The Understanding and Treatment of Immigrant Trauma Survivors: Finding the Right Mix

This paper reviews attempts by three authors to describe psychoanalytic conceptualizations and treatment of torture victims. It argues that because the transference-countertransference configuration with immigrants who have not suffered torture is very similar to that of torture survivors, that no special diagnostic categories, theories, or treatment methods are needed to work with torture survivors. Second, the paper contends that newer psychoanalytic paradigms such as Hoffman's Social Constructivism may assist clinicians to capture the richness and complexity of clinical work with torture survivors better than do traditional analytic conceptions such as neutrality. Via an analysis of the three papers in this volume, I conclude with a consideration of the strengths and the weaknesses of the field of cross-cultural psychotherapy in general.     

Jungian Perspectives on the Etiology and Treatment of Torture

As increasing numbers of people worldwide suffer the effects of torture and other war trauma, practitioners are challenged to adapt their theoretical backgrounds to their treatment. One such school of thought, Analytical Psychology, contains several premises that can help to decipher the causes of violence and oppression, and provides potentially useful techniques for treating those who have suffered their effects. Practitioners who find themselves in a position to treat survivors of torture and other war trauma can draw upon the basic principles of Analytical ology outlined in this article to enhance their treatment modalities.     

The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample

Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment.     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

Group therapy for refugees and torture survivors: treatment model innovations

The paper discusses varieties of group therapies with refugees and torture survivors and the logic behind enhancing traditional group therapies to fit the unique experiences of refugees and torture survivors. It discusses some lessons learned from practice and from empirical research and some recommended adaptations. Finally, it discusses the Center for Torture and Trauma Survivors' therapy group model for torture survivors and describes two of its variants: The Bashal group for African and Somali women and the Bhutanese multi-family therapy group. Group therapies, in this model, extend to community healing. One of the essential and innovative features of the model is that it focuses not only on treating individual psychopathology but also extends to community healing by promoting the development of social clubs and organizations that promote the values and culture of the graduates of the therapy group and the continuation of social support. New graduates from the group join the club and become part of the social advocacy process and of group and community support and healing. This model adds an ecological dimension to the traditional group therapy.     

Standing in Between: The Healing Praxis of Mayan Women Intermediaries in Post-Genocide Guatemala

ABSTRACT

This article examines how Mayan intermediaries make meaning of their roles in accompanying Mayan women survivors of gross violations of human rights as they search for truth, justice, and reparation in post-genocide Guatemala. Using a constructivist grounded theory approach, the authors analyzed in-depth interviews with six intermediaries who worked with survivors in the context of a seven year feminist participatory and action research project. The findings reveal that healing from the legacies of armed conflict as well as from historical racialized gendered oppression are at the core of Mayan intermediaries’ work with the Mayan women survivors with whom they established an intersubjective relationship, contributing to each other’s healing. The importance of economic justice for survivors’ healing and the scant and circumscribed talk about sexual violence—the grievance central to the work with most of the survivors—emerge as important findings of this study and require future exploration.     

Treating survivors of war trauma and torture.

Psychologists are in a unique position to assist individuals and groups in the world who have survived torture and war trauma. Symptoms of posttraumatic stress disorder and other psychological diagnoses can be treated effectively by mental health professionals and trained lay counselors in the smallest of communities in the world. This article proposes a model for the treatment of survivors of torture and war trauma. This model has been designed to be useful to mental health professionals and to lay individuals in communities who constitute the front line in treatment: health providers, midwives, ministers, and teachers. The model is presented through examples of its use in the training of mental health counselors in the United States and in the training of promotores (health promoters) and comodrones (midwives) in Guatemala.     

Human rights and mental health among Latin American women in situations of state-sponsored violence. Bibliographic resources

A Task Force of the American Psychological Association Division 35, Psychology of Women, has been collecting resources that address issues of human rights and mental health among Latin American women living in situations of war and/or state-sponsored violence. This work is being conducted primarily by women's groups, progressive organizations, and individual women in these contexts of institutionalized political violence. This paper describes our reflections on themes that emerged from our reading of this work. We discuss the false dichotomy between public and private violence, the silencing of women as an inevitable consequence of state-imposed violence, and the collective efforts of women to resist violence and heal its effects. These themes suggest that extreme violence against women can be most adequately understood and responded to within a psychosocial and cultural framework. We examined three issues that emerge from the material gathered by the Task Force that suggest how some Latin American psychologists and activists have begun to articulate such a framework: (a) exile within and outside of one's country of origin; (b) torture, the most extreme form of state-sponsored violence; and (c) nontraditional, culturally appropriate interventions that are alternatives to Anglo-Saxon theory and practice. The work of Latin American individuals is described here as a resource for all who are engaged in the struggle to achieve justice for women.     

