Speaking the Unspeakable: The Treatment of Torture Survivors

1. Speaking the Unspeakable: The Treatment of Torture Survivors Elizabeth Scott MacWilliams, LCSW Brent Pace, LCSW

2. References Presentation and bibliography available at www.uhhr.orgwebsite. Healtorture.org

3. 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. Mission Statement:

4. 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

5. 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

6. 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

7. 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

8. Characteristics of Torture Center 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.

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

10. 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 HealTorture.org

11. 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

12. Triple Trauma Paradigm Pre-Flight Flight Post-Flight HealTorture.org

13. 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

14. 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

15. 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 HealTorture.org

16. 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”

17. 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

19. Autonomy vs Shame and Doubt Trust versus Mistrust

20. Initiative vs Guilt Autonomy vs Shame and Doubt Trust versus Mistrust

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

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

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

24. Generativityvs Stagnation Intimacy vs Isolation Identity vs Diffusion Industry vs Inferiority Initiative vs Guilt Autonomy vs Shame and Doubt Trust versus Mistrust

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

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

27. Torture Identity vsDiffusion Ego Integrity vsDespair Intimacy vsIsolation GenerativityvsStagnation Autonomy vsShame and Doubt Initiative vsGuilt Industry vsInferiority Trust vsMistrust

28. Torture Diffusion Despair Stagnation Isolation Shame and Doubt Guilt Inferiority