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|"The Relevance of Refugees: Reflections on Theory and Practice" Article appearing in Anthropology Newsletter, 1999 by Peter W. Van Arsdale, Ph.D.
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Torture, Justification, and Human Rights: Toward an Absolute Proscription
Human Rights Quarterly, 2007, vol. 29, no. 2, pp. 346-367 (22)
Twiss, Sumner B.
Abstracted by: Annmarie Barnes
SEE LISTING ON HUMAN RIGHTS PAGE
Trust Building from the Perspective of Survivors of War and Torture
Social Service Review, March 2004, vol. 78, no. 1, pp. 26-40
Abstracted by: Marie E. Ott
Refugees who have survived war and torture have experienced unthinkable situations. These traumatic events continue to negatively affect the lives of the survivors even after they have arrived in the country of refuge. For a refugee survivor there may be feelings of vulnerability, extreme guilt for having survived when family and friends did not, as well as inability to adapt to the new culture. These factors contribute to the refugee survivor’s negative self-concept and a loss of trust in others. This article addresses the mechanisms surrounding trust building between a refugee survivor client and a service providing professional. In Western countries, in order for the professional to help the survivor, the survivor will need to disclose the traumatic events that he or she experienced. For this to happen, the survivor needs to trust the professional. Based on theoretical aspects of the interactionist perspective, this article contends that trust is a result of a complex process involving the prospective client’s interpretation of his or her social relationship with the professional. This article discusses the reasons why trauma has an adverse impact on a refugee survivors’ self-concept and trust. Because of the nature of how acts of torture are carried out, a person who has experienced torture will not know who to trust and who to distrust. For survivors of war and torture, the process of trust building is especially complex. A framework is presented on how a service providing professional can earn the trust of a prospective client, from the client’s perspective. In a session the prospective client assesses the trust-worthiness of the professional through observation and interaction. The client observes not only professional’s office setting in which the encounter is taking place, but also the professional’s appearance and mannerisms. In addition, the client verbally engages the professional and may pose questions to learn about the professional’s values, beliefs, and knowledge. With this information the prospective client is able to define the professional and predict his or her possible future actions. As the client collects and interprets these observations and interactional cues, the client assesses them along three parameters: self-concept, perceived self, and definition of the professional as a significant other. In the concluding remarks, it is underlined that in order for survivor clients to disclose their painful histories, they must build a trustful relationship with the helping professional. Before this happens, the professional must be perceived as a competent and sincerely caring person. Survivor clients are not passive. Rather, they actively seek information in order to determine the trustworthiness of the professional. The framework presented in this article will help professionals understand the trust building process from the client’s perspective.
Refugee Survivors of Torture: Trauma and Treatment
Professional Psychology: Research and Practice, 2001, vol. 32, no. 5, pp. 443-451(9)
Abstracted by: Jaime Rall
Given the author's assertion that the practice of torture has increased in recent years, and the unprecedented numbers of torture-surviving refugees fleeing to the United States, the need for psychologists to be prepared and able to work with torture survivors is increasingly well-documented. Refugees are generally typified by having endured extreme abuses of human rights, and the resulting trauma is often exacerbated by the processes of exile, resettlement, status determinations, and the stresses of cross-cultural transitions. The experience of torture " "the deliberate, systematic or wanton infliction of'suffering" (p. 443) " can be further psychologically debilitating. Common psychological sequelae include "blame and shame", somaticization (experience of physical symptoms in response to psychological concerns), denial, repression, and conditions of helplessness, guilt, depression, or post-traumatic stress disorder [PTSD]. These symptoms often represent techniques for coping with the extreme cruelty of the torture situation that are now maladaptive in a new setting. Unless treated, these symptoms can shut down" and emotionally isolate the person experiencing them. Despite the clear need for psychotherapeutic treatment for torture survivors, there has been a lack of professionals who are qualified, willing, and emotionally prepared to work with this challenging population. In addition, physical health concerns have often been emphasized in refugee services, to the neglect of mental health needs. This article argues that, for reasons of professional responsibility and social justice, psychologists must assist these survivors in their recovery. A well-developed practice framework for serving this population should incorporate knowledge of refugee and torture experiences with multicultural principles, the psychology of trauma recovery and rehabilitation, and concepts of power and liberation. Multicultural competence includes knowledge of cultural contexts, traditions, understandings, and norms, as well as culturally-specific strengths, supports, vulnerabilities, and risks. Trauma recovery principles are central to the treatment of these multiply traumatized clients. Herman's stage model of trauma rehabilitation (1992) is recommended as a treatment framework for torture survivors. The first stage is establishment of immediate safety in the therapeutic relationship and in the environment, by addressing the client's immediate economic, legal, or medical problems before psychological concerns. The second stage is the reconstruction process, by re-visiting, re-interpreting and re-framing the traumatic experiences in terms that are meaningful and affirming to the client. In this stage, the psychologist must also beware vicarious trauma that s/he might experience after hearing horrifying narratives. The third stage is reconnection, with one's own identity and in relationship with others. A multidisciplinary approach to refugee services can facilitate the use of this model. Finally, concepts of power and liberation are integral to the treatment of refugees. The alienation, domination, and defenselessness inherent in the torture situation, and the added dislocation of exile, underscore the client's experience of power relationships. The use of Herman's stage model within a multicultural framework can systematically address the internalized oppression suffered by survivors, and validate the truth of the injustices they have survived. Engaging in psychological interventions with torture survivors is thus an important way that psychologists can meaningfully promote social justice.
