Thursday, January 23, 2025

The Importance of Metabolic Psychiatry in Clinical Practice

 






Dr. Sarath Panduwawala and Dr. Ruwan M Jayatunge

Metabolic psychiatry is a new field in psychiatry, and it examines mental health issues associated with metabolic dysfunction. Current evidence indicates an association between metabolic dysfunction in the brain and mental illness (Smith, 2024).

Metabolic syndrome also has a huge impact on mental health. The metabolic syndrome, which is connected with abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein, has an impact on mental health parameters. Although metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes, it can cause psychiatric morbidity (Bolton et al., 2013).

Clinical evidence indicates that psychiatric conditions have increased risk for metabolic syndrome (Penninx & Lange, 2018). According to Ho and colleagues (2014), the cause of metabolic syndrome in psychiatric patients is likely to be multifactorial, and psychotropic drugs such as second-generation antipsychotics and mood stabilizers are established risk factors. Antipsychotic-induced weight gain is an existing problem in treating psychiatric patients. Mood stabilizers, particularly lithium and sodium valproate, have been associated with metabolic syndrome (Chang et al., 2009). 

Takeuchi and team (2009) state that metabolic syndrome is associated with increased prevalence of depressive disorder and depressive symptoms, and prevalence ranges from 36 to 50%. Tricyclic antidepressants can cause insulin resistance and hypertriglyceridemia, and patients can experience substantial weight gain (Chokka, Tancer & Yeragani, 2006).

The patients with bipolar disorder have a higher risk of metabolic syndrome than the general population (Chi et al., 2013). As described by Kim and team (2007), dysregulation of the HPA axis with subsequent glucocorticoid resistance, impaired glucose tolerance and insulin resistance, dysregulation of the sympathetic nervous system, and increased pro-inflammatory cytokine production across both phases of bipolar disorder could cause significant negative effects on metabolism. 

Schizophrenia is associated with a greater risk of diabetes mellitus (de Hert et al 2009). Metabolic syndrome is common among people with schizophrenia, and the prevalence is around 5 times higher than that in the general population (Ho et al., 2014).

Yaffe and team (2004) elucidate that metabolic syndrome is associated with cognitive decline, Alzheimer’s disease, and vascular dementia, and the effects could be due to neuroinflammation, oxidative stress, impaired glucose metabolism, and impairment of vascular reactivity. Therefore, identifying and treating metabolic dysfunction in psychiatric patients are essential. Promoting healthy lifestyle practices, diet modification, moderate exercise, and weight management are crucial.

Metabolic Psychiatry discusses the ways to evade the risk of premature mortality in psychiatric patients. The metabolic approach to mental health treatment is imperative. According to Greenblatt (2023), metabolic psychiatry focuses on the removal of processed foods and refined carbohydrates, often implementing a ketogenic diet for the metabolic benefits. The brain chemistry can be changed with optimal nutrition. 

 

(Dr. Sarath Panduwawala is a retired Consultant Psychiatrist who served as a visiting psychiatrist of the Sri Lanka Army.  Dr. Ruwan M Jayatunge is a medical doctor and a Psychologist also a member of the (APA) American Psychological Association)

 

 

REFERENCES

 

Bolton PS, Knight M, Kopeski LM. Metabolic Syndrome: Psychiatric–Mental Health Nurses’ Knowledge of Risks and Care Practices. Journal of Psychosocial Nursing and Mental Health Services. 2016;54(11):44-53. doi:10.3928/02793695-20161026-01.

ChangHHChouCHChenPS et al (2009High prevalence of metabolic disturbances in patients with bipolar disorder in TaiwanJournal of Affective Disorders117: 124–9.

ChiMHChanghHTzengNS et al (2013The prevalence of metabolic syndrome in drug-naïve bipolar II disorder patients before and after twelve week pharmacological interventionJournal of Affective Disorders1467983

Chokka, PTancer, MYeragani, VK (2006Metabolic syndrome: relevance to antidepressant treatmentJournal of Psychiatry Neuroscience31414.

 de Hert, M, Dekker, JM, Wood, D et al (2009) Cardiovascular disease and diabetes in people with severe mental illnesses: position statement from the European Psychiatric Association (EPA), supported by the European Association for the study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry, 24: 412–24

Greenblatt,J. (2023). What Is Metabolic Psychiatry? Retrieved from ; https://www.psychiatryredefined.org/what-is-metabolic-psychiatry/

Ho CSH, Zhang MWB, Mak A, Ho RCM. Metabolic syndrome in psychiatry: advances in understanding and management. Advances in Psychiatric Treatment. 2014;20(2):101-112. doi:10.1192/apt.bp.113.011619.

KimYKJungHGMyintAM et al (2007Imbalance between proinflammatory and anti-inflammatory cytokines in bipolar disorderJournal of Affective Disorders104: 91–5.

Penninx, B. W. J. H., & Lange, S. M. M. (2018). Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues in Clinical Neuroscience, 20(1), 63–73. https://doi.org/10.31887/DCNS.2018.20.1/bpenninx.

Smith, D. (2024).Metabolic Psychiatry – A new paradigm in the management of Mental Health disorder? Retrieved from https://www.swissre.com/reinsurance/insights/metabolic-psychiatry-management-mental-health-disorder.html

Takeuchi, T, Nakao, M, Nomura, K et al (2009) Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study. Diabetes/Metabolism Research and Reviews, 25: 762–7.

YaffeKKanayaALindquistK et al (2004The metabolic syndrome, inflammation, and risk of cognitive declineJAMA292: 2237–

Tuesday, January 21, 2025

Analyzing the Prabhakaran Factor

 


Ruwan M Jayatunge M.D. PhD

Civilized society is perpetually menaced with disintegration through this primary hostility of men towards one another. Sigmund Freud.


