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.
References
Jayatunge, R. M. (2016, June 21). The cultural perspectives on psychological trauma in Sri Lanka. LankaWeb. https://www.lankaweb.com/news/items/2016/06/21/the-cultural-perspectives-on-psychological-trauma-in-sri-lanka-2/
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