Out of the Ashes
Los Angeles Times (October 22, 2000)
Helping torture survivors heal is becoming a publich health specialty, with the U.S. moving so subsidize programs in L.A. and elsewhere.
By ANNE-MARIE O'CONNOR, Times Staff Writer
His memory is as blurry and golden as a dreamscape. He is a boy of 9 in his house on the river in Africa, playing hide-and-seek. His mother hums on the sun-warmed veranda. Christopher de Victorino has clung to this warm memory ever since paramilitary men came to take his life away. It wrestles for his attention with other recollections that are the stuff of nightmares: The sight of his father, bound and bloodied. The sound of his mother being raped on the bathroom floor. The cold kiss of raindrops spilling over Christophers broken body after he was tortured and left for dead in a jungle.
If these warring images of his past have brought his present to a standstill, its not evident as the baby-faced former philosophy student, now 25 and a political refugee, holds court with a laughing group of friends at a picnic in Santa Monica. Its a sunny day, and billowing clouds rise from the ocean like mountains. Its hard to imagine that any of these people suffer from the paralyzing bouts of depression, insomnia and anxiety that are typical for survivors of torture.
"This is my first social group Ive bonded with since coming here," said De Victorino. "Its easy to talk to them. I know its safe with them. It makes me feel at home. It gives me inner peace to know someone else suffered this. I know Im not the only one."
The group is known as the Healing Club, a Los Angeles support group for torture victims and their families. The club is an arm of the pioneering Los Angeles Program for Torture Victims, one of two dozen torture rehabilitation programs in the U.S.
The grisly public health specialty is in growing demand as immigrants flow in from countries where torture is a by-product of political turmoil--or a systematic tool against democracy and dissent.
Torture victims suffer from what experts call a "silent epidemic"--psychic wounds that few of their new acquaintances know about and even fewer could imagine. Anyone haunted by a wounding loss--the death of a child, the suicide of a loved one, a messy divorce--can understand the crippling force of painful memories. For most such losses, there are universal grieving rituals.
Healing from torture, experts say, is far more complicated. And in Los Angeles and other big cities, it can be particularly difficult because many victims are exposed to violence once again in poor, crime-ridden neighborhoods where, due to economic necessity, they now make their homes.
Helping torture survivors has evolved from a crusade by volunteer health professionals into a medical movement. The U.S. Torture Victims Relief Act is disbursing $7.2 million to American rehabilitation programs--including $500,000 for the Los Angeles one. The bills sponsors estimate that tens of thousands, and perhaps hundreds of thousands, of torture victims now make their homes in the United States. Caregivers say successful therapy can mean the difference between leading a full, productive life and retreating into an aloof existence that can keep even a victims spouse and children at a distance. In the process, therapists are learning important new lessons about trauma, recovery and human resilience that could help people suffering from experiences as varied as discrimination and incest.
"We cant make them forget. But we can help them live with the memories. And we can help them remember things differently" said Dr. Jose Quiroga, a paternal, soft-spoken physician for the U.S.
Department of Veterans Affairs and the volunteer medical director of the Los Angeles program. Using borrowed space at the Venice Family Clinic and the Clinica Monsenor Oscar A. Romero Quiroga in the Pico-Union neighborhood conducts physical examinations of torture victims and oversees their physical rehabilitation. His partner, Ana Deutsch, a therapist at Community Counseling Services/Amanecer near downtown Los Angeles, leads a team of volunteer mental health professionals. And on the last Saturday of every month, she convenes a small group for the Healing Club.
The 2-decades-old nonprofit organization is one of 220 established worldwide to treat and care for torture victims. Others in California are based in San Francisco, San Diego and San Jose. The shoestring nature of the program is about to change with the new federal funding this month. The money will allow staffers, including a case manager, to receive some compensation for their time. The program has been assisting 60 patients a year but now plans to double in size, Deutsch says.
A Heartbreaking New Counseling Field
When the Los Angeles program began, few guidelines existed for treating torture survivors. Deutsch and Quiroga developed their own approach to healing scarred hearts and broken bodies, beginning with efforts to get patients to tell their stories and receive thorough medical examinations. Many victims have badly healed bones. Broken teeth are common.
Emotional wounds--self-hatred, guilt, shock--are less evident. Torture victims from countries where political violence is commonplace often do not realize the connection between their ordeal and lingering depression. They usually find their way to the Healing Club through referrals from social workers and immigrant advocates.
For many, it is a relief to simply find a supportive group of people with whom they can share their histories. As Vietnam vets learned long ago, most people are not interested in tales of unpleasant events in far-off places.
