SPEAKING THE UNSPEAKABLE THE TREATMENT OF TORTURE SURVIVORS

SPEAKING THE UNSPEAKABLE: THE TREATMENT OF TORTURE SURVIVORS Elizabeth Scott Mac. Williams, LCSW Brent 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

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. Center for Victims of Torture

Estimated Number of Torture Survivors 5 -35% of refugees ~20, 000 in Utah

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 Heal. Torture. org

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

Triple Trauma Paradigm Pre-Flight Post-Flight Heal. Torture. org

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 Heal. Torture. 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 Heal. Torture. 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 Heal. Torture. org

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

Autonomy Shame. Mistrust and Doubt Trustvsversus Trust vs Mistrust

Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Intimacy vs Isolation Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Generativity vs Stagnation Intimacy vs Isolation Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Ego Integrity vs Despair Generativity vs Stagnation Intimacy vs Isolation Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Ego Integrity vs Despair Torture Generativity vs Stagnation Intimacy vs Isolation Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Trustvsversus Autonomy Shame. Mistrust and Doubt Trust vs. Mistrust

Torture Identity vs Diffusion Ego Integrity vs Despair Intimacy vs Isolation Autonomy vs Shame and Doubt Generativity vs Stagnatio Initiative vs Guil Industry vs Inferiority Trust vs Mistrust

Torture Despair me and Doubt Inferiority Diffusion Isolation Stagnation Guilt