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Clinical Resources on Torture Rehabilitation

Allodi, F & Cowgill, G. “Ethical and Psychiatric Aspects of Torture: A Canadian Study.” Canadian Journal of Psychiatry, 27,1982. 98-102

Allodi, F. & Randall, G. Physical and Psychiatric Effects of Torture: Two Medical Studies. In E. Stover & E. O. Nightingale ( Eds.). The Breaking of Bodies and Minds. 58-78. New York: W. H. Freeman, 1985.

Allodi, F. & Rojas, A. The Health and Adaptation of Victims of Political Violence in Latin America (Psychiatric Effects of Torture and Disappearance) Paper Presented at the 7th World Psychiatric Congress, 1983, Vienna, Austria.

Astrom, C., Lunde, I. Ortmann, J., Boysen, G. & Trojaborg, W. Sleep Disturbances in Torture Survivors. Acta Neurologica Scandinavica, 79, 1989, 150-154.

Auerhahn, N. & Laub, D. Annihilation and Restoration: Post-Traumatic Memory as Pathway and Obstabcle to Recovery. International Review of Psychoanalysis, 11, 1984, 327-344.

Archibald, H. & Tuddenham, R. (1965). Persistent Stress Reaction After Combat. Archives of General Psychiatry,12. 475-781
This paper looks at ” combat fatigue” symptoms in WWII veterans 20 years after the war. It finds PTSD-type symptoms in these men, which have been ignored. Their work suggests that without treatment such symptoms worsen with age and perhaps may become untreatable. The paper is interesting in part because it provides some perspective and history to more recent recognition of the persistence of chronic problems from combat stress.

Barfoed, G. Bjenregaard, B., Busch, E., Clausen, E. maller, G. Schow, G. & Stage, K. Physical Threapy of Torture Victims. Unpublished manuscript, 1983, Danish Medical Group, Al Copenhagen, Denmark.

Basoglu, M. (Ed.). ( 1992). Torture and its Consequences: Current Treatment Approaches. Cambridge: Cambridge University Press.

Berger, D., The Survivor Syndrome: a Problem of Nosology and Treatment. American Journal of Psychotherapy, 31, 1977, 238-251.

Berger, P., Documentation of Physical Sequelae. Danish Medical Bulletin. 27, 1980, 215-216.

Bergmann, M. Recurrent Problems in the Treatment of Survivors and their Children. In M. Bergmann and M. Jacovy (Eds.), Generations of the Holocaust, 247-266. New York: Basic Books, 1982.

Bettelheim, B. Individual and Mass Behavior in Extreme Situations. Journal of Abnormal and Social Psycholgy, 38, 1943, 417-542.
Boehnlein, J. Clinical Relevance of Grief and Mourning among Survivors of Cambodian Concentration Camps. American Journal of Psychiatry, 142 (8), 1985, 956-959.

Beiser, M & Ganesan, S. Catastrophic Stress and Factors Affecting its Consequences Among Southeast Asian Refugees. Social Science and Medicine, 28(3), 1989,183-195.

Bettelheim,B. (1943). Individual and Mass Behavior in Extreme Situations. Journal of Abnormal and Social Psychology. 38.417-452
One of earliest survivor accounts of coping mechanisms within Nazi labor camps. The author focuses on transformations of personality and defenses– especially extreme detachment and mass regression. He discusses the cognitive and emotion disintegration, which results from torture, imprisonment, forced labor, and extreme deprivation.

Boehnlein, J.K.Kinzie, J.D.,Ben, R. & Fleck. J (1985). One-Year Follow-Up Study of Posttraumatic Stress Disorder Among Survivors of Cambodian Concentration Camps. American Journal of Psychiatry. 142(8), 956-959.
This follow-up of an earlier Kinzie, et.al. (1983)– see below) study shows more improvement than expected using medically based therapy and monthly meetings with therapist. Supportive therapy, based on current life experience and avoidance of past, plus medication, led to improvement in ” intrusive” symptoms (nightmares, recurrent thoughts, sleep disturbance, startle reactions) but not ” avoidant” symptoms (isolation, emotional numbing, sense of shame). The authors question whether these patients are in remission or recovery. (The paper also inadvertently raises the question of whether their therapeutic approach supports avoidant symptoms.)

