Experience Of Torture Research Articles

Human Rights of Asylum Seekers with Psychosocial Disabilities in Europe.

Background:The migrants crossing the Mediterranean towards Europe have dramatically been increased in 2015 as the number of incidents and deathsObjective:This editorial summarizes the results of our work and highlights some critical aspects that hinder the care to asylum seekers with stress disorders.Method:Screening for mental disorders was performed in all migrants joint three camps in Sardinia (January-September 2015) using K6, Short Screening Scale for Post Traumatic Stress Disorder (PTSD) and with an interview. Positives were evaluated by psychiatrists and if they needed, have been treated and evaluated at the start of treatment and three months later.Results:22.1% of the sample, (22.6% female, 38.5±12.9 years) were positive for at least one screener; 8.7%, (24% female) had a diagnosis of depressive or bipolar DSM5 disorders and 7.6%, (25% female) of PTSD. After three months of treatment: 51 treated people (26.8%) had left the camps. 53.1% of those remaining declared had relatives in northern Europe that they wanted to reach. Only 8.3% showed a significant clinical improvement.Conclusion:Clinical improvement was dramatically poor in people who stay in the camps. Dissatisfaction and feeling they could not join relatives may have had a negative impact. In PTSD, with the experience of torture and seeing family members killed, staying with surviving relatives in stable conditions would be an important part of treatment. From this point of view the UE Dublin Regulation seems not to be in agreement with the UN Convention on the rights of persons with disabilities

Physical Correlates of Torture Exposure in Karen Refugees

ABSTRACTWe explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research.

Addressing the Needs of Survivors of Torture: A Pilot Test of the Psychosocial Well-Being Index

Survivors of torture experience numerous psychosocial stressors that threaten individual well-being in resettlement. This study reports findings from a pilot test that applied the newly developed Survivors of Torture Psychosocial Well-Being Index. The study used a case-level mixed design to assess survivor psychosocial well-being across 16 life domains from intake up to 18 months. Ecological systems theory grounds this study. Participants demonstrated increased well-being as evidenced by statistically significant change on the mean ratings of their total scores. Three case examples illustrate the instrument. Practice applications, lessons learned, study limitations, and future directions are presented.

What Torture Survivors Teach Assessors About Being More Fully Human

ABSTRACTThis article illustrates the complex sociocultural components in the forensic psychological assessment of a young Ethiopian woman's claim for political asylum due to a well-founded fear of persecution and for relief under the Convention Against Torture. It draws attention to the subtle social and cultural influences in the practice of forensic psychological assessment with an emphasis of reflective practice, which is contextualized in the interpersonal theory of Sullivan. In the interpersonal approach, the essential work of the assessor is to pay careful attention to the microinteractions between the client and the assessor as reflections of the interpersonal (meaning social and cultural) processes, eschewing the illusion of objectivity.In this case study, I illustrate the particular cultural dilemmas for client and assessor in conducting a forensic assessment of psychological trauma, including cross-cultural, gender, and legal difficulties in arriving at an informed, objective, and compassionate assessment of an individual seeking asylum after an especially brutal experience of torture. I argue that collaborative therapeutic assessment methods adapted for forensic practice offer an approach to assessment of psychological trauma that provides more accurate and compassionate assessment than so-called neutral standard forensic assessment practice.

Exploring Female Genital Cutting Among Survivors of Torture.

Though the practice of female genital cutting (FGC) has been framed as a form of gender-based torture, few studies have examined the prevalence and impact of the practice among documented survivors of torture. This article presents a secondary analysis of data from 514 African-born women at an interdisciplinary clinic for survivors of torture. Results indicate few demographic differences between those who experienced FGC and those who had not, though a larger proportion of the FGC group were West African and identified as Muslim. Many with FGC were in the process of applying for asylum, reported sexual and psychological torture, and cited gender as a basis for their persecution. The FGC group evidenced unique correlates related to immigration status and psychological and sexual torture experiences that the non-FGC group did not. Findings indicate that female survivors of torture with FGC represent a distinct group with specific mental health needs.