Treating Refugee Victims of Torture: Creation of the Rocky Mountain Survivors Center
Journal of Immigrant Health, Vol. 1, No. 3, 1999 pp 155-164 (9)
Peter W. Van Arsdale and Dennis F. Kennedy
Abstracted by: Alexandra Nichols
“Training Refugee Victims of Torture” focuses on the creation of the Rocky Mountain Survivors Center ” (RMSC) which emerged from the “Refugee Mental Health Access Project” (RMHAP) in Denver, CO. Van Arsdale and Kennedy provide us with the broader theories behind RMSC’s philosophy and the ways in which these theories are put into practice. The article exemplifies the roles that both anthropology and psychology play in broadly dealing with refugee issues, as well as mental health and human rights. In looking at the role that RMSC plays in the Denver community working with refugees, Van Arsdale and Kennedy begin by laying out the theoretical and conceptual foundations within the international context. This is done through definitions of torture and a review of domains and literature that focus on this area. In reviewing domains of study and literature pertaining to this field, the authors note that a domain focusing specifically on suffering and pain has not been clearly defined but that it does however intersect with the 5 domains mentioned in the article. They are also sure to make mention of the fact however that both torture and treatment are not to be conceptualized as a “field” but rather as an experience that one goes through. This can however be an area of sub-specialization within health care. In discussing these theories at the national level, the authors explore how while psychiatric interventions are at times necessary when working with survivors of torture, it is necessary to approach this in a multidisciplinary manner involving expertise from fields such as anthropology, sociology, as well as non-clinically trained social behavioral scientists. Expertise from each of these areas will have insight into challenges to be faced. A number of these therapeutic challenges developed by psychiatrist JM Jaranson are discussed in the article. These challenges focus primarily on the matching of patient needs and expectations with those of the counselor to develop a cure as well as the counselor’s expectations to integrate the client into the community. Additional challenges occur in understanding the clients cultural context in relation to the context of American culture as well as understanding conflicting concepts of mental health with clients most notably fearing mental illness. Van Arsdale and Kennedy bring these theoretical concepts to the local level by beginning to link them to practical perspectives. Van Arsdale and Kennedy lay out a model constructed by Antonio Martinez that is based on four interrelated subsystems which can be used for “tracking” both torture and therapeutic interventions. These subsystems include: 1) the individual level, 2) the family and community, 3) the larger societal subsystem including state level forces and 4) the macro subsystem including international/global consideration. While the RMSC focuses primarily on subsystems 1 and 2, understanding all 4 can provide additional insight into both power and control structures and well as intervention action at the RMSC, Van Arsdale and Kennedy provide us with several case studies. The first illustrates the “tracking” which Martinez refers to. The second applies Jaranson’s therapeutic challenges and a third case denotes the difficulties surrounding some interventions and why a traditional medical model may not be as effective. Since RMSC’s first emergence in 1996 it has considerably grown in both numbers as well as breadth of services provided. Key findings of “what works” for RMSC have included a social service/case management model, accessing a wide range of community-based resources, trained volunteers, delivery of care in non-threatening, no-hospital like settings and tapping diverse sources of information and available resources.
