TREATING VICTIMS OF TORTURE
by Dr. Pierre Duterte of France
The Association for the Victims of Re-pression in Exile (AVRE)
was created by Doctor Helene Jaffe in 1984. She still works as a director
doctor of the health care center and is the other full-time doctor with
me. We work with a part-time general practitioner, a physiotherapist, a
psychologist, a few translators, a secretary, and a secretary assistant
who is in charge of the computer work, an accountant. We also have as voluntary
workers the Director of the Association, an accountant, a social assistant,
a pharmacist, and a nurse.
We have a Health Care Center located in Paris, where we receive the foreign
patients who have endured torture, repression or mistreatments in their
country and we do "global" work with them. To cure is okay but
you also have to have somewhere to sleep. We also send missions abroad as
we did twice in Guinea this year. So far our team has been to Guinea-after
Sekou Toure's death-Mauritania, Zaire, Turkey, Morocco, the Philippines,
Iraqi Kurdistan, Chad-after Hissene Habre's fall-and Slovenia. In April
we were in Chad and will go again soon. We are planning to go to Lebanon
also. We adapt our missions to local conditions and try to train doctors
on site.
The Body's Memory
For a general practitioner, a scar is usually nothing more than a mark-often
ne-glected-resulting from surgery, an accident, or sometimes from a fight.
Most of the time it's only the esthetical problem that makes the patient
come and talk about it, or perhaps the practitioner's curiosity in asking
about it.
For a victim of repression, however, a scar may be an unbearable mark of
the terrible hardship which he has lived through, a badge of his courage,
the proof of the truthfulness of his story (or the vehicle for a false one),
a visible symbol of his new life, or a reminder of his weakness, of his
renouncement. The scar may be all of that for a victim of repression. In
such cases, these scars hold the evidence of suffering linked to barbarity,
the statement of physical martyrdom, but also of a never-healing wound so
deep that it can interfere in every instant of one's life. It is necessary
to be able to unveil what is behind the "palpable" in the suffering
endured, what is buried behind these marks. It is necessary to take the
time to listen, to wait for confidence to become real and strong. It is
important not to be demanding, not to transform oneself into yet another
interrogator, to allow the one who suffered to keep a private place where
there are secrets just for himself.
Careful listening is sometimes essential to explain scars in a strange location,
as were those that a Senegalese showed to me. He had scars only on the scalp,
on top of his shoulders, on the dorsal side of his forearms and hands, the
front side of his legs and feet. Unbelievable? No! Not if you have been
beaten while in crouching position, your back to the wall, hands, arms and
legs protecting your face, your body!
For someone who has endured electric shocks, the simple act of undressing
and lying down on a table, with electrodes attached for an electrocardiogram,
is an unbearable ordeal, reason enough to recall the torture chamber. While
talking with a patient who is trying to free himself from the shackles of
his memories, of the horror, of the mad world which he has experienced,
one might notice, suddenly, that the words stop, the expression in the eyes
disappears, flees, runs away, his thoughts going to a place thousands of
miles away. This may occur after touching a scar on the hand or grazing
the misshapen, dislocated finger. Suddenly he is once again transported
to the torture scene! After looking, rubbing his wrist where the mark of
his bonds or a pair of tight handcuffs remains, what a lot of memories come
back to mind? He realizes that he has unconsciously, while sitting on a
chair, crossed his wrists behind the back of the chair. Simple gestures,
simple glances, unfortunate remarks can bring you back to your torturers,
your inflicted wounds.
Not being able to endure even the sight of your own naked body in a mirror
because of memories of forced stripping in front of laughing torturers,
because of humiliating acts or remarks that you had to hear; not being able
to stare into the mirror that endlessly sends back the reflection of the
indelible hurt, the image of your body forever marked by these stigmata,
marks of barbarity. That's what your body can be-your own image transformed
into the representation of torture.
It is not essential to touch a scar in order to be sent back into a grim
past. Every time that you notice you can't hear someone talking on the side
where your ear has been destroyed by beating, you return to your Iranian
prison cell! When this happens countless times every day, you end up preferring
to be alone rather than face the lack of understanding in the gaze of the
person you couldn't hear. When 20 years after being released from the sinister
Boiro Camp in Guinea, you still cannot walk properly nor make an about-turn
because of polyneuritis due to vitamin deficiency; when your eyes can hardly
see-how can you be free of the hell of Ahmed Se' kou Toure's cells and their
black starvation diet, synonymous for so many prisoners with excruciating
death in about twenty days?
