Visits to detained torture victims by the ICRC (II): The psychological impact of visits and interviews with detained torture victims
01-01-2000 Article, Torture, Volume 10, Number 2, 41-44 p., 2000, by Marina Staiff
This article was published in the journal TORTURE, Volume 10, Number 2, 41-44 p., 2000, and reproduced with the kind authorization of the publisher.
Marina Staiff, Medical Coordinator for Dentention-related Activities, International Committee of the Red Cross (ICRC)
Torture is an experience without parallel; it is capable of causing a wide range of physical and psychological suffering. At the psychological level, torture places the victim in a position of helplessness end distress powerful enough to produce mental and emotional damage regardless of his pre-torture psychological status. The psychological effects of torture, however, occur in the context of personal meaning, personality development, and social, political, and cultural factors. It is important to recognize that not everyone who has been tortured develops a diagnosable mental illness. However, many victims experience profound psychological reactions.
Ideally, every person who has been tortured should have the opportunity to speak about his ordeal. Apart from the need to document torture, this is the ICRC’s approach when visiting these persons in their places of detention.
During its visits, the ICRC does not provide prisoners with medical or psychiatric treatment per se. It goes without saying that no psychotherapeutic work can be achieved in the conditions under which prison visits take place, even when those visits are frequently repeated and when there is sufficient time to speak at length with every single prisoner.
Nevertheless, particularly when its visits take place during or immediately after the interrogation period, the ICRC does try to help the prisoner cope with his ordeal and does its utmost to limit the ill-treatment itself. To this end delegates regularly ma ke specific recommendations to the detaining authorities and act directly to relieve some of the effects of the ill-treatment.
In particular, the ICRC always endeavours to restore communication between prisoners and their families, and communication with the outside world in general (when this has been cut off). The organization’s long-term presence “in the field”, with its mobility'and network of contacts – and authorization to make use of both – enables it to deliver messages from prisoners to remote villages, and vice versa, and to facilitate travel by the families to visit their loved ones in prison.
Access to independent medical advice from an ICRC doctor can be of tremendous importance for a prisoner who in some situations may have no access whatsoever to medical care, or who may not trust the prison doctors (the issue not being whether such distrust is justified). Prisoners who are currently under interrogation, or have just completed it, often suer great anguish about the long-term consequences of the torture and what these may mean for their future health. In many cases, the feared consequences have been promised to them by the torturers themselves. Fortunately, after appropriate history-taking and examination, it is frequently possible to give the prisoners some reassurance and guidance (explaining why they were not whatever they were told, and basically saying: “Well, they haven’t broken you as badly as that”), which may relieve them of an enormous psychological burden.
In the period immediately following arrest, and when they are kept incommunicado in prolonged solitary confinement, prisoners find themselves in a situation of de facto “disappearance” (whether such disappearance is real or imagined). This represents a sickening plunge into abandonment and distress, with the feeling that “nobody can help me”. Obviously, ICRC visits to persons in this situation are of extreme importance to them. Knowing that people on the outside are concerned about them and doing something for them is knowledge that can do much to ‘help them to survive. [1 ]
What the ICRC does during its visits, beyond its assessment and documentation work, is generally perceived by the prisoners as an invaluable means of improving their situation. They sometimes stress how much more these visits mean to them than anything that could have been accomplished as part of a simple fact-finding mission.
That said, I feel we should look beyond these high-profile aspects of the visits and ask to what extent the ICRC or other visiting organizations can do the prisoners good – or harm – when meeting them during or shortly after the interrogation period. This question has been repeatedly posed within the ICRC, and I would like to discuss it here both on the basis of the ICRC’s long experience in this domain and on the experience and thought put into the subject by therapists working to help torture victims, particularly those therapists who, I feel, have something to say in response to the ICRC’s questions. It is not, however, a matter of seeking pat answers but rather of fostering a process of open-minded inquiry.
I believe that some of the ICRC’s working methods can themselves play a beneficial role psychologically. Generally speaking, they show the prisoner that being tortured has not caused him to be cast out of the human race, and that there are people who are concerned about him. And, as pointed out above, registration can play the symbolic role of providing temporary affiliation to a group.
