Engaging the sacred in treatment

Torture by its very nature creates distress in part related to the intentionality of the trauma inflicted. Consequently, it is necessary for clinicians to address many of the existential concerns that arise in the course of treatment. Often in clinical training, issues of spirituality are deferred to spiritual caregivers. It is important when working with torture survivors to consider the myriad of ways in which the spiritual dimension is interfaced with. For some, efforts to address physical and emotional symptoms may fall short of that which is necessary for full recovery.Torture affects individuals on multiple domains simultaneously. Many survivors speak about the damage that has been inflicted to their souls. Furthermore, survivors may come from cultures where religion is a way of life and cannot be separated from one’s daily life experiences. Helping people connect to communities of faith can be critical to not only decreasing the isolation that survivors may have, but also potentially helping in the process of restoring one’s capacity to trust again. As clinicians, our own life views can impact on the work we do. It becomes important to take a personal inventory as to how we ourselves answer the question why such cruelty exists. key words: torture, trauma, spirituality Introduction Central to the practice of torture is the intention of cruelty and destruction. It is perhaps best summarized by the Berber proverb: “Whoever wants to hurt never misses his target”.1 Torture has many goals: to get information, to destroy the individual, to destroy the family, to terrorize communities, and in more recent times, ethnic cleansing.2 As with any traumatic event, our assumptions about the world as a benevolent and meaningful place and the self as worthy are challenged.3 In countries where state-sponsored terrorism exists, the involvement of government further complicates the betrayal experienced by survivors and their families. Torture influences four realms of human existence: the spiritual, emotional, social, and physical.4 Hopelessness, alienation, and shattered trust in God, society, and oneself can arise out of the direct confrontation with evil. Furthermore, survivors may suffer from guilt and shame for surviving, for being a silent witness, or for being identified as one to be tortured.5 The Istanbul Protocol was developed by human rights advocates and the United Nations in order to develop standards for the assessment of individuals claiming torture.6 As summarized by the Istanbul Protocol, torture can result in multiple psychological responses: T O R T U R E V o lu m e 1 5 , N u m b e r 1 , 2 0 0 5 1 Torture and spirituality: Engaging the sacred in treatment Linda Piwowarczyk, MD, MPH* *) Boston University School of Medicine Boston Center for Refugee Health and Human Rights Boston Medical Center Dowling 7 One Boston Medical Center Place Boston, Mass. 02118 USA [email protected] S C I E N T I F I C A R T I C L E Posttraumatic Stress Disorder Somatic complaints such as pain and headache Depressive Disorders