The impact of racism and discrimination on mental health of refugees and asylum seekers

With the strong focus on terrorism in recent years, there is an increasing concern that the fundamental rights of refugees and asylum seekers may be violated in the interest to combat acts of terrorism. It may also lead to increasing racism and discrimination towards these populations.Racism and discrimination encompass the negative stereotypes and prejudicial beliefs that people may hold, as well as inequitable practices that may result hereof.Knowledge about the mental health consequences of racism and discrimination is of clear clinical relevance for psychiatrists worldwide, as a significant proportion of psychiatric patients will have a background as refugees and asylum seekers. Many of them have experiences of war, strife, persecution and torture that further ads to their mental distress.The paper will outline the psychiatric symptomatology related to racism as well as ethical dilemmas and educational needs for the psychiatric profession.Further the role of national psychiatric associations in combating racism and discrimination by e.g. defining best practices and revising medical training curricula will be outlined.http://www.mariannekastrup.dk/Disclosure of interestThe authors have not supplied their declaration of competing interest.

Intimate partner violence as seen in post-conflict eastern Uganda: prevalence, risk factors and mental health consequences.

BackgroundConflict and post-conflict communities in sub-Saharan Africa have a high under recognised problem of intimate partner violence (IPV). Part of the reason for this has been the limited data on IPV from conflict affected sub-Saharan Africa. This paper reports on the prevalence, risk factors and mental health consequences of IPV victimisation in both gender as seen in post-conflict eastern Uganda.MethodsA cross-sectional survey was carried out in two districts of eastern Uganda. The primary outcome of IPV victimisation was assessed using a modified Intimate Partner Violence assessment questionnaire of the American Congress of Obstetricians and Gynaecologists.ResultsThe prevalence of any form of IPV victimisation (physical and/or sexual and/or psychological IPV) in this study was 43.7 % [95 % CI, 40.1–47.4 %], with no statistically significant difference between the two gender. The factors significantly associated with IPV victimisation were: sub-county (representing ecological factors), poverty, use of alcohol, and physical and sexual war torture experiences. The mental health problems associated with IPV victimisation were probable problem alcohol drinking, attempted suicide and probable major depressive disorder.ConclusionIn post-conflict eastern Uganda, in both gender, war torture was a risk factor for IPV victimisation and IPV victimisation was associated with mental health problems.

Treatment Resistant Symptoms of Complex PTSD Caused by Torture During War

Objective: The purpose of this study was to evaluate the severity and complexity of a treatment resistant PTSD caused by torture during war. The inclusive criteria included the experience of torture and no efficacy of provided therapy after five years of being treated due to severe war-related PTSD. Method: The study was conducted on 24 treatment resistant PTSD patients from former Yugoslavia who had been tortured during their captivity as the POW. Despite being already diagnosed and treated due to their war-related PTSD, all patients were screened by the Structured Clinical Interview for DSM-IV (SCID), MMPI, and the Posttraumatic Stress Diagnostic Scale (PDS). Results: Results of the initial assessment revealed that 19 out of 24 patients satisfied criteria for treatment resistant symptoms of complex PTSD due to severe trauma experience. Conclusion: The treatment resistant PTSD is very a complex condition that requires various ways to make real contact with, endeavour congruent, emphatic and unconditional positive regards for the patients. It is important that clinicians do not use a ‘copping’ but qualitative and idiographic individual approach to each patient finding differences value alongside.

War trauma and torture experiences reported during public health screening of newly resettled Karen refugees: a qualitative study.

