Documentary delves into relationship between survivors and those who offer them treatment

“More than one million refugees have come to the US, fleeing torture and political violence,” begins Refuge: Caring for Survivors of Torture, an outstanding new documentary from the Refuge Media Project.

The vast numbers are staggering, but what makes a greater impression in this stand-out documentary are the small, individual stories from survivors and those who offer them care and support as they resettle in the US.

Ben Achtenberg, project director at the Refuge Media Project and producer/director of Refuge, says the film – seven years in the making – came about as his general interest in healthcare and mental health issues drew him to organisations and healthcare providers that offer support to survivors in the US. Previously, he was nominated for an Oscar for the film Code Gray: Ethical Dilemmas in Nursing, which he produced and served as cinematographer. Mr Achtenberg also won the 2009 IRCT Film Competition for his 30-second public service announcement.

“During the same period, I had started contributing to organizations that work with survivors and, in particular, was receiving the newsletters of Center for Victims of Torture in Minneapolis and similar groups around the country, about their work with survivors. At some point, it clicked that this was the film I should focus on.”

The stories presented in the approximately one-hour film are diverse, from a physician from Guatemala to an older man from Liberia who wishes to move his daughter to the US. They have different stories of torture, different stories of migration to the US, but they have all sought refuge and have found their way to the various featured torture treatment programmes, many of which are IRCT members. (A full list of organisations featured in the film can be found on their website)

Through the stories of survivors, both devastating and inspiring, we take home still another call to action – that healthcare professionals will, in fact, see a survivor of torture during their work, and they need to know what to look for and how to approach it so that the person can receive appropriate care.

“People who have survived torture are living everywhere in our communities, though you may not know who they are,” says Mr Achtenberg. “If you’re in or going into a healthcare or human services profession, you will encounter torture survivors in your client population. How you deal with them can have an impact on their ability to thrive in their new communities.”

It’s a delicate and caring relationship between the health professionals – doctors, therapists, social workers – and the survivors of torture they treat. “It’s a doctor that can listen to you and make you feel like you’re a human being,” says one survivor in the film. Another describes a mural painted by survivors at a centre in Boston: “We come from our countries, swimming across and arrive here naked, but you pick us up and give us back what we have lost.”

This wonderful film offers a unique perspective into the world of torture survivors, their experiences and reservations opening up, and into the world of the care-givers, as they approach the formidable task of helping them recover their dignity and life.

For more information on the film, please visit http://www.refugemediaproject.org/. To order a DVD of the documentary, email Ben at ben@refugemediaproject.org to inquire about pricing.

Rehabilitation in Zimbabwe: the community approach

Eugenia Mpande and I sit down in a quiet corner at the conference centre in Yaoundé where our regional meeting of centres from sub-Saharan Africa is taking place. She’s excitedly reflecting on how thrilling it is to meet other anti-torture activists and counsellors of survivors of torture.

“It’s just so rare that we get to meet such like-minded people who are so much in line with what you are doing and what you want to achieve,” she says. “You feel stronger.”

There’s a lot of fear in doing this work, she says, reflecting on the recent arrest of fellow Zimbabwean and previous colleagues . But coming together to share experiences both validates and lifts up other human rights defenders across the region.

Eugenia calls herself a human rights activist, and she has worked to rehabilitate survivors of torture since 2002, when political violence plagued the Zimbabwe in the period around the election. During that contested election, an estimated 30 people were killed and almost 1,500 arrested.

Eugenia now is in her third year of work at Tree of Life, a community-based, survivor-led organisation that rehabilitates survivors of torture, trauma and violence through a specific form of group therapy.

It’s just one example of how an organisation can approach the mental rehabilitation of survivors of torture.

In Zimbabwe, and in sub-Saharan Africa to a large degree, trauma is not necessarily just individual but collective, Eugenia says. Often violence is committed in public, in the presence of an entire community.

“All are witnesses to the violence, and it becomes a larger community story,” she says.

This is particularly true in Zimbabwe, when, in 2008, political violence around the presidential election resulted in the deaths of more than 300 people. But the goal of such violence was to terrorise and intimidate communities and political opponents into voting in a certain direction. Fear within the community destroys the social fabric, Eugenia says, resulting in more crime and violence and precipitating a recurring cycle.

In 2008, “ZANU-PF-led government, at the highest levels, was responsible for widespread and systematic abuses that led to the killing of up to 200 people, the beating and torture of 5,000 more, and the displacement of about 36,000 people.”

– Human Rights Watch, 2011

Thus, the intervention and rehabilitation must also take a community approach.

But before beginning any workshops, Tree of Life first identifies the areas in need of their work. They held workshops through the Harare area, Mashonaland to the north, and Matabeleland to the southwest. Matabeleland was the region where the Gukurahundi massacres took place in the early 1980s arising from a political divide following independence that resulted in violent repression by the Fifth Brigade, a specially trained force created by Mugabe. An estimated 20,000 were killed, many in public executions. Eighty percent of adults reported a torture experience, with 50% reporting psychological problems as a result, according to a 1998 study in the region [DOC].

Within a particular community, they identify key people and leaders to help in building a relationship with the community. Those key leaders also assist in identifying individuals who would benefit from the group therapy.

“It can take a lot of time to build these relationships,” Eugenia admits. But this brings a community-driven and grassroots nature to the workshops.

