"A Nation Passing Through Psychological Trauma"

On my drive towards my workplace I was very intently listening and humming along Louis Armstrong’s “What a Wonderful World,” the lyrics going like this: “I see trees of green, red roses too, I see them blue for me and you, and I think to myself, what a wonderful world.”” I SEE SKIES ARE BLUE, clouds of white, bright blessed days, dark sacred nights, and I think to myself. What a wonderful world!”  Indeed a wonderful world blessed to us by our Creator, The Lord of the Heavens and the Earth. Just then we came to a sudden halt due to a car accident two cars ahead of me, the driver of the car in his mid-twenties accusing another driver who seemed somewhere in his fifties that he was recklessly driving and that the accident happened because of the older gentleman’s negligence. I intently watched and saw them bicker about what to do next, as I looked left and right, I saw drivers of other vehicles(all cars) watching but with deep frowns. I pulled down the window and started enquiring the gentleman in the next car about what had really happened? His answer was: "I don’t know how it happened but I am really concerned about the fact that we all should not stand here, with these pile of cars, its very dangerous, what if there is a suicide bomber standing amidst us? What if there is a grenade attack?" In no time at all several men jumped out from their cars and asked the two affected cars to be pulled away from the road and that we should disperse as soon as possible since these are not safe times. Every face I noticed looked insecure, panic-stricken, timid and terrified, with deep frowns  and an agitated manner. I figured, this is the aftermath of the Bomb scare we face!
Pakistanis as a nation have been encountering a plethora of bomb blasts since the Russian invasion of Afghanistan almost 30 years back. Our Army jawan’s targeted, our security personnel brutally killed, civilians, women and children suffering from these deadly attacks leaving us battered, perforated and bruised on a daily basis now. As if this wasn’t enough to torment the people, the constant price hikes, the fading act of wheat, sugar from the consumer market. The constant, electricity breakdown; list of impact of this on-going crisis.

One obvious and tragic price of this open war is the toll of death and destruction. But there is an additional cost, a psychological cost borne by the survivors of war and socio-economic pressure, and a full understanding of this cost has been too long repressed by a legacy of self-deception and intentional twisting. After peeling away this “legacy of lies” that has perpetuated and glorified warfare there is no escaping the conclusion that combat, and the killing that stays at the heart of combat, is an extraordinarily traumatic and psychologically costly endeavour that profoundly impacts all who participate in it. This psychological cost of such a crisis is most readily observable and measurable at the individual level. At the national level, a country at war can anticipate a small—but statistically significant—increase in the domestic murder rate, probably due to the glorification of violence and the resultant reduction in the level of repression of natural aggressive instincts essential to the existence of civilization.

At the group level, even the most elite unit is usually psychologically destroyed when between 50 and 60% casualties have been inflicted, and the integration of the individual into the group is so strong that this destruction often leads to depression and suicide. However, the nation (if not eliminated by the war) is generally resilient, and the group (if not destroyed) is inevitably disbanded. But the individual who survives combat and bomb blast may well end up paying a profound psychological cost for a lifetime. The increasing impact of these effects on hundreds and thousands of survivors is pervasive, with significant potential to have a profound effect on society at large. A psychiatric casualty is a participant who is no longer able to partake in combat due to mental (as opposed to physical) debilitation. Psychiatric casualties seldom represent a permanent debilitation, and with proper care they can be rotated back into the line. Research has demonstrated that, after combat, psychiatric casualties are strongly predisposed toward the more long-term and more permanently debilitating manifestation of Post-Traumatic Stress Disorder.

The actual casualty can manifest it in many ways, ranging from effective disorders to somatoform disorders, but the treatment for the many manifestations of combat stress involves simply removing the affected from the combat environment. But the problem is that the military does not want to simply return the psychiatric casualties to normal life, it wants to return them to combat these casualties understandably reluctant to do so. The evacuation syndrome is the paradox of combat psychiatry. A nation must care for its psychiatric casualties, civilians who are of no value on the battlefield indeed, their presence in combat can have a negative impact on the morale of other combatants and they can still be used again as valuable seasoned replacements once they have recovered from combat stress. But if combatants begin to realize that within them the insane are being evacuated, the number of psychiatric casualties will increase dramatically.