BackgroundKaren refugees have suffered traumatic experiences that affect their physical and mental health in resettlement. The United States Centers for Disease Control and Prevention recommends assessing traumatic histories and mental health symptoms during initial public health screening. This article reports the traumatic experiences that Karen refugees were able to describe during a short screening and contributes knowledge to existing human rights documentation systems.MethodsFour semi-structured and open-ended items asked about lifetime experiences of war trauma and torture. Interviews were completed with adult, Karen refugees during their initial public health screening. Experiences of war trauma and torture were coded using the extensive Human Rights Information and Documentation (HURIDOCS) Micro-thesauri coding system. Additional codes were created to describe experiences not captured by existing codes.ResultsOver 85% of 179 Karen people interviewed experienced life-threatening war trauma. All participants who reported war trauma or torture stories were able to describe at least one event. New war trauma codes proposed include: widespread community fear, systematic destruction/burning of house or village, exposure to dead bodies, orphaned in the context of war, injury caused by a landmine, fear of Thai police or deportation from Thailand, and harm or killings in the context of war. New torture codes include: forced portering; forced to be a human landmine sweep; forced to be a soldier, including child soldier; forced contact with a dead body; and removal of the eyes.ConclusionKaren refugees were able to report traumatic experiences in the context of a brief health screening. The findings confirm existing reports of human rights violations against Karen people and suggest that additional codes be added to the HURIDOCS Micro-thesauri system that is used by torture treatment centers. Understanding the nature of traumatic experiences of this group is important for health providers working with resettled Karen refugees in their countries of resettlement. Health providers may need specialized training to understand the traumatic histories of this new refugee group, learn how to initiate conversations about trauma and its impact on health, and make appropriate mental health referrals in the context of a brief public health screening.

Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in‐depth semi‐structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre‐migration experiences of torture and trauma; familial factors of intergenerational conflict; post‐migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self‐medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre‐ and post‐settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psycho‐education.

Wounded I Am More Awake: Finding Meaning After Terror by Julia Lieblich & Esad Boskailo (review)

Reviewed by: Wounded I Am More Awake: Finding Meaning After Terror by Julia Lieblich & Esad Boskailo Dhana Hughes, Post-doctoral Researcher (Anthropology) (bio) Julia Lieblich & Esad Boskailo, Wounded I Am More Awake: Finding Meaning After Terror (Vanderbilt University Press 2012), 177 pages, ISBN 978-0-8265-1825-5. This lucid and deeply engaging book provides rich insight into what it is to survive extreme violence and recreate life in the aftermath. Set against the backdrop of the Bosnian war, the book follows the story of a Bosniak doctor, Esad Boskailo, who survives six concentration camps and goes on to qualify as a psychiatrist working with trauma survivors in the US. The book is a collaborative project, with human rights journalist Julia Lieblich telling Boskailo’s story. It raises issues about the difficulty of talking about terror, of bearing witness to and writing about trauma, and of the risks of “retraumatisation.” The authors skillfully and sensitively weave the human experience of terror with selected literature on psychology and trauma. The book is primarily situated with reference to Viktor Frankl’s Man’s Search for Meaning, which we are told resonates deeply with Boskailo’s own search for meaning after terror. A compelling read, the book’s strength lies in its accessibility to a wide audience and ability to intimately engage with the reader at a “human level.” The book is emotionally challenging at points, but this only adds to its value and importance. The book is divided into two substantive sections. The first section, which is focused on Boskailo’s life during the war, is utterly compelling. It gives rich insight into survival through terror, as it follows Boskailo’s everyday experience inside the Croat-run concentration camps. This section details the graphic and often harrowing psychological and physical torture inflicted on the detainees. Prisoners were dehumanized and ritually humiliated by the guards for sadistic gratification. For instance, we are provided with the stark example of a vulnerable schizophrenic Bosniak prisoner who is pumped up with steroids by the guards and goaded to beat and kill fellow prisoners. He is ultimately found hanging in his cell. Uncertainty, fear, and a sense of disempowerment mark the experience of detention. The example of a prisoner who wakes up every morning with bite marks on his body, as a result of trying to bite himself to death through the night, illustrates the emotional trauma that the experience of torture and detention entails. Intimate sociality becomes central to survival: we are told of inmates sleeping with arms and legs touching for reassurance, and we learn about the nature of relationships between the prisoners themselves, and between the prisoners and the guards. The second section follows Boskailo’s journey to piece together his life after violence. In addition to his family, an important component of Boskailo’s own quest for meaning after terror is in finding work as a psychiatrist helping other trauma survivors. This section sets out a number of individual case-studies of Boskailo’s patients. These powerful personal stories “humanize” the implications of trauma to the reader as we learn about the diverse ways in which survivors deal with the legacies of terror and recreate life in the aftermath. The case studies show the limits of medical interventions [End Page 242] alone. Central to “healing” after terror, we are told, is finding meaning—a reason to live—after trauma. This meaning is shown to be anchored in the social and material world—through finding meaningful work, family, friends, social activism, and so on. In this section Boskailo further addresses the question of what it is to treat trauma survivors while being a survivor himself. He asserts the importance of the quality of the relationship between therapist and survivor, which must be built on trust and empathy. Boskailo’s story is told in fragments, which illustrates the fragmented nature of traumatic memories. But somewhat surprisingly, a discussion on the vagaries of memory; its influence on narratives of violence and implications for life in the aftermath, is lacking. A powerful theme that is woven through the book is that of intimate social relationships, the betrayal of intimacy, and its implications for rebuilding life after terror...