Identified individuals then are interviewed to assess their trauma. Anyone with a history of trauma, torture, or suicidal ideation may join, and between eight and ten are selected for a given workshop.

Tree of Life

As Eugenia begins to explain the process, the name ‘Tree of Life’ immediately becomes so obviously appropriate for this approach to psychosocial rehabilitation. At one point in our discussion, I bring up the Pando trees in the U.S. – it’s a forest of approximately 47,000 trees that all share the same root system. It’s technically the largest single organism in the world. Eugenia beams at the mention.

“Community is very powerful within our culture,” she says.

The Tree of Life approach uses this metaphor of the tree to bring about storytelling and group therapy over three very intense days. The group all stay within the same venue, eating together and sleeping together in preferably natural, outdoor settings. The tree metaphor leads to a greater understanding of the trauma experiences, a greater appreciation for one’s personal strengths and a greater understanding of the importance of community strength and support.

There are eight ‘circles’ through the course of the three-day workshop, where participants are brought together to identify and share the parts of their lives using this tree metaphor: soil (culture), roots (family), trunk (early life), branches (later development), leaves (current life), fruits (high points), scars (the traumas), and finally the power circle.

Through each circle, facilitators guide the participants through personal story-telling, eventually building trust within the group and leading to the ‘scars’ circle.

“It’s step-by-step building trust and respect within the group,” Eugenia says. “Many have not been listened to before, not given a voice. They can go on for a long time, but they are never interrupted.”

The process of sharing one’s traumas and the torture they experienced can be extremely intense and emotional.The facilitators are highly trained and skilled in handling these emotions. Tree of Life also has a comprehensive programme of support and care for the facilitators to prevent secondary traumatisation.

“In our culture, men can’t show emotions, but it happens in our circle.”

It’s a process of building confidence, empowerment and, most importantly, compassion to break the cycle of violence. Perpetrators are often also recommended and welcomed to join in a group, because, Eugenia says, “They also need healing; some of the perpetrators are also victims of organised violence and torture who have been forced or coerced to commit these acts of violence.”

Local human rights groups have reported that those who committed serious crimes during the 2008 elections often continue to live in the same communities in which they committed the crimes, sometimes next door to their victims.

– Human Rights Watch, 2011

After a three-day workshop, participants are given the chance for more one-on-one counselling if they wish then referred when there is need. Tree of Life works closely with other organisations providing medical treatment and support to survivors of torture. The organisation also follows-up with all participants within three months. Many participants even go on to become facilitators themselves – exponentially continuing the process within communities – following comprehensive training by Tree of Life.

A research study in  2012 concluded that the survivors felt, “that that the process had helped them… and had changed in the way that they felt about their torture.” One hundred and fifty nine participants were evaluated both prior to and after the workshop.. The participants  reported large effect size decreases in symptomatology, dropping  below the examinations threshold for psychological “caseness”, meaning they returned to psychological health. Overall, there was a significant improvement in their psychological well-being and community connectedness evidenced in the research.

Eugenia attributes this to the method of story-telling and group therapy within the community setting itself. “An environment can be toxic, but community healing can itself sustain the intervention.”

By Tessa, Communications Officer at the IRCT. The NSA project is supported by the European Commission.

Invest in mental health: Right of torture victims to psycho-social rehabilitative services

It’s a common story here. After 20 years of war and violence, Somalia has one of the world’s highest rates of mental-health disorders. An estimated one-third of its eight million people are affected by some kind of mental illness, yet there are only three trained psychiatrists in the entire country to care for them, according to the World Health Organization.
Many Somalis with mental disorders are simply chained to beds or imprisoned in criminal jails for years, leaving them with permanent trauma and physical injuries. “Degrading and dangerous cultural practices such as being restrained with chains are not only widespread but also socially and medically accepted,” the WHO said in a recent study of Somalia’s mental health care. (PDF)

World Mental Health Day is each year the designated day to promote awareness of mental health issues worldwide. But it’s more than that. At World Without Torture, we promote every torture victims right to holistic rehabilitative services. What is holistic?

Rehabilitation after suffering from acts of torture is a long and complicated process. Depending on the acts of torture, it can involve lengthy medical treatment. But, as importantly, torture victims also have the right to full psycho-social treatment and rehabilitation.

Many victims suffer from post-traumatic stress disorder (PTSD), which includes symptoms such as flashbacks (or intrusive thoughts), severe anxiety, insomnia, nightmares, depression and memory lapses. Mental illnesses can be completely debilitating to a victim of torture.

This year, the theme of World Mental Health Day is ‘investing in mental health,’ and during the current trend of austerity measures, spending cuts, and financial instability, we must remember to not only maintain our current funding for mental health services, but increase it. Treatment through psycho-social, contextually-based rehabilitation is a basic right of every victim of torture – a right that many have yet to see fulfilled.

As conflicts around the world continue and states continue to torture, we must reaffirm our commitment and obligations to victims of torture and fund the holistic rehabilitative services that are every victim’s right.

UPDATE: Check out other blog posts for World Mental Health Day, compiled by PsychCentral

The consequences of torture reach far beyond the immediate pain (IRCT)
Mental illness ‘rampant’ in Somalia (Al Jazeera English)
Mentally ill are stigmatized, misunderstood and shackled in Somalia (Globe & Mail)
World Mental Health Day (World Health Organization)
2011 World Mental Health Day (World Federation of Mental Health)
Post- Traumatic Stress Disorder / PTSD (Health and Human Rights Info)