The juncture of law and morality in prohibitions against torture

Conclusion The right to be secure from torture, a right that encompasses moral as well as legal strictures against the practice, is supported by increasingly stringent human rights instruments. In this essay, I have discussed the principal instruments and their place in the anti-torture field considered broadly. The phenomenon of these international instruments foreshadows an ever-widening range of legal initiatives against torture, and is emblematic of the increasing importance attached to respect for human life and human dignity. The diversity of international treaties providing against torture such as, for example, The Convention on the Prevention and Punishment of the Crime of Genocide (1948), The Supplementary Convention on the Abolition of Slavery (1956), The International Convention on the Elimination of All Forms of Racial Discrimination (1965), and The International Convention on the Suppression and Punishment of the Crime of Apartheid (1973), indicates the interconnectedness of a wide range of human rights issues.The boundaries that have been drawn around the violation constituted by torture are clearer at present than are those bounding many other rights. Rights commonly categorized as of an economic nature - the right to food and to development, for example - are undergoing processes of definition and implementation. One challenge of this paper is to generate procedures presently attached to such specific human rights violations as torture to rights with less clear parameters. In this way, the growing effectiveness of procedures against torture can serve in the long term to strengthen the bases of international human rights law while in the short term helping to expand the armory of procedures for the protection of less clearly-defined, rights. International human rights law offers a practical tool towards eliminating torture from states' instruments for governing and provides a model for the development of procedures in other categories of rights, while bringing universally declared moral aspirations and legal authority into closer alignment.     

Dignity,Torture, and Human Rights

This paper focuses on a distinct puzzle for understanding the relationship between dignity and human rights. The puzzle is that dignity appears to enter human rights theory in two distinct roles: on the one hand, dignity is commonly pointed to as the foundation of human rights, i.e. that in virtue of which we have human rights. On the other hand, dignity is commonly pointed to as that which is at risk in a subset of human rights, paradigmatically torture. But how can dignity underpin all human rights, and yet only be at stake in very specific human rights violations? And if dignity is lost in torture, how can the tortured retain their human rights? In this paper I offer a solution to these puzzles, in the form of a new theory of dignity. On this new theory, an individual’s dignity can be constituted via either of two pathways: the agent’s own normative competencies, or the authority of her community. The former is what’s typically at stake in practices such as torture; it in virtue of the latter that we have human rights.     

What constitutes torture?: psychological impediments to an objective evaluation of enhanced interrogation tactics

Torture is prohibited by statutes worldwide, yet the legal definition of torture is almost invariably based on an inherently subjective judgment involving pain severity. In four experiments, we demonstrate that judgments of whether specific interrogation tactics constitute torture are subject to an empathy gap: People who are experiencing even a mild version of the specific pain produced by an interrogation tactic are more likely to classify that tactic as torture or as unethical than are those who are not experiencing pain. This discrepancy could result from an overestimation of the pain of torture by people in pain, an underestimation of the pain of torture by those not in pain, or both. The fourth experiment shows that the discrepancy results from an underestimation of pain by people who are not experiencing it. Given that legal standards guiding torture are typically established by people who are not in pain, this research suggests that practices that do constitute torture are likely to not be classified as such.     

PROFESSIONALIZING SURVIVAL: THE POLITICS OF PUBLIC MEMORY AMONG HOLOCAUST SURVIVOR-EDUCATORS IN MONTREAL

The majority of Holocaust survivors never speak publicly about their experiences, but those who do tend to find themselves at the centre of commemorative work in their communities. As Holocaust scholars, Holocaust education institutions, and members of the general public become increasingly interested in how to ethically universalize the lessons of the Holocaust, the public Holocaust survivor's role has broadened. It is no longer enough to recount one's own experience; survivors are expected to speak to current human rights abuses and genocides.In Montreal, Canada, a city which once claimed the third largest survivor population in the world, public survivors do a great deal of work. They give testimony in schools and at commemorative events, organize book clubs, write plays, direct films, teach, act as museum docents, and assume roles as community spokespeople. Given their dedication to this work, and a push to get them to speak beyond their personal experiences, we argue that there is a major shift taking place: the act of giving public Holocaust testimony is being professionalized. This professionalization raises unique questions about how people who lived through the Holocaust conceptualize themselves and their identities as survivors. By treating testimony as professional work, survivors contemplate, on a daily basis and in an applied manner, their stances on big questions regarding hierarchies of suffering, comparability, the connection between the personal and the political, blame and forgiveness, as well as many other relevant themes that are central to Holocaust and memory scholarship. All of this plays out in their testimonies.     

FEMINIST APPROACHES TO RELIGION AND TORTURE

Feminists look critically at any infliction of pain on others, usually requiring that it be consensual, and often both consensual and for the benefit of the person afflicted. Most torture of women is not recognized under official definitions of torture because it is not performed by or with the consent of (government) officials. Women are, however, also victims of torture under official definitions as military or civilian prisoners or as members of defeated populations in war, and are more often subjected to sexual torture, which until recently has not been understood either as torture or even a war crime. Rape, especially serial gang rape, it is argued, should be understood as torture, as the essence of torture is the use of severe pain to obscure or obliterate the victim's sense of agency.     