Velupillai Prabhakaran (1954–2009) was the leader of the Liberation Tigers of Tamil Eelam, and he launched a destructive proxy war against the Sri Lankan government for over nearly three decades. Prabhakaran was the most lethal and cataclysmic force experienced by the Sri Lankan state in recent history. For many years, he was able to continue his ferocious attacks against the people and the state of Sri Lanka. Following these aggressions, over 100,000 lives were lost, and millions of dollars’ worth of property were destroyed.

Prabhakaran permanently changed the Sri Lankan political landscape and created a collective trauma among people. He became the public enemy number one in the South. Furthermore, he turned the rich Tamil values that are flourished with the doctrine of Hinduism and the teachings of Mahatma Gandhi into a totalitarian cyanide culture. Although Prabhakaran was considered a megalomaniac or a mass murderer in the South among his followers, they used to worship him as a demigod. They hailed him as a hero, a messiah, or a deliverer. Some compared him to the ancient Tamil warrior Sagkillian, who fought against the Portuguese. According to them, Prabhakaran was the person who brought respect and identity to the Tamil people. He had been recognized de facto as the sole representative of the Sri Lankan Tamils, despite the fact that he had eliminated thousands of Tamils, including intellectuals like Dr. Rajini Theranagama, Dr. Nelan Theruchelvam, Mr. Lakshman Kadirgamar, PC, etc. Some of his blind followers still believe that Prabhakaran is alive and is secretly living in Eritrea.  

Prabhakaran committed high-profile killings. He was directly involved in the assassination of Rajiv Gandhi, the former Prime Minister of India. Also, under his orders, Ranasinghe Premadasa, the 3rd President of Sri Lanka, was killed. Moreover, he violated local and international laws, killing statesmen, ministers, and civilians. Also, he was accused by the United Nations of nonstop child conscription. His involvement in human rights abuses was seriously questioned by the West. However, his alleged war crimes and crimes against humanity were not taken to the International Criminal Court (ICC) in The Hague. Upon his death in 2009, he got away with war crime charges. 

Although Prabhakaran was a destructive force, he had military capabilities and organizational skills and knew how to motivate people and convert them into diehard fighters and suicide bombers. His leadership qualities were exceptional. His cadres feared and respected him. He was a tactician and had remarkable skills in the military operations. He launched a number of attacks against the Sri Lankan forces, sometimes overrunning military camps. Furthermore, he was a lethal force that kept fighting for nearly three decades. Even the Indian Army, which is the second largest in the world after China and has over 1.4 million active troops, could not defeat him. One time, he was invincible. 

His war machine faced a number of experienced military commanders. Was he a military genius or a skilled tactician? Some say he followed the war tactics of the great Vietnam General Vo Nguyen Giap, who launched massive attacks against the American forces. 

How could such an uneducated common man make such a huge accomplishment? Indeed, he was a destructive force. But his talents cannot be underestimated. We ought to understand how Prabhakaran was able to create an immense killing machine. Maybe the secret lies within his personality. 

In his book "Inside an Elusive Mind, Prabhakaran M.R. Narayan Swamy describes him as the world's most ruthless guerrilla leader. Moreover, M.R. Narayan Swamy highlights some of Prabhakaran's personality traits. According to M.R. Narayan Swamy, these personalities and psychological features transformed Prabhakaran into a remorseless, unsympathetic, and vindictive person. However, in my opinion, M.R. Narayan Swamy had not gone deep enough inside Prabhakaran’s inner psyche to analyze his behavior and personality traits. 

Indeed, (according to his assumptions), Prabhakaran had valid reasons to start his vicious military campaigns against the Sinhalese and the Sri Lankan government. As a child, he observed Sinhala nationalism and ethnic riots against innocent Tamil civilians. These events created a blazing hatred for the Sinhalese nation. 

Once, when I delivered a lecture on war trauma in Sri Lanka at Washburn University in Kansas, USA, in 2006, one of the professors asked me a direct question. He asked me whether the Prabhakaran factor was created by Sinhala-Buddhist Chauvinism. According to Professor Daya Somasundaram of the University of Jaffna, Tamil militancy was a creation of the Sri Lankan State and armed forces (Page 56: Scarred Minds by Daya Somasundaram). Perhaps these statements do not validate the rising of the Prabhakaran factor. There were other certain personality traits that made the former LTTE leader a ruthless killing machine. His remorseless, die-hard personality made him one of the most callous paramilitary leaders in recent history. 

Undeniably, specific personality factors contributed to Prabhakaran's character and his destructive nature. Along with Prabhakaran, other Tamil militants like Sri Sabarathnam (Tamil Eelam Liberation Organization (TELO) leader) and Uma Maheswaran (People's Liberation Organization of Tamil Eelam (PLOTE) leader) launched attacks against the Sri Lankan security forces. 

The other two leaders were more moderate, and they had no strong prejudice or racial hatred towards Sinhalese people. They were more educated than Prabhakaran. The PLOTE leader, Uma Maheswaran, had Marxist ideas, and he was willing to collaborate with the Sinhalese people who respected the right of nations to self-determination. But Prabhakaran was an uncompromising nationalist. He condemned Uma Maheswaran and Sri Sabarathnam and later killed them. 

Prabhakaran was unschooled and a dropout. His school education was limited to year 10. Some of Prabhakaran's contemporaries indicate that he had a dislike and resentment towards educated people. He had feelings of inadequacy and inferiority when he dealt with educated people. He refuted a number of Tamil intellectuals and even went to the extent of physically eliminating them. Prabhakaran disrupted the school education of thousands of children and sometimes forcibly conscripted them to his baby brigade. 