The Political Philosophy of Zhang Taiyan: The Resistance of Consciousness by Viren Murthy

Reviewed by: The Political Philosophy of Zhang Taiyan: The Resistance of Consciousness by Viren Murthy Carine Defoort Murthy, Viren. The Political Philosophy of Zhang Taiyan: The Resistance of Consciousness. Leiden: Brill, 2011. viii, 268 pp. $148 (cloth) Zhang Taiyan 章太炎 (or Zhang Binglin 章炳麟) (1869–1936) is known as one of the important revolutionaries of early twentieth-century China. Anti-Manchu, a scholar of "national learning," and a critic of Western influence, Zhang cannot easily be categorized as either conservative, reformer, or revolutionary. Viren Murthy's study shows the intricacies and evolution of Zhang's thought, with a focus on his Buddhist inspiration, more specifically the Yogācārā (Consciousness-only) school. He starts out from Zhang's personal experience of maltreatment and torture, when he was put in jail (1903–06) after being accused of plotting against the Qing regime. Zhang spent the following years in Japan (1906–10), where he was influenced by Japanese thinkers and German idealism. Out of intellectual debates with reformers such as Kang Youwei and Liang Qichao, Murthy unravels Zhang's own "unique philosophy of negation" (p. 5) as a criticism of Western categories and institutions, and more particularly of global capitalist modernity. On an even broader scope, Murthy's study also offers an entrance into tensions between old and new, nationalism and universalism, tradition and global modernity. The first chapter, which also functions as introduction to the intellectual scene, immediately throws the reader into a rather dense debate on modernity, capitalism, and Zhang Taiyan. Drawing on Japanese, Western, and Chinese scholarship, Murthy argues that the contrast between Zhang's anti-Manchu nationalism and his Buddhist self-negation was conditioned by global capitalist modernity. He heavily draws on the ideas of the contemporary public intellectual Wang Hui, with whom Murthy worked in Beijing, but also on other scholars such as Takeuchi Yoshimi, Chang Hao, Alex Schneider, and Georg Lukás. The second chapter analyzes shifts in Zhang's views, moving away from Kang Youwei's reformist ideal of a multiracial nation-state toward an anti-Manchu Han nationalism considered modern as well as rooted in the past. The following chapters all concern the integration of Buddhism into Zhang Taiyan's thought. Chapter 3 shows how Zhang differed from Liang Qichao in using Yogācārā Buddhism to counter capitalist modernity and entities entailed by it such as science, universal laws and ethical principles, nation-building, and imperialism. Buddhist insights combined with the Daoist idea of confusion (huo) helped to deconstruct the notion of the subject and to create a provisional subject willing to sacrifice itself in a revolutionary context. In Chapter 4, Murthy argues that Zhang negated the ideas of (Hegelian) evolution and historical progress, and that he saw the world as constituted of appearances caused by fluctuations of consciousness resulting from "karmic seeds." Convinced of the world's illusionary nature, Zhang cherished self-negation and the end of history. The fifth and last chapter shows how Zhang warned his contemporaries against the oppressive nature of such notions as "rationality," "equality," and "universal principle" as means to control man and dominate the world. Using Buddhism and inspired by Zhuangzi's idea of "equalization" (qi), Zhang rejected the homogenizing influence of global capitalism in favor of an embrace of particularities and a detachment from words. The conclusion argues that Zhang Taiyan's critical stance against the homogenizing power of capitalist modernity, its evolutionary visions, and its abstract principles is still relevant today. As Murthy notes, "Zhang's work is especially significant in Chinese intellectual history since it is one of the first attempts to overcome the alienation caused by capitalism in thought by invoking Buddhist categories" (p. 242). Murthy tries to show how Zhang's legacy has been critically adopted by his student and cultural critic Lu Xun and by Murthy's own teacher, the "new leftist" Wang Hui. Murthy's book can probably be situated in this line of intellectual heritance. Readers less acquainted with the topic will probably have a hard time following the intricacies of Murthy's arguments. Murthy's work reads as a sophisticated reflection for insiders. Carine Defoort University of Leuven Copyright © 2014 Twentieth-Century China

