The Treatment of Torture Survivors Elizabeth Scott MacWilliams LCSW Brent Pace LCSW References Presentation and bibliography available at wwwuhhrorg website Healtortureorg Mission Statement ID: 309843
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Speaking the Unspeakable: The Treatment of Torture Survivors
Elizabeth Scott MacWilliams, LCSWBrent Pace, LCSWSlide2
ReferencesPresentation and bibliography
available at www.uhhr.org website.Healtorture.orgSlide3
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.Slide4
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 OrtizSlide5
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 definitionSlide6
TORTURE is an attempt to destroy a person’s will to live and ability to trust in anyone or anything.
Center for Victims of TortureSlide7
Purpose of TortureDestroy a sense of community
Eliminate leaders or members of the communityCreate a climate of fearProduce a culture of apathy and silenceCreate a sense of familial disruptionDestroy a population of people (
e.g.
genocide / ethnic cleansing)
Center for Victims of TortureSlide8
Characteristics of TortureCenter for Victims 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.Slide9
Estimated Number of Torture Survivors
5-35% of refugees~20,000 in UtahSlide10
Types of Physical Torture
Detention BeatingsBurnsShakingDental traumaSuspensionElectrical shock
Cutting wounds
Insertion of pins under nails
Simulated drowning
Stress positions
Sensory stimulation
Sexual trauma
HealTorture.orgSlide11
Types of Psychological Torture
Mock executionsHumiliationsDeath threatsThreats against family membersForced confessionsSigned confessionsSensory deprivation
Sensory stimulation
Violation of taboos
Behavioral coercion
Forced witness to tortureSlide12
Triple Trauma ParadigmHealTorture.org
Pre-Flight
Flight
Post-FlightSlide13
Pre-Flight
Harassment/intimidation/ threatsFear of unexpected arrestLoss of job/livelihoodLoss of home and possessionsDisruption of studies, life dreamsRepeated relocationLiving 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.orgSlide14
Flight
Fear of being caught or returnedLiving in hiding/undergroundDetention at checkpoints, bordersLoss of home, possessionsLoss of job/schoolingIllnessRobbery
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.orgSlide15
Post-Flight
Low social and economic statusLack of legal statusLanguage barriersTransportation, service barriersLoss of identity, rolesBad news from homeUnmet 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
HealTorture.orgSlide16
How to HelpGoals:
Re-establish trustSurvivor centered and trauma informedIncreased functionality rather than symptom reductionActions we take must be within the survivor’s cultural, political, and historical contextSpeak from a place of genuine interest
“I’m wondering what it’s like to come to this office”Slide17
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 ResilienceCreate hope for the futureSlide18Slide19
Trust versus Mistrust
Autonomy
vs
Shame and DoubtSlide20
Trust versus Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
GuiltSlide21
Trust versus Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
Guilt
Industry
vs
InferioritySlide22
Trust versus Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
Guilt
Industry
vs
Inferiority
Identity
vs
DiffusionSlide23
Trust versus Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
Guilt
Industry
vs
Inferiority
Identity
vs
Diffusion
Intimacy
vs
IsolationSlide24
Trust versus Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
Guilt
Industry
vs
Inferiority
Identity
vs
Diffusion
Generativity
vs
Stagnation
Intimacy
vs
IsolationSlide25
Trust 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
DespairSlide26
Trust 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
TortureSlide27
Trust
vs
Mistrust
Autonomy
vs
Shame and Doubt
Initiative
vs
Guilt
Industry
vs
Inferiority
Identity
vs
Diffusion
Ego Integrity
vs
Despair
Generativity
vs
Stagnation
Intimacy
vs
Isolation
T
ortureSlide28
Shame and Doubt
Guilt
Inferiority
Diffusion
Despair
Stagnation
Isolation
T
orture