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

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Psychological Sequelae of
TortureSuzanne R. Merlis, Psy. D.

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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.

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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

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Definitions Cont

• A personal definition
• When individuals become the target of
  political violence, their worlds crumble. There
  is nothing life giving left. Trust in ones 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)

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The Triple Trauma Paradigm

• The trauma event
• Flight
• Resettlement and acculturation

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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

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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)

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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?

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Resettlement

• Trauma of Displacement
• Immigration status/asylum process
• Adjustment (loss of ties to ones land and
  identity)
• Basic needs unmet
• Separation from family and cultural supports
• Continued persecution of family and friends
• Lack of safety and security

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Key Aspects of PTSD

• Interaction between two factors
• painful and intrusive memories of the trauma
• the defenses used to ward off those memories

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Trauma Symptom Categories
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Re-experiencing the Trauma

• Flashbacks
• Intrusive thoughts and memories
• Nightmares with content of the trauma
• Triggers

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Avoidance

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

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Hyperarousal

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

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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

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Altered Self-Concept

• Personality change
• Feeling of being damaged, contaminated
• A sense of fore-shortened future
• Problems of impulse control resulting in atypical
  behavior

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Dissociative Symptoms

• Dissociation
• Depersonalization

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Sexual Dysfunction

• Fear of sexual activity
• Fear of homosexuality
• Erectile dysfunction
• Disturbance in sexual arousal

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Psychotic-like Symptoms

• Delusions
• Hallucinations
• Bizarre ideation and behavior
• Perceptual distortions
• Paranoia

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Common Somatic Complaints

• Headaches
• Back pain
• Musculoskeletal pain

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Beyond PTSD

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

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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

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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

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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