Dr. Gustavo Gilbert, a renowned American psychologist, analyzed some of the Nazi leaders, like Hermann Göring and the commandant of the Auschwitz concentration camp, during the Nuremberg trial. Dr. Gilbert found an explicit factor that was specific to the Nazis. He identified that the Nazis had a low level of empathy. Also, they had some kind of dual nature. In their private lives, they loved their wives and kids, but when the savage side came into action, they could kill tens of thousands of women and children in gas chambers. There are marked personality traits that were characteristic of Prabhakaran. 

At school, Prabhakaran was mediocre. He was struggling and falling behind in school. He continuously had learning difficulties. Furthermore, he displayed cruelty toward animals, especially cats, squirrels, and birds. Also, he practiced unusual pain-inducing rituals like pricking himself with needles and sleeping in gunny bags with chili powder. These show sadistic and masochistic instincts, which he displayed during the adolescent period.

As a child, Prabhakaran had an inclination towards violence. He hardly obeyed the social rules. Sometimes he used to steal chemicals from the school laboratory to make primitive bombs. On several occasions, he ran away from home and stayed with his relatives. At the age of 16, he set fire to a bus that belonged to the Ceylon Transport Board. At a certain point, young Prabhakaran was uncontrollable to his parents. His adolescent spitefulness and vindictiveness later turned into mass social aggression. 

It is possible to believe that young Prabhakaran suffered from conduct disorder. As described by Fairchild and colleagues (2019), conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behavior. Conduct disorder usually emerges in childhood or adolescence and lies on a spectrum of disruptive behavioral disorders. Conduct disorder demonstrates aggression and violations of the rights of others and evolves over time.  Often, they have repetitive and persistent antisocial behaviors. 

However, there was another side to Prabhakaran. He was a loving father and a cordial person to his personal friends. Anita Pratap, who is an Indian writer and journalist, met Prabhakaran in person and describes him as a charismatic and charming person. In 2003, I interviewed Karate Grand Master Shihan Bonnie Roberts, who met Prabhakaran in Vanni. Mr. Bonnie Roberts stated that Prabhakaran was a friendly and warm person. Nevertheless, his warmth never extended to Sinhalese people.

During his childhood, Prabhakaran frequently heard horrendous stories about the Sinhalese people and their atrocities committed against Tamil people. During the 1958 communal riots, Prabhakaran was a four-year-old child. He heard many stories that revealed brutalities unleashed by Sinhalese people against the Tamil people. During that era, such stories were often fabricated and exaggerated by both parties in order to arouse national feelings. As a child, Prabhakaran often heard these stories, and naturally he developed an animosity against the Sinhalese people. 

Young Prabhakaran had a private tutor, and he was an ultranationalist. This tutor became one of the most influential men of his life, and he injected racial venom into young Prabhakaran. Prabhakar grasped many ideas and racial prejudices from this tutor. 

Another unconfirmed story (told to me by Capt. Amith of the Military Intelligence Corps - Sri Lanka) describes how seven-year-old Prabhakaran witnessed one of his uncles being savagely beaten by a police constable in Jaffna. I think this story has some credibility. During the fifties and sixties, even in the seventies, many policemen who went to serve in Jaffna went with wrath and discontentment. Many police officers were sent to the North following disciplinary issues. Those who went to Jaffna following punishment transfers. These people suffered from severe work-related stress. Their anger and frustration were often focused on the civilians living in the Northern peninsula. Unlike in the South, the police brutality was interpreted in racial terms. 

His birthplace, VVT, or Valvettithurai, was famous for illicit smuggling. This village was often raided by the Sri Lanka Police and the Navy. The first Sinhalese people Prabhakaran saw were these law enforcement officers. Little Prabhakaran became emotionally shattered when he heard about the killing of a poosari in Panadura during the 1958 anti-Tamil riots. This event was described in Malith Jayathilaka's book titled Alimankada as well. The poosari was savagely beaten and burnt alive by the mob.

In his childhood image, the Sinhalese people were brutal, disrespectful to the Tamil people and their culture, and violent by nature. He believed that the majority Sinhalese were constantly tormenting the Tamil people. He wanted to take revenge someday, and he was determined. He wanted to create a brutal, violent force to fight against the Sinhalese.

Certainly, there were a number of atrocities committed against the Tamil people by some Sinhalese factions. Most of them were politically motivated. These atrocities were not accepted by the peace-loving Sinhalese majority, and they condemn such attacks. Even during the 1983 communal riots, many Sinhalese families protected their Tamil neighbors from mob attacks. Professor Rajan Hoole describes the 1983 communal riots as well-planned, politically organized terror against Tamil civilians. According to him, it was not a racial attack due to the high emotions of the Sinhalese public. The burning of the Jaffna Public Library in 1981 was a form of cultural attack against the Tamil people. This malicious act was orchestrated by a group of politicians, and the blame went to the Sinhalese people. 

Prabhakaran was a victim of caste discrimination. social exclusion, stigmatization, and marginalization by the high-caste Tamils made him indignant. Prabhakaran belonged to the fishing (Karayer) caste. The caste system was very much authoritative in Jaffna, and the people of the Karayer caste could not freely move with the high-caste Vellalar Tamils. As a matter of fact, Prabhakaran and his family suffered caste oppression, and it created insecurity, low self-esteem, and an inferiority complex in him. Moreover, he had anger and resentment towards high-caste Vellalar Tamils. His attacks against Vellalar Tamils were less discussed. His first victim, Alfred Thangarajah Duraiappah, the mayor of Jaffna, was a well-respected high-caste Vellalar Tamil. He demanded respect from the Vellalar Tamils, and once he kidnapped a Vellalar girl. This girl, Mathivathani Erambu, later became his wife. Moreover, he arranged Vellalar brides for his lieutenants, such as S. P. Thamilselvan, who belonged to the Ambattan caste. The Ambattans are the Tamil barbers. (S. P. Thamilselvan was the leader of the political wing of the Liberation Tigers of Tamil Eelam).

