Book Review

At the Side of Torture Survivors: Treating a Terrible Assault on Human Dignity

N Engl J Med 2001; 345:1284-1285October 25, 2001

Article

At the Side of Torture Survivors: Treating a Terrible Assault on Human Dignity
Edited by Sepp Graessner, Norbert Gurris, and Christian Pross. 241 pp., illustrated. Baltimore, Johns Hopkins University Press, 2001. $46.50. ISBN: 0-8018-6627-8

Available for the first time in English, At the Side of Torture Survivors is an outstanding collection that brings an extraordinary international perspective to the growing literature on the treatment of the survivors of torture. The book's 12 chapters and afterword, all by members of the staff of the Berlin Center for the Treatment of Torture Victims, are consistently well written and substantive. Each chapter contains an intimate and unflinching description of the treatment of victims of torture and at the same time takes great care to provide context for professional and lay readers. The authors are clinicians who openly acknowledge the atrocities committed during World War II by many Germans, including members of the medical profession. For these authors, this history makes their work that much more necessary and meaningful. These clinicians face the reality of torture head on and, through their excellent writing, help the reader to face it, too.

The authors explain in detail that the goal of torture is the destruction of a person's identity. With this in mind, the goal of treatment is to restore that identity, to help the survivor of torture to be able to say, “Yes, that really did happen to me, but I am no longer a victim; I am a survivor.” To reach that goal, the Berlin Center for the Treatment of Torture Victims, founded in 1992, provides a variety of services for torture survivors, including general medicine, psychiatry, psychotherapy, physiotherapy, art therapy, social work, and administration. Persons come to the center from more than 30 countries, with many recent arrivals from Yugoslavia and Turkey.

The great strengths of this book are its courageous depiction of the complexities of torture and the treatment of torture victims and its honest appraisal of when and how treatment succeeds or fails. Each chapter offers a different perspective on what can be done, and many offer specific examples that put a human face not only on the torture survivor but also on the therapist. The descriptions of the tortures themselves are detailed and graphic; the reader is forewarned of this and also advised that confrontation of the horrors that human beings force on one another is a necessary part of treatment. It is also a necessary step toward ending the practice of torture.

The topics covered in the book include physical-rehabilitation techniques, the role of advocacy in treatment, the effects of torture on memory, the complex relation between the physical and psychological consequences of torture, the effects of torture on personal relationships, the specific physical consequences of particular forms of torture, the grim reality of life in refugee camps, and special treatment methods, such as dream work and storytelling. The crucial significance of the cultural characteristics and personal history of the patient and how these attributes must be incorporated into treatment are discussed throughout the book. The descriptions of treatment also deal with the effects of the treatment process on the therapist during individual sessions and over the long term. The treatment methods described are grounded in theory, most notably object-relations theory, which suggests that torture undermines a person's core identity and that the goal must be to help patients reconnect with their identity and with the reality of their past, their future, and most important, their present. The authors also take a fresh look at the debate about the applicability of the diagnosis of post-traumatic stress disorder to survivors of torture by describing the specific symptoms that may make a diagnosis of complex post-traumatic stress disorder or disorder of extreme stress more appropriate.

The authors are clearly well acquainted with current research and with approaches used in torture-treatment centers throughout the world. What comes through in their writing is the extraordinary respect that they hold for their patients as they accompany them through the hell of their past toward a future that, though it may not hold a cure, may bring an easing of pain and a renewed ability to find joy.

In his foreword, Bahman Nirumand notes that the therapists who work with these patients “dedicate a portion of their very own being, of their soul, to each individual victim. How can one thank them for this selflessness?” This is a good question, for it is at the heart of this selflessness that true healing can begin. The world owes them thanks not only for their courageous clinical work but also for their efforts to share their experiences and those of their patients with all of us in this exceptional book.

Ellen T. Gerrity, Ph.D.
National Institute of Mental Health, Bethesda, MD 20852
egerrity@nih.gov