For six years, I worked with torture survivors in the Middle East, primarily in Palestine, South Lebanon, and Western Jordan. I functioned as a Social Rehabilitation Counsellor for children and young adults with severe Post Traumatic Stress Disorder and Acute Anxiety. Essentially, this involved the rebuilding of trust and function with children and young adults who had endured severe trauma.
According to the United Nations, torture is "any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as coercion or punishment." However, torture is far more than this pedantic explanation can imply.
The process of torture is designed to invade and destroy the belief of the subjects in their independence as a human being - obliterating presumptions of privacy, intimacy, and security and annihilating their unspoken faith that these things can save them. Beyond merely violating the subjects' mental and physical independence, torture breaks the victim's sense of self and purpose.
Beatrice M. Patsalides, Ph.D describes this process in 'Ethics of the unspeakable: Torture survivors in psychoanalytic treatment,' as:
"As the gap between the 'I' and the 'me' deepens, dissociation and alienation increase. The subject that, under torture, was forced into the position of pure object has lost his or her sense of interiority, intimacy, and privacy. Time is experienced now, in the present only, and perspective - that which allows for a sense of relativity - is foreclosed. Thoughts and dreams attack the mind and invade the body as if the protection that normally contains our thoughts - giving us space to breathe and separating between inside and outside, past and present, me and you - is lost."
Read more about Patsalides experiences with torture survivors at: http://www.apres-coup.org/mt/archives/title/2005/01/ethics_of_the_u.html
For survivors, torture often leads to lasting mental and physical health problems of a wide-ranging nature, encompassing everything from sexual impairment, acquirement of infectious disease, chronic pain, and musculo-skeletal problems, to brain injury, epilepsy, or dementia. Overall, however, Post Traumatic Stress Disorder (PTSD) dominates the lives of torture survivors and normally enslaves them to a life wrought with distress and hardship.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. It is a severe and ongoing emotional reaction to an extreme trauma, to such a degree that one's standard psychological defenses are incapable of coping.
The type of trauma involved consists of damage to the psyche occurring as a result of the event in question. When that trauma leads to PTSD, the damage may involve physical changes inside the brain, and to the brain chemistry, which affect the person's ability to cope with stress. This disability can, and often does, debilitate or prevent success in social and professional situations and, at its worst, can destroy the basic foundations of interpersonal relationships.
Trauma is relative to the individual, but there are certain elemental events which generally produce moderate to severe PTSD regularly - childhood abuse, violent physical assault or witnessing such an event, medical complications or severe illness, a serious accident, adult experiences of sexual assault, violent or life threatening natural (or man made) disasters, or incarceration.
The experience can be singular or an enduring cycle, completely overwhelming the individual's ability to integrate the ideas and emotions involved with the trauma, into their lives following the event. The sense of being devastated in this way can be delayed by weeks or years, as the person struggles to cope with the immediate danger. The trauma involved normally incorporates a feeling of complete helplessness in the face of a real or subjective threat to one's life or to that of loved ones, to bodily integrity, or sanity. There is frequently a violation of the person's familiar ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when people or institutions depended on for survival violate or betray the person in some unforeseen way.
Patients with PTSD display biochemical changes in the brain and body, which are different from other psychiatric disorders such as major depression.
In PTSD patients, suppression of the hormone dexamethasone cortisol is normally above average. This hormone is vital to the process of immuno-function and stress response. Furthermore, certain hormones associated with adrenal operation and sexual function are distinctly different than within healthy individuals. Beyond biochemical changes, PTSD also involves changes in the brain itself. Combat veterans of the Vietnam war with PTSD showed an 8% reduction in the volume of their hippocampus in comparison with veterans who suffered no such symptoms. This area of the brain is used in storing and processing spatial information.
Treatment and recovery is possible, though absolute rehabilitation is marginal at best. Given the variations in trauma exposure world-wide and the vast deviations in development and availability within the many affected groups, a treatment which is effective to one individual or group may not be so within another. Prolonged Exposure Therapy, wherein the sufferer learns to confront his/her anxiety, is commonly used; as are stress management techniques, psychotherapy, and pharmacological remedies.
Statistically, however, a combination of the above mentioned treatments is most effective when used in conjunction with a resource relative to the individual's ability to rebuild trust and establish commonalities. This normally involves the presence of a caregiver on whom the sufferer can come to depend, and in some cases, latch onto. This is particularly true in the case of child trauma survivors however it is also prevalent among severely traumatized adults.