Self-Reported Head Injury Among Refugee Survivors of Torture

To examine the prevalence of self-reported head injury among treatment-seeking refugee survivors of torture, a population at high risk for such injuries. A total of 488 survivors of torture accepted at a torture treatment clinic between January 1, 2008, and December 31, 2011. Harvard Trauma Questionnaire, incidence of head injury and resulting loss of consciousness (LOC), chief physical complaints, general health scale, indicators of torture severity (length of detention, sexual assault, and number of different persecution types). Of the 488 cases reviewed, 335 (69%) patients reported sustaining a blow to the head. Of the 335 with head injury, 185 (55%) reported LOC following the injury. Those who reported sustaining a head injury were significantly more likely to be men, to have a greater number of types of torture experiences, and report sleep disturbances and headaches as their primary medical complaints. The high rates of head injury and head injury followed by LOC among treatment-seeking survivors of torture indicates the need for torture treatment centers to assess for possible brain injury. Our findings suggest that patients with possible traumatic brain injury (TBI) may be at a higher risk of negative physical outcomes than those without possible TBI.

Jean Amérys Ethik der Erinnerung: Der Körper als Medium in die Welt nach Auschwitz by Sylvia Weiler (review)

Reviewed by: Jean Amérys Ethik der Erinnerung: Der Körper als Medium in die Welt nach Auschwitz by Sylvia Weiler Dagmar C. G. Lorenz Sylvia Weiler, Jean Amérys Ethik der Erinnerung: Der Körper als Medium in die Welt nach Auschwitz. Göttingen: Wallstein, 2012. 448 pp. Jean Améry’s 100th birthday in October 2012 occasioned new scholarship about him and his work and publications of earlier writings, including the book publication of Sylvia Weiler’s dissertation, which had been submitted in 2008 at the Free University of Brussels. Austrian-born Holocaust survivor and anti-Fascist Jean Améry, a philosopher, literary author, and public intellectual, chose Brussels as his place of residence and begun to publish in German presses only after initial hesitation. His essays on the Shoah did earn him respect in post-1945 Germany and Austria—less so his fiction—but similar [End Page 152] to Günter Anders, his contributions to the Shoah and memory debates were eclipsed by others, especially by the members of the Frankfurt School. An “Ehrengrab,” a grave site for distinguished Austrians, was dedicated for him at the Vienna Central Cemetery. Weiler’s far-reaching study adheres to the systematic structure of a dissertation. It guides the readers safely from one topic to the next, but on the other hand, it makes the critical narrative less appealing than necessary. In more than four hundred pages Weiler examines Améry’s multifaceted work, which includes essays, critical and journalistic pieces, and narrative prose—youthful fiction such as the novel Die Schiffbrüchigen and later works like Lefeu oder der Abbruch. In addition to exploring Améry’s ideological development and his intellectual positions vis-à-vis prominent post-Shoah critics including Theodor Adorno and Hannah Arendt, who experienced Nazi persecution but not the reality of the camps, the book traces the circumstances of the author’s socialization, his changing conceptions of his Jewishness, and his significance in the European, particularly German-language, memory discourse. Intertextualities are scrutinized as well, for example the literary models Améry chose for his narratives, such as Proust for his 1945 novel fragment. Proust, according to Weiler, inspired the topic of the body as the primary medium of remembrance. In his famous collection of essays, Jenseits von Schuld und Sühne (1966), Améry conveys immediate and intense impressions of the physical experience of torture and deprivation that eclipse any heroic notion such as the often-mentioned triumph of the spirit in the face of adversity. As it were, Améry reveals a keen awareness of the body as prison, which manifests itself in different ways, through pain, sickness, and aging. Weiler explores