Prabhakaran became a fugitive in 1975 after killing the mayor of Jaffna. In 1976, he was charged with a bank robbery. Prabhakaran closely associated with many outlaws, like Sivakumar, Kuttumani, Sellakelli, etc. But he had his own uniqueness.

From 1972 to 1978, Police Officer Bastianpillai was behind Prabakaran. He was determined to arrest Prabhakaran and put him behind bars. But many times, he failed. The main reason for the failure was that Inspector Bastianpillai thought Prabhakaran was a conventional criminal. But he was more than a conventional criminal, even in his early years. He was different from other Tamil outlaws. The authorities were able to arrest his associates, but they could not track Prabhakaran.

Prabhakaran never had any constant, sincere friends. Over the years, he was close to Gopalaswamy Mahendraraja, aka Mahattaya, and Vinayagamoorthy Muralitharan, alias “Karuna Ammaan.” Later, he disliked and suspected them, and both became his enemies. Prabhakaran killed Gopalaswamy Mahendraraja. However, Vinayagamoorthy Muralitharan was able to escape from Prabhakaran’s deadly claws.

For Prabhakaran, friendship had no meaning. He was manipulative and used people for his own gain. Prime Minister Rajiv Gandhi and President Premadasa underestimated his manipulative nature. They thought he was genuine. But they made a fatal mistake. 

The former LTTE member Srikumar Selvarajah Kanagaratnam, aka Raheem, was with Prabhakaran from 1983 to 1990. According to Srikumar Selvarajah Kanagaratnam, Prabhakaran was a religious person but not a religious extremist, and he worshiped the Lord Muruga. Once Prabhakaran went to Palani Murugan Temple in Tamil Nadu to prove a pledge. Selvarajah Kanagaratnam further says that Prabhakaran was a teetotaler and never even drank tea or coffee. He was soft-spoken and never went into a rage throwing tantrums. Srikumar Selvarajah Kanagaratnam once saw Prabhakaran shedding tears while resolving an internal dispute. He was a sensitive person, says the former LTTE member who is now living in Canada.

 Prabhakaran admired Ernesto "Che" Guevara, Mao Zedong, and the freedom fighters of the Indian struggle, mainly Subhas Chandra Bose and Bhagat Singh. However, Prabhakaran never had any specific political ideology or vision. The LTTE theoretician Anton Balasingham Stanislaus was a Marxist. But Prabhakaran had no deep knowledge of Marxism or Leninism. His religion and ideology were Tamil ultranationalism. 

Prabhakaran had a deep mortal fascination with torture, and he often used torture to eliminate his enemies. Pottu Amman (Shanmugalingam Sivashankar), LTTE's intelligence chief, was Prabhakaran’s personal instrument of terror. Pottu Amman’s role could be described as that of the SS chief, Heinrich Himmler, or Lavrentiy Beria of the NKVD. According to an eyewitness’s testimony, Prabhakaran had a torture house in Devipuram village, Kilinochchi, in Northern Sri Lanka. Whoever went to Devipuram Torture House endured unimaginable torture and was finally driven to death. Torture had become a method of political control for the LTTE.

Prabhakaran had an ultimate fantasy in his mind. He wanted to create a Great Chola Empire. (The Chola Tamil dynasty originated from southern India and at its peak achieved imperialism under the Medieval Cholas in the mid-9th century CE.). This may have looked absurd, but his inner mind was geared towards this fantasy. Mr. J. N. Dixit, former Indian High Commissioner, has also described this fantasy in his book “Assignment Colombo. Prabhakaran closely interacted with Hindu mythology. Unconsciously, he wished to be the Great Destroyer and the Great Creator. Prabhakaran’s inner fantasies had caused severe human trauma. As a result of three decades of armed conflict, many had lost their lives, and a large number are suffering from various physical and psychological ailments, especially PTSD.

The paradoxical feature of Prabhakaran’s character was fear of death. The Tamil poet Archives Kasi Ananthan stated that Prabhakaran had extreme fears of his death. (Inside an Illusive Mind Prabhakaran by Narayan Swami). He felt anxious about death from time to time. Following “death anxiety,” Prabhakaran took drastic measures to strengthen his security. Even the Indian Army could not reach him. However, he experienced negative emotional reactions in his mortality, which forced him to eliminate his opponents.

Some followers of Prabhakaran thought that he had some sort of divine guidance and some sort of divine power. This was a part of Cult Prabhakaran and the veneration by his supporters. The suggestibility was very high among his followers. They blindly contributed to his fantasy. His fantasy of Greater Eelam" encompasses Tamil Nadu and the other South Indian states (Andhra Pradesh, Tamil Nadu, Karnataka, and Kerala). It’s interesting to know that the dictators like Pol Pot, Saddam Hussein, etc., had fantasies too. Pol Pot wanted to take Cambodia to the ancient Angkor Civilization via killing fields. Saddam Hussain believed that he was the reincarnation of King Nebukad Nazar. This nostalgia caused the deaths of tens of thousands. Similarly, Prabhakaran’s Great Chola fantasy caused a lot of deaths and chaos.

