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This paper considers some dilemmas relating to developing effective assistance with and to people who have lived through extreme events in a civil war and ‘post-conflict’ context within Sri Lanka. The tsunami which devastated many coastal areas of Sri Lanka in December 2004 and left many people with no homes or livelihood has further affected the country. A major issue is how far the concepts and methods of western psychology and psychiatry are appropriate to radically different cultures and contexts: in particular, how post-conflict and post-disaster psychosocial rehabilitation may depend in complex ways on local specifics and interact or not with biomedical notions of PTSD diagnosis and individual therapy. The relationship between a culture and its healing rituals is a complex one. Cultural, socio-political, existential and personal meanings, expressions and responses to civil war or traumatic events and their aftermath are likely to be mediated by each individual and the context in which they occur. This paper details our findings and offers some suggestions for future practice.

Health Pluralism: A More Appropriate Alternative to Western Models of Therapy in the Context of the Civil Conflict and Natural Disaster in Sri Lanka?