Regular repetition of visits is also important. It not only enables the ICRC to gain a comprehensive understanding of the different problems in a place of detention, and slowly to build up meaningful dialogue, based on trust, between the organization and the prisoners, but it also constitutes foreseeable b reaks for the prisoner in his everyday ordeal. Such visits are completely at odds with the machinery of repression, holding up as they do a contrasting reality – the ICRC and its mandate – against the reality of detention, interrogation, and torture. To that extent, they can bring a breath of fresh air into a stiflingly dosed world whose inhabitants are supposed to have a horizon limited to the four walls around them. ICRC visits perhaps help to restore to these people an outlook that they have lost amid all the pain, the fatigue, the isolation, and the anxiety. [1 ]
Torture generally does harm to certain areas of the human psyche [2,3 ] while leaving others intact. Giving prisoners the chance to express themselves, and to demonstrate that those areas are still intact, can be a way of helping them to ‘find themselves’ again. When the prisoner tells a visitor from the outside world what he believes in and what motivates him, he is reminded of his own place in his cultural milieu, in his own family or social group. He can express his customs and cultural values. It can be at once astonishing, awkward, and encouraging to be greeted in a cell with hospitality and kindness by prisoners who lack virtually everything and are feeling physically unwell. It would be unthinkable to refuse this kindness, even when it is obvious that the prisoner is depriving himself of what little he has. The best thing is to thank him for his generosity and take an interest in his preferences, his view of the world, his life.
Andrea Sabbadini points out that “many survivors of torture just need to talk of their dramatic experiences with a sympathetic listener who can accept and believe them without feeling excessive horror, anxiety or pity; such ‘ testimonial therapy’ has at times a powerful cathartic effect. At other times, longer-term psychotherapy becomes necessary.” [4 ]
Naturally, a prison is not a place that can be regarded as peaceful and conduciv e to confidentiality. Nevertheless, despite the prison environment, the ICRC’s experience is that, if an interview about torture takes place with guarantees of confidentiality, and if the delegate devotes sufficient time and attention to privacy, and shows'intelligence’, the experience will generally be beneficial for the detainee while having no pretensions of constituting any sort of therapy.
But what does ‘intelligence’ consist of in the framework of interviews with torture victims by persons who are not psychotherapy professionals? As mentioned above, it is essential for the listener to be clear and unambiguous. This sets him apart from the torturer in a fundamental way. It is equally essential to know the objectives of the torture, the methods used, the consequences, the groups targeted, and the coping mechanisms most frequently adopted by the victims; this not only in order to be able to ‘ hear’ what the prisoner says, but also to show him that you know what he is talking about, that you understand (at least as far as a non-torture-victim can understand) that he has been able to convey something, i.e. that someone is there to whom he can pour his heart out.
This is corroborated by the experience of the centres for the rehabilitation of torture victims, where the therapists are aware that the more detailed their knowledge of the mechanisms used by torturers, the more effective they can be in caring for their charges. [2,4-6 ]
In addition, as Andrea Sabbadini has written, the interviewer must listen with sympathy but without expressing too much horror, anxiety, or pity. This can be difficult because accounts of torture are a strain not only for those who give them. The interviewer may find it difficult to maintain the ever-precarious balance between being overly distant from the prisoner (as a means of protecting oneself) and getting too close (through excessive identification). Neither is usually very useful to the prisoner.
The interview may make the prisoner experience painful emotions. It can happen, though rarely, that a prisoner expresses hostility towards the interviewer, whom he takes to be either part of the repressive system itself or an idly curious bystander. Though this is always unpleasant for the interviewer, he should allow such feelings to be expressed and remain aware that an enormous charge of non-enacted aggressiveness is among the problems suffered by torture victims. Although the person taking delivery of such aggressiveness may not be the right target, this is an opportunity to try to convey in words a justified anger, resentment, and hatred.