Brende, J.O. (1981). Combined Individual and Group Therapy for Vietnam Veterans. International Journal of Group Psychotherapy. 31(3) , 367-378.
This paper discusses the need and value of recapitulation of trauma as an integrating process. The author advocates group work, but he also used individual therapy to establish greater trust. The emphasis group is on the clients developing trust in their own controls and learning to expose of vulnerability.

Chodoff, P. (1963). Late Effects of the Concentration Camp Syndrome. Archives of General Psychiatry, 8, 323-333.
This study of survivors fifteen years after their liberation describes the symptomatology and etiology of “concentration camp syndrome” (an early PTSD term). The author mostly disagrees with Eitinger’s (1961–see below) finding of organic brain syndrome as the source of psychiatric symptoms and relates them instead to the psychological stresses during and after internment. He identifies eight factors, which affect prognosis, including age at time of interment, organic factors, and loss of home and family members.

Cienfuegos, A. J.,& Monelli, C (1983). The Testimony of Political Repression as a Therapeutic Instrument. American Journal of Orthopsychiatry, 53(1), 43-51.
The authors report work in Chile with survivors and families recoring testimony about repression and torture. This Project provided catharsis, restored “ego force” sufficiently to allow dynamic therapy, built trust with the therapist, and reduced anxiety and depression for many.

Chodoff, P. Late Effects of the Concentration Camp Syndrome. Archives of General Psychiatry, 8, 1963, 323-333.

Cohn , J. Danielsen, L., Inger, K., Koch, L., Severin, B., Thogersen, S. & Aalund, O. A Study of Chilean Refugee Children in Denmark. The Lancet, August 24, 1985. 437-438.

Comas-Diaz, L.& Padilla, A. Countertransference in working with Victims of Political Repression. American Journal of Orthopsychiatry, 60(1), 1990, 125-134.

Cowgill, G. & Doupe, G. Recognizing and helping Victims of Torture. The Canadian Nurse, 12, 1985, 19-22.

Crisis Politica y Dano Psicologico. Santiago, Chile: Colectivo Chileno de Trabajo Psicosocial, 1982.

De Wind, E. Psychotherapy Alter Traumatization Caused by Persecution. In H. Krystal & W. Niederland (Eds.) Physic Traumatization: Aftereffects in Individuals and Communities, 93-114, New York: Little, Brown, & Co., 1971.

Dunayevich, J. & Puget, J. State Terrorism and Psychoanalysis. International Journal of Mental Health, 18(2), 1989,98-112.

Eaton, W.W., Sigal, J.J., & Weinfeld, M. (1982). Impairement in Holocaust Survivors after 33 years: Data from an Unbiased Community Sample. American Journal of Psychiatry,139 (6),773-777.
A report from Montreal on differences in impairment of Jewish survivors of Holocaust with those who immigrated earlier. The authors found greater psychological impairment, but not physical, and no differences corresponding to age of trauma. Those who perceived a recent increase in anti-Semitism showed highest number of symptoms.

Eitinger, L. (1961). Pathology of the Concentration Camp Syndrome. Archives of General Psychiatry. 5, 79-87.
This study of physical and psychiatric aftereffects of Norwegian survivors of Nazi concentration camps concludes that many of these effects are a consequence of organic brain syndrome resulting from starvation, malnutrition, and physical abuse. The psychiatric symptoms (identified here by the old term” neurasthenia”) are labeled the ” concentration camp syndrome” (a forerunner of PTSD.)

Eitinger, L. Rehabilitation of Concentration Camp Survivors. Psychotherapy and Psychosomatics, 17, 1969, 42-49.

Fischman, Y. & Ross, J. Group Treatment of Exiled Survivors of Torture. American Journal of Orthopsychiatry, 61(1), 1990, 135-142.

Fishman, Y Interaction with Trauma: clinician’s Response to Treating Psychological Aftereffects of Political Repression. American Journal of Orthopsychiatry, 60(1), 1991, 179-185.

Genefke, I. Rehabilitation of Torture Victims. In the Violation of Human Rights: The Quest for Understanding. Symposium conducted at the Beverly Hilton Hotel, Beverly Hills, CA. September, 1984.