The civilian victims of war may suffer the greatest psychological harm, for they have not been prepared by the expectation of military training to manage the stress, shock, and fright of violence and loss as soldiers have. The civilian population from the Northern and tribal areas of Pakistan in particular; the IDPs, who were drawn away from their safe surroundings and pushed out deliberately to live in the camp sites and makeshift toilets to use. The children who have lost their parents in this uncalled for war are the real casualties we need to take into consideration. Even if collateral casualties among civilians are few, significant wars universally scare many more people into fleeing from danger if soldiers do not deliberately force them away (as in “ethnic cleansing”); wars typically create up to vast populations of displaced refugees who may live dangerous and desperate lives with uncertain futures.

If this isn’t enough the sleep disorders faced by people affected in this mental trauma are huge. Insomnia or lack of sleep in simple terms is another problem faced by people living in the proximity or war/ bomb blast. The body clock starts ticking and tells the neural links that the surroundings are unsafe for sleep. The results of this are very dangerous to health of the civilians and the soldiers alike. Continued proximity to the war/bomb blast situation combined with an “expectancy” of rapid return to combat, are the principles developed to overcome the paradox of the evacuation syndrome. These principles of proximity and expectancy have proven themselves quite effective since World War I. They permit the psychiatric casualty to get the rest that is the only current cure for his problem, while not giving a message to still healthy comrades that insanity is a ticket away from the madness of the battlefield.

Even with the careful application of the principles of proximity and expectancy the incidence of psychiatric casualties is still enormous. During World War II, 504,000 men were lost from America’s combat forces due to psychiatric collapse—enough to man 50 divisions. The United States suffered this loss despite efforts to weed out those mentally and emotionally unfit for combat by classifying more than 800,000 men 4-F (unfit for military service) due to psychiatric reasons. At one point in World War II, psychiatric casualties were being discharged from the U.S. Army faster than new recruits were being drafted in. Swank and Marchand’s World War II study of US Army combatants on the beaches of Normandy found that after 60 days of continuous combat, 98% of the surviving soldiers had become psychiatric casualties and the remaining 2% were identified as “aggressive psychopathic personalities.” Thus it is not too far from the mark to observe that there is something about continuous, inescapable combat which will drive 98% of all men insane, and the other 2% were crazy when they got there.

Where can anyone begin to detail the consequences of war? Prominent or insurmountable losses compile and historians duly record them. But the “little” tragedies of which personal hells are made; these may so easily be forgotten. Even worse, they may never be fully known, except perhaps by a very few. The impact of war may be terrible. Many may suffer immediate pain, horror, destruction and death. But the legacy of war may just as easily be absences: things which never were, or things which were lost to those who go on afterwards. A contribution never made. A composed state of mind never regained. These “little” things are tremendous things to some human world called a person, yet they are so difficult to really know.

In order to understand war, we must try to appreciate the real effects of war in scales both sweeping and individual — for the sweeping developments come down to the individual, where they are really felt. Only this way can we understand war as humans suffer it. We must not shy away at this basic education demanded by the enthusiasm of fighting future war simply because war disgusts, or because of any other lack of encouragement. Mental anguish during and after warfare should not be underestimated compared to more visible wounds inflicted on other parts of the body which bleed. The invisible wounds to the psyche may actually feel more acute (and are certainly more common), whether resulting from combat it self, living in or near a combat zone, personal connection to a soldier, or simply exposure to war from bomb blasts as the member of a warring population, including intake of propaganda and ideology.

This nation of ours was created to lead as in the times of Khalifa Harun Rashid, or Aaron the Upright as he was popularly recognized, in 763 when he laid down the foundation of the Abbasid’s rule in Baghdad. Exemplary advances were made in those times in Mathematics, Literature, Science, Astronomy, and Medicine. Baghdad was known to be the centre for learning. Eminent names in their professions were brought forward to serve the nation. I am still hopeful as the citizen of this God gifted country. I believe we were created on a special day and for a definite purpose. The philosophy of Allama Iqbal needs to be revisited for I believe the youth of this nation are the future custodians this country has.


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