow, 1991; Goodwin-Gill & Cohn, 1994). War-related stress has an impact on youngsters’ emotions and attitudes. Children exposed to war show stronger identification with community (Jensen & Shaw, 1993) and develop a worldview of dominating political and nationalistic factors (Punamäki & Suleiman, 1990), often highly correlated to pro-war attitudes (Feshbach, 1994). Punamäki and Suleiman found that the more the Palestinian children were exposed to political hardships, the more they employed active and courageous modes for coping. Thus, children may not always be mere passive victims of war, but are taking an active part in political struggles going on in their societies. Ideology is seen as having a collective impact, though based on individual psychological mechanisms. Reflecting the material realities of the society and mirroring the conditions in which people live, it can function as a source of intellectual enquiry and revolutionary zeal (Carlton, 1990). Amnesty International (AI) estimates that worldwide over 300,000 children under the age of 18 are fighting in armed conflicts, with many under the age of 15 (Amnesty, 2002). This violates the United Nations Convention on the Rights of the Child, a violation that has also been applicable to Sri Lanka. A recent report from AI, which covers the period of January to December 2001, confirms the recruitment of children into Tamil armed groups in Sri Lanka (Amnesty). Some of these children were as young as 10 (Machel, 2001). Different accounts from Sri Lanka (de Silva & Hobbs, 2001; Somasundaram, 2002) claim that children recruited to fight are indoctrinated to hate the enemy. They are involved in military tasks like manning sentry posts, and digging bunkers. They undergo training in use of munitions, firearms, radio-communication and mock battles. Those aged 14–18, are used in frontline fighting, while the younger ones are kept in reserve. But in difficult battles or mass attacks, young children form an “effective fighting force” (Somasundaram, 2002, p. 1269). Participation in combat has been shown to result in profound effects on these children. Death and injury being one side of the coin, the psychological effects seen in those who survive are reported to be devastating. Practicing psychiatrist in northern Sri Lanka, Daya Somasundaram, reports of severe symptomatology in this population, ranging from posttraumatic symptoms to psychotic symptoms leaving these children as “complete psychological and social wrecks”

Scand J Psychol 46 (2005)

(Somasundaram, 2002, p. 1270). The author also comments that compared to the direct war with the Sri Lankan State, the internal conflict between different Tamil rebel groups which led to Tamils torturing and killing their own people went deeper into their hearts, resulting in more and severe psychological problems (Somasundaram, 1998). DSM-IV defines posttraumatic stress disorder (PTSD) as a pervasive anxiety disorder that follows exposure to stressful events accompanied by intense fear, helplessness, or horror. The symptom criteria include intrusions, arousal and avoidance. These symptoms must cause significant distress or impairment in social, occupational, or other areas of functioning important to the person (American Psychiatric Association, 1994). Studies on war-related PTSD in nonWestern populations have been extremely scarce, and research on combat-related PTSD in these populations has been nearly neglected. This cultural limitation in the field of PTSD has recently been acknowledged (Foa, Keane, & Friedman, 2000). It has further been speculated that PTSD among nonWesterners is characterized by a complex symptom profile and a chronic life course, causing more disability compared to a Western population (Kessler, 2000).

The assumptive world and information processing Parkes (1975) has coined the term “assumptive world” to refer to people’s view of reality as they believe it to be, as a “strongly held set of assumptions of the world and the self which is confidently maintained and used as a means of recognizing, planning and acting” (p. 132). Building on this concept, Janoff-Bulman (1992) writes about shattered assumptions, with the claim that posttraumatic symptoms result from an individual’s conscious or unconscious attempts to cope with the loss of meaning. When one’s basic assumptions of the construction of the world and its reality is in mismatch with perceptions following exposure to potentially traumatizing events, the result is a disorganized memory structure as manifested in PTSD. A reintegration of these shattered assumptions of the world into a workable set of beliefs helps to adapt better and gives relief. Thus, recovery is seen as re-establishing an integrated, comfortable assumptive world that incorporates the traumatic experiences. PTSD is therefore viewed as a disorder of information processing, as the primary deficit in PTSD has been suggested to lie in the capacity of organizing environmental percepts into integrated wholes (McFarlane, 2000). This study focuses on ideological commitment and posttraumatic stress in a sample of former child soldiers from Sri Lanka living in exile in Norway. Given the combination of extreme exposure to chronic stress as child soldiers, their vulnerable age, and their status as former soldiers resettled in another country, we expected to find a generally high level of reported posttraumatic symptoms in our subjects. In particular, those who experienced the change from a war towards the Sinhalese government to an internal Tamil

