Millions of former Turkish military have PTSD

From Today's Zaman in Turkey:

Approximately 2.5 million young men in Turkey who completed tours of duty in the Southeast during their compulsory military service might have been afflicted by "Southeastern Anatolia Syndrome," a 1995 study found.

Yet not much has been done to treat these men, many argue today. The report notes chilling findings that 25 percent of soldiers surveyed who are suspected of having the syndrome are suffering from antisocial personality disorder in addition to other problems such as major depression, schizophrenia, agoraphobia, social phobias, panic disorder and generalized anxiety.

One of the authors, Mehmet Sungur, told Sunday's Zaman that not much progress has been made on the issue since a report titled “Common Features of [Posttraumatic Stress Disorder] PTSD Cases Amongst a Group of Military Staff Referred from the Southeast Region of Turkey” was first published in the Journal of Cognitive Psychotherapy in 1995.

Experts underline that there might be many young men in society with a number of psychological disorders due to Southeastern Anatolia Syndrome and this situation is one of the obstacles facing the government in its efforts to end the decades-long Kurdish problem.

Southeastern Anatolia Syndrome, like Vietnam Syndrome is actually PTSD and characterized by the typical psychological symptoms that emerge following a distressing event that is outside the range of usual human experience. Soldiers in southeastern Anatolia frequently encounter life-threatening conditions due to clashes with the outlawed Kurdistan Workers' Party (PKK), which is listed as a terrorist organization by the US, the European Union and Turkey.

“Since the first attack of the PKK in 1984, up until now, almost 2.5 million young men have served in the areas of conflict. Approximately 6,000 have lost their lives and 5,000 have been disabled physically, but we don't know how many of them have been psychologically disabled,” says Nihat Ali Özcan, an expert on terrorism from Turkish Union of Chambers and Commodity Exchanges (TOBB) University.

No statistics have been compiled about those men and no scientific research comducted, except for the study dating back to 1995, which indicated that “all we know is that there is a significant increase in the numbers of referrals of PTSD cases from the Southeast in comparison to the previous three years.” But it is very difficult to know where these “forgotten” soldiers are and from which psychological conditions they are suffering.

Recently, however, Turkey did learn what happened to one of them, after he massacred six of his family members in a military-style trap.

Served in Hakkari, killed all the family

According to media reports, Şafak Köksal had served in Hakkari and Yüksekova and completed his compulsory military service almost one-and-a-half years ago. His relatives and friends indicated that since his return to his hometown of Çaycuma in Zonguldak, he had only talked about how they clashed with the PKK. Köksal also named his 5-month-old son “Doğu,” which means East in Turkish. But after his return, he was frequently aggressive toward his wife and the couple separated.

Köksal, who is believed to be suffering from Southeastern Anatolia Syndrome, ambushed his wife's family in the forest on Aug. 20 as they returned from the mine where they worked, laying a piece of wood in the road so that their car could not get past. Her sisters got out of the car to remove the wood from the road, and he shot and killed them; his mother and father-in-law were shot before they were able to exit the car. Afterwards, he went to the home of his in-laws, breaking a window to enter and then shot his wife, Ayşe (22), and her brother, Aydın Köroğlu (20).

Köksal is now in jail, and his son has been taken into state custody, but he is definitely not the only one who might explode at any time.

After the incident, there were discussions on Southeastern Anatolia Syndrome, but they were quickly forgotten as few young men whose psychology had been affected because of trauma are involved in such incidents.

There was no suitable atmosphere for research

“Since our study, of course, some other studies were done about posttraumatic stress disorder [PTSD] but none of them with the soldiers, as we did. A suitable atmosphere for a similar study has not arisen,” said Professor Sungur, who is now the head of the psychiatry department at Marmara University. He conducted the research for the article when he was doing his military service. Psychiatrists Aksın Sürmeli and Ahmet Özcubukcuoğlu from the Gülhane Military Academy of Medicine (GATA) also contributed to the research.

All the patients who participated in the research were on military duty at the time of the traumatic event, and 20 percent of them encountered the bodies of soldiers killed in action.

“A wide range of concurrent psychiatric disorders accompanied PTSD cases. Twenty-five percent of the cases experienced major depression, 20 percent of the cases experienced schizophrenia, 10 percent experienced agoraphobia, 5 percent experienced social phobia, 15 percent experienced panic disorder and 10 percent experienced free-floating anxiety alongside the PTSD. Twenty-five percent of the PTSD cases had avoidant personality disorder and antisocial personality disorder was present in another 25 percent of the cases,” according to the researchers' article, published in volume 9 of the Journal of Cognitive Psychotherapy.

Professor Sungur told Sunday's Zaman that they did not have the chance to follow up with the soldiers who participated in this study after their military service.

“Curing PTSD might take a long time. Some of them might not even be cured. It depends on the conditions of rehabilitation. For example, the studies show that the ones who have a happy family life are able to be cured faster,” he said.

The article also indicates that the degree of disability associated with PTSD varies widely.

“It may result in severe social and occupational incapacitation. In the study, at the time of referral, none of the subjects were able to continue soldiering and their home, social and personal activities were severely impaired due to the problem.”

The article also states that the study carries the disadvantages of a retrospective study and “predictors of outcome could be identified better by longitudinal data with a long-term follow-up that allows the clinician the opportunity to see natural course of the disorder.”

To keep the performance of the soldiers up

In October 2008, 13 years after this study, GATA established a war psychiatry department. According to an official statement from the department, their aim is to “determine and eliminate the sources of stress which cause the deterioration of a soldier's performance.”

The Web page of the department urges soldier to get professional help if they feel anxious, frustrated and angry.

“Those former soldiers have a tendency toward violence. It is not easy to establish peace where such people are living,” said Şebnem Korur Fincancı, the chairperson of the Turkish Human Rights Foundation (TİHV) and a forensic doctor by profession. She also recalled the incident in Zonguldak and warned that Turkey should be ready for similar events, if it does not take measures to address such problems.

“Those people are wounded but the army does not acknowledge it. There is this image of the heroic Turkish soldier. They also refrain from getting professional help. It is too difficult and painful to face these traumas although it would help them and society,” she said.

Fincancı told Sunday's Zaman that the TİHV will start a “social trauma” program in which they will try to help people who are suffering from trauma as a result of clashes including Southeastern Anatolia Syndrome, adding, “Such work has nothing to do with politics; it is a must for the future of society.”