Treatment, Support Groups Assist Torture Survivors by Carolyn Cosmos Before each torture session, ìa doctor examined me, checked my pulse, lungs, my blood pressure. I think they wanted to be sure I didnít die,î recalled Orlando Tizon, a former Roman Catholic priest tortured in more than 60 sessions during a five-year Philippine imprisonment in Mindanao under Ferdinand Marcosís martial law. Tizon was arrested in 1982 for fostering rural health cooperatives and loan programs in the Visayan Islands. ìAll political prisoners were tortured. You were lucky to get out alive,î he said. Torture and prison conditions left the living with lung complaints and tuberculosis, as well as broken bones and cuts, high blood pressure (hypertension), malnutrition and kidney problems, said Tizon, who was hospitalized with a kidney ailment and suffers from post-imprisonment hypertension. Dr. Dodo Maheri, a member of the Sindh National Council in Pakistan and an activist for Sindhi rights, spent 13 years in Pakistani prisons, once after a 1979 arrest under General Zia-ul-Haqís 1977-1985 martial law and an imprisonment two years ago. Maheri said he was beaten with chains and forced to stand without sleep for ìmany d ays and nights.î He is now unable to stand for any length of time. Both Tizon and Maheri speak of fear, mistrust and anger in the wake of their torture, but they have coped, even thrived, in part by helping others. And as torture survivors slowly put their lives back together, they are finding more outlets and support groups to deal with their pain, both physical and emotional. Maheri, trained as a medical doctor, has become a Sindhi writer speaking out against torture, a human rights activist, a poet and a politician. Tizon is now assistant director at the Torture Abolition & Survivors Support Coalition International (TASSC), founded by Sister Dianna Ortiz, who is also a torture survivor. Based in Washington, D.C., TASSC has sites in other U.S. cities and abroad. Tizon and Ortiz advocate ending torture and fostering TASSCís ìcommunities of healing.î Ortizís advocacy includes sharing her own torture story. A U.S. citizen and missionary nun, Ortiz was kidnapped in 1989 by security forces in Guatemala, burned, gang-raped, lowered into a pit of dead and dying people, and forced to hold a knife that was plunged into another person. She cannot recall her previous life and since her torture has suffered from suicidal thoughts, chronic sleeplessness, nightmares, guilt, extreme shame and a deep sense of personal contamination. Encountering the stories of torture victims and their burdens can be ìterrible,î acknowledged Dr. James Gordon, a professor in the Department of Psychiatry and Family Medicine at Georgetown University in Washington. He is also the founder of Healing the Wounds of War, a program for torture and disaster survivors that includes alternative medicine options. Working with child soldiers in Mozambique who had been tortured, badly beaten and forced to kill their own parents, ìI cried,î Gordon said. ìItís incredibly painful to see what human beings are capable of doing. So you see the worst, but you also see [in survivors] the bestópeople who are generous and beautifully open with a kindness to other people.î Gordon said that torture and disaster survivors frequently have medical conditions ìthat do not relate in any obvious wayî to their physical injuries, including swelling (edema), kidney problems, hypertension, fatigue and digestive difficulties, all of which are the result of prolonged stress. His findings have come from observations of torture victims in Africa, Bosnia, Kosovo, Macedonia and the United States. In Bosnia and Kosovo, for instance, clinicians reported a higher overall incidence of cancer in the population after the Bosnian Civil War from 1992 to 1995. Post-traumatic stress disorder (PTSD) is common among torture victimsóas it is among those exposed to war, natural disasters, devastating accidents, rape and child abuse. PTSD parameters include anxiety, insomnia, recurrent dreams, flashbacks, avoidance of situations that resemble the trauma, memory loss and emotional detachment. ìPTSD may be extremely long-lasting,î wrote Dr. Ben Green, a psychiatrist at Britainís Royal Liverpool University Hospital, in the journal Current Medical Research and Opinion. He cites one study in which 18 percent of World War II combat veterans were PTSD symptomatic for more than 50 years, and PTSD was present in 70 percent of the study participants who had been prisoners of war. Treatments Address Darkness Treatment and advocacy groups and networks have emerged around the globe to help torture survivors. In 1986, there were only two medical centers for survivors in the United States, the Center for Victims of Torture (CVT) in Minneapolis and the Marjorie Kovler Center for the Treatment of Survivors of Torture in Chicago. Now, there are 33 such centers. Similarly, Amnesty International (AI), formed in 1961, has expanded its Health Professionals Network to 32 countries and currently has some 1.5 million members, supporters and subscribers around the world. Another classic example of the ever-growing number of torture support groups is the Rehabilitation and Research Centre for Torture Victims, based in Copenhagen and created by Dr. Inge Genefke in 1979. The group now has a global network of 200 medical programs and also works with the United Nations. Here in Washington, Genefke was recently given CVTís Eclipse award before members of Congress in a ceremony attended by Ambassador of Denmark Ulrik Federspiel. Tizonís TASSC (pronounced ìtaskî) has its own take on healing. It involves survivors initiating informal meetings to socialize and talk about their experiences, encounters that create ìphysical and emotional relief.