Tuesday, July 25, 2017

Miles to go: Seven years on from Saffron

A key figure in the protests that engulfed Myanmar in September 2007, Gambira spent four years and two months behind bars – and was brutally tortured by his captors – before being released from prison in a January 2012 amnesty. Having once taken on the military regime, Gambira is now engaged in a new battle: overcoming post-traumatic stress disorder that stems from his time in prison, writes Kayleigh Long.

Gambira (right) talks with therapist Dr Rory Magee at The Cabin in Chiang Mai, northern Thailand. Photo: SuppliedGambira (right) talks with therapist Dr Rory Magee at The Cabin in Chiang Mai, northern Thailand. Photo: Supplied

It was the meditation that Gambira learned as a young monk that helped him to survive prison, with its beatings, boredom and awful food. It helped him to be free – “free from fear, free from anger, free from grief”, he says – despite the bare walls and iron bars.

These days, he meditates just once a day, before bed.

While the rest of us take it for granted, sleep does not come easy for Gambira, who shot to prominence as one of the leaders of the 2007 protests. When it does finally arrive, his dreams are filled with recurrent nightmares.

“I have dreams – it is like physical torture. They’re not really beating [me] now, but it is not far away,” he told The Myanmar Times during a recent interview in Chiang Mai.

A pair of jeans and a plain T-shirt – sometimes matched with black-rimmed glasses (a gift from the US embassy) and a leather jacket – have replaced the monk’s robes that the 35-year-old wore for most of his adult life.

Some outward signs of his time in the Sangha remain. When speaking Burmese, he has a deep, rhythmic voice - a cadence that likely developed from years of chanting. One of the hardest aspects of transitioning to lay life, he says, was adjusting to the informal tone of conversation.

Like many monks, Gambira had a formidable memory. This helped him greatly when he went underground before the uprising, as it was too dangerous for plans to be written down.

He can still recall much about the four years and two months he spent behind bars - normally solitary confinement - in prisons in Yangon, Sagaing, Ayeyarwady and Mandalay regions. But since walking free in January 2012, Gambira has struggled to remember basic things, such as taking the minimum-dose mood stabilisers he has been prescribed, or the antihistamines for his sinus problems.

A physician who treated him upon his release said he showed signs of traumatic brain injuries (TBI) from the severe beatings inflicted by guards. When he first got out, his speech had been affected and he was prone to slurring.

Life after prison was tough. Never out of the spotlight for long, Gambira made a short-lived return to the Sangha, and entered into an even shorter marriage. He was rearrested several times and eventually moved to Thailand, where he sought treatment for post-traumatic stress disorder (PTSD).

Some of the scars he bears from prison, like those around his wrists from being forced to wear steel handcuffs for months at a time, will not fade. With treatment, though, there is hope that his poor memory, insomnia, headaches and recurrent nightmares – all textbook PTSD symptoms – can be alleviated, if not cured.

Life at The Cabin

In mid-2014, Gambira became an outpatient at The Cabin, a high-end rehabilitation facility on the outskirts of Chiang Mai. At US$13,000 a month, The Cabin’s treatment programs would normally be outside Gambira’s means, but he has been taken on for free as part of the centre’s CSR program.

His treatment at The Cabin is a regular schedule of yoga, mindfulness meditation and eye movement directional reprocessing (EMDR) therapy, overseen by his therapist, Rory Magee.

EMDR was developed in the late 1980s by Dr Francine Shapiro who, while taking a walk one day, found that moving her eyes from side to side reduced the severity of troubling memories. She conducted tests and developed a clinical method that involved having a patient make repetitive eye movements from one side to the other, often following the therapist’s pen or finger, while conjuring up the thoughts or memories they found most troubling.

While initially dismissed as fringe science, a psychiatric snake oil for the 1990s, studies have since shown eye movements appear to play some role in processing traumatic memories – though exactly how this works is a matter of some conjecture.

The therapist asks the patient to remember a scenario or event in as much detail as possible: sights, sounds, smells, sensations, emotions. It’s shown to have a high success rate, and as a rule of thumb can halve the amount of therapy time required.