as a central theme the “ethics of remembrance,” which initiates a comparative analysis of Adorno, Arendt, and Améry. With reference to Enzo Traverso, who asserts that the former two authors were able to “think” or imagine Auschwitz, Weiler maintains that Améry would have objected to such a notion. She adds that neither Arendt nor Adorno accorded the Holocaust, the death camps, and torture the same significance as did Améry, who had experienced them firsthand. Yet she agrees with Traverso, who observes that beginning with the 1960s the former German-Jewish exiles living in Germany had a monopoly on how to interpret the Holocaust. Améry, on the other hand, who found himself in a somewhat marginal situation within the debates of that time, articulated the lack of regard for the victims’ narratives and analyses. Weiler suggests examining perhaps the two most important postwar intellectuals, [End Page 153] Adorno and Améry, in depth as complimentary as well as contradictory models. The central issue in Weiler’s book is Améry’s ethics of remembrance. The analysis of the far-reaching implications of this aspect of Améry’s oeuvre is intended to show that with its philosophical, social, and political dimensions, this author’s approach could serve as a framework for a comprehensive Holocaust interpretation. Weiler convincingly argues that Améry’s transdisciplinary oeuvre deserves renewed attention and a central place in the Holocaust discourse. In clear and persuasive prose Weiler presents complex intellectual discussions as well as descriptive passages...

The Prevalence of Torture and Associated Symptoms in United States Iraqi Refugees

Iraqi refugees face difficulties resettling in the US, which may be partially due to high rates of torture. This study determines the rates of torture experience, primary and secondary, among Iraqi refugees in the US; and the association to physical and mental health symptoms on arrival. A retrospective review was conducted in 2011 on the post-arrival health screens of Iraqi refugees resettled in Utah in 2008 and 2009. Measures included reports of torture experience as defined by the United Nations; reports of physical and mental health symptoms at the time of screening; and association of torture to the presence of symptoms on arrival. The study included the health screens of 497 (97%) of eligible Iraqi refugees. Most experienced torture (56%) before arrival in the US Logistic regression revealed that torture was the most significant predictor of mental illness symptoms. Iraqi refugees in the US have a high prevalence of torture, and torture is associated with the presence of both mental and physical symptoms on the post-arrival health screen. This information is critical to the development of successful resettlement strategies for Iraqi refugees.

Healing After Torture

The experience and sociocultural context of torture and its treatment have received little attention in the biopsychosocial model of Western mental health for survivors of torture. The main focus has been on the reduction of symptoms of posttraumatic stress disorder and related conditions. Using grounded theory methodology, we investigated survivors' perceptions of the nature and process of healing after torture. The participants included 11 adult refugee torture survivors (9 men and 2 women) from African and Asian countries. Their stories of healing centered on the role of "moving on" with their lives, which included aspects of cognitive reframing and empowerment. Reliance on belief and value systems, safety measures, and social support, despite continuing psychological and physical symptomatology, enabled the moving-on process. Implications for theory, research, and practice are discussed.

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

BackgroundRefugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems.MethodsThe study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis.ResultsOne of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms.ConclusionGeneral practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.

1081 – Detention and mental health of torture survivors - what do we know and what do we do?

