speaking the unspeakable: the treatment of torture survivors elizabeth scott macwilliams, lcsw brent...

SPEAKING THE UNSPEAKABLE: THE TREATMENT OF TORTURE SURVIVORS

Elizabeth Scott MacWilliams, LCSW

Brent Pace, LCSW

References

Presentation and bibliography available at www.uhhr.org website.

Healtorture.org

http://www.uhhr.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.


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)


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

http://en.wikipedia.org/wiki/File:Vietconginterrogation1967.jpg

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


Initiative vs Guilt



Initiative vs Guilt

Industry vs Inferiority



Initiative vs Guilt


Identity vs Diffusion



Initiative vs Guilt



Intimacy vs Isolation



Initiative vs Guilt



Generativity vs Stagnation




Initiative vs Guilt





Ego Integrity vs Despair



Initiative vs Guilt





Ego Integrity vs Despair

Torture

Trust vs Mistrust

Autonomy vs Shame and DoubtInitiative vs Guilt


Identity vs DiffusionEgo Integrity vs

Despair Generativity vs

Stagnation Intimacy vs Isolation

Torture

Shame and Doubt

GuiltInferiority

DiffusionDespair Stagnation

Isolation

Torture

speaking the unspeakable: the treatment of torture survivors elizabeth scott macwilliams, lcsw brent...

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