Les normes et standards de la documentation des allégations de torture et autres mauvais traitements selon le protocole d’Istanbul

Torture and ill treatment constitute a serious violation of basic human rights. Health professionals are actors capable of acting, in addition to caring for the victims, for the advent of a world without torture. Thorough investigation and substantiated documentation of allegations of torture can help victims to tell the truth about what has happened to them and support them in their quest for justice and reparation. They help victims to obtain credible evidence that torture has taken place, allowing them to assert their rights. Trained health professionals can document the physical and psychological trauma resulting from torture, and link them to specific torture practices with a very high level of credibility, using the Istanbul protocol, a manual on documentation of torture approved by the United Nations. Victims can use this evidence to formally file a complaint to substantiate allegations in civil or criminal cases, as a basis for their request for rehabilitation assistance, and as an official acknowledgment of the harm they have suffered. This work aims to point out the important role of the doctor in the process of documenting the allegations of torture and other ill treatment and the need for training on the ethical, legal and practical aspects of this intervention in order to participate in prevention, and fight against this crime.     

The Effects of Moral and Pragmatic Arguments Against Torture on Demands for Judicial Reform

Torture can be opposed on the basis of pragmatic (e.g., torture does not work) or moral arguments (e.g., torture violates human rights). Three studies investigated how these arguments affect U.S. citizens' attitudes toward U.S.‐committed torture. In Study 1, participants expressed stronger demands for redressing the injustice of torture when presented with moral rather than pragmatic or no arguments against torture. Study 2 replicated this finding with an extended justice measure and also showed the moderating role of ingroup glorification and attachment. Moral arguments increased justice demands among those who typically react most defensively to ingroup‐committed wrongdoings: the highly attached and glorifying. Study 3 showed that the effect of moral arguments against torture on justice demands and support for torture among high glorifiers is mediated by moral outrage and empathy but not guilt.     

Negotiating Discourses: The Dialectical Identities of Survivor-Therapists

The psychiatric survivor movement is a political movement dedicated to fighting for human rights in the mental health system. People who identify as psychiatric survivors have experienced human rights abuses in the mental health system. A small number of psychiatric survivors have chosen to reenter the system as mental health professionals, and the current project focuses on the experiences of people with this dual-identity. The primary goal is to facilitate further dialogues between psychologists and the survivor movement by exploring the implications of identifying with both discourses. I interviewed five survivor-therapists, and asked how their identities as psychiatric survivors influence their approaches to therapy, and the nature of the relationship between these two identities.     

Spirituality and Sexual Abuse: Issues and Dilemmas for Survivors

Abstract

Sexual abuse profoundly affects survivors to the extent that they are unable to maintain previously held viewpoints or ways of being, including those relating to their spirituality. Certainly the experience has considerable potential to complicate the spiritual lives of survivors. For Christian survivors, this may include how they perceive and relate to both themselves and God as well as affect participation in sacraments such as eucharist and reconciliation. Spiritual traditions often promote the embracing of silence, but this may be problematic for survivors who have been silenced and unable to give expression to their experiences. Similarly, socialization resulting in beliefs that Christians should always forgive and/or never be angry needs to be overcome. While negotiating these pitfalls may result in explorations of spirituality being even less straightforward for survivors of sexual abuse than it is for others, a transformative spirituality within a Christian framework can be realized.     

Group Treatment with French-Speaking African Survivors of Torture and Its Effects on Clinical Engagement: Can Hope Be Operationalized?

This study examines the clinical engagement of French-speaking African survivors of torture by measuring how often they utilize adjunctive programmatic services (i.e., mental health, social, and legal services) in relation to their involvement with the Francophone support group. Thirty-two clients who attended at least five Francophone group therapy sessions were identified and matched with their counterparts who never attended the Francophone group. We compared the number of services the clients in the Francophone group and the control group utilized, controlling for the number of services the clients utilized before attending the Francophone group. We found that the Francophone group showed significantly greater overall programmatic engagement. For the types of services utilized, the Francophone group sought out more mental health services, but there was no significant difference in social and legal services. These findings suggest that involvement with the Francophone group can be linked to increased levels of programmatic engagement.     

Ego-Identity Achievement and Perception of Risk in Intimacy in Survivors of Stranger and Acquaintance Rape

One hundred twenty-two women participated in a study of the relationship between acquaintance/stranger rape and the respective variables of ego-identity achievement (attainment of self-image during adolescence that integrates one's ideas of what one is and what one wants to be) and perception of risk in intimacy (perception of close interpersonal relationships as a risky proposition). Results showed that compared to women who had not been sexually assaulted, survivors of rape in general reported lower ego-identity achievement and greater perception of risk in intimacy. Focusing on acquaintance rape and stranger rape with age at the time of assault as possible moderator, it was found that lower ego-identity achievement was systematically related to acquaintance rape in women who had been raped during their adolescent years, but not in survivors of rape during adulthood. Perception of risk in intimacy was significantly higher among women who had been raped when adolescents compared to those who had been raped during adulthood, but only in relation to acquaintance rape.