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Ideological commitment and posttraumatic stress 513


conflict are expected to show a high degree of stress symptoms based on losing an ideological explanation of their experiences. Anyhow, to cope for an extended period in highly adverse circumstances, an assumptive world which provides the explanatory context for why one is exposed to political and military threat, and an ideological context for why it is worthwhile to partake in the struggle is important. The context affirms the suffering of the individual or the group as necessary and even desirable, and thereby enhances the ability to cope (Milgram, 1993). The dominating cognitive factors are also able to exert control over the emotional state of the individual protecting him/her from the harshness of traumatic distress. Thus, ideological commitment in the present, with schemas of political thinking supporting their past as active players in the war, is expected to have a protective impact on warrelated mental health. Individuals with a strong ideology are those who have been successful in integrating the past experiences into a whole, in consistency with their already existing schemas or assumptive world, and would therefore report having less frequent symptoms. On the contrary, those with a weak ideological commitment at the present are most probably having trouble adapting to the mismatching information and integrating it into their assumptive world. Shattered assumptions or loss of meaning of their past as active participants in the struggle, makes them more vulnerable to developing posttraumatic symptoms. Being involved in atrocities unwillingly will contribute to the development of posttraumatic symptoms, because these events will contradict with the assumptive world, and will make the reintegration of this information difficult. As we pursue to study the little-

known phenomena of ideology in former child soldiers, we have used qualitative methodology to uncover the native constructions of how participants describe their commitment in their own terms (Norris, Weisshaar, Conrad, Diaz, Murphy & Ibanez, 2001).

METHOD Sample Eighteen men and two women, a total sample of 20 adult Tamils who were former rebels of any Tamil armed group, were included in the study. Names of the rebel groups are not to be specified in this article. All subjects had been active participants in warfare with the Sri Lankan Sinhalese government, and as given in Table 1, were less than 18 years of age at the time of recruitment. They had left Sri Lanka within the year bracket of 1986–1995, the majority leaving their country in 1987. They were living in Norway (Bergen/Oslo) at the time of the study, and were either students, under employment, or students with part-time jobs. None of the participants had a previous or current psychiatric history.

Data collection The sensitive research topic led to limited support for data collection from the Tamil communities in Bergen and Oslo. There was also a complete lack of authorized/unauthorized information on the number of former Tamil child soldiers living in Norway (and in Sri Lanka). Thus, probability sampling was unfeasible for this study. Based on the first author’s and the local Tamil communities’ prior knowledge about individuals who had been active as child soldiers in Sri Lanka, the first contacts were either made by the first author, or by third persons who were known to the potential participants.

Table 1. Sample description

Subject code

Gender

Age

Age joined as soldier

Combat training (months)

Exposure range (months)

Time since exposure (months)

Time in Norway (months)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Mean Range

Male Male Male Male Male Male Male Male Male Female Male Male Male Female Male Male Male Male Male Male

25 23 26 28 29 37 24 26 27 27 25 27 23 25 21 24 24 24 26 28 25 23 –37

16 13 16 16 17 14 17 15 17 17 16 16 15 15 17 15 16 14 14 17 15 13 –17

3 1 5 3 18 12 3 12 24 10 3 4 2 0 2 18 2 3 6 12 7 0 –24

36 24 30 48 36 48 36 36 60 36 12 24 60 120 6 72 24 24 30 36 39 6 –120

84 96 90 96 108 84 48 96 120 84 96 108 36 8 48 42 60 96 120 96 76 8 –120

84 84 96 96 108 84 2 96 96 24 96 84 10 8 48 24 60 96 108 84 69 2–108


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A three-month period was used to contact all the individuals whom we knew had been active as child soldiers in Tamil armed groups in Sri Lanka. Everyone who was approached agreed to participate, though there was hesitation and suspiciousness related to the intention of the study. Getting access to a representative sample was out of the question for this study, and the sample size was solely determined by feasibility. A copy of the letter from the second author (at the time of study, President of the Norwegian UNICEF committee) was given to each participant before the interview. This letter explained the intention of the study and assured anonymity and confidentiality. It was further confirmed that those participants who felt a need for consultation/therapy would be able to receive it at the Center for Crisis Psychology, Bergen, Norway.

