Transcript Psychological Sequelae of Torture

Psychological Sequelae of Torture
Suzanne R. Merlis, Psy. D.
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.
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
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)
The Triple Trauma Paradigm
 The trauma event
 Flight
 Resettlement and acculturation
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
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)
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?
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
Key Aspects of PTSD
Interaction between two factors:
 painful and intrusive memories of the trauma
 the defenses used to ward off those
memories
Trauma Symptom Categories
Re-experiencing the Trauma
 Flashbacks
 Intrusive thoughts and memories
 Nightmares with content of the trauma
 Triggers
Avoidance
 Avoidance of thoughts, conversations,
activities, places, or people
 Emotional constriction
 Social withdrawal
 Personal detachment
 Inability to recall details of the trauma
Hyperarousal
 Difficulty falling asleep and staying asleep
 Irritability or increased anger
 Difficulty concentrating
 Hypervigilance
 Startle response
 Generalized anxiety
 Gastrointestinal distress
Depression
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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
Altered Self-Concept
 Personality change
 Feeling of being damaged, contaminated
 A sense of fore-shortened future
 Problems of impulse control resulting in
atypical behavior
Dissociative Symptoms
 Dissociation
 Depersonalization
Sexual Dysfunction
 Fear of sexual activity
 Fear of homosexuality
 Erectile dysfunction
 Disturbance in sexual arousal
Psychotic-like Symptoms
 Delusions
 Hallucinations
 Bizarre ideation and behavior
 Perceptual distortions
 Paranoia
Common Somatic Complaints
 Headaches
 Back pain
 Musculoskeletal pain
Beyond PTSD
 Complex PTSD (Herman, 1997)
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Alterations in affect regulation
Alterations in self-perception
Alterations in relations with others
Alterations in consciousness
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
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
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