î ìWe survivors must be allowed to speak for ourselves and empower ourselves. One big effect of torture is isolationóand fear,î Tizon said. ìYou donít trust anyone and you keep away from other people. Our theory is that breaking the isolation and building trust is basic in the healing, and we think it is only a survivor who can talk in a language other survivors can understand.î Gordonís program, run by his Center for Mind-Body Medicine in Washington, uses techniques such as relaxation, biofeedback, meditation, movement and imagery, as well as teachings on psychological self-care, self-expression and group support, to help traumatized individuals heal themselves. There is an emphasis on activities such as dance and drawing, deep breathing, discussions of family trees, and the creation of a safe and sacred place that is ìpart of cultures all over the world,î Gordon said. ìWeíre helping people to express their vulnerability and call on their own strengths to heal themselves.î Supported by the World Health Organization, the program has trained 700 professionals in Kosovo and has been incorporated into Kosovoís Community Mental Health system. Gordonís organization is also developing programs for Israel, Gaza and the West Bank, Iraq, Afghanistan, Sierra Leone and South Africa. Closer to home, Gordonís center works with immigrants living in Washington who are ìfleeing authoritarian regimes,î and others who have been affected by war, torture and imprisonment. Gordon said his center has seen various government officials, diplomats, poets, union officials, activists and students. In addition, the center ran post-9/11 programs for the families of New York City firefighters and is planning to work more closely with those affected by the Sept. 11 Pentagon attack. Research Illuminates Damage and Recovery The Istanbul Center for Behavior Research and Therapy (ICBRT) has developed treatments for earthquake survivors that also apply to torture survivors, said Dr. Metin Basoglu, the centerís director and founder. Basoglu is also editor of the 1992 book ìTorture and Its Consequences: Current Treatment Approaches.î The ICBRT exposes survivors of the 1999 earthquakes in Turkey to real or simulated situations that evoke the disasters they endured to help them ìgain control over their fear and traumatic stress problems.î These interventions, Basoglu told The Washington Diplomat, can ìimprove post-traumatic stress disorder in earthquake survivors in 76 percent of the cases after one session and in 88 percent after two.î Survivor empowerment is a common theme among the various torture treatment successes, and Basogluís extensive research shows how this method helps people recover from PTSD. ìTorture survivors, like most other trauma survivors, fear and avoid situations that remind them of the torture events. Such avoidance perpetuates fear and leads to helplessness and depression, restriction in daily function and social disability,î said Basoglu, adding that this process can be reversed by exposing survivors to real or simulated situations similar to those they fear in a way that provides them with a sense of control. This approach is part of a cognitive behavioral therapy called ìexposure and response prevention,î which has successfully treated other anxiety disorders, including obsessive-compulsive disorder. For example, in Basogluís study of earthquake survivors published this past April in the American Journal of Psychiatry, 10 survivors were exposed to simulated earthquake tremors in a model house. After only a single session, eight of the 10 participants showed marked improvement. Another Basoglu study set to be published shortly examined the results of cognitive-behavioral treatment (CBT) in a tortured asylum-seeker living in Sweden. Basoglu said the treatment ìled to significant improvement across all measures of post-traumatic stress disorder, anxiety and depression Ö [and suggested that] CBT could be useful in treating tortured asylum-seekers and refugees.î How does PTSD happen and how does torture affect the brain? Animal and human studies show that stress damages the hippocampus in the brain, which creates problems with learning and memory, said Dr. Hidenori Yamasue of the University of Tokyo Graduate School of Medicine and a lead researcher in a groundbreaking brain study recently published in the Proceedings of the National Academy of Sciences. Magnetic resonance imaging (MRI) of the brain has shown a reduction in the volume of the hippocampus among combat veterans and victims of child abuse. Studies in animals have also shown that in another part of the brain, the anterior cingulate cortex (ACC), damage can boost fear responses, Yamasue said. His Tokyo team used a new brain-scan technique involving high-resolution MRI on 25 survivors of the infamous 1995 Tokyo Sarin gas attacks. The team found that the ACC was significantly smaller in the survivors who were suffering from PTSD compared to those without the disease. The team also found that the severity of the PTSD symptoms was directly linked to the size of the reductionóthe more brain damage, the more symptoms the patient had. The ACC plays an important role in the way we pay attention, regulate our emotions and experience fear, and the Tokyo study sheds light on the path torture takes through the brain and how this translates into extreme harm avoidance and fear. However, Yamasue cautions that his work does not address cause and effect. It is not yet known if a naturally smaller ACC contributes to PTSD in the wake of trauma or if the trauma itself causes the ACC to shrink. Said Londonís Basoglu of the Tokyo work, ìThe mind-body connection in stress is well known, and this study is yet another confirmation of this point.î An interesting study, he said, would be to see if PTSD treatments could reverse and normalize the changes Yamasue found in the anterior cingulate cortexóa research question that underscores the importance of developing good treatments for survivors. Carolyn Cosmos is a freelance writer in Washington, D.C.