Every time you hear the word "AIDS," every time you take tablets,
every time you have a blood test, you see your torturer again perforating
your skin and injecting a contaminated liquid containing deadly viruses-you
are facing spiritual scars, memory scars, in the present and the forbidding
future. Torturers have managed to adapt themselves to the times. A few years
ago they were injecting hepatitis virus, but nowadays, AIDS seems to be
in favor!
Your own body can produce scars when you have to undergo a treatment to
lower high blood pressure or diabetes resulting from stress, severe anxiety.
These diseases are a clinical and biological trace of the evolution of memory,
of pain. The decrease of high blood pressure is quite often linked to psychological
improvement. But it takes years to evolve at quite a slow pace.
Fortunately, medical practice can bring back the smile! How pleasant it
is to see a smile light up the sad, closed, marked face of a Sikh who was
literally scalped while suspended by his hair. So important is hair in his
religion that the wound is far more than just a physical, visible one. His
face lit up, displaying such joy when I told him that surgery will be attempted,
and that there is every chance that he will be able to stop wearing a cap-such
an inadequate mask for this unbearable insult.
We as doctors, must take the time to get inside a story, however dramatic
it may be. Even if we can only walk part of the way together, perhaps we
can help untangle the web of despair created by these wounds and scars.
The Bedroom and Darkness
For those living an uneventful life, night may be the medium for crystalizing
fears, anguish and fantasies. One need only observe how movie-makers exploit
this moment of time in their films. But for someone who has been through
the crushing, destructuring machine called torture or isolation, night and
the bedroom can become an unlivable, unendurable time and space every evening,
every week.
Darkness is already at the root of fear of the unseen, of isolation! That's
one of the reasons why torturers work more often at night. It increases
the anguish that they want to instill in their victims to advance their
sinister projects. Being lost in the night is a destabilizing panic, greatly
amplifying weakness. You can't find your way; you don't remember where you
were; you don't recognize the aptly labeled "ghost houses," houses
turned into torture "homes" in Sudan. There is also loneliness
in the dark. There is no help-everyone is sleeping except you! There is
only isolation, abandonment, absence, and disappearance.
So, we can understand why some victims can't sleep during the night, can't
lie down after taking off their clothes, don't succeed in facing the loneliness
couched in the darkness, in the enclosed space of a bedroom. We can understand
why, for some people, sleeping during the day is reassuring because it offers
the only possibility of rest, though never longer than a few hours taken
from the realm of fear.
The memory of the darkness of the cell also prevents you from sleeping in
your bedroom with the door closed and the lights off because degrading and
filthy words come back daily to your ears, words that you heard while electric
shocks were applied to your genitals, initiating the sexual impotence that
still remains. Bedrooms and beds are supposed to be an ideal space for sexuality.
That's why the image of this tortured sex which was electrified, raped,
torn, bruised and above all badly humiliated, is what reappears in such
a place
During the night, in the darkness, vigilance becomes blurred, loosens its
grip, and makes all the defenses which were slowly built up during the day,
permeable. Memories kept in the background aren't held back and can buzz
at the doors of nightmares. To be cornered every night by horrible memories,
which increase and find their place where torturers wouldn't have hesitated
to drive them; to re-experience your failed death every night-this is exactly
what your torturers inflicted on you and continue to, for weeks, months,
years, no matter how far away they are.
How can it be easy to find yourself in a space the size of a cell, involuntarily
brought back into the very same conditions that once crushed and humiliated
you, fragmented your body and mind? How distant are those peaceful nights,
serene, and filled with pleasure! How far away is the time when closing
the door and turning off the light were conditions for a refreshing sleep!
How good it was when you could slide between the sheets with a naked, clean,
relaxed body.
How to become normal again? Perhaps first by accepting that you aren't abnormal,
that what was abnormal was the terrible time, that part of life squeezed
between a normal life and the actual endeavor to regain "normality."
To be able to face this terrible darkness of the past, the silence that
has enveloped the horror ever since; to accept your own screams, your own
tears in the midst of the night; to succeed in lessening nightmares, sleepless
nights which are a reminiscence of the horror-this is, without a doubt,
a hard, but forceful challenge to torturers, a challenge that the victim
and his doctor have to take up, so that they can push the torturer back
into the dark cold scornful night-alone.
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