Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial

Halvorsen, J.Ø. & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology 51, 495–502. Torture has severe mental health effects, especially in terms of posttraumatic stress disorder (PTSD) and depression. However, there is still a lack of empirical treatment studies. The present paper presents data on 16 torture survivors receiving 10 sessions of narrative exposure therapy (NET). Symptoms of PTSD and depression, assessed by Clinician‐Administered PTSD Scale (CAPS) and Hamilton Rating Scale for Depression (HRSD), decreased significantly from pre‐treatment to 6‐month follow‐up, with Cohen’s d effect sizes of 1.16 and 0.84, respectively. Although treatment gains were moderate, further research on evidence‐based treatments for PTSD and depression in refugee torture survivors is warranted.     

Idiots,Ideologues, and Just Plain Interested: The Individuals who Engage in Amateur Waterboarding on the Internet

This article examines 65 amateur waterboarding videos to investigate why ordinary people become involved in waterboarding. There appears to be several explanations for this involvement: thrill-seeking, ideology, and educational reasons. The article highlights waterboarding’s dangers, and its potentially transformational effects on individuals. Findings are situated in relation to Michel Foucault’s work on torture, and what is known about health professional involvement in experimental torture during the War on Terror.     

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.     

Physical Correlates of Torture Exposure in Karen Refugees

We explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research.     

Les nouveaux «Gastarbeiter»? Les réfugiés sur le marché du travail suisse

With about 28,000 asylum requests a year since 1990, Switzerland is one of the western countries with the highest inflow of refugees. The aim of this article is to answer two questions: What is the role of refugees in the Swiss economy? and what are the factors influencing their incorporation into the labour market? The research is based on the multivariate analysis of an individual database of 110,000 asylum seekers and refugees, in-depth interviews and 174 questionnaires to refugees and employers.     

Political and media discourses about integrating refugees in the UK

This article addresses political and media discourses about integrating refugees in the UK in the context of the “refugee crisis”. A discursive psychological approach is presented as the best way to understand what talk about the concept is used to accomplish in these debates. A large corpus of political discussions (13 hours of debate featuring 146 politicians) and 960 newspaper articles from the UK were discourse analysed. The analysis identified five dilemmas about integration: Integration is positive and necessary, but challenging; Host communities are presented as welcoming, but there are limits to their capacity; Refugees are responsible for integration, but host communities need to provide support; Good refugees integrate, bad ones don't; Refugees are vulnerable and are skilled. All are used to warrant the inclusion or exclusion of refugees. The responsibility of western nations to support refugees is therefore contingent on the refugees behaving in specific ways.     

Women and Political Torture:

Although women and children represent 80% of persons who flee their countries for reasons of persecution as refugees, scant attention has been given women in the literature describing severe human rights abuses, including torture. Torture is an extreme form of trauma that involves the strategic destruction of the human being. The torturer uses every aspect of the person's being. In the case of women, their own femaleness is used as a weapon. This paper focuses on special issues faced by women who are survivors of torture. The author directed the first center in the United States providing a multidisciplinary care for survivors of political torture.     

Recognition and personhood: A critique of Bernstein's account of the wrongfulness of torture

J. M. Bernstein argues that to capture the depths of the harm of torture, we need to do away with the idea that we possess intrinsic and inviolable worth. If personhood is inviolable, then torture can inflict only apparent harm on our standing as persons. Bernstein claims that torture is a paradigm of moral injury because it causes what he calls “devastation”: The victim experiences an actual degradation of his or her personhood. Bernstein argues that our value is given to us through mutual recognition and hence can be lost. In this paper, I argue that if our human value can be lost, then it first must be built up. If it must be built up, then the question of our status before the building begins must be answered. Bernstein faces a problem of human beings who fall outside relations of mutual recognition and hence are valueless. His best option for answering this problem is to point to the centrality of the body in his account of recognition, but doing so reveals a notion of intrinsic worth implicit in his account. I call for a revision of Bernstein's account that can hold on to devastation without eschewing intrinsic worth.     

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.     

“You cannot forgive and you cannot forget”: The Serbian refugee settlement experience in Australia

Currently, there is limited research on the settlement experiences of refugees from the Balkan regions and in particular Serbia. There is also a need to provide a contextual understanding of the refugee settlement experience. The current study explored the refugee experience of 12 male Serbian refugees (aged 30 to 65), who migrated to Australia following the Yugoslav Civil War (1991–2001). A qualitative, phenomenological methodology explored the experiences of the refugees from their own perspective. Thematic coding of the interview data revealed the two major themes of settlement and traumatic experiences, as central to the experiences of this group of refugees. Language difficulties, discrimination, stigmatization of Serbian identity, multiple losses and grief, and failing of the justice system to establish accountability and provide reparation to the victims were all significant obstacles to successful settlement. Most salient, however, were the experiences of torture and trauma. Participants were still trying to negotiate these memories years after the events. Nevertheless, some participants showed strong resilience and the belief that they became stronger as a consequence of their experiences. We encourage those working with Serbian refugees to help them search for meaning in their stories of trauma.     