Prabhakaran created a cult of personality that glorified violence and death. He created the Black Tigers, who were motivated to kill and get killed. He used children as young as 10 to kill and inflict torture, becoming the world’s most ruthless terrorist leader. In the latter stages he was overconfident and thought that he was invincible. With such a pompous attitude, he closed Mavil Aru' sluice gates in July 2006, depriving over 15,000 farmers of water. It was the beginning of his downfall. The Prabhakaran saga ended in May 2009 in the Nanthikadal lagoon. According to General Kamal Gunarathna, Prabhakaran was killed by a senior NCO of the 4th Vijayabahu Infantry Regiment. However, the former LTTE member Srikumar Selvarajah Kanagaratnam (Raheem) believes that in the final moment, when he realized that there was no escape, Prabhakaran shot himself.

   

Interviews


1.     Interview with the Late Lt. Col Thuwan Meedeen Military Intelligence Unit Sri Lanka Army 2002/ 2005

 2.     Interviews with Lance Corporal PS (Former POW for more than 5 years)

 3.     Interview with Mr. Jayalath -POW and a civil worker attached to the Poonariyn Camp

 4.     Interview with Major P Military Intelligence Unit Sri Lanka Army

 5.     Lt Gen Gerry De Silva – Former Commander of the Sri Lanka Army

 6.     Ravi De Siva – Undergraduate Rochester University USA –

 7.     2 Interviews with Mr. X – Former member of the LTTE

 8.     Interview with Mr. R – Member of the LTTE

 9.     The former LTTE member Srikumar Selvarajah Kanagaratnam aka Raheem

 10. Corporal Th Member LLRP Special Forces

 11. Lt Col Sarath Embawa Special Forces Sri Lanka Army

 12. Re Fr A – LTTE Sympathizer from Mulangavil Killinochi

 13. Brigadier Roshan Silva - Director Infantry Sri Lanka Army

 14. Brigadier K. H Thammita

 15. Brigadier D.S.G Kempetiya

 16. Maj. General Wajira Wijegunawardana Former Commander of the East

 17. Maj General Sunil Thenakoon Former Commander of the North

 18. Dr. Jayalath Jayawardana M.P

 19. Mr. Bonny Roberts – Who met Prabhakaran in 2005

 

 References:

Clifford T. Morgan / Richard A King/ John R Weisz – Introduction to Psychology ISBN 0-07-043210-4 P 661

 Dixit J.N- Assignment Colombo;2001     

 Hoffman, L. (1993). An introduction to Child Analysis. Journal of Clinical Psychoanalysis 2:5-26.

 Hoole.R -Sri Lanka Arrogance of Power

 Jayatunge Ruwan M. - Posttraumatic Stress Disorder ISBN 955-599-370-5 P 47

 Jayatunge Ruwan M. – Combat Stress ISBN 955-20-8233-4

P40-43

 James C. Coleman/ James Butcher Abnormal Psychology and Normal Life ISBN 0-673-15213-8 P275,278 279

 Linda C. Mayes, M.D. and Donald J. Cohen, M.D (1993) The Social Matrix of Aggression-Enactments and Representations of Loving and Hating in the First Years of Life.

Psychoanalytic Study of the Child, 48:145-169.

Lahey B.L/ Ciminero A.R Maladaptive Behaviour- An Introduction to Abnormal Psychology ISBN0-

673-15151-4 P322-333

 Narayan Swami -Inside an Illusive Mind Prabhakaran

 News Paper Articles (Daily News, Dinamina, Ravaya, Island, Lakbima )

 Philip C. Kendall/ Constance Hammen – Abnormal Psychology ISBN 0-395-62183

p 46, 60, 164, 459, 460, 461, 465, 475

Ross Vasta / Marshall M. Haith / Scott A. Miller- Child Psychology P 440, 446, 461,467 12

Robert S. Feldman – Understanding Psychology – ISBN -0-07-289146-7 P628,630.

Selma Fraiberg (1982) Pathological Defenses in Infancy. Psychoanalytic Quarterly, 51:612- 635.Sigmund Freud (1930) Civilization and its Discontents. 

 Somasundaram Daya – Scarred Minds ISBN 81-7036-725-5

P95, 116

 Tinbergen N (1981) On the History of War, in aggression and Violence: A Psychobiological and Cultural Approach

Zimbardo P.G Psychology and Life ISBN 0-673-15418-1

P 55, 56, 202

Sunday, January 19, 2025

වික්ටර් අයිවන් විසින් හෙළි කල යාපනය රෝහලේ නීති විරෝධී මිනිස් අවයව (වකුගඩු ) ජාවාරම

 




 

වික්ටර් අයිවන් ලංකාවේ මහා පරිමානයෙන් සිදුවූ හොරකම් / ජාවාරම් ගැන හෙළි කලා. ඔහුගේ අවසාන වාර්තාව  වුනේ ලංකාවේ සිදුවන නීති විරෝධී මිනිස් අවයව ජාවාරම එනම් වකුගඩු ජාවාරම​. 

