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.org website. www.uhhr.org  Healtorture.org

3. 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.

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 HealTorture.org Pre-FlightFlight Post-Flight

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

18. Trust vs. Mistrust

19. Trust vs Mistrust Trust versus Mistrust Autonomy vs Shame and Doubt

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

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

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

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

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

25. Trust vs. Mistrust 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

26. Trust vs. Mistrust 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

27. Autonomy vs Shame and Doubt Initiative vs Guilt Industry vs Inferiority Identity vs Diffusion Ego Integrity vs Despair Generativity vs Stagnation Intimacy vs Isolation

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