Assessment Following informed consent, the first author of the study interviewed and assessed participants in her native language Tamil. The scales measuring exposure and posttraumatic symptoms were orally translated to Tamil during the interview and completed in dialogue with the subject, to reduce misinterpretations.

Exposure As to the knowledge of the authors, there are no existing standardized instruments to measure exposure in child soldiers. The Exposure Scale for Child Soldiers used in this study (ESCS; Raundalen, n.d.), was applied for clinical purposes by the second author in his work with child soldiers in Mozambique in the late 1980s and in Liberia shortly after. This short assessment scale was found to be helpful and valid in detecting core issues of exposure among child soldiers. The ESCS had 11 items, and based on the particular nature of the ethnic conflict in the time frame during which our subjects were involved, a 12th item, “Have you tortured or killed Tamils?”, was included in the scale by the first author.

Posttraumatic symptoms An extended version (Raundalen & Dyregrov, n.d.) of the widely used self-report measure of posttraumatic symptoms, the Impact of Event Scale – Revised (IES – R, Weiss & Marmar, 1997), was used to measure the frequency of intrusive, avoidance, and arousal symptoms. Horowitz’s original scoring scheme of 0, 1, 3, and 5 for frequency responses of “not at all,” “rarely,” “sometimes,” and “often” were used (Horowitz, Wilner & Alvarez, 1979).

Ideological commitment Mainly adapting the categories found to be valid in measuring ideological commitment among children living in the war zones of Israel, Palestine and Ireland (Punamäki, 1987, 1996; Muldoon & Wilson, 2001), we have chosen a qualitative approach to explore the phenomena of ideological commitment in our sample of former child soldiers. Following our observations of some degree of patriotism expressed by all participants during the interviews, we have, in accordance with qualitative research principles (Denzin & Lincoln, 2000), replaced the category “patriotic involvement”, with non-ambivalent identification of role and participation in combat. Besides, patriotism is related to pro-war attitudes (Feshbach, 1994), and thus stands in contrast to the first category, glorifying the armed Tamil struggle. The following themes were defined as reflecting strong ideology among our former child soldiers in this study: (1) glorification or

Scand J Psychol 46 (2005) justification of the Tamil struggle to achieve an independent state “Tamil Elam”; (2) non-ambivalent identification with the role and participation as soldiers; and (3) defiant attitudes toward the enemy. Negative expressions of these themes, coded as weak ideology, were: (1) not glorifying/justifying the struggle; (2) ambivalent identification with the role of soldier and active participation or regret; and (3) non-defiant attitudes toward the enemy. Ideological commitment was assessed based on data from a semi-structured interview, sentence completion, and a written assessment. The semi-structured interview was intended to create an open communication atmosphere, stimulating the individuals to include personal matters and opinions, and facilitating the follow-up of issues raised by each of them. Issues covered during the interview were mainly based on factors before recruitment, reasons for recruitment, combat life, reflections on combat life and their current situation. However, this study is partly based on interview data focusing on combat life and reflections on combat life only. Topics covered in the interview included the participants’ lives as combatants, duties and routines, friends, their emotional wellbeing as child soldiers, and their contacts with family and the community, and were followed by structured questions on time since combat life and their reflections of combat life at the present, asking them: “How did you cope with combat life?” “What was the best of being a soldier?” (Antoniussen & Haugen, 1995). “What was the worst of being a soldier?” “Do you regret having been a soldier?” “Do you think you have been a good soldier?” and “How do you think your life as a soldier has had an impact on your life?” The Sentence Completion task has been used in war-related research (Netland, 1992; Kimble et al., 2002), and based on the characteristics of the armed conflict in Sri Lanka, was developed by the first author with the intention of tapping ideological issues among the participants: “If I would have been in my country____”; “I feel anger____”; “I feel hatred____”; “The Sinhalese____”; “My joining the armed group____”; “I feel like crying____”; “If I had died in the armed group____”; “I am happy____”; “Cyanide capsule____” (deadly poison hanging around a militants’ neck, to be swallowed under risk of capture). The written assessment was developed by the first author to identify ideological elements in subject-responses to the following topics: “Who am I?”; “my past”; “my present”; and “my future”.

