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Professional News
Program for Torture Victims Faces Cross-Cultural Challenges
Psychiatric News
Volume 38 Number 13 page 9-9

A special program at Bellevue Hospital in New York City is helping survivors of torture rebuild their lives in the United States.

These refugees fled totalitarian regimes, civil wars, or ethnic conflicts in their homeland, and many will carry for the rest of their lives not only the psychological effects of their ordeal, but also the physical scars.

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The artwork of a torture survivor. Courtesy of the International Rehabilitation Center for Torture Victims in Copenhagen, Denmark. 

"We have treated many patients from Sierra Leone who had PTSD or symptoms of PTSD and were permanently disabled by rebel soldiers fighting against the government," said Asher Aladjem, M.D., at APA's 2003 annual meeting in May in San Francisco. "Many young men in the army had their arms hacked off. As Muslims, they are required to wash their hands before they pray, which they couldn't do. They also couldn't vote because that was done by fingerprints in their largely illiterate society. In their society, they became powerless and totally dependent on their community for food to survive because there is no welfare system."

Aladjem is chief psychiatrist at Bellevue's Survivors of Torture program. Joining him on the panel were some of his colleagues in the program: psychiatrist Kimberly Busi, M.D., psychiatry fellow Sophia Banu, M.D., and chief psychologist Ilene Cohen, Ph.D.

When communist China cracked down on religious freedom in Tibet in the 1990s, Chinese officials forced Tibetan monks to sit and stare at the sun for hours, causing corneal abrasions, burns, and loss of consciousness, said Aladjem.

During the Serbian/Bosnian conflict in the 1990s, an estimated 50,000 Bosnian women were raped by Serbian soldiers, he said. The women were warehoused in an isolated area, and many became pregnant and later gave up the babies for adoption.

Many torture survivors enter the Bellevue program with a host of physical, psychological, and practical needs. Bellevue offers comprehensive medical care, including gynecological, psychiatric, and psychological services; rehabilitative services, including physical and occupational therapy; social services, including assistance with employment and shelter; and English language classes and tutoring, said Aladjem.

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Mr. C., a Tibetan man, was imprisoned and tortured by communist Chinese officials for demonstrating against the repression of religious freedom, said Banu, who evaluated and treated him at Bellevue in late 2001. He was beaten so badly during an interrogation that he lost consciousness and his head was gashed. A nurse bandaged the wound to prevent his death. During another interrogation, he was hung upside down and given electric shocks. He was starved and forced to work in the fields and abused psychologically and verbally.

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The artwork of a torture survivor. Courtesy of the International Rehabilitation Center for Torture Victims in Copenhagen, Denmark. 

Mr. C. had a history of hepatitis B. He tested positive for tuberculosis and was treated for it, said Banu. She also diagnosed him with posttraumatic stress disorder and prescribed sertraline.

Banu began seeing Mr. C. once or twice a month for individual therapy and medication checks. Mr. C. joined a therapy group for Tibetans and began attending English classes offered through the program. A legal advocate helped him apply for political asylum. Banu testified at his immigration hearing about his PTSD, the psychological abuse he had experienced, and physical symptoms caused by the torture.

"When Mr. C. was granted asylum last year, he thanked all the staff for our help," said Banu.

Besides the therapy group for Tibetans, there are therapy groups for French-speaking Africans, English-speaking Africans, physicians, and women, said Aladjem.

Busi reported the results of a 1999 survey of 256 patients in the program. Fortyone percent were diagnosed with PTSD, 25 percent with major depressive disorder, and 11 percent with generalized anxiety disorder.

Aladjem said the symptoms of PTSD may mask an undiagnosed preexisting condition. For example, a Russian homosexual man who had hyperactive behavior was repeatedly imprisoned and tortured by guards in the former U.S.S.R. His behaviors included demonstrating, dancing, and taunting the guards in Red Square.

"When he came to our program, we diagnosed him with bipolar disorder," said Aladjem. "We suspected that he got into trouble with the authorities when he was manic. So, yes, he had posttraumatic stress disorder, but the underlying reason for his behavior was bipolar disorder."

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"We are continually amazed at how resilient these survivors are. We remind them of their strengths that enabled them to survive the torture and their journey to the United States," said Aladjem.

Busi mentioned a few studies comparing torture survivors with strong political and/or spiritual beliefs and survivors without them. The results showed that people who were activists and/or spiritual believed there was a purpose to their arrest and torture and fared better psychologically than survivors without those beliefs.

Banu said that Mr. C.'s Buddhist faith helped him cope with his imprisonment and torture. "When other people in the prison were screaming when they were tortured, he would try to cover his ears or pray. He also prayed when he was being beaten. He stopped blaming his captors for their inhumane behavior by recalling a Buddhist saying that some people behave badly because they have bad Karma," said Banu.

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The staff faces many cross-cultural challenges. A major hurdle is gaining the survivors' trust because of what they have endured, which sometimes involved physicians, including psychiatrists, collaborating with the repressive government. For example, patients from the former U.S.S.R. and Eastern Europe are understandably wary of psychiatric medications because they were misused under communism.

By contrast, patients from third-world countries like Tibet have never been exposed to psychiatry before, said Aladjem. "You can imagine a Tibetan monk who spent his life taking care of others having to accept that medications can be another form of healing," he noted.

Another cultural challenge crops up when staff communicate to patients through interpreters, who typically are from the same country or ethnic group as the patient. "They often do not translate the patient's words verbatim because they try to improve upon them or assume what the patient meant. This is frustrating because we don't get to hear the entire story in the patient's words, and nuances are lost," said Aladjem.

A detailed description of the program is posted at the Bellevue program's Web site at <www.survivorsoftorture.org>.

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The artwork of a torture survivor. Courtesy of the International Rehabilitation Center for Torture Victims in Copenhagen, Denmark. 

"We have treated many patients from Sierra Leone who had PTSD or symptoms of PTSD and were permanently disabled by rebel soldiers fighting against the government," said Asher Aladjem, M.D., at APA's 2003 annual meeting in May in San Francisco. "Many young men in the army had their arms hacked off. As Muslims, they are required to wash their hands before they pray, which they couldn't do. They also couldn't vote because that was done by fingerprints in their largely illiterate society. In their society, they became powerless and totally dependent on their community for food to survive because there is no welfare system."
Anchor for JumpAnchor for Jump

The artwork of a torture survivor. Courtesy of the International Rehabilitation Center for Torture Victims in Copenhagen, Denmark. 

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