SPEAKING THE UNSPEAKABLE: THE TREATMENT OF TORTURE SURVIVORS Elizabeth Scott MacWilliams, LCSW Brent Pace, LCSW.
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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
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 Doubt
Initiative vs Guilt
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Identity vs Diffusion
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Identity vs Diffusion
Intimacy vs Isolation
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Identity vs Diffusion
Generativity vs Stagnation
Intimacy vs Isolation
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Identity vs Diffusion
Generativity vs Stagnation
Intimacy vs Isolation
Ego Integrity vs Despair
Trust vs. MistrustTrust versus Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
Industry vs Inferiority
Identity vs Diffusion
Generativity vs Stagnation
Intimacy vs Isolation
Ego Integrity vs Despair
Torture
Trust vs Mistrust
Autonomy vs Shame and DoubtInitiative vs Guilt
Industry vs Inferiority
Identity vs DiffusionEgo Integrity vs
Despair Generativity vs
Stagnation Intimacy vs Isolation
Torture
Shame and Doubt
GuiltInferiority
DiffusionDespair Stagnation
Isolation
Torture
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