Armored vehicles and "internally displaced persons" (refugees-to-be) in Glodane Village, Kosovo. The photo was released at a Pentagon press briefing on April 6, 1999.

Photo courtesy of the Department of Defense.


In cars and on tractors
16 APRIL 1999 Almost a million refugees have left Kosovo, hounded by Serb soldiers, paramilitaries and police. Their faces -- and their stories of massacres, forced expulsions and torched villages -- remind us of "ethnic cleansing" in Bosnia. We recall the genocide of Tutsis in Rwanda in 1994. We remember the millions of Cambodians who witnessed mass murder between 1975 and 1979. We see Angolans still trapped in decades of civil war.

We see the survivors of these travesties, and wonder: What happens to someone who is tortured, or who witnesses wholesale murder? How does being violently forced out of your homeland affect your psyche? And how can mental health professionals invent treatments that work for traumatized refugees and victims of torture? Glodane Village

We'll lump refugees and torture victims together because the categories actually overlap. "We estimate that about 25 percent to 35 percent of refugees have been tortured, and the rest have been traumatized," says Evelyn Lennon, a social worker at the Center for Victims of Torture in Minneapolis.

A need for healing
While warfare and torture are ancient, the effort to treat victims of political violence is more modern. The field has its roots in the recognition that, decades after the closure of Nazi concentration camps, Jewish Holocaust survivors were still hurting. In the 1970s, during the repression of General Augusto Pinochet, clandestine support groups in Chile offered legal and psychological help to torture victims and families of "disappeared" (murdered) citizens. In the 1970s and '80s, Dutch and Danish professionals organized treatment centers for torture victims. In the 1970s, psychologists in the United States saw anxiety, sleeplessness and anger among soldiers returned from the war in Vietnam.

The similar symptoms of these different agonies earned them the label post-traumatic stress disorder (PTSD). The Diagnostic and Statistical Manual IV, the bible of psychological diagnosis, says PTSD can result from undergoing or witnessing torture, combat, violent personal assault (see pp. 424-30 of "Diagnostic and ..." in the bibliography).

Common symptoms of PTSD include:

  • Intense fear, helplessness or horror
  • Recurrent and intrusive memories or dreams of the event
  • Outbursts of anger
  • Guilt over survival
  • Difficulty concentrating
  • Exaggerated response to reminders of the trauma

Roger Garms, a Wisconsin psychologist who has been treating PTSD patients for two decades, says about half of people with the condition recover within a year. Beyond that time, "You end up with chronic PTSD, and the symptoms don't seem to heal with time."

How does that translate to real life? Stevan Weine, a psychiatrist at the University of Illinois at Chicago, recalls a meeting of Bosnian survivors that was overwhelmed by memories.

...I walk into the cafeteria carrying my infant daughter in one arm and her blue diaper bag on my shoulder. When V. sees us he starts screaming at the other Bosnians, "See, that's what they do! That's what Serbs do!" The next hour is spent trying to help him to contain the torrent that has so suddenly erupted. The story comes out in bursts and fragments ... about the morning when he was on a forced march with his sister and her baby and they came to a Serb checkpoint at a bridge. You had to throw all your belonging over the bridge into a net. He tells the soldiers, "We need diapers for the baby." The soldiers grab the baby and throw her into the river. When the child's mother tries to jump in after her, she is shot dead. As he paces, shouts, and kicks the air for a tense hour, the school cafeteria is that bridge. Eventually he calms down and says, "I saw your child, and the memories came alive." Excerpted from "When History is a Nightmare..." (see bibliography)
Unquestionably, prevention is the best "treatment" for torture and the traumas of refugees. But as the crisis in Kosovo indicates, and the existence of 22 million refugees proves, prevention is failing.

Want to read about some innovative treatments for the psychological scars of torture and displacement?

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