The Healing Club is designed to assist dislocated refugees in rebuilding ruptured connections to the happier periods of their lives. Members meet once a month and go to museums, movies or the zoo. At most outings, they let the painful ties that brought them together remain unspoken. Often, they bring their children or spouses along to enjoy the day.
"They have been hurt, humiliated and degraded. They need to strengthen themselves by creating good memories that trigger memories of the good times," said Deutsch, an Argentine-born intellectual with a kind face who regularly empties her pocketbook--and her refrigerator--for her clients.
Deutsch knows something about searing memories. She and her family were forced to flee Argentina in the 1970s during her countrys "dirty war" in which thousands of people died or disappeared.
Quiroga has had to make his own peace with the unforgettable times in which he has lived. As a personal physician to Chilean President Salvador Allende, he was among the faithful summoned to Chiles national palace before the army assaulted it in the bloody 1973 military takeover. He is still haunted by the memory of entering the presidential chambers just as Allende raised a gun to his head. Before anyone could stop him, Allende pulled the trigger.
The next flash of artillery light revealed that his face was gone. Until now, the eight-member Los Angeles program staff has made do with a $15,000-a-year United Nations grant, helping survivors receive medical treatment, psychological counseling, job referrals and housing. Their expertise has put them in demand.
Quiroga and Deutsch regularly travel to other California cities to help train professionals who find torture victims at community clinics, churches and schools but are unsure how to help.
"The general mental health practitioner does not have that kind of expertise," said Dr. William Arroyo, a clinical assistant professor at USCs Keck School of Medicine, who has treated Central American torture survivors. "If they get help, theres more hope.
For those who continue to suffer severely, they simply will not be able to function in American society. "Theres no cure," Arroyo emphasized. "Unfortunately, many of these people live in low-income, gang-ridden neighborhoods and are exposed to killings and shootings that trigger horrific memories."
Those who have suffered torture come from around the globe. The federal bills sponsors say more than 70 countries practice or condone torture, and an Amnesty International study released last week cited deaths by torture in more than 80 nations.
Torture survivors tend to arrive in the United States in geographic waves. Many survived the Holocaust. Then came victims from Eastern Europe, and survivors of communist "re-education camps" in Southeast Asia. Anti-communist Latin American military governments prompted the next influx in the1980s, as people fled bloody repression that targeted nuns and labor unionists along with suspected leftist guerrillas. Many recent victims are Africans or Middle Easterners.
One Survivors Haunted Odyssey
Christopher de Victorino still cries when he describes being tortured. He arrived in Portland, Ore., as a political refugee under a church resettlement program in 1995. With no relatives or friends in the United States, he eventually came to Los Angeles to escape the cold and to find other people from Africa, and wound up in a tiny rented room on skid row. Odd jobs have paid bills. But he spends most of his time escaping into his writings--essays, a science fiction screenplay, a memoir already hundreds of pages long.
He puts off sleep until the wee hours because he has nightmares that his torturers are chasing him. He has fantasized about taking his own life. "He hasnt won yet," therapist Deutsch said, "but were going to make him win."
De Victorino is still haunted by the disappearance more than a decade ago of his father, a grass-roots anti-apartheid activist in South Africa, and his mothers rape and her subsequent arrest. Later, he became a refugee and was resettled in Zambia, where by his account, he was a popular philosophy student. He says he joined the refugees union and wrote articles about the problems of displaced Africans, but he says he had only social ties to student political movements at the university.
He says his roommates often teased him for his studiousness. And on one Saturday night in August 1994, when they left for a party, he thought he heard them coming back for one more attempt to pry him away from his books. Instead, the door crashed open and paramilitary police slammed him onto the floor.
When he opened his eyes, he was lying naked on a slab of cold concrete, he says. His hands and feet were bound, and his body throbbed with pain. A man peered down and told De Victorino he had been rounded up, along with other students, because he was believed to be involved with Angolan guerrillas. "They kept saying, You have guns, youre making bombs, tell us where, " he recalls. De Victorino denied it and the man broke his nose. The next day, his captors broke three of his teeth with a wire cutter, he says. Then they whipped him. On another day they held his head under water. They hung him by his hands until he screamed. They made him beg for sips of water and crusts of bread. They threatened to gouge out his eyes.
He was starving. His eyes were swollen and infected. And like many people, he cracked. "I just started saying anything," he says. "I named people who were known to be involved in political groups, innocent people, any name that came to my mind. If you mention a name, they would go pick them up, then they would come back and ask me."
One rainy night they threw him in a car trunk, drove him to the outskirts of a jungle, shot him and drove away, he says. Villagers found him and took him to a nearby hamlet. He remained in hiding for six months while relief officials petitioned for his entry into the United States.
