A Day In The Life Of Survival

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Torture / SURVIVAL

Illustration by SARAH JOHN Gloria had a long journey ahead of her,
building a future from fragments.
Dr Gill Hinshelwood was there from the start.

The path towards survival a victim of torture has to travel is slow and painfully difficult. Many survive literally, but may spend a lifetime wishing they had been killed. Some kill themselves years later.

Gloria, who fled persecution in the Democratic Republic of Congo (formerly Zaire), succeeded in finding a life worth living, albeit utterly different from the past. Her story is both unique yet representative of those who have had to overcome torture and exile, a double dose of fear and danger.

At the time of torture, the victim is one helpless and mindless scream of agony. When she is released or escapes, seemingly superhuman strengths are drawn on in order to reach a place of safety. Yet on arrival these 'survivors' often trudge back and forth to hospitals and social services seeking relief for apparently inexplicable symptoms.

Gloria felt lost and alone when she reached a place of safety, but relief kept her buoyant at first. It did not last. Three months later she presented to a refugee centre with a carrier bag full of medicines to treat symptoms from top to toe, appointment cards and papers, looking thin, tired and utterly defeated, saying: 'No-one understands me.' This is what torture does to people. It fragments, breaks their links: externally, with the family, community, country; internally, so that bits of the mind and body seem to have isolated primitive existences beyond control.

A typical day in Gloria's first few months of exile demonstrates this. She has been housed in a room in a large and noisy mixed hostel. Her