Analysis The study was supported by a staggered research design, which maximizes information gathering, permits ongoing reflective analysis, and ensures repeated cross-triangulation validity testing. Confirmatory feedback of transcripts was received from participants prior to conducting analyses. In addition, validity was also ascertained via questioning multiple informants and by crosschecking and triangulating information with other data sources (between the different qualitative data and between the qualitative and quantitative data). To assess ideological commitment among the subjects, the analysis of the qualitative data was done in accordance with established principles and practices governing qualitative research (Mays & Pope, 1995; Office of Behavioral and Social Sciences Research: National Institutes of Health, 1999).

Coding procedure To capture participants’ answers in their own words, the interviews were audiotaped and then transcribed verbatim. The text was then translated into English, by the first author. Content analysis involved careful examination of interview transcripts, the sentence completion task, the written assessment as well as detailed fieldnotes maintained by the first author in order to identify themes and



Scand J Psychol 46 (2005) trends included in our definition of ideological commitment. The data was read independently by the first author and another psychologist, and coded by sentence for the presence or absence of the themes defining ideological commitment. This ensured reliability (Mays & Pope, 1995). Presence of any one of the three themes defining ideological commitment gave a plus code for strong ideology and negative expressions of these themes gave a plus code for weak ideology. Protocols were identified for these themes for each individual, and the codes were counted and compared to see the dominant response pattern for each participant. A relatively higher score on strong ideology, compared to the score of weak ideology resulted in that particular individual being coded as having a strong ideological commitment, and vice versa. The following example illustrates the method of coding for ideological commitment through parts of the data protocol for subject 15, male: Excerpts from the semi-structured interview: “I joined the group out of the passion to fight for my country and save my people.” (Though patriotic, also involves pro-war attitudes. Thus, coded as strong ideology) “Youngsters in their school age know about the standardization system in our country. As Tamils they are discriminated. Even if you study you are going to be under suppression. Tamils need a higher cut off point than the Sinhalese, to get to the University. So we see that we have no future.” (Political awareness; though no direct indication for strong/weak ideology) “The loss of my father was the first bad feeling in my life. I was 14 then. He was a heart patient, and the doctor had advised us to take extra care of him. During a round up, the Army forced him to stand in the hot sun for a long time. This affected him. He was admitted to the hospital and died after few days. I usually come first in class. After this incident my rank was fifth. So, you see.” (Emotionally laden statement about personal loss; not coded for ideology) “. . . later, I saw and heard of many atrocities done to our people. When your sisters are raped and your mother is slaughtered what can you do? You are just 17. How would you feel? This is the reason for many youngsters joining armed groups. They are not brainwashed or anything like that.” (Justification of war; coded as strong ideology) “I needed security and I wanted to take revenge for what they did to my father. Only boys with personal losses are able to withstand military life for a long time. They have this determination to take revenge.” (Emotionally laden statement; not coded for ideology) “. . . now they say that Sri Lanka is a Buddhist country. Once Jeyawardane (the president of Sri Lanka, at the time) said that the Sinhalese are like a tree and Tamils have to creep up on this tree if they wish to come to a better position. You know, Tamils have a rich history dating longer than the Whites. They have lived for generations and generations in our country. I have learned history. The Sinhalese hate the Tamils, because Tamils are keen in studies and have attained higher positions. They were burglars at that time, you know. . . .” (Defiant attitudes toward the enemy; coded as strong ideology) What was the worst of being a soldier? “. . . nothing. We had a good life in the group.” (No ambivalence; coded as strong ideology) Some examples from sentence completion: “The Sinhalese, when compared to the 70’s and 80’s have become more civilized people.” (Defiant attitude toward the enemy; coded as strong ideology). “If I had died in the armed group, I would have been happy to die for the freedom of my people.” (Glorification of the struggle