Introduction Torture survivors often present a complex clinical picture with mental and physical symptoms and illness in addition to social incapacities. Torture survivors can be subjected to deprivation of liberty in a variety of situations. Detention might remind the torture survivor of former torture experiences and thus add further to the strain of being detained. Objective To evaluate and discuss the present knowledge of mental health consequences of detention of torture survivors and to present and discuss practices relating to detention. Aim To focus attention on existing evidence and problematic practices in relation to this. Methods Results from key publications within the field will be resumed and discussed and implications outlined. Results Research on the impact of detention on torture survivors is almost non-existent. A negative impact of detention on mental health of torture survivors can however be deducted mainly from the existing evidence on asylum seekers. Whether screening for torture experiences and following systematic monitoring of mental health are going on worldwide remains obscure, but from a Danish perspective it is likely that torture survivors are not identified. Conclusion Torture survivors constitute a vulnerable group mentally, physically and socially. A negative impact of detention on mental health can be deducted mainly from studies on asylum seekers. Identification of torture survivors is necessary before decision on detention is taken. Scientific evidence on the subject is missing. Research initiatives and monitoring of practices are necessary.

TORQUEMADA DE AUGUSTO BOAL: UMA CATARSE DO TRAUMA

A partir de um estudo de caso sobre o teatrólogo brasileiro Augusto Boal, o presente artigo busca refletir sobre a questão da tortura no teatro de resistência ao regime militar no Brasil. A experiência de tortura vivenciada pelo artista, assim como sua produção enquanto dramaturgo, escritor e diretor teatral, ancoraram profundamente a atual reflexão. Assim, a partir da análise de sua peça Torquemada (1971) e do romance Milagre no Brasil (1979), foi possível perceber suas motivações, suas escolhas estéticas e dramatúrgicas e estabelecer um elo entre o momento de sua vida da experiência de prisão, tortura e exílio e sua produção artística de então.

Christmas visits … ‘Don't worry’

Click to increase image sizeClick to decrease image size Notes 1. Whitehead, Affidavit, 19 Feb. 1982, Docket 1.47, Record of Inquest. 2. The South African Congress of Trade Unions (SACTU) was allied to the African National Congress (ANC). Although not prohibited, it was effectively crushed by its leaders being banned, imprisoned or forced into exile. 3. Breytenbach, Affidavit, 18 June 1982, Docket 2.1021, Record of Inquest. 4. Six Christmas cards – six in and six out – were negotiated two weeks earlier by the Detainee Parents’ Support Committee with Col. Muller, along with weekly (Friday morning) acceptance of food parcels and clothing, plus books, games and puzzles approved by the commanding officer. Dirty washing could also be returned. See Minutes meeting DPSC & Col. Muller, 10 Dec. 1981 in Emma Mashinini, Strikes Have Followed Me All My Life, London: The Women's Press, 1989: 139. 5. Whitehead, Affidavit, Record of Inquest. 6. Whitehead, Affidavit. 7. After a ‘near-death’ experience of torture, Auret van Heerden has made a statement and is now being allowed to recover. Neil's close friend and comrade, Gavin Andersson, who was detained and released, escaped to Botswana before the security police came to re-arrest him. 8. This is the same Special Branch interrogator who, in 1964, claimed that the detainee Babla Salojee had deliberately jumped to his death out of a seventh storey window in The Grays, Johannesburg's former police headquarters. Those who survived Swanepoel's ‘standing torture’ included my husband Nandha, whom he threatened with having his body dumped down a mine. One of their people would investigate, he added, and that would be ‘end of story’. By 1966, Major Swanepoel commanded the new security police camp in South West Africa's far north and the counter-insurgency squad that became the notorious ‘Koevoet’. Death was integral to Swanepoel's repertoire. He is said to have commanded the policemen who, in 1976, open fired on black school children in Soweto and Alexandra. 9. Van Heerden Statement, 16 Sept. 1982, Docket 4.1B, Record of Inquest. 10. Van Heerden Statement, 16 Sept. 1982, Docket 4.1B, Record of Inquest.