Genefke, I & Aalund, O. Rehabilitation of Torture Victims- Research Perspectives. Manedssfrift for Praktisk laegegerning, January, 1983.

Goldfield, A.,Mollica, R. Pesavento, B. & Faraone, S. The Physical and Psychological Sequelae of Torture. Journal of American Medical Association, 259(18), 1988, 2725-2729.

Gonsalves, C. The Psychological Effects of Political Repression on on Chilean Exiles in the U.S . American Journal of Orthopsychiatry, 60(1), 1990, 143-153.

Grubich-Simitis, I. Extreme Traumatization as Cumulative Trauma: Psychonanalytic Investigations of the Effects of Concentration Camp Experiences on Survivors and their Children. Psychoanalytic Study of the Child, 36, 1981, 415-450.

Haley, S. When the Patient Reports Atrocities: Specific Treatment Considerations of the Vietnam Veteran. Archives of General Psychiatry, 30,1974,191-196.

Hariotos-Fatouros, M. The official Torturer: A learning Model for obidence to the Authority of Violence. Journal of Applied Social Psychology, 18,1988,1107-1120.

Hollander, N. Psychoanalysis Confronts the Politics of Repression: The Case of Argentina. Social Science and Medicine, 28(7), 1989, 751-758.

Hoppe, K.(1971). Chronic Reactive Aggression in Survivors of Severe Persecution. Comprehensive Psychiatry. 12(3), 230-237.
An exploration of the psychodynamics of chronic aggression (from irritability to uncontrolled hostility) in a small percentage of Holocaust survivors. The author finds those verbalizations gives relief and helps prevent somatization. The defensive function of aggression can be channeled into group/political work.

Horowitz, M. Stress Response Syndromes: A Review of Post-Traumatic and Adjustment Disorders. Hospital and Community Psychiatry, 37(3),1986,241-249.

Hougen, H.Physical and Psychological Sequelae to Torture: A controlled Clinical Study of Exiled Asylum Applicants. Forensic Science International, 39,1988,5-11.

Kalucy, R.The Health Needs of Victims of Torture. The Medical Journal of Australia, 148,1988,321-322.

Kinzie, J.D. (1978). Cross-Cultural Psychotherapy. The Malaysian Experience. American Journal of Psychotherapy, 26, 220-231.
Kinzie describes his experience as an American psychiatrist working in Malaysia, specifically the need to incorporate aspects of the culture into the psychotherapy. The relationship between the therapist and the patient is still foremost in the therapy, but largely through the therapist fitting into some culturally sanctioned role, such as healer or wise man. For example, by using appropriate meds, which give immediate relief, the therapist matches the expectations of the patient that a healer will do this.

Kinzie, J.D. (1978). Cross-Cultural Psychotherapy. American Journal of Psychotherapy, 32, 510-520
Kinzie here identifies three components of successful cross-cultural psychotherapy: ” the sensitive use of the medical model, awareness of the subjective phenomenology of each individual patient.”

Kinzie, J.D., Tran, K.A., Breckenridge, A., & Bloom, J.D. (1980). An Indochinese Refugee Psychiatric Clinic: Culturally Accepted Treatment Approaches. American Journal of Psychiatry. 137(11), 1429-1432.
The authors trained native counselors for supportive therapy with Vietnamese Refugees. Their approach avoided psychological interpretation and relied upon anti-depressant meds. They discuss the process of gaining community acceptance and finding a culturally based strategy for treatment.

Kinzie, J.D., Fredrickson, R.H., Ben,R.,Fleck,L., &Karls,W.(1983). Post-traumatic Stress Disorder Among Survivors of Cambodian Concentration Camps. American Journal of Psychiatry. 141. 645-650.
Evidence of PTSD among survivors of Pol Pot regime validates it as a cross-cultural diagnosis. This clinic used interpreters for psychotherapy. They concluded that disclosure of past trauma exacerbated symptoms: a cultural belief that bad fortune is a consequence of past life misdeeds made disclosures shameful rather that cathartic. (This paper raised questions about using expressive therapies with patients from other cultures and about what therapeutic approach helps.)