Amputation as a Strategy of Terror in Sierra Leone
High Plains Applied Anthropologist, Vol. 24, No. 2, Fall, 2004, pp. 158 – 173
Fogelberg, Kate and Thalmann, Alexandra
Abstracted by: Cara Dilts
In Sierra Leone during the 1990s, between 50,000 and 70,000 people were killed, and 20,000 maimed. Initially, Sierra Leone was ignored by the global community and written off as another small-scale, local, civil war. The Revolutionary United Front’s (RUF) terror campaign had been going on for nearly ten years by the time the international press finally started reporting on the atrocities. Analyses of the crisis attributed the “unexplainable violence” to tribalism and cultural conflict, but recent theories have shifted to include an explanation that includes economic and global influences. Prior to the introduction of the diamond industry in the 1930s, Sierra Leone enjoyed relative prosperity and peace. Now, Sierra Leone holds the lowest rank on the Human Development Index (HDI) and quality of life continues to deteriorate. The diamond-smuggling business is the most highly developed and organized industry in the region. Government officials have become embroiled in this profit-making industry, causing corruption to run rife and essential services to be ignored. In 1990, only 30 percent of the nation’s youth were enrolled in school at all levels, and a large number of uneducated youth turned to the illicit diamond mining industry or to the RUF, who provided a social network and sense of belonging to the young soldiers. The RUF also abducted youth into their swelling ranks. Amputation included political, sociopolitical and economic purposes for the RUF. Amputation was used as a political tool to control the masses. People’s hands were cut off if they dared to vote. The hands were sent to the President in a symbolic gesture to demonstrate the government’s inadequacy and powerlessness to control the RUF. As a sociopolitical tool, the RUF used amputation to ensure combatants’ loyalty to the group. Children were forced to maim or kill their own relatives as a rite of initiation. The forms of suffering brought about through amputation impacted the stability of the social order by transforming the physical workforce and transforming the psyche of victims. The economic ramifications of amputation included using terror strategies to displace people away from diamond-mining areas, giving the RUF control of the mines. The RUF could then purchase enough Liberian arms to sustain their war and enough drugs to coerce their combatants into committing more atrocities. During harvest time, amputation was used to keep the population dependent upon them for food. Basically, amputation was cheap and effective. The war has now been officially over for three years, but the effects of ten years of amputations permeate Sierra Leone. Efforts to rehabilitate both amputee victims and child soldiers have been largely ineffective, and the state continues to be overrun by extreme poverty. Sierra Leone has a long road ahead to strengthen its political, economic and social institutions to ensure that future conflicts do not occur.
Somali and Oromo Refugees: Correlates of Torture and Trauma History
American Journal of Public Health, April 2004, vol. 94, no. 4, pp. 591-598 (8)
Jaranson, J, Butcher J, Halcon L, et. al.
Abstracted by: Keely Tongate
Refugees and asylum seekers have a high risk of experiencing politically motivated torture, most studies cite between 5% and 35%. However, estimating torture prevalence and posttraumatic stress disorder among refugee communities is an extremely difficult undertaking. This five-year community-based epidemiological study of Somali and Ethiopian (Oromo) refugees in Minnesota tasks itself with determining torture incidence and associated problems. The methodology of the study included a comprehensive questionnaire to a sample of 1,134 East African refugees. It sought to identify demographic characteristics, torture methods, and pre and post flight circumstances surrounding the refugee sample. The study used the United Nation’s definition of torture as the foundation for identifying torture victims. Persons acting in an official capacity intentionally inflicting physical or psychological pain in a discriminatory manner is the basis for the UN definition. The participants of the survey were deemed torture survivors if they responded affirmatively to any of the three questions asking directly if they had been tortured or had experienced one of the torture techniques that were construed as fundamentally part of a “torture session.” The results of the study found that torture incidence ranged from 25% to 69%, a figure markedly higher than previously found. Those most often exposed to torture were Oromo men (69%) and Somali women (47%). This study, in contrast to other works, show that women and the less educated are just as likely to be tortured as men and those with higher education levels. The most significant finding was the link between torture exposure and the prevalence of posttraumatic stress disorder symptoms. The study highlighted the importance of education, economic solidity, social support and religion as the foundation for healthy refugee communities. Not surprisingly, the more prevalent trauma and torture instances was reflected in more generalized problems within the refugee community. Thus, the impact of torture and trauma has a clear impact on refugees that needs to be addressed in resettlement communities. This study was limited to noting torture prevalence between two East African refugee communities. However, it seeks to highlight the absence of information about the effects of trauma and torture on wider refugee groups. It demonstrates the lack of treatment facilities for torture survivors worldwide. It also recommends screening East African and women refugees for possible torture exposure. However, it notes that less than 1% of the highly traumatized population sampled chose to follow-up with mental health services. This phenomenon demonstrates the need to evaluate why the limited services for torture survivors are being under utilized both for the study’s East African sample group and the greater refugee population.