More often, particularly when torture is a recent experience, the prisoner may burst into tears, or come close to it. In such situations, a visiting delegate may feel overwhelmed and powerless (a bit, in fact, like the prisoner himself). Showing that he cares by allowing the prisoner to express some of his suffering is probably the most appropriate thing a visiting delegate can do.
An important point should be made at this juncture. The message that the prisoner gets from his torturers is that he had better talk, and fast! If an interviewer from a human rights or humanitarian organization is not careful, he can send the same message if he avidly seeks information and is clearly in a hurry. When visiting a place of detention you must at all costs avoid urging the prisoner against his will to describe torture scenes in detail; you must avoid giving the impression that he is being subjected to some new form of interrogation, and this even if you have already explained to him the purpose of the interview. If a prisoner is clearly reluctant to speak, therefore, one should leave it at that because to insist might elicit excruciating emotions. That said, the ICRC delegate makes sure that the prisoner knows that there will be other opportunities to speak, if he wishes, in the days to come or at the next visit, and tells him that he may, if he wishes, speak with the ICRC doctor.
What the delegate usually does, sometimes following the painful moments described above, is to ask the prisoner to tell him what has happened between the time of his arrest and the present. In most cases the prisoner is telling the story for the first time, as a stubborn silence usually surrounds the subject of torture. Even when prisoners live together in groups, they seldom speak among themselves about what they have endured. Humiliation, shame, and the desire to forget usually override any desire to share it. When they are entitled to family visits, they do not discuss it with their loved ones either. And they seldom speak of it with the health-care staff of the place of detention. What usually happens is that everyone knows or vaguely guesses – but no one broaches the subject. Torture? Swept under the carpet. Yet speaking about it with someone able to understand is often precisely what the prisoner would like to do, although he may be torn between the need to tell and the desire to forget.
Putting together an account for an interviewer who is not part of the system (but has a certain knowledge of it) demands a mental effort; that is, it requires memories and images to be organized logically in terms of space, time, and sequence, so that another person can understand what happened. For it is precisely a person’s normal ability to make sense of what occurs in his life that torture aims to disrupt, and it is this ability that the victim’s account is intended to restore. In short, what torture may have disorganized in the victim’s mind, his account to the delegate may begin to put back together.
The ICRC delegate’s aim is to work with the prisoner to reconstruct exactly what has happened to him. Ideally, this process should be spread over several visits taking place in close proximity, which is possible in some cases but not in others. If the prisoner can dearly see what this process is intended to achieve, i.e. to pass that information on to the responsible authorities as part of the organization’s effort to eradicate torture, the ICRC delegate can no longer be perceived as a passive spectator or as part of the repressive system.
By submitting to the authorities its conclusions, based on the allegations received directly from the prisoners, the ICRC is in fact enabling the prisoners to take a direct part in an attempt to improve the overall situation. This gives them a means of reacting to what has been done to them and a sense of empowerment. Indeed, ICRC staff often see a prisoner relax and gain self-assurance as his story is committed to paper.
These are but several considerations that certainly need further scrutiny. They should not obscure the fact that what lies at the heart of the psychic harm that can be induced by torture can obviously not be addressed in the framework of prison visits. As Françoise Sironi [2 ] puts it, two factors lie at the origin of the psychic damage in torture victims: at the conscious level the impossibility to understand the torturer, and unconsciously the acceptance of the torturer’s theory. Mental mechanisms such as these can only be addressed in a psychotherapeutic situation.
Finally, these considerations should not obscure the fact that it is ultimately for each prisoner himself to decide whether ICRC visits are of benefit to him.
Respecting the prisoner’s informed choice
As stated above, confidentiality is the cornerstone of the ICRC’s work on behalf of prisoners. This confidentiality has several aspects.
The ICRC maintains a confidential dialogue with the authorities, at whatever level, who are responsible for the detention of the prisoners it is visiting. As mentioned earlier, this requires ICRC not to make its endings public, other than in very exceptional circumstances. The resulting confidentiality is what enables it to be present in the first place, and to develop its prisoner-welfare activities in many different situations around the world.