and non-ambivalence related to participation and identification as soldier; coded as strong ideology) “Cyanide capsule was the honey that safeguarded our moral excellence (Glorification of the struggle and non-ambivalence related to participation as soldier; scored as strong ideology).” Response to the written assessment given below, expressed patriotism but with a clear justification of active participation for selfdetermination and achieving an independent state for Tamils, and was coded as strong ideology: Who am I? – I am a Tamil from Tamil Elam. I have a leader, and I enjoy working under him. I love my country and people. Past: It is the past. Present: I am a parrot locked up in a golden cage. Future: I am living with the hope that my ambitions and dreams (in achieving Tamil Elam) will come true. Parts of the qualitative data material above shows many statements coded as strong ideology, none with weak ideology and some statements not coded for ideology. Based on the above given data, the dominant pattern being strong ideology, this participant will be coded as having a strong ideological commitment. Prior to the quantitative analysis of data, the IES items that did not belong to the original IES-R were taken out. Assuming that we had a non-normal distribution based on a small sample, we used distribution-free nonparametric procedures. Spearman correlations and Mann-Whitney U tests were conducted with Statistica for Windows, Version 6.0.

RESULTS Exposure The sample as a whole reported of being highly exposed to potentially traumatizing events as listed in the ESCS. All had seen wounded, seen dead bodies, had lost someone close, and had been in situations where they thought they were going to die. Thirteen (65%) had been wounded, seventeen (85%) had been in direct combat, nine (45%) had killed, and five (25%) reported they had participated in torturing/killing other Tamils. Only one reported to have been forced to fight and kill. All except one had seen others been killed from a short distance. Many reported having seen hundreds of dead bodies, mutilated bodies, and some had buried their dead friends. “My friend, his brain was shattered and there were worms. . . .” (Male, subject 13) “After the attack we came back to our village. Our lane was full of dead bodies. The houses were still burning. The whole village had this smell . . . the smell of dead bodies” (Female, subject 14) “I have driven lorries full of dead boys. About 40 bodies piled on one another. You can’t eat afterwards. After all the hard training they die in combat. . . . So sad to think about it” (Male, subject 7)


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Posttraumatic symptoms

Table 2. Posttraumatic symptoms and ideology

Measured by the IES-R, the total score of posttraumatic symptoms in the sample ranged from 10 to 69, with a mean of 43. Spearman correlation analyses found no significant relationships between IES scores and age joined in armed group (r = 0.35, p < 0.05), length of training (r = 0.13, p < 0.05), length of exposure (r = 0.21, p < 0.05), time since exposure (r = −0.10, p < 0.05) or time lived in Norway (r = −0.35, p < 0.05).

Subject code Intrusion Avoidance Arousal IES-total Ideology

Ideology Independent ratings on ideology resulted in 90% agreement (on 18 participants) in the total sample. Total agreement was achieved following a discussion between the independent raters. Five individuals (including one woman) were coded as having a strong ideology, and the rest of the 15 as having a weaker ideological commitment. Personal achievement in combat, popularity, combat experience, friendship, the knowledge and experience acquired by being a combatant, and the support of the community were considered as the best of combat life. Some of the former combatants felt a relief, and even felt it as the best of combat life, that they had not killed any Tamils and were not personally responsible for any killings. The death of friends, killings of their own people, the guilt of being responsible for unnecessary killings, and being confronted with morally conflicting situations were the worst experiences for most of them.