That Gambira is in need of treatment is clear. When he arrived at The Cabin, Gambira was to be an in-patient but became so distressed when staff took away his medication – standard practice in an addiction treatment facility – that he insisted on leaving. The fact that he would be unable to leave the facility and would have to surrender basic freedoms such as regulating his own medication intake seemed to trigger something. The Cabin agreed to take him on as their first outpatient, provided he kept up his appointments.

Sitting on a couch in the sunny group therapy room at The Cabin, Dr Magee explains that trauma can generally be divided into two categories: “little t” and “big t”.

The former includes upsetting experiences, such as a bad breakup, a humiliation, a failure and getting fired: events that can have a major and enduring impact on a person’s mental state.

“Big t” trauma, meanwhile, completely overwhelms a person, and is characterised by an acute sense of helplessness and founded, abiding fear of death. It often presents in witnesses or victims of violence, natural disasters, rape, war. Post Traumatic Stress Disorder gained widespread recognition after the Vietnam War, with the “you weren’t there, man” phenomenon of shell-shocked veterans rising to prominence and giving way to a broader dialogue. PTSD gained official recognition in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, in the 1980s.

Gambira’s is trauma with a big, big “T”. This sort is not consigned to the semantic memory – that is, the “this is something that happened at x point in time”, factual-recall part of the brain. Those with PTSD exist on the brink, in a near-permanent state of heightened anticipation.

Sensory triggers can bring trauma crashing back into the present, with overwhelming feelings of hopelessness and fear. There are also physical effects: sudden rushes of adrenaline, an elevated pulse, affected breath. Dr Magee gives the example of a former patient who’d seen action during his time in the armed forces and who, when a car backfired, was suddenly nowhere to be seen. As far as this man’s mind and body were concerned, he was still in a war zone.

To tackle Gambira’s most serious traumas, Dr Magee asks him to imagine the worst period at each of the five prisons he did time in, while guiding him through eye movements. Overall, Gambira says, he has found that starting EMDR has reduced the incidence and severity of nightmares, his moods have stabilised, his headaches have all but gone away, and he is less easily triggered. He still has an extraordinary amount of trauma to contend with, but he’s working through it.

“I think I am getting better,” Gambira says. “About 80 percent; 20pc remains. I [still] get really sad; I need to take a rest. The doctors tell me to take a rest for a year – at least.”

Before the revolution

Gambira was born in June 1979 as Mg Nyi Nyi Lwin, a name he tattooed crudely on the back of his hand as a child. His father was a publisher and a key organiser of anti-government protests in Meiktila in 1988; young Mg Nyi Nyi Lwin would help his mother give food to protesters at sit-ins.

Despite his later pro-democracy activities, he laughingly describes himself as a “black sheep” of the family. He ran away from home at 12 to join the Tatmadaw but quickly grew to dislike the system of discipline that saw the entire unit punished for one member’s misbehaviour. Occasionally there were beatings. He lasted just four months before deserting, and entered the Sangha.

The 2007 protests, quickly dubbed the Saffron Revolution, were a long time coming. An underground networks of activists had been quietly working for years to lay the groundwork for an uprising in the style of 1988; Gambira was involved in coordinating between the Sangha and laypeople in Yangon and Mandalay.

They were presented with an opportunity when the government dramatically increased fuel prices in August 2007 – a move that exacerbated dissatisfaction with living conditions under the military.

Tensions rose further when the authorities broke up a peaceful protest in Pakokku, Magwe Region, and injured several monks. In response, the All Burma Monks Association (ABMA) was formed on September 9 by merging four smaller monastic groups. The ABMA set a September 17 deadline for an apology from the police. When this was not met, the following day monks began what is known as patta nikkujjana kamma, or the upending of the alms – a refusal to accept donations from military families, thus denying them merit.

This tactic, the gravest moral weapon in the Sangha’s arsenal, had been deployed on just a handful of occasions in recent history: against the British, against the communists, and once when three monks were killed while protesting the imprisonment of five of their counterparts for inciting violence against Muslims near Mandalay.

The monks continued with their peaceful protests, demonstrations that were broadcast around the globe. The world then watched as the military launched a brutal crackdown, imprisoning many of the movement’s organisers. Gambira went into hiding.

On November 4, 2007, the Washington Post ran an editorial Gambira had penned on snack wrappers by the light of a fire while lying low in the jungle. He says this was taken to the border by a runner, who he thinks read it down a phone line to someone who forwarded it to the newspaper for publication.