speaking the unspeakable: the treatment of torture survivors

SPEAKING THE UNSPEAKABLE: THE TREATMENT OF TORTURE SURVIVORS

Elizabeth Scott MacWilliams, LCSWBrent Pace, LCSW

References Presentation and bibliography available

at www.uhhr.org website. Healtorture.org

Mission Statement:The Utah Health & Human Rights Project (UHHR) is a direct service and advocacy agency that promotes the health, dignity, and self-sufficiency of refugees, asylees, and immigrants who have endured severe human rights abuses, including torture, war-related trauma, and human trafficking. UHHR is guided by profound respect for the dignity and resiliency of our clients. We believe that all survivors of human rights abuses deserve the opportunity to live fulfilling, dignified, and productive lives.

The Changed World of the Tortured

“Emerging from the situation in which we were tortured, survivors often feel, and are, misunderstood. People expect us to be who we were before the torture occurred. But an individual changes dramatically. The consequences of torture are, multi-dimensional and interconnected; no part of the survivor’s life is untouched.”

Sister Dianna Ortiz

What is torture?“ …any act in which severe pain or

suffering, whether physical or mental, is intentionally inflicted on a person…for any reason…by or at the instigation of, or with the consent of a public official or other person acting in an official capacity.”

Excerpt from UN Convention Against Torture definition

Center for Victims of Torture

TORTURE is an attempt to destroy a person’s will to live and ability to trust in

anyone or anything.

Center for Victims of Torture

Purpose of Torture Destroy a sense of community Eliminate leaders or members of the

community Create a climate of fear Produce a culture of apathy and

silence Create a sense of familial disruption Destroy a population of people (e.g.

genocide / ethnic cleansing)

Center for Victims of Torture

Characteristics of Torture At least two persons are involved: a

perpetrator and a victim. The torturer has complete physical

control over the victim. Pain and suffering are an integral part of

torture. Torture is a purposeful, systematic

activity.

Estimated Number of Torture Survivors

5-35% of refugees ~20,000 in Utah

HealTorture.org

Types of Physical Torture Detention Beatings Burns Shaking Dental trauma Suspension Electrical

shock Cutting

wounds

Insertion of pins under nails

Simulated drowning

Stress positions Sensory

stimulation Sexual trauma

Types of Psychological Torture Mock executions Humiliations Death threats Threats against family members Forced confessions Signed confessions Sensory deprivation Sensory stimulation Violation of taboos Behavioral coercion Forced witness to torture

HealTorture.org

Triple Trauma Paradigm

Pre-Flight Flight Post-Flight

Pre-Flight Harassment/intimidation/

threats Fear of unexpected arrest Loss of job/livelihood Loss of home and

possessions Disruption of studies, life

dreams Repeated relocation Living in hiding/underground Societal chaos/breakdown Prohibition of traditional

practices Lack of medical care

Separation, isolation of family

Malnutrition Need for secrecy, silence,

distrust Brief arrests Being followed or

monitored Imprisonment Torture Other forms of violence Witnessing violence Disappearances/deaths

HealTorture.org

HealTorture.org

Flight Fear of being caught or

returned Living in

hiding/underground Detention at checkpoints,

borders Loss of home, possessions Loss of job/schooling Illness Robbery Exploitation: bribes,

falsification

Physical assault, rape, or injury

Witnessing violence Lack of medical care Separation, isolation of

family Malnutrition Crowded, unsanitary

conditions Long waits in refugee

camps Great uncertainty about

future

HealTorture.org

Post-Flight Low social and economic

status Lack of legal status Language barriers Transportation, service

barriers Loss of identity, roles Bad news from home Unmet expectations Unemployment/

underemployment Racial/ethnic discrimination Inadequate, dangerous

housing

Repeated relocation/ migration

Social and cultural isolation Family separation/

reunification Unresolved

losses/disappearances Conflict: internal, marital,

generational, community Unrealistic expectations

from home Shock of new climate,

geography Symptoms often worsen

How to Help Goals:

Re-establish trust Survivor centered and trauma informed Increased functionality rather than

symptom reduction Actions we take must be within the

survivor’s cultural, political, and historical context

Speak from a place of genuine interest “I’m wondering what it’s like to come to

this office”

How to Help “If you were back home and you had to

tell your story who would you tell it to? Is there something I can do that _______would have done?”

“What was that like for you?” Validate-Reassure-Respect Resilience Create hope for the future

Trust vs. Mistrust

Trust vs MistrustTrust versus Mistrust

Autonomy vs Shame and Doubt

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs Inferiority

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs InferiorityIdentity vs Diffusion

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs InferiorityIdentity vs Diffusion

Intimacy vs Isolation

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs InferiorityIdentity vs Diffusion

Generativity vs Stagnation

Intimacy vs Isolation

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs InferiorityIdentity vs Diffusion

Generativity vs Stagnation

Intimacy vs Isolation

Ego Integrity vs Despair

Trust vs. MistrustTrust versus Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt

Industry vs InferiorityIdentity vs Diffusion

Generativity vs Stagnation

Intimacy vs Isolation

Ego Integrity vs Despair

Torture

Trust vs Mistrust

Autonomy vs Shame and DoubtInitiative vs GuiltIndustry vs Inferiority

Identity vs DiffusionEgo Integrity vs

Despair Generativity vs

Stagnation Intimacy vs Isolation

Torture

Shame and DoubtGuiltInferiority

DiffusionDespair Stagnation Isolation

Torture