Ideology and posttraumatic symptoms Table 2 shows the frequency of reported posttraumatic symptoms in the sample, and their categorizing as having a strong or weak ideological commitment. The following quotes from participants illustrate that those coded with strong ideology expressed less acknowledgment of being negatively affected by their participation and vice versa. Selected quotes from participants with strong ideology: “We have not committed any atrocities. We fight, only against the Army. We are well disciplined. We cannot have any psychological effects of war. . . .” (Male, subject 15) “I never cry. . . . I never cry even in a funeral where they have all the bodies of those who died in combat. When they bomb or there is shooting, I am on the street watching, even when I was pregnant. I just wanted to know the direction where it came from. My sister screams after me, asking me to get into the bunker. I just say, don’t worry Akka (Tamil word for sister). . . . Hearing all these sounds my baby will grow up to be a strong and determined child in the future. . . . The war has not affected me in any way. I am not scared

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

6 19 12 21 14 8 27 6 19 25 15 16 14 15 12 22 19 16 3 17

4 17 18 23 4 9 23 7 26 18 24 24 26 0 15 19 14 19 6 24

0 15 9 11 13 8 11 0 17 26 14 11 16 11 7 22 9 14 9 14

10 51 39 55 31 25 61 13 62 69 53 51 56 26 34 63 42 49 18 55

Strong Weak Weak Weak Weak Strong Weak Weak Weak Weak Weak Weak Weak Strong Strong Weak Strong Weak Weak Weak

Note: IES – Impact of Event Scale.

of anything. I still wish I could have continued in the group. My sister wrote to me, that lately many women soldiers died in an attack. I am sad, because I can’t see their bodies.” (Female, subject 14) Quotes from some participants with weak ideology: “It was really difficult in the beginning. There was nobody to talk about my feelings. I was living all alone. That was a terrible time. All these events came like pictures in the night. I had terrible dreams. I could not sleep. I could not eat. I was not going to school. I was not functioning at all.” (Male, subject 20) “At a party where everybody has a good time, I sit there feeling all alone. I have lost the ability to enjoy things. Some people look at the flowers and say, ‘look how beautiful they are’.” (Male, subject 9) “. . . Torturing and killing people. . . . We also see dead bodies of the Army. All this troubled me. Often when I got up in the morning, I felt as if something was pressing me on my chest, not letting me get up . . . it was difficult to breathe.” (Male, subject 12) Mann-Whitney U tests with independent samples, with ideology as the grouping variable supported the above findings derived from qualitative data. Significant group differences were found between the strong and weak ideology groups, on avoidance (Mann-Whitney U = 9.50, Z = −2.44, p < 0.05), arousal (Mann-Whitney U = 9, Z = −2.48, p < 0.05) and total




IES scores (Mann-Whitney U = 11, Z = −2.31, p < 0.05), but not on intrusions.

Time and ideology “You know how politics is? Even when you have 10% doubts, you kill. A human being’s life has become worthless. Gradually I felt I could not accept these things. Weapon is not the solution for everything. Our common enemy is not the Tamils. We are killing our own people. It is like killing your own family.” (Male, subject 20) “. . . . At the time of the ethnic riots and after that in combat, I thought of the Sinhalese only as my enemies. But later on, after I left the group, I got the chance to move with many of them and understood that there are both evil and goodhearted people among the Sinhalese. Now I feel sorry to think that I could also have killed good people.” (Female, subject 10) The above are examples of quotes from subjects coded as having weak ideology, their expressions showing ideological commitment to the cause getting weaker with the passage of time. The Mann-Whitney U test showed a significant difference between the ideology-groups on time elapsed since exposure to the last combat event (U = 12.5, Z = −2.18, p < 0.05).

Exposure and ideology As shown in Table 3, when compared with a total index of exposure intensity (sum of the exposure variables showing response variance in the sample: length of exposure, been wounded or not, had killed or not, had or had not killed or tortured Tamils and had been or not in direct combat), none of the six with high exposure intensity (with total scores 4 and 5) had been coded as having a strong ideology.