Kinzie, J.D., & Fleck, J. (1987). Psychotherapy with Severerly Traumatized Refugees. American Journal of Psychotherapy. 41, 82-94.
A report of the therapeutic work at an Oregon clinic with political trauma survivors (a continuation of the other Kinzie, et al. papers). This clinic uses a medically based treatment with limited psychotherapy. The earlier symptomatic relief in patients (Boehnlein, et al–see above) was lost under the stress of life changes (e.g., child leaving home restimulated loss of relatives in camps.). The authors discuss problems inherent in therapeutic work, counter transference reactions, therapeutic biases and cultural differences as well as effective strategies.

Kinzie, J.D., Evaluation and Psychotherapy of Indochinese Refugee Patients. American Journal of Psychotherapy, 35(2), 1981,251-261.

Kinzie, J.D. & Fleck,J. Psychotherapy With Severly Traumatized Refugees. . American Journal of Psychotherapy, 41(1), 1987, 82-94.

Kinzie, J., Fredrickson, R.,Ben,R. Fleck,J. & Karls,W. Post-Traumatic Stress Disorder Among Survivors of Cambodian Concentration Camps. American Journal of Psychotherapy, 141(5),1984,645-650.

Klein, H. (1974). Delayed Affects and After-effects of Severe Traumatization. Israel Annals of Psychiatry. 12. 293-303.
Framed in classical psychoanalytic terms, this paper examines the effects & survival strategies of Israeli survivors of ghettos and camps during the Holocaust: the loss of meaning and sense of causality in external world, the reliance upon fantasized of past of idealized world, and magical thinking, leading to PTSD-type symptoms later. The author discusses the meaning of survival guilt and resistance to treatment.

Krystal, H.( Ed.) Massive Psychic Trauma, New York: International Universities Press, 1968.

Krystal, H. & Niederland, W.(Eds) Psychic Traumatization: Aftereffects in Individuals and Communities, New York: Little, Brown & Co., 1971.

Lin, K-M, Tazuma, L., & Masuda, M. (1979). Vietnam Refugees. Archives of General Psychiatry. 36. 955-961.
This paper reports ongoing research into the resettlement process of Vietnamese refugees. The difficulties of resettlement are reflected in high levels of physical and mental dysfunction. Divorced or widowed women with children showed the highest levels of distress and the greatest difficulty adapting to the new life.

Lira, E.,Becker,D.& Castillo,M. Psychotherapy with victims of Political Repression in Chile: A Therapeutic and Political Challenge. 1988. Manuscript published in J. Gruschow and K. Hannibal (Eds.), Health Services for the Treatment of Torture and Trauma Survivors, 91-114. Washington DC: American Association for the Advancement of Science, 1990.

Lira, E. Weinstein, E, Dominquez, R. Kovalkys,J.,Maggi, A. Morales, E. & Pollarolo,F.(Eds.). Psicoterapia y Represion Politica. Mexico: Siglo XXI Editores,1984.

Lunde, I. Mental Sequelae to Torture. Madedsskrift for Praktisk laegegering, August, 1982. Translated manuscript.

Mollica, R. Wyshak,G. & Lavelle,J. The Spsychosocial Impact of War Trauma and Torture on Southeast Asian Refugees. American Journal of Psychiatry,144(12), 1987,1567-1572.

Niederland, W. (1968). Clinical Observations on the “Survivor Syndrome”. International Journal of Psycho-Analysis. 49. 313-315.
Primarily descriptive, the paper is a psychoanalytic approach to ” survivor syndrome” (early PTSD-term). The author emphasizes profound sense of guilt as dynamic factor in symptomatology.

Ortmann, J. Genefke, I. Jakobsen,L. & Lunde, I. Rehabilitation of Torture Victims: An Interdisciplinary Model. The American Journal of Social Psychiatry, 7(3),1987,161-167.

Ostwald, P.& Bittner, E. Life Adjustment After Severe Persecution. American Journal of Psychiatry, 124(10), 1968, 87-94.

