Dr. Ruwan M Jayatunge M.D. PhD
Killing a human being is a psychologically
distressing act (Jensen & Simpson, 2014). Research indicates that soldiers
who have engaged in killing are at a higher risk of developing post-traumatic
stress disorder (PTSD) compared to those who have merely observed acts of
violence (Winkle & Safer, 2011). Traditional PTSD frameworks focus heavily
on fear, personal danger, and helplessness; in contrast, the act of killing
creates unique trauma profiles characterized by issues of perpetration, moral conflict,
and existential guilt (Maguen et al., 2011). The impact of killing during
warfare notably heightens the likelihood of military veterans experiencing
psychosocial issues and an increased risk of suicide (Purcell et al.,
2026).
Soldiers often find themselves
grappling with a profound moral dilemma following the act of taking enemy
lives, as they confront the stark contrast between their military conditioning
and their innate human empathy. This internal conflict frequently leads to
intense shame and an existential crisis, as they struggle to reconcile their
actions with their moral beliefs and the value of human life. As a result of
impact killing solders have functional impairment with higher rates of anger,
violence, and relationship issues (Maguen et al., 2009). Nordstrand
and colleagues (2026) assert that the long-term psychological effects of
killing are likely shaped by the specific context in which the act occurs. This
complex interplay involves multiple factors, such as group norms, mission
objectives, pre-deployment anticipations, and the process of reintegrating into
civilian life, all of which can significantly influence the psychological
aftermath of such actions.
The
Eelam War in Sri Lanka, which spanned from 1983 to 2009, profoundly affected
the psychological well-being of many combatants, particularly in relation to
their experiences of killing enemy personnel. Given that Sri Lanka is
predominantly a Buddhist nation, many soldiers were raised in environments
steeped in Buddhist teachings, which emphasize the principles of Karma and
rebirth. The act of taking a human life often led to significant internal
conflict and distress, as these soldiers grappled with the moral implications
of their actions in light of their cultural and spiritual beliefs.
The
Impact of Killing (IOK) among military veterans in Sri Lanka has evolved into a
multifaceted mental health crisis that spans several decades. This crisis is
primarily fueled by profound moral injury, which arises from the ethical dilemmas
faced during combat, alongside an overwhelming sense of spiritual guilt that
veterans carry as a result of their experiences. Additionally, the lingering
effects of unaddressed combat trauma contribute significantly to the
psychological distress experienced by these individuals.
During
our treatment of soldiers, we encountered numerous combatants who exhibited
significant personality transformations due to their experiences of taking
enemy lives. The subsequent case vignettes illustrate the profound
psychological responses these individuals faced.
Lieutenant
RXT was a promising young officer whose aspirations for a distinguished
military career were abruptly derailed during the tumultuous JVP uprising of
1988/89. The situation escalated dramatically when his camp was infiltrated by
rebels, resulting in the tragic loss of five of his soldiers and an attempted
theft of firearms. In the heat of the confrontation, Lieutenant RXT found
himself in a position where he had to take the life of one of the assailants,
an act that, while deemed necessary and justified in the context of self-defence,
left an indelible mark on his psyche. The aftermath of this encounter proved to
be devastating; the weight of having taken a life burdened him with profound
guilt and remorse, leading to a gradual decline in his mental well-being. As he
struggled to cope with the emotional fallout, he turned to alcohol as a means
of escape, which in turn caused him to neglect his military responsibilities
and fostered a pervasive sense of foreboding regarding his future. Over the
years, this downward spiral intensified, culminating in a debilitating
addiction to alcohol that necessitated multiple hospitalizations for
alcohol-related disorders, further isolating him from both his personal
relationships and professional obligations.
Sergeant
Major TXL, a seasoned non-commissioned officer, had a distinguished career
marked by his involvement in numerous operations against the Liberation Tigers
of Tamil Eelam (LTTE). One particularly harrowing incident occurred when
Sergeant Major TXL and his unit were ambushed while travelling in a military
vehicle. This sudden attack resulted in the tragic loss of five of his
comrades, plunging the team into a fierce firefight. The chaos of battle not
only claimed the lives of his fellow soldiers but also led to collateral
damage, tragically affecting innocent civilians caught in the crossfire. The
emotional toll of this event weighed heavily on Sergeant Major TXL, leaving him
profoundly shattered. As he progressed further into his military career, he
found himself increasingly isolated, plagued by intrusive memories of the
violence he had witnessed and participated in. These haunting recollections
contributed to a deepening sense of despair, culminating in a desperate moment
when he attempted to take his own life by jumping in front of an oncoming
train. However, a turning point came when he sought spiritual therapy, which
fostered a significant transformation in his life. Through this process,
Sergeant Major TXL embraced a deeper faith, leading to a remarkable change in
his personality and outlook on life as he found solace and purpose in his
newfound spirituality.
