Torture Survivors: Recognizing Special Needs

This post will be a summary of a lecture given my Mary Fabri. (Here is a NPR story on the Kovler Center! Mario is my supervisor and Mary (the lecturer) is my major boss. http://www.chicagopublicradio.org/Program_WV.aspx?episode=13687 )

Mary Fabri is the Senior Clinical Director at Marjorie Kovler Center and is considered an international expert in torture treatment. She's a pretty incredible person and been an advocate for survivors for years and years. Here is a summary of her lecture with my own thoughts added in italics.

1. Types of Torture
a. Physical- How it's usually depicted in TV and films.
b. Psychological- Much more effective and longer lasting.
c. Sexual-common in both genders
d. Deprivation (social, sensory, sleep, hygiene, health, nutrition)


2. Realities for Refugees and Asylum Seekers


a. There are no safe places
(1) One thing to keep in mind with torture survivors is that they have forever loss their sense of home. Picture your own government betraying your trust by torturing you and forcing you into exile. Your sense of homeland, motherland, fatherland is lost forever. Torture survivors have serious trust issues. This fact adds a lot of pressure. When you forget to call a client to remind him/her of an appointment, it's a small act of betrayal. On the other hand, trust doesn't just come from being polite and smiling a lot. It takes years of kindness and support.

b. Separation from family, friends, community- Imagine leaving your family for a weekend. Now picture leaving for 6-12 years (the typical average for our clients). Just imagine the stress. When families are reunited, it can actually be immensely stressful for everyone involved.

c. Deep sense of being different
(1) 90% of our female clients have been raped. Rape victims often feel perpetually violated.
(2) Psychological torture involves dehumanization. When you are screaming at and described as nothing more than a cockroach, some part of you believes it. After all, how could any normal human be treated like that? Torture is so effective because the horrific acts humans do is beyond cruel. It's simply unimaginable.



3. Triple Trauma Paradigm

a. Traumatic event- As Westerns, the diagnosis for our clients is Post-Traumatic Stress Disorder. Well the diagnosis is helpful, there are several problems with this diagnosis for torture survivors:
(a) First of all, the diagnosis criteria for PTSD were made from studies involving American rape victims or American veterans returning from war. The diagnosis criteria was not involve a wide variety of cultures and situations.
(b) The use of the word "post" is highly misleading. As will see in the triple paradigm, trauma persists beyond the actual torture.
(c) The use of "disorder" is also misleading. These reactions are not a disorder but a normal, biological reaction. The experience of torture is so surreal the brain really struggles to cope with it. A common reaction to torture survivors is "flashbacks." Flashbacks can strike after the smallest stimulus and are so vivid the survivor believes he/she is re-experiencing the torture. Psychologists tell us the brain is replaying the event in an attempt to understand what happened.

b. Flight- Think of how traumatic hiring a human smuggler would be. Imagine putting thousands of dollars into a man's hand who could easily kill you, rob you, rape you or even sell you. Also, think of victims of domestic abuse; actually leaving the abusive spouse is considered to be one of the most difficult parts of spousal abuse. The flight itself is traumatic.
c. Resettlement and acculturation- I think you can imagine with this part. I've tried in my previous posts and will continue to attempt to explain the traumatic difficulties of asylum seekers on a daily basis while they attempt to resettle.



4. Three major Sequelae of Torture- These are the three abnormal conditions commonly found in torture survivors.


a. Avoidance- A very common tactic used by many people in a wide variety of traumas. Painful memories are difficult to burden so many people attempt to shed them. Survivors avoid talking about the experiences or even their home country in general. Survivors also withdraw emotionally from their surroundings (CAT scans of survivors' brains have found the pre-frontal cortex and hippocampus (where emotions are relayed through out the brain) actually shrink). Many survivors begin actively destroying their memory. Testifying in court as to what occurred in their past is often impossible. In addition, many of my clients consistently forget to come to doctor's appointments. I used to think it was just a cultural thing for some or even just common memory problems many people have. In reality, some clients spend so much time actively destroying their memory that the memory ceases to properly function.

b. Hyperarousal. In addition to the shrinkage of the prefrontal cortex, CAT scans have found that the amygdala (fear center in brain) in survivors are abnormally large. Many clients rarely sleep. Some clients never sleep normally again for the rest of their life. In Long Way Gone (memoir of a child soldier) he admits to never sleeping more than 3 hours a night (in addition to all their other problems, fear and anxiety become way worse without sleep). Hyperarousal is a biological response to a threat to the survival of the body. The problem with many survivors is they were persecuted for years so they can't quit that state. Concentration is difficult and GI problems are VERY common (I see it all the time when scheduling medical appointments).

c. Depression. Many survivors find no joy in life anymore. A common experience for our clients is a professional with a family is forced to flee. They left their family behind (if they're alive at all) and are forced to live in a country where they know almost no one, don't speak the language, and if they're employed at all work in a job way below their skill level. The simple fact is many survivors of torture wish they had died at the hands of their torturers. The sense of loss is simply too great.


5. Altered Self-Concept. Many survivors no longer know themselves. Many describe undergoing a personality change or feel damaged and contaminated. This loss of personality is the lasting damage of psychological torture.


Feel free to ask any questions! I'll post the answers in the comment section.