යාපනය රෝහලේ වකුගඩු පිලිබඳ වෛද්‍යවරයා අනියම් සායනයක් පවත්වා ගනිමින් වකුගඩු තැරැව්කරුවන් විසින් ගෙන එන තරුණයන් පරික්‍ෂා කොට යහපත් මට්ටමේ  වකුගඩු ක්‍රියාකාරීත්වය ඇති පුද්ගලයන් වකුගඩු දායකයන් ලෙස බොරැල්ල ප්‍රදේශයේ පුද්ගලික රෝහලකට යොමු කරනු ලැබුවා. මේ ක්‍රියාවලිය මගින් ඔවුන් අති විශාල මුදලක් වංචනිකව උපයා ගත්තා. මේ ජාවාරම පිලිබඳව  මුලින්ම හෙලි කරන ලද්දේ රාවය පුවත්පත හරහා  වික්ටර් අයිවන් විසින්. මානව හිමිකම් ක්‍රියාධරයෙකු වන සැමුවෙල් චන්ඳ්‍රහසන් පවසන පරිදි  ද්‍රවිඩ තරුණයන් 500 ආසන්න පිරිසක් ඕස්ට්‍රේලියාවට පැමිණ තම වකුගඩු රහසේ  ධනවත් දායකයන්ට මුදලට විකුණා තිබේ. මෙම තරුණයන් බහුතරය පරික්‍ෂා කොට නිරෝගී වකුගඩු දායකයන් බවට සහතික කොට තිබෙන්නේ මේ අදාල කූට වෛද්‍යවරයා. 

වික්ටර් අයිවන් විසින් කල හෙළිදරව්ව නිසා  යාපනය රෝහලේ වකුගඩු ජාවාරම පිලිබඳව සෞඛ්‍ය හා දේශිය වෛද්‍ය සේවා අමාත්‍යාංශයේ හදිසි වැටලීම් අංශය මගින් පරීක්‍ෂණයක් පැවැත්වීම සඳහා ජි.කේ.ජි.එන්.ප්‍රියදර්ශන මහතාව විමර්ශන නිළධාරි ලෙස පත් කොට යවනු ලැබුවා. එහෙත් වකුගඩු මාෆියාවේ බලපෑම් නිසා විමර්ශන කටයුතු හරි හැටි කෙරුනේ නෑ. එය තවත් නාමික පරීක්‍ෂණයක් වුනා.   

පසුව මේ වෛද්‍යවරයා පොලොන්නරුව රෝහලට මාරුවී ගියා. වික්ටර් අයිවන් විසින් සිදු කල හෙලිදරව් කිරීම නිසා පොළොන්නරුව මහ රෝහලේ අධ්‍යක්‍ෂ වෛද්‍ය ඉන්දික සම්පත් මහතා ඇතුළු කාර්‍යමණ්ඩලය මිනිස් අවයව ජාවාරම් සිදු කල මෙම වෛද්‍යවරයා පිලිබඳව  සෝදිසියෙන් සිටි අතර පොලොන්නරුව රෝහලේදී ඔහුට නීති විරෝධී කූට වකුගඩු සායන පැවැත්වීමට ඉඩකඩ  අසුරා දැමුවා.  අහේතුවකට මෙන් රාවය පුවත් පත වසා දැමුනා . ඒ නිසා තව දුරටත් වකුගඩු හොරකම් ගැන වික්ටර් අයිවන්ට ලිවීමට අවකාශයක් තිබුනේ නෑ. නමුත් ඔහු පත්තු කල වෙඩිල්ලේ දෝංකාරය නිසා හොරෙන් කෙරී ගෙන ගිය වකුගඩු ජාවාරම පිලිබඳව ජනතාව තොරතුරු දැන ගත්තා.  රාවය පුවත් පත දිගින් දිගටමා තිබුනා නම් වික්ටර් අයිවන්  මේ සටන අත නොහරින බව විශ්වාසයි.  

Repulsive Meditation ; Treatment for Sex Addiction




Repulsive meditation (contemplation of the disgusting/meditation on foulness), or Pilikul Bhavana, aka Ashubha Bhavana, are reflections on repulsiveness. It is a form of insight meditation. In this meditation, thirty-one parts of the body are contemplated in a variety of ways through mindfulness. This type of meditation is indicated in sex addiction, and it helps to overcome desire and lust and eventually reduce craving and attachment for the body and bodily pleasure.   

People with sexual addiction (hypersexual disorder) are having obsessive thoughts and behaviors as well as sexual fantasies. Hypersexual behavior can be considered an addictive disorder. It is an impaired regulation of sexual desire and sexual compulsivity, including having sex with uncontrolled excessive frequency. Usually personal distress, shame, and guilt are associated with this condition. 

Repulsive meditation can be an adjunctive therapy for the treatment of sex addiction.   While practicing repulsive meditation, the meditator realizes the impermanence, decay, and suffering associated with the body. He perceives the body as composed of elements that are constantly changing (aging), subject to dissolution and decay.    

This meditation can be considered as an antidote to feelings of lust. While meditating, the meditator makes an effort to lower the sensual desire, lust, and bodily attachment. The meditator realizes that the human body is impermanent, changing, repulsive, and rotting in nature. The meditator is not suppressing his sensual fulfillment; instead, he realizes the genuine nature of carnal pleasures. He can control the development of clinging. 

Dr. Ruwan M Jayatunge M.D. PhD 

Saturday, January 18, 2025

Puttalam District Community Mental Health Programs ; By Dr Ruwan M Jayatunge -Focal Point Mental Health

 





Puttalam District Community Mental Health Programs
By Dr Ruwan M Jayatunge -Focal Point Mental Health
Ministry Of Health Sri Lanka

You tube Link ; https://www.youtube.com/watch?v=EkLQ3U4R7eY

Monday, January 13, 2025

Tuesday, January 7, 2025

The Training Program by Gary Noesner of the FBI

 



My dear friend Gary Noesner—the former FBI agent and the key negotiator during the Waco siege—agreed to conduct a 40-min educational Zoom program for Sri Lankan professionals who are interested in positive communication and hostage negotiations. This is a free session, and we are inviting members from the security forces and educators. Those who like to take part in this program should send their request to transyl2014@gmail.com with their full name and current profession. We are planning to have this program in mid-February 2025. 