“It takes a village to heal a child”: Necessary spectrum of expertise and benevolence by therapists,Non-Governmental Organizations,and the United Nations in managing war-zone stress in children traumatized by political violence

This article highlights the post-traumatic stress responses in some war-zone children who were exposed to political violence—witnessing unspeakable horror, maimings, brutal beatings, torture, and murders. Children inducted into rebel military units to serve as child-soldiers further traumatized self and others by raping and killing children and adults. Additionally, some children go without food, shelter, and adult protection, while finding themselves as refugees in a foreign country. This article advances some conceptual, technical, and practical issues in intervention with these children and provides a model of intervention that seeks to integrate established international policies of the United Nations (UN) and Non-Governmental Organizations (NGOs) along with cognitive, behavioral, and psychodynamic clinical approaches in the context of cultural/racial sensitivity and indigenous folk medicine. The child's adaptational strengths are discussed, and the recognition and management of transference and countertransference are not ignored in the treatment of traumatized children. Basically, the author's point of view is that Western models of interventions are very useful, but that the personal, cultural, social, spiritual, and economic resources of the child's homeland or village probably constitute the best system for healing and integration after brief or continuous exposure to political violence.     

A peocess model of ethnocultural counselling for African survivors of organized violence

By analysing some 500 counselling and psychotherapy cases of survivors of organized violence as a therapist and supervisor over ten years the author developed a heuristic framework for a process model of ethnocultural counselling considering: (1) African counsellor's indigenous concepts, (2) a WHO-UNHCR approach, (3) a heuristic approach to psychotherapy, (4) a constructive narrative perspective, (5) an ethnopsychotherapeutic approach, and (6) a counselling approach for lay counsellors. The counselling process model comprises the following components: (1) Establishing a counselling relationship and motivation for change; (2) defining the problem, explanatory models, goals, and finding interventional means; (3) social comparison, cognitive undoing, metaphors, shared experiences and relaxation techniques; (4) working through the trauma, testimony approach; (5) ritualistic, cognitive and supportive approaches; (6) principle of education and advice; (7) evaluating and revizing treatment and stabilizing behaviour. These seven counselling components are described and counselling case examples are provided from Sudanese refugees in a large camp in Uganda and Malawian torture survivors in Malawi.     

Torturers and the Tortured

Abstract

Patrick Lenta and Jessica Wolfendale have written two very thoughtful discussions on torture. A central question that arises in responding to these essays in terms of my recent book, Stoic Warriors, is whether ancient Stoicism affords any insights into both the propensity to inflict torture as well as the capacity to endure it. Wolfendale suggests that the learned capacity to endure torture, and in particular, becoming desensitised to pain, may be part of the psychological background that informs a willingness to inflict torture. Training in resisting torture, such as that which special operations troops typically go through, involves not only learning techniques, which can then be reverse engineered in applying torture (what some argue has happened in Guantanamo Bay), but also learning the kind of stress inoculation that makes one willing to use those techniques. In short, military training that involves torture resistance hardens one’s soul and makes one indifferent to the suffering that torture involves. This indifference, Wolfendale claims, is not unlike Stoic apathy. I want to argue, on the contrary, that Stoic apathy is substantively different. However, before making the case, I take up a number of other preliminary points raised in both papers. I conclude with some remarks about interrogation in general.     

Refugee Discrimination – The Good,the Bad,and the Pragmatic

This article addresses three questions. To what extent does the current refugee regime discriminate among refugees? When is such discrimination wrong? Could discrimination ever be justified pragmatically, for the sake of admitting more refugees given political constraints? In answer to the first question, it finds discrimination is rampant. There is the kind of discrimination that gets noticed: discrimination that states choose to enact within the refugee regime. But there is also a kind of discrimination that is missed: discrimination that is a product of the regime itself. The second question proves tricky. Matters are clear at the extremes. Discrimination based on need is permissible. Discrimination based on race or religion is not. In between, we have a set of hard cases that are more difficult to judge. The article searches for relevant criteria. Finally, on the last question, the article concludes that a political leader could be justified in enacting discrimination as a pragmatic response to political constraints but that, even on such occasions, discrimination remains wrongful.     

Intimacy,sport and young refugee men

This article is about research with a group of young refugee men from Sudan and their relationship to football (soccer) as they resettle in Australia. It provides evidence of the resilience, independence and autonomy that such young refugees possess and what these young men's intimate knowledge of these qualities can teach us. In other words, how can we as researchers learn from these young refugees about how they perform these qualities and how may we accommodate this during ethnographic research and in sports-based intervention programs aimed at empowering such young people? Further, the article explores the role of intimacy in this process by accounting for the role of affective connections on and off the sporting field. The argument is that intimacy can help those involved negotiate the power inequities present in sports-based intervention programs and in associated research.     

Torture in the Naked Public Square

Is torture ever ethically permissible? O’Donohue et al. (2014) argued that there are situations in which it is not only morally permissible but actually morally obligatory to torture a prisoner. Arrigo, DeBatto, Rockwood, and Mawe (2015) wrote a critical reply; O’Donohue et al. (2015) have responded. Yet to date, the specifically ethical weaknesses of the O’Donohue et al. position have not been examined; no argument against torture has been offered, nor have the lessons of the CIA’s secret program been taken into account. The present article moves the discussion forward on all three fronts. A case against torture is offered on pragmatic grounds.     

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.     

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.     

Revisiting The Body in Pain: The Rhetoric of Modern Masochism

A common-sense definition of pain would state first of all that pain is bad: pain is by definition what all living creatures most fundamentally seek to avoid. And yet, anyone with an average range of experience knows that much of what is ordinarily termed pain??from stretching to massage to exercise to childbirth??is not necessarily aversive. Self-proclaimed masochists are one group who embrace and embody the complex human relationship with pain as both an undeniably material experience, but also a practice deeply embedded in culture and rhetoric. Reading through Elaine Scarry and Deleuze and Guattari, this article seeks to engage the apparent paradox that makes pain both an irresistible weapon of torture and a mechanism towards an ecstatic restructuring of subjectivity. The article posits that it is precisely the complex discourse and rhetoric of pain which allows the material experience of it to be so radically contextually determined.