The
narrative of Major AWX serves as a distressing exploration of the profound
effects that killing can have on the human psyche, illustrating how individuals
can devolve into compulsive murderers. Initially, Major AWX was a promising
student hailing from a prestigious school in Kandy, whose academic prowess led
him to the Kothalawala Military Academy, where he graduated as an infantry
officer. He subsequently joined the Vijayaba Infantry Regiment (VIR) and was
deployed in various operational zones, where he encountered the traumatic realities
of combat. Over time, the psychological toll of these experiences manifested in
significant alterations to his personality. Following his involvement in lethal
military engagements, Major AWX underwent a disturbing transformation,
ultimately becoming an individual driven by an insatiable urge to kill. During
a therapy session, he chillingly remarked that he "fossilizes
enemies," a statement that underscores his desensitization to violence,
which soon extended beyond enemy combatants to innocent civilians. Despite his
attempts to seek psychological assistance, his treatment was thwarted by
bureaucratic obstacles, leaving him without the necessary support or monitoring
as he returned to the battlefield. His mental health deteriorated rapidly,
marked by debilitating headaches, intense rage, hyperarousal, intrusive
combat-related thoughts, and burgeoning homicidal tendencies. This unchecked
decline culminated in his emergence as a cold-blooded serial killer,
responsible for the brutal murder of several innocent individuals. A
particularly heinous act occurred in 2004 while he was stationed with the 215
Brigade in Mannar, where he lured a victim to the Manthottam camp, intoxicated
him, and subsequently committed a gruesome murder by stabbing, dismembering,
and incinerating the remains. Ultimately, Major AWX was apprehended by the
police, but tragically, he took his own life while in custody at Bogambara
Prison. This tragic outcome raises critical questions about the systemic
failures that prevented him from receiving timely and effective treatment,
suggesting that with appropriate intervention, many lives, including his own,
could have been spared from the devastating consequences of his actions.
These
case studies indicate that "The impact of Killing" can lead to a
profound Collision of Conscience, resulting in significant psychological
transformations among soldiers. Following their involvement in acts of killing,
many combatants experience intense feelings of guilt, which can subsequently
lead to depression and a profound sense of isolation from their peers and
society. This emotional turmoil often manifests in various detrimental ways,
with some individuals becoming addicted to violence, perpetuating a cycle of
aggression that further entrenches them in a life marked by brutality and moral
conflict. The psychological ramifications of such experiences highlight the
complex interplay between combat, mental health, and the potential for ongoing
violence, underscoring the need for comprehensive support systems for those
affected.
Psychological interventions are essential for soldiers grappling with guilt, depression, and intense emotions after engaging in combat and taking enemy lives. These interventions can provide the necessary support to help them process their experiences, manage their feelings, and promote mental well-being. By addressing these psychological challenges, we can facilitate their recovery and reintegration into civilian life. According to MacNair (2002), the impact of killing manifests through profound guilt, nightmares, and higher symptom severity than traditional PTSD, often requiring specialized therapeutic approaches to address. Komarovskaya and colleagues (2011) highlight that this trauma is uniquely linked to perpetrating harm, requiring targeted, specialized mental health interventions rather than general protocols.
The
Impact of Killing (IOK) treatment protocol, developed by VA clinical
psychologists such as Dr. Shira Maguen, aims to address the moral injury
experienced after taking a life. This protocol is generally administered over
ten sessions as an individual cognitive-behavioral therapy. It integrates
components from Cognitive Behavioral Therapy (CBT), Gestalt therapy, and
existential or relational psychotherapies to provide a comprehensive
therapeutic approach (Maguen et al.,2017).
Self-Forgiveness
Integration also represents a valuable therapeutic approach aimed at
alleviating the psychological distress linked to the profound consequences of
taking a life. This method facilitates a transformative journey for individuals
grappling with guilt and remorse, guiding them away from patterns of
self-destructive behaviour that often arise in the aftermath of such traumatic
experiences (Purcell et al., 2022). By
fostering a sense of healthy accountability, this approach encourages
individuals to confront their actions and the associated emotional turmoil,
ultimately promoting a path toward healing and personal growth. Through the
process of self-forgiveness, individuals can begin to reconcile their past,
allowing them to reclaim their sense of self-worth and move forward with a
renewed perspective on life.
Furthermore,
the healing process from the psychological trauma associated with violence,
such as that depicted in "The Impact of Killing," can be
significantly facilitated through the integration of cultural elements (Jayatunge,
2016). In Sri Lanka, a nation with a rich cultural heritage spanning over 2,500
years, traditional practices, beliefs, and communal activities serve as vital
mechanisms for emotional recovery. This deep-rooted culture not only provides a
sense of identity and belonging but also offers various forms of expression and
support that can help individuals cope with their psychological wounds.
Indigenous
Shanthikarma (healing) rituals, which focus on mitigating emotional distress, alongside Thovilaya, a form of
psychodrama, play a crucial role in addressing the psychological trauma
experienced by combatants affected by the profound consequences of killing.
These practices often incorporate rhythmic drumming, which serves to stimulate
both hemispheres of the brain, thereby facilitating a healing process akin to
Eye Movement Desensitization and Reprocessing (EMDR). Such traditional rituals
are not merely cultural expressions; they are vital therapeutic interventions
designed to restore a sense of balance and harmony in individuals who perceive
a disruption in their cosmological order due to their experiences in conflict.
By engaging in these time-honoured practices, combatants can find pathways to
healing that respect their cultural heritage while effectively addressing the
psychological scars left by their experiences.
In addition,
spiritual therapy plays a crucial role in the healing journey of soldiers who
are dealing with the intense psychological repercussions associated with taking
a life. This therapeutic approach is deeply rooted in Buddhist philosophies and
incorporates various meditation techniques, particularly Vipassana and Metta
Meditation (meditation of lovingkindness), which focus on cultivating
mindfulness, compassion, and the recognition of the interconnectedness of all
living beings (Jayatunge, 2023). By participating in these meditative
practices, soldiers are allowed to enhance their awareness of their internal
thoughts and emotions, enabling them to navigate their traumatic experiences
within a nurturing and understanding framework. The core tenets of Buddhism
advocate for a compassionate confrontation with one’s suffering, promoting
acceptance and insight that can lead to a profound sense of inner tranquillity and resilience. As soldiers engage with these spiritual practices, they may
discover a transformative path toward healing that not only addresses their
psychological scars but also fosters a renewed sense of purpose and a deeper
connection to the broader arras of life.
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