DISCUSSION This study suggests that ideological commitment has a significant impact on the development of severe posttraumatic symptoms among former child soldiers. A minority of the participants expressed strong ideological commitment to the cause. However, particular events of exposure and time elapsed since combat-life seemed to moderate this positive effect. Our study sample was highly exposed to potentially traumatic events. Majority of the former child soldiers also reported frequent posttraumatic stress symptoms. Intrusions are by van der Kolk (1996) considered to be “normal” among people exposed to extreme events, whereas development of avoidance and arousal symptoms is considered to be more pathological. The reporting of intrusive symptoms was not significantly different between the ideology groups in our sample. Length of military training was not related to posttraumatic symptoms. Perhaps length of training is less significant than

Table 3. Exposure and ideological commitment Subject code

Direct combat

Wounded

Killed

Killed / tortured Tamils

Exposure length

Exposure length (months)

Exposure index

Ideology

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 1 2 1 2 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1

1 1 2 1 2 2 1 2 1 1 1 2 2 1 1 1 1 1 1 2

3 3 2 3 2 1 3 3 1 1 1 1 3 2 3 1 3 1 1 1

2 2 2 2 2 2 2 2 1 2 2 1 2 2 2 1 2 1 1 1

1 2 2 1 1 1 1 1 1 1 2 2 1 1 2 1 2 2 2 1

36 24 30 48 36 48 36 36 60 36 12 24 60 120 6 72 24 24 30 36

3 2 0 3 1 3 3 2 5 4 3 3 2 2 2 5 2 4 4 4

Strong Weak Weak Weak Weak Strong Weak Weak Weak Weak Weak Weak Weak Strong Strong Weak Strong Weak Weak Weak

Notes: Response codes: Yes/High = 1; No/Low = 2; Not Known = 3. Exposure length: equal or higher than median 36 = 1; lower than median 36 = 2. Exposure index = direct combat + wounded + killed + killed/tortured Tamils + high exposure length. © 2005 The Scandinavian Psychological Associations/Blackwell Publishing Ltd.

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the quality of training, which we have not measured in our study. Neither did length of exposure to combat, time elapsed since exposure to the last combat events nor time lived in the host country relate to posttraumatic symptoms. It might be speculated that risk and resiliency factors become less relevant when it comes to high magnitude events such as combat (Yehuda, 1999). The severity of stress, rather than the length of an individual’s exposure to potentially traumatic events, might be more significant in the development of PTSD symptoms. An ambiguity closely associated with the identity crisis of adolescents is the fluctuation between the hero image many youngsters carry into combat and their subsequent perceptions of themselves as wasted and being misused. According to Somasundaram (1998) the initial altruism and dedication seen among the Tamil militants soon disappeared as they became disillusioned by their involvement in incongruous activities. Moral dimensions of combat and the significant perceptions of self and the world are stressed to be important issues among former combatants with stress disorders (Gregory & Belenky, 1987). Abusive unnecessary violence with witnessing of cruelty is considered to be particularly traumatogenic, as evidenced in the Kuwaiti and Vietnam wars (Nader, Pynoos, Fairbank, Al Ajeel & Al Asfour, 1993; Hiley-Young, Blake, Abueg, Rozynko & Gusman, 1995). It has also been stated that the risk of PTSD was enhanced among the African American veterans of the Vietnam War, because of their identification with the Vietnamese people (Pynoos, 1994). As expected, the exposure factor of involvement in the internecine war among the Tamil militant groups, turned out to be of great significance for the participants in our study, because the process of reintegration becomes painful when the values and ideologies that are justifying their fighting for the “cause”, conflicts with the harming and killing of their own people. As expected, the results further imply that ideological commitment to a cause might have a protective influence on the mental health of our former combatants. This finding is in accordance with previous studies showing strong ideology associated with good mental health among children (Punamäki, 1996; Muldoon & Wilson, 2001). But it is suggested that the protective effect of ideological commitment is most visible at the lowest levels of war experiences (Punamäki). This seems to be true in our sample too, as none of our former combatants expressing strong ideological commitment were among those with the highest exposure intensity. Summerfield (1998) has emphasized the relevance of “social memory” in understanding war trauma. He argues that the experience of war being or not being traumatic depends on the social context and on what these events mean to the people involved. However, ideology usually mirrors the conditions in which people live, and “social memory is sustained in the medium of ever-changing social contexts” (West, 2000, p. 182). Experiences that are meaningful in a given context might change, when encountered with a contradicting reality. This is probably also true for our population. Leaving their


