1. Psychological Sequelae of Torture Suzanne R. Merlis, Psy. D.

2. Torture: Is the deliberate intention to destroy the physical and/or psychological well-being of an individual. Impacts the will and dignity of the individual, communities, associations, and movements. Is documented in 151 countries.

3. Definitions cont: A sociopolitical act: “ a strategy used to undermine political leadership and intimidate entire communities so that they will submit to the will of those in power or those seeking power.”  Andrea Northwood, Ph. D. Center for Victims of Torture, Minneapolis, Minnesota

4. Definition’s Cont: A personal definition: “ When individuals become the target of political violence, their worlds crumble. There is nothing life giving left. Trust in one’s self, in humanity, and in God is shattered. The survivor feels more kin to the dead than the living. We are left with fear, guilt, humiliation, helplessness, shame, nightmares, flashbacks, hideous memories. The survivors world, a world we wish to flee.” Sister Diana Ortiz (1998)

5. The Triple Trauma Paradigm The trauma event Flight Resettlement and acculturation

6. Series of Impacts and Injuries Multiple Losses : Control, identity, voice, trust, beliefs, meaning, values, relationships Physical and psychological symptoms (Acute & Chronic Illness, PTSD) Symptoms can be understood as a “normal” response to profoundly abnormal and aversive circumstances Duration of symptoms and exacerbation of new stressors =more psychological harm

7. The Trauma Event Contextual Framework- how did the event come about? Culture Sociopolitical background and heritage Theory and Practice of Torture Acts of Torture (Physical, Sexual, and Psychological)

8. Flight Attempts to escape- how many? Escape and Exile- how did they get out? Route of Transit- how did they get here? Arrival- what happens when they get here?

9. Resettlement Trauma of Displacement Immigration status/asylum process Adjustment (loss of ties to one’s land and identity) Basic needs unmet Separation from family and cultural supports Continued persecution of family and friends Lack of safety and security

10. Key Aspects of PTSD Interaction between two factors: painful and intrusive memories of the trauma the defenses used to ward off those memories

11. Trauma Symptom Categories

12. Re-experiencing the Trauma Flashbacks Intrusive thoughts and memories Nightmares with content of the trauma Triggers

13. Avoidance Avoidance of thoughts, conversations, activities, places, or people Emotional constriction Social withdrawal Personal detachment Inability to recall details of the trauma

14. Hyperarousal Difficulty falling asleep and staying asleep Irritability or increased anger Difficulty concentrating Hypervigilance Startle response Generalized anxiety Gastrointestinal distress

15. Depression Loss of pleasure Appetite disturbance Sleep disturbance Psychomotor agitation or retardation Chronic fatigue Feelings of worthlessness Diminished attention, concentration, and memory Thoughts of death and dying, suicidal ideation

16. Altered Self-Concept Personality change Feeling of being damaged, contaminated A sense of fore-shortened future Problems of impulse control resulting in atypical behavior

17. Dissociative Symptoms Dissociation Depersonalization

18. Sexual Dysfunction Fear of sexual activity Fear of homosexuality Erectile dysfunction Disturbance in sexual arousal

19. Psychotic-like Symptoms Delusions Hallucinations Bizarre ideation and behavior Perceptual distortions Paranoia

20. Common Somatic Complaints Headaches Back pain Musculoskeletal pain

21. Beyond PTSD Complex PTSD (Herman, 1997) Alterations in affect regulation Alterations in self-perception Alterations in relations with others Alterations in consciousness

22. Recovery Guiding principle: Restoring power and control Process can be slow Outcomes of traumatic experience is a consequence of multiple factors Access to culturally appropriate therapeutic, rehabilitative, social and legal services

23. Navigation of the Asylum Process Retraumatizing Events Story is not believed (have to prove and document) Interface with systems- legal, health, governmental, social Physical surroundings Telling often means re-living

24. Asylum process cont: Retraumatizing Effects Loss of control Guilt (self-blame or survivors guilt) Memory lapses and credibility problems Degradation and depersonalization Increased isolation and vulnerability Time is often frozen