When he arrived, he had surgery for a leaky heart valve and spent six months in rehabilitation. After he moved to Los Angeles he was homeless for a time, drifting phantom-like through his life like an urban Sufi. One day, he walked into a skid row residence hotel and the manager told him: "This is the last stop, the last place, the very bottom of where you can be."
The manager referred him to Deutsch and the Healing Club. But he had to be coaxed into going. "[Deutsch] told me, Christopher, you need help. "
Now he looks forward to the meetings. He loves speaking with a Somalian, who enlivens the group with her broad smile, bright head scarves, and her four handsome sons. Theres the member from Nigeria and the woman from Ethiopia who brings her husband. Theres the Salvadoran and his adult son. Hes eager to meet a new guy from Zambia.
"It helped me so much," De Victorino says. "I had been so afraid of everyone, so paranoid. Its so good to see the people. To be liked."
Arriving at a Kind of Acceptance
In an age of intensive research into emotional trauma, discussion on how to best care for torture victims is becoming a staple topic at mental health conferences worldwide. At a National Alliance for Refugee Mental Health conference in Burbank in late July, panel discussions ranged from helping female torture victims deal with the stigma of rape to using theater workshops to aid victims of the Bosnian conflict.
"Healing isnt necessarily a cure--it is the process of accepting what has happened," said Mary Fabri, a clinical psychologist at the Marjorie Kovler Center for the Treatment of Survivors of Torture in Chicago. "Part of the healing process is being able to identify with who they were before and then find a way to go on living with what theyve experienced."
Experts say there is usually little in anyones life to prepare him or her for the deliberate infliction of physical and emotional pain. Common physical torture methods are burning, whipping, rape, suspension upside down, submersion in water to the brink of drowning, and electric shocks to sensitive areas. Psychological torturers employ threats, humiliation, insults and lies. Victims are told their children or spouses will be put to death, or in some cases, children are tortured in front of parents.
Some experts say gathering information is not the primary purpose of torture--the victims terrified ramblings are often useless. The Denmark-based International Rehabilitation Council for Torture Victims characterizes torture as a calculated effort to "break down the personality and destroy the identity of the victims."
Victims are often deliberately allowed to live--in many cases doctors are assigned to revive them--so their maimed bodies and crushed spirits will make others think twice before defying the status quo.
Rebuilding fragile psyches that have been ravaged by torture is no less than a battle for the soul itself, according to Chilean playwright Ariel Dorfman, whose play "Death and the Maiden," tells the story of a womans confrontation with her torturer.
"Torture is an assault on your most intimate and permanent identity," Dorfman said in a telephone interview. "The struggle for that identity will continue for many years. What the torturer desires, fundamentally, is to place his voice inside your head and possess you. Your identity becomes very much embodied in the moment of torture. It makes it very difficult to get rid of."
Many victims are disabled by depression, feelings of despair, guilt and powerlessness. They find it difficult to trust people. Flashbacks and nightmares blur the line between past and present. Survivors whose torture had a sexual component may avoid intimacy. Some victims become dependent on drugs and alcohol or focus on phantom pains. Suicide is not uncommon.
Dr. Quiroga treated Maria Guardado, 65, for badly set broken bones after she arrived from El Salvador. Guardado says she was tortured for three days by a right-wing death squad in 1980 and left for dead. Guardado hyperventilates as she describes her violators--a lingering symptom, she says, of her broken ribs. Those who treated her believe her gulping breaths are a physical manifestation of lingering terror. "Its a reliving experience and a very painful one," USCs Arroyo said. "Many of them have exaggerated, startled reactions to sounds, sights and smells they associate with being tortured."
New research on post-traumatic stress disorder shows that torture victims may experience shifts in brain chemistry common to others exposed to acute stress, which antidepressants can help to counteract.
The fact that many survivors were previously talented, well-adjusted people increases their chances of healing, experts say. The psychic healing has a strong social component. "Keeping the secret is damaging," said Rose Marie Durocher, an L.A. Unified school therapist who volunteers with the Los Angeles program. "There is so much relief when they finally talk about it."
Yet women are often reluctant to acknowledge torture because it is considered tantamount to admitting to being raped, according to experts.
For many public health professionals, a universal question also looms. "I have asked myself many times, How long will it take societies to recover? " said Alberto Concha Eastman, a mental health expert at the Pan-American Health Organization in Washington, D.C. "Societies do not like to face up to it, because it is very harsh. It will take years to recover the social ethic."
Copyright 2000 Los Angeles Times