home country, many of these ex-combatants for the first time get the opportunity to distance themselves from their group and from their war-torn homeland and thus modify their values. The study findings imply that with time elapsed since exposure, ideological commitment becomes weaker. In former Mozambican combatants it was found that the acceptance and reintegration of new views of the enemy was a long and painstaking process that also caused moral conflicts (West, 2000). According to Janoff-Bulman (1992), we have an information processing bias towards maintaining old schemas rather than changing them. At the same time, individuals who are at a stage of developing schemas or having weak schemas will incorporate inconsistent information easily. Thus, we might speculate that those subjects in our sample with a weak ideology have from their time of recruitment already had a less firm determination in becoming a rebel on ideological grounds, whereas those expressing strong ideological commitment at the present, were so from their time of recruitment. Child soldiers are a highly heterogeneous group, differing vastly in their experiences depending on the context of war and on the unique characteristics of the culture to which they belong. Such factors have an impact on how our participants remember, relate to and interpret their past as child rebels. The Tamil culture emphasizes suffering as augmenting the moral power of the sufferer, and serving, sacrificing and tolerance is generally underscored rather than self-aggrandizement and self-seeking (Wadley, 1980). Hindu (religion of the majority of the Tamils) philosophy encourages contextuality and sanctions inconsistency, thereby lessening the burden of moral responsibility from an individual. The former child soldiers’ active participation and their reflections of this participation in rebel groups should be understood within this sociocultural framework.

Methodological considerations The assessment of ideological commitment among the participants was based on their present and retrospective reflections, and thus does not give adequate insight into ideological commitment at the time they were combatants. This limitation should be considered when interpreting the results, along with the fact that posttraumatic symptoms were solely assessed by the self-report measure, the Impact of Event Scale. Mental health problems related to war trauma are not restricted to posttraumatic symptoms alone. In addition, the IES has not been independently validated in the Tamil culture to which the participants in the study belong. The first author conducting and interpreting the interviews being a native Tamil, issues related to language and the cultural understanding of modes of expression have been tackled sensitively. In qualitative data collection, the researcher is regarded as a research instrument. Anyhow, along with the advantages of the investigator belonging to the same ethnic group of the participants, there is a risk of




cultural bias that should be considered (Mays & Pope, 1995). We have approached this issue by involving a non-Tamil researcher in coding the subjects on ideology. Maintaining confidentiality is not an easy task within a relatively small Tamil community exhibiting tight social interconnections. Thus it is not to undermine that participants were concerned about this confidentiality issue which could have influenced their response pattern. The lack of a control group and bias related to the non-random selection of participants, limits the possibility for a firm conclusion. Knowledge about Tamil child soldiers in general was almost lacking at the time of this study, and to which extent this sample represented the real gender distribution of the population was not known. Problems considered unique to girl child soldiers seem not to fit the Tamil girl child soldiers joining armed groups in Sri Lanka, as shown by Lamberg (2004) and evidenced from quotes like the following from female participants in this study: What was the best of being a soldier? – “I was clever in firing. The revolution songs and the training gave us great encouragement. It was a good life. We went in search of equal rights. Likewise we got equal training like the boys.” However, the skewed distribution with only two women in the sample demands caution. Issues of generalization should be further questioned because of the small sample size.

CONCLUSION The general lack of studies on child combatants leads to limited knowledge on how these individuals judge and remember their own participation. Thus, in spite of limitations, this study gives important insight into a group usually difficult to access. Strong ideological commitment seems to safeguard individuals from developing mental health problems. Anyhow, it is of importance that the majority in our sample did not have a strong ideology. One should also consider the negative impact of exposure intensity on ideological commitment and how ideology might weaken with time. Another issue of significance is that despite persistent posttraumatic stress symptoms, none of our subjects were under psychiatric care. Thus, further longitudinal studies are needed to affirm our conclusions on the impact of ideological commitment on mental health. This study was supported with grants from the Norwegian Research Council (128240/320), University of Bergen, and L. Meltzers Høyskolefond. Thanks to Grethe Johnsen for her efforts in coding the qualitative data.

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