The fact, therefore, that the ICRC goes on working in connection with a given situation while not publishing its findings does not in any way mean that those findings are positive.
At the same time, the ICRC has a confidential dialogue with the prisoners whom it visits. Provided that it obtains the prior consent of each individual prisoner concerned, it will use their allegations in representations to the authorities aimed at bringing the ill-treatment to an end.
Prisoners may refuse to allow their stories to be used for fear of reprisals. Their refusal must always be respected, even when the ICRC believes that their fear is unfounded. There is always the possibility that the prisoner knows better than the delegate, and in any case the prisoner's trust cannot be betrayed.
Therefore, in the event of refusal, a different way must be found to address the problem, a way that makes no direct use, at least for the time being, of the information obtained from the prisoners. Or one must even refrain completely from making one’s findings known to the detaining authorities until circumstances allow the prisoners to feel less afraid. This may be difficult to accept because it may seem intolerable to remain silent while knowing precisely what terrible things are happening. But in such cases the prisoner’s wishes must take precedence over all other considerations.
The opposite also exists and is no less difficult to deal with. It can happen that a determined prisoner in full possession of his faculties wants his story and his identity to be forwarded to the authorities in every detail, despite the risks that he knows he is running. In view of those risks (such as possible reprisals by those in charge of his place of detention), do we have the right to refuse to forward his allegations? We certainly have an obligation to discuss the matter with him and ensure that he has properly considered the implications, duly weighing his motivations and the potential risks. But one should not simply refuse to consider the request. Making his story known, bearing witness to what has happened, may be what this prisoner needs more than anything else. In such cases, his account constitutes a personal revolt that will enable him to counter the psychologically crippling effect of his torture and thus make him stronger. In view of this fact, refusing to convey his story could do him more harm than agreeing to do so.
In short, when the ICRC (or some other prisoner-welfare organization) takes on the task of speaking for the prisoner, it must never forget that the story he tells is ultimately his story, and that the use to be made of it must ultimately be left to him to decide. But the concerned agency owes this person all possible precautions to avoid placing him in danger.
Any direct and immediate benefit that prisoners may derive from visits is important for the ICRC, because the visits can have the effect of breaking isolation, restoring contact with loved ones, and providing an independent medical opinion or actual treatment. At the same time, an approach that is humane and informed can go some way to countering some of the psychological effects of the message that torture victims get from their oppressors.
It goes without saying that the pursuit of these direct benefits must never be separated from the ultimate goal: preventing the use of to rture. For the ICRC, striving for that goal consists essentially in making oral and written representations at all levels of the authorities concerned. Obviously, continuing such visits without noting any improvement or any political will toward improvement is ethically difficult to sustain over the long term.
1. Beaujolin MH. Echecs et succès des mécanismes inconscients de defense dans certaines situations de torture. Presentation, Istan-bul 1992.
2. Sironi F. Bourreaux et victimes: pspchologie de la torture. Paris: Odile Jacob, 1999.
3. Sironi F. Comment se debarrasser de son tortionnaire? In: Victimes: actes et silences. Rouen; Publications de I’Universite de Rouen, no. 204, 1995.
4. Sabbadini A. From wounded victims to scarred survivors. In: Berke Jh, Pierides S, Sabbadini A, Schneider S. Even paranoids have enemies: new perspectives on paranoia and persecution. London: Routledge, 1998.
5. Zajde N. Le traumatisme. In: Nathan T, Blanchet A, lonescu S, Zajde N. Paychatherapies. Paris: Odile Jacob, 1998.
6. Vesti P, Somnier F, Kastrup M. Psychotherapy with torture sur-vivors. Copenhagen: IRCT, 1992;
(1) Torture victims ohen say: “I can’t think anymore.”
a) The above text is a slighdy revised version of a paper originally presented at the VIII International Symposium on Torture, New Delhi, India.The first part of this presentation was published in Torture 1/2000 with the title “ Visits to detained torture victims by the ICRC (I): management, documentation, and follow-up”.