Dr. Ruwan M Jayatunge M.D. PhD 


About Gary Noesner 

Gary Noesner was an FBI hostage negotiator. He was heavily involved in numerous crisis incidents covering prison riots, right-wing militia standoffs, religious zealot sieges, terrorist embassy takeovers, airplane hijackings, and over 120 overseas kidnapping cases involving American citizens. Gary Noesner retired from the FBI in 2003 following a 30-year career as an investigator, instructor, and negotiator.

Gary Noesner conducted effective communication with David Koresh—a cult leader and Gary was able to save some hostages held by him. David Koresh (Vernon Howell), a religious fanatic in Texas  had illegal weapons and also had an alleged practice of having sex with girls as young as twelve. There were ongoing child physical and sexual abuse inside the compound. David Koresh taught that he was a messiah and brainwashed his followers to prepare for Armageddon. 

On Feb. 28, 1993, Noesner flew to Waco, Texas, to serve as a negotiator in a crisis that would change the FBI forever. During an attempt to make an arrest at an isolated compound in Mount Carmel, Texas, 80 armed ATF federal agents were embroiled in a shootout with members of the Branch Davidians, a religious group led by David Koresh. Four agents and five Branch Davidians were killed, Koresh was injured and an armed standoff began that would last until mid-April. 

The day after the gun battle, when FBI agents arrived on the scene, Noesner spoke with Koresh on the phone, “Hi, David. This is Gary,” he said. “I just got down here, and I want to make sure that you and your family get out of this situation safe and sound.”

Noesner led a team of 24 negotiators who secured the release of 35 people, mostly children, from the compound. At one point, Koresh agreed to surrender to authorities, but later reneged, saying that God had told him to wait. This led some FBI agents impatient. 

The FBI made a full 60 hours of negotiation with Koresh. Gary Noesner was gaining a considerable success. Despite Gary Noesner's recommendations, some of the FBI officers planned a full-scale military operation. Noesner left Waco and, after his departure, no further Davidians were freed.

On April 19 the FBI raided the compound, using military-grade weaponry such as armored tanks, as well as tear gas. A fire broke out—the source of which remains disputed—and 76 of the 85 Branch Davidians, including Koresh and a number of children, were killed.

The Waco siege is similar to the mass suicide at Jonestown that was orchestrated by Jim Jones. It was the 51-day siege between FBI agents and members of the Branch Davidian religious group in Waco, Texas. The siege took place between February 28 and April 19, 1993.   

The story of Waco is also the story of disagreements over religious freedom, the rights, and the boundaries of the federal government. Moreover, it was about underestimating the power of communication.    

Waco did not end with David Koresh's death. Right-wing anti-government bomber Timothy McVeigh carried out his 1995 Oklahoma City bombings in part as a direct response to Waco, where he had been an eyewitness at the siege.

 



Monday, January 6, 2025

The life is like a Russian Roulette

   



 

The life is like a Russian roulette
Dangerous and unpredictable
It is a game of chance that could end deadly
Often taking foolhardy risks
It’s highly irresponsible
Morally indefensible
But the end is guaranteed
You cannot escape
With each click of the gun
Your fears intensify
If you are religious
Behold to your god
If you are an atheist
Count on fatalism 
Anyhow your destiny is sealed
The odds are stacked against you
Though its hard , it's easy to play
You spin the cylinder of a revolver
With one bullet and points the gun at your head
Then pull the trigger
There is only one bullet
In one of the six cylinder slots of the revolver
You can count on probability
The cylinder is spun to randomize the position of the bullet
Your anxiety and hesitation are high
If the chamber with the bullet is fired
You are history
If you get a silver bullet
Consider you are lucky
You can have a comfortable instant death
If the revolver is loaded with an explosive bullet
People can see your brain matter on the floor


Ruwan M Jayatunge

Sunday, January 5, 2025

ව්ලැදිමීර් විසෝස්කි ගේ Кони привередливые -Fastidious Horses ගීතය


 


ව්ලැදිමීර් විසෝස්කි  ගේ  Кони привередливые  ( Fastidious Horses) ගීතය

කඳු බෑවුම සහ අගාධයට ඉහළින්
මහා දුර්ගයේ මා අසු පිට නැග යමි
දූවිල්ල , සුලඟ සහ මීදුම අතරින්
බොඳවූ මාර්ගයේ මා ගමන් කරමි
 
අධිවේගී  අසුන් මාගේ කසය නොසලකති
ඔවුන් වේගවත් බවින් බවින් යුතුව ගමනේ යෙදෙති
වෙහෙස, දූවිල්ල , හුස්ම ගැනීමේ අපහසුව
මාගේ ගායනට බාධා කරති

මා කඳු බෑවුමේ ගමන් කරමි
අසුන්  ඉතා වේගයෙන් දිව යති
මාගේ ආයාචනා නොසලකති 
විඩාපත් අසුන්ට ජලය අවශ්‍යව ඇත
එහෙත් අසුන් නොනවත්වාම දිව යති

මා විනාශය අභියසය
කුණාටුවට අසුවූ පියාපතක් මෙනි
උදෑසන ඇද හැලුනු හිම
මා යටකර ගනු ඇත
මාර්ගය තරණය කිරීමට
මා අසීරුවෙන් අසුන් මෙහෙයවමි

අධික වේගයෙන් දිව යන අසුන්
කස පහර නොතකති
මාගේ ගීතය ගායනා කිරීමට
මට ඇති අවකාශය අල්පය
මා ආයාචනා කරමි 
එහෙත් මාගේ ආයාචනා 
කිසිවෙකුට නොඇසෙයි

ඉක්මන් නොවන්න
මම ඔබෙන් අයදිමි
තද බෑවුමේ සිටින මා
අසීරුවෙන් ගීතය අවසන් කරමි

සංචාරය සඳහා අපට කාලය තිබුණි
දෙවියන් වහන්සේට ප්‍රමාදයන් නොමැත
එහෙත් දේවදූතයන්  ගේ ගායනය කෙසේ අසම්ද ?
ඔවුන් එවැනි නපුරු කටහඬකින් ගායනා කරන්නේ මන්ද ?

