The Treatment of Torture and Trauma: A Clinical Psychological Perspective

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By Nilofer Rehman
26th June, the International Day in Support of Victims of Torture is observed globally. Torture is one of the worst crimes against humanity. The direct implications of torture are both physical as well as psychological. Of these two, the psychological effects are more difficult to cope with by the survivor of torture. The physical injuries can be healed, while the psychological effects take time to heal. The survivors may live their whole lives with the psychological and emotional effects; often the survivors succumb to these effects.

People who are subjected to torture suffer a severe form of trauma. We all use the word “trauma” in everyday language to mean a highly stressful event. Traumatic events refer to extremely stressful experienced events that can overwhelm a person’s ability to cope. Traumatic events are unique individual experiences of events or enduring conditions in which – the individuals ability to integrate emotional experience are overwhelmed or the individuals experience a threat to life, bodily integrity or sanity. The individual may be overwhelmed emotionally, of his or her normal mental functions and physically. Torture can be faced by males and females, all ages, all races, all classes, all sexual orientations, all religions and all nationalities.

Trauma is an event outside normal human experience. The trauma of torture generally leave us feeling powerless, helpless, paralyzed, intense fear or horror. It tends to be sudden and overwhelming, and potentially life threatening. Though there are different traumatic events one can experience, they show common elements, such as unexpected, the person was unprepared; and there was nothing the person could do to prevent it from happening (beyond physical control).

It is also an individual’s subjective experience that determines whether an event is or not traumatic. These is likely to be due to one or more of these factors – the severity of the events, the individual personal history, the larger meaning the event represents for this individual, skills to deal with the experience, values and belief held by the individual, the reaction and support from family members, friends and/or professionals. Most of us have had at least one traumatic experience in our lives – for example, death of a loved one, serious illness or breakdown of a primary relationship. At such times we may have been very upset, or frightened or sad. But usually the grief passes; the pain lessens over time and eventually become normalized. But sometimes people experience life threatening or life changing situations that are so distressful or cruel that the memory doesn’t fade, not even slightly. For some people the experience is so extreme that they find they can’t get over it to move on with life.

Trauma is different from stress. Stress disregulates our nervous system but for only a relative short period of time. Within a few days or weeks our nervous system calms down and we revert to a normal state of equilibrium. This return to normalcy is not the case when we are traumatized.

There are common effects or conditions that may occur after a traumatic experience. Sometimes these responses can be delayed, for months or even years after the event. The following are symptoms that may result from unresolved trauma – physical (eating disturbances, sleeping disturbances, sexual dysfunction, low energy, chronic, unexplained pain; emotional (depression, spontaneous crying, despair and hopelessness, anxiety, fearfulness, compulsive and obsessive behavior, feeling out of control, irritability, angry and resentment, emotional numbness, withdrawal from normal routines and relationships), cognitive or mental function (memory lapse especially about the trauma, difficulty in making a decision, decreased ability to concentrate, feeling distracted , attention-deficit hyper activities; re-experiencing the trauma (intensive thoughts, flash backs or nightmares, sudden flood of emotions or images related to the traumatic events); and emotional numbing and avoidance (a total blank, avoidance of situations that resemble the traumatic event, detachment, depression, guilty feeling, grief reactions, hyper-vigilance, jumpiness, an extreme sense of being “on guard”, insomnia, obsession with death).

There are also other possible emotional effects of trauma. Some of them are on common personal and behavioral character like substance abuse, compulsive behavior, uncontrollable reactive thoughts like rage, inability to make healthy lifestyle choices, dissociative symptoms like inability to love a dear one, feeling of ineffectiveness, shame, despair, hopelessness, feeling permanently damaged, or a loss of previously sustained beliefs. Trauma can even affect interpersonal relationships like inability to maintain close relationship or choose appropriate friends and mates, sexual problems, hostility, arguments in family members, employees or co-workers, or social withdrawal and feeling constantly threatened.

What one can do to help survivors immediately after a trauma?

One of the best ways to help a traumatized person is simply to listen compassionately and actively; and make the person aware that we are willing to listen. We must make the person believe or reassured that we are willing to help and there are realistic ways to make it okay, that s/he can survive. We should suggest practical assistance. We should not ask if we see that something needs doing, we should suggest that we will do it. This is much more effective than simply saying “If there is anything I can do….”. We shouldn’t criticize the person’s reaction, instead minimize the trauma and suggest it was fate of God’s doing, minimize the person’s feelings or say we know exactly how they feel. We should not interfere with actions the person has chosen to take, unless they are endangering themselves or others.

Recovering from a traumatic experience takes time. We must give ourself time to heal and mourn the losses we have experienced. We should not try to force the healing process. We must be patient with the pace of recovery. We have to prepare for difficult emotions. There are some strategies that can be used by the individual to heal from these worst condition. Some of the strategies are:
· Don’t isolate: – After following a trauma, we may want to withdraw from others. But isolation makes things worst. Connecting to others will help us heal, so we must make an effort to maintain our relationship and avoid spending to much time alone.
· Ask for support: – It’s important to talk about our feelings and ask for the help we need. We much try to take help from a trusted family members, friends and counselor.
· Establish a daily routine: – We must try to stick to a daily routine with regular time for waking, sleeping, eating, working and exercise. We must also try to schedule time for relaxing and social activities, too.
· Take care of our health: – It is important to note that a healthy body increases our ability to cope with stress. We have to get a plenty of rest and exercise regularly and eat a well-balanced diet. It is also important to avoid alcohol and drugs.

When to seek professional help for emotional and psychological trauma
Everyone heals at his or her own pace. But if months pass, and our symptoms are not letting up, we may need professional help.

It’s a good step to seek professional help if we are:
· Having trouble functioning at home or work
· Suffering from severe fear, anxiety, or depression
· Unable to form close, satisfying relationships
· Experiencing terrifying memories, nightmares or flashbacks.
· Avoiding more and more things that remind us of the trauma
· Emotionally numb and disconnected from others
· Using alcohol or drugs to feel better
In order to heal from the psychological and emotional effects of trauma, we must face and resolve the unbearable feeling and memories we have long avoided. Otherwise they will return again and again, unbidden and uncontrollable. Trauma treatment and healing involves:
· Processing trauma-related memories and feeling
· Discharging pent-up “fight –or- flight” energy
· Learning how to regulate strong emotions
· Building or rebuilding the ability to trust other people
Trauma counseling is also very much effective in handling emotional trauma. Some of the techniques used are Ventilation which includes play therapy, journal/letter writing, art therapy, story- telling, puppetry, dance therapy, etc. Cognitive restructuring like positive thinking, logical thinking, attribution of meaning, and handling grief and guilt can also be used in treating such types of clients.

Counsellors can also use behavioral technique like daily scheduling, anger management, building self esteem, positive self talk, problem solving, and thought management. Relaxation technique like meditation, deep breathing and imagery works Talk therapy is also one of the most important traditional therapy uses by the counsellor.

Supporting victims of torture or survivors of trauma means enabling the persons to come out and deal with the problems, sometimes with the help of trained professionals. Sometimes, it may be too difficult for a survivor to make the first step towards reaching out to others. In such cases, forming self-help therapy can be very helpful. Medical and other health professionals must be aware and alert to the client who has been tortured or traumatized, and obliged to develop the skills to attend the problems appropriately. An enabling policy and professional environment is necessary for this, and the government has a very important role to play.

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