Ostwald, P. & Bittner,E. (1968). Life Adjustment After Sever Persecution. American Journal of Psychiatry. 124(10), 1393-1400.
This study questions the supposed success of some concentration camp survivors in their new lives. The authors find that while many have established outwardly successful lives, their inner lives are as painful and troubled as those of the most obvious” failures.” Psychiatric diagnoses of ” successful” survivors are similar to those of the unemployed and ” marginally adjusted.” The authors conclude that for some survivors the only recompense, which they can envision for their suffering, is material and social success, but that therapy can restore some emotional pleasures as well.

Peebles, M. Post-Traumatic Stress Disorder. Bulletin of the Menninger Clinic, 53(3),1989,274-286.

Petersen, H. The Controlled Study of Torture Victims. Scand J. Soc Med, 17, 1989,13-20.

Petersen, H., Abildgaard, U.,Daugaard,G.,Jess, P., Marcussen,H & Wallach, M. Psychological and Physical Long-term Effects of Torture. Scand J Soc Med, 13, 1985,089-93.

Puget, J. Social Violence and Psychoanalysis in the Argentinean Context. British Journal of Psychotherapy, 5(3),1989,363-369.

Rahe, R., Looney, J., Ward, H., Tung, T.M., & Liu, W. (1978). Psychiatric Consultation in a Vietnamese Refugee Camp. American Journal of Psychiatry. 13(2), 185-190.
This report on experiences of Vietnamese in refugee camps immediately after their flight to the U.S. is valuable primarily for information about the ordeals, which refugees undergo in their resettlement. It recounts bureaucratic misdeeds, inevitable frustrations, and further dramatizations, which occur in temporary camps.

Randall,G.,& Lutz, E. ( 1992). Serving Survivors of Torture. Washington DC: American Association for the Advancement of Science.

Rasmussen, O.& Lunde, I. Evaluation of Investigation of 200 Torture Victims. Danish Medical Bulletin, 27(5), 1980,241-243.

Reid,J & Strong, T. Rehabilitation of Refugee Victims of Torture and Trauma: Principles and Service Provision in New South Wales. The Medical Journal of Australia, 148, 1988,340-346.

Roth, E., Lunde, I., Boysen, G. & Genefke, I. Torture and its Treatment. American Journal of Public Health, 77(11), 1987, 1404-1406.

Somnier, F.E. & Genefke, I. K. (1986). Psychotherapy for Victims of Torture. British Journal of Psychiatry. 149, 323-329.
The authors describe the meaning of torture and neuropsychological effects of it. They suggest a 3-phase course of therapy. Short-term cognitive and expressive therapy plus pain-relieving physical therapy relieved emotional and psychological distress. These authors believe a reconstruction of traumatic events is necessary to give cognitive meaning to experience.

Stover, E. & Nightingale, E. (Eds.) The Breaking of Bodies and Minds: Torture, Psychiatric Abuse, and the Health Professions. New York: W. H. Freeman, 1985.

Suedfeld, P. (Ed.) Psychology and Torture. New York Hemishphere Publishing Corporatin, 1990.

Svendsen, G. When dealing with Torture Victims Social Work Involves the Entire Family. Socialradgiveren, November 1985. Translated manuscript.

Ulman, R. & Brothers, D. A Self-Psychological Reevaluation of Post-Traumatic Stress Disorder (PTSD) and its Treatment: Shattered Fantasies. Journal of the American Academy of Psychoanalysis, 15(2),1987, 175-203.

Ursano, R., Boydstun, J., & Wheatley, R. (1981). Psychiatric Illness in U.S. Air Force Vietnam prisoners of War: A Five-Year Follow-Up. American Journal of Psychiatry.138 (3), 310-314.

This study of psychiatric illnesses among ex-POW’s in Vietnam adds little new information about the effects of extreme stress, but does establish that it is the stress of captivity rather than personality predisposition which is the source of psychological problems since all of these survivors had extensive psychiatric evaluations by the U.S. Air Force prior to service.

Walker, J.I.,& Nash, J.L. (1981). Group Therapy in the Treatment of Vietnam Combat Veterans. Internation Journal of Group Psychotherapy. 31 (3), 379-389.

This paper is an introduction to work with veterans: it reviews symptoms and emphasizes the need for direct inquiry. The authors stress using a group approach with the therapist taking an active role.

Weschler, L. (1990). A Miracle, A Universe: Settling Accounts with Tortures. New York: Pantheon Books.