අපට ඇසෙන්නේ ගීතයක් ද ?
නැතොහොත් දුක්ඛිත සීනුවක විලාපයද ?

අකීකරු අසුන් නිසා ගමන දුෂ්කරය
පියඹා නොයන ලෙස මා ඔබගෙන් අයදිමි
ඔබට ජීවත් වීමට කාලය නොමැති නම්
අවම වශයෙන් ගායනා කිරීම අවසන් කරන්න

මා අසුන්ට විරාමයක් දෙමි
මා ගීතය අවසන් කරමි
එහෙත් මා තවමත් සිටින්නේ බෑවුමේය​. 


ව්ලැදිමීර් විසෝස්කි  ගේ  Кони привередливые  ( Fastidious Horses) ගීතය දෛවයේ නොවැළැක්විය හැකි බව සහ යමෙකු ගේ ආසන්න අවසානයට එරෙහි අරගලය නියෝජනය කරන අන්දම අශ්වයන්ගේ රූපකය හරහා ව්ලැදිමීර් විසෝස්කි පවසයි. කථකයා තම අශ්වයන් කඳු බෑවුමක් දිගේ පදවාගෙන යමින්, විනාශය සහ නොවැළැක්විය හැකි අවදානමක් පිලිබඳ පෙන්වා දෙයි. කඳු මුදුනේ රූපය සංකේතවත් කරන්නේ ජීවිතයේ අවිනිශ්චිතභාවය සහ තමාගේම මරණයට එරෙහිව නිරන්තරයෙන් කරන අරගලයයි. කාලය සහ ඉරණමෙහි නිර්දය ගමන මෙම ගීතය අවධාරණය කරයි. ස්වභාවධර්මය,  පැකිලීමකින් තොරව ඔහුව අතුගා දමන බලවේගයක් ලෙස පුද්ගලාරෝපණය කරයි. දෛවය හමුවේ බල රහිත බව  සහ නොවැළැක්විය හැකි දේ ප්‍රමාද කිරීමට නිෂ්ඵල උත්සාහයක් බව කියයි.  

දෙවියන්වහන් සේ අභිමුඛය සහ දේවදූතයන් ගේ ඝෝර ගීත නාදය  මරණයේ ප්‍රවේශය සහ මරණින් මතු ජීවිතය සංකේතවත් කරයි. අසුන් ගෙන් වේගය අඩු කරන ලෙස කරන ඉල්ලිම යනු තමා ආරම්භ කළ දේ අවම වශයෙන් තම අවසානය පැමිණීමට පෙර අවසන් කිරීමට ඔහුගේ ආශාවයි. සමස්තයක් වශයෙන්, ගීතය දෛවය, මරණ සහ කාලයාගේ ඇවෑම, අරගලය යන තේමාවන් වෙත යොමු කරයි.වේගවත් අශ්වයන් නියෝජනය කරන්නේ කෙනෙකුගේ ජීවිතය නියම කරන පාලනය කළ නොහැකි බලවේගයන් සහ ඉරණමට අභියෝග කිරීමට ඇති නොහැකියාවයි.කථකයාගේ ආයාචනා සහ ප්‍රාර්ථනා නොතකා, ඔහු අවසානයේ ඔහුගේ ඉරණම පිළිගන්නා නමුත් ඔහුගේ කාලය අවසන් වීමට පෙර අවම වශයෙන් ඔහුගේ ගීතය සම්පූර්ණ කිරීමට ඉඩ දෙන ලෙස ආයාචනය කරයි. මෙම ගීතය හරහා විසෝස්කි ජීවිතයේ අස්ථිර ස්වභාවය සහ මරණයේ නොවැළැක්විය හැකි බව පිළිබිඹු කරයි.

රුසියානු ගායකයෙකු, ගීත රචකයෙකු, කවියෙකු සහ නළුවෙකු වූ ව්ලැදිමීර් විස්සෝස්කි යනු රුසියානු ආත්මයේ කැටපතකි. සෝවියට් සමයේ නිහඞ පරම්පරාව නියෝජනය කල ඔහු තම ගීත තුලින් ජීවිතය තේරුම් කර දීමට උත්සුක විය​. ඔහුගේ බහුවිධ කුසලතාව සෝවියට් දේශයේ පමණක් නොව බටහිර ලෝකයේද ප්‍රචලිතය​. නිල සෝවියට් සංස්කෘතික සංස්ථාපිතය විසින් ඔහුගේ කාර්‍යය භාරය නිර්මාණ නොසලකා හැරියද ජනතාව ඔහුව ආදරයෙන් වැළඳ ගත් හ​. ඔවුන් ගේ හදවත්වල විස්සෝස්කි යන නාමය අමරණීයය​. ඔහු රුසියාවේ බොබ් ඩිලන් ලෙසද නම් කරති. 


Mikhail Baryshnikov in White Nights - "Capricious Horses"

(White Nights is a 1985 American musical drama film directed by Taylor Hackford and starring Mikhail Baryshnikov, Gregory Hines, Jerzy Skolimowski, Helen Mirren and Isabella Rossellini.) 

Link ; https://www.youtube.com/watch?v=rzfmQ70cBj8

 

 

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