Torture survivors, especially children, have lost the ability to relate to their environment through conventional psychological reactions. Stress, for them, often leads to severe impairment of function and resolve and can, in some cases, debilitate them entirely.
For adults, this means that the element of fear often hangs ever-present regardless of circumstance while other emotional and psychological reactions, such as desire, feelings of intimacy and friendship, are denied. There is normally a cycle of response varying between psychic numbness and extreme agitation with little to no ability to trust or create the normal human relationships necessary to function in society.
For children, this means that the development process itself can be, and often is, severely damaged, making it difficult or impossible to restore the psychological make-up required for a successful adulthood.
Working with trauma survivors to treat these circumstances means being a part of reconstructing confidence, dependence, and trust. It means being there for the victim, demonstrating acceptance in all forms, and constructing an intimate bond with them, often an affectionate one, on which they may rely and fall back on.
For me, this means being involved in the process of rebuilding love and acceptance in a very unique and powerful way. I have witnessed extreme pain and the consequences of unspeakable horror, however, I have also shared in the bonds of trust and recovery in a way most people never see. It is a pathway filled with tumultuous suffering yet, in those moments when genuine rehabilitation begins, it also becomes the doorway to a compelling and life-long friendship.
In the last two decades a comprehensive research study was done to assess the specific scientific basis of physiological delays/impairments in development resulting from trauma in childhood. The results gave evidence to the fact that substantial neurobiological changes result from abuse and trauma in the formative years. To download an article detailing the main points of the study, click here.
Médecins Sans Frontières (MSF,) directly translated as 'Doctors Without Borders,' is an international humanitarian aid organization that provides medical assistance to populations in danger in more than 70 countries around the world.
In carrying out humanitarian assistance, MSF seeks also to raise awareness of crisis situations, acting as a witness and advocate, either in private or in public, about the plight of populations in danger. In doing this, MSF sets out to alleviate human suffering, protect life and health, and strengthen respect for fundamental human rights.
Only a small percentage of the populations, that find themselves in a situation of danger, gain the attention of the media. MSF teams travel to places that gain no attention elsewhere, to assist those who have fallen victim to natural or man-made disasters. MSF volunteers have a story to tell when they return from their missions, and they use their experiences to speak of what they have seen. For MSF, raising awareness of these populations and the situations they are in, is an important task. Whenever possible, MSF volunteers give interviews and make presentations with worldwide facilities for those wishing to speak to their communities. MSF also mounts exhibitions and, from time to time, releases publications, with the aim of raising awareness.
It is part of MSF's work to address any violations of basic human rights encountered by field teams and violations perpetrated or sustained by political circumstances. This is accomplished through confrontation of the responsible parties themselves, as well as, mobilization of the international community through public appeal. In order to prevent compromise or manipulation of MSF's relief activities, MSF maintains neutrality and independance from individual governments. The organization also tries to ensure that the majority of funds raised for its work come directly from contributions of the general public. In this way, MSF guarantees equal access to its humanitarian assistance.
MSF has been setting up emergency medical aid missions around the world since 1971.
The Public Committee Against Torture in Israel (PCATI) is an Israeli based NGO aiming to strengthen democracy and the rule of law by protecting human and civil rights. PCATI believes that the use of torture as a method of interrogation undermines the foundation of democracy and facilitates a powerful contradiction to Israeli and international conventions. Torture violates the most fundamental constitutional right - that of Human Dignity and Freedom - which the Penal Code, the Laws of Evidence and the UN International Convention Against Torture specifically bans and which was signed by the state of Israel.
PCATI provides legal counsel and aid to victims of torture, and assistance to attorneys representing them. PCATI monitors the implementation of the High Court of Justice decision prohibiting torture in interrogation, and is involved with all investigative authorities in Israel: the Military, Police, GSS etc., actively lobbying against legislation which would allow torture during interrogation or permit the holding of hostages by law. The organization continually campaigns for public opinion in Israel, developing educational programs as a national and international resource center for information on torture and related fields of human rights in Israel and the Palestinian Authority.
Click here to download a PCATI publication (pdf) detailing torture of Palestinians in Israel. Warning: contains graphic and disturbing descriptions of violent acts.
