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“Man’s capacity for inhumanity is beyond normal comprehension,”
begins Archbishop Desmond Tutu in his forward to this book. He continues,
“Yet there is also within each one of us a potential for evil
to dominate and possess us. By the grace of God, there is also in
each of us a potential for overwhelming love.” I am sure these
comments resonate for many of us who have worked with severely traumatized
and tortured individuals; this book attests to the truth of these
words.
This edited volume is very much the story of the Berlin Center
for the Treatment of Torture Victims. Founded in 1992, this specialized
polyclinic has treated hundreds of patients from the former East
Germany and more than 30 countries in Africa, Asia, the Balkans,
and the Middle East. Each chapter is written by a member of this
clinic and is augmented by plenty of case material. These anecdotes
and the excellent translation from German make the book quite readable,
although some of the graphic case descriptions may be disturbing.
It is hypothesized in the book that the existence of such a treatment
centre in Germany is no accident, given that country’s history
(that is, its Nazi past and the experience of the Berlin Wall),
which may contribute to a wider societal acknowledgement of the
reality of torture than is found in North America. In this age of
globalization, however, the German context does not limit the book’s
relevance. The stories and case examples are certainly not dissimilar
to those we encounter, although there are some aspects that may
not apply (for example, the peculiarities of the German refugee
and asylum claims process).
Although not a reference source for the latest theory and research
in the field of severe posttraumatic stress, the book offers basic
descriptions of object relations, cognitive, behavioural, humanistic,
and psychobiological understandings of the impact of severe trauma
and torture on individuals. Theory and research are not its strengths,
however. These lie, rather, in the case material and examples.
Different chapters in the book emphasize different aspects of the
problems faced by torture survivors, together with the Center’s
overall approach. The Center advocates for a holistic approach that
includes assisting torture survivors to obtain medical, legal, social,
economic, cultural, psychotherapeutic, and spiritual support. It
describes its strategy as “Integrative Psychotherapy,”
which uses psychodynamic, cognitive, behavioural, psychodrama, Gestalt,
hypnotic, art, somatic (that is, concentrative movement therapy),
and family therapies.
Again, the book does not go into detail about how to assess and
provide psychotherapy to torture victims. Through the cases described,
however, it does give a broad overview that demonstrates the complexity
of this work and why too narrow an approach is unlikely to meet
with successful outcomes. It also repeatedly emphasizes the importance
of prioritizing trust and maintaining clear and consistent therapeutic
limits and boundaries.
The Berlin Center for the Treatment of Torture Victims is politically
neutral; in Chapter 7 Christian Pross writes that it is important
for therapists in this field to limit political involvement. Despite
this, parts of the book display quite a bit of political editorializing.
For example, Chapter 7 critiques the German refugee and asylum process
and also advocates for public victim forums. Similarly, Chapters
10, 11, and the Afterword critique the German refugee asylum process,
and Chapter 11 critiques the judicial system under which male judges
may hear the cases of female victims of torture.
Chapters 9, 10, 11, and the Afterword give an excellent description
of the problems legitimate refugee claimants often face, but the
book’s failure to address the fact that some asylum seekers
may indeed fraudulently claim to be torture victims is a shortcoming.
The book seems to assume that denied refugee claims are mostly due
to the system’s failure to take into account the biological,
psychological, social, political, and cultural issues that prevent
asylum seekers from giving an adequately detailed story. It would
have been helpful if at least some attempt had been made to look
at the issue of false claims and the problem of malingering.
Chapter 8 includes a particularly interesting perspective from
Britta Jenkins, a translator and receptionist at the Center. She
writes about speechlessness, language, and our tendency to try to
minimize horror. She relates her personal experiences, describes
their impact, and offers her approach to handling things: she speaks
to others about what she has seen and heard. This viewpoint from
a nonclinician working with trauma survivors does not often receive
due recognition. It is one we should likely consider more in settings
where trauma survivors are treated.
Another especially good contribution is offered by Johan Lansen,
in Chapter 12. He eloquently reminds those of us who work in this
field of the potential personal pitfalls, including vicarious traumatization,
mood and anxiety problems, and burnout. However, he also describes
the work’s potential benefits, including the inspiration it
can bestow and its potential to elevate, humanize, and make us wiser.
He suggests some practical ways to tip the balance in favour of
the benefits by limiting workloads, taking short breaks between
sessions, engaging in case presentations and discussions with peers,
debriefing after particularly difficult occurrences, and obtaining
formal supervision and consultation.
This is not a book for those who are looking for hard science and
research to provide best practice and evidence-based care. It is,
nonetheless, a valuable contribution summarizing the experience,
perspective, and work of one of the world’s only centres entirely
devoted to the care and treatment of victims of torture and political
oppression. The writers are clearly a dedicated group whose stories
and ideas are worth listening to.
In his forward, Desmond Tutu concludes, “May it [this book]
also encourage those who are concerned for human rights to an even
stronger commitment and zeal to oppose oppression.” I do believe
that this volume can at least meet part of Archbishop Tutu’s
wish; that is, to motivate, energize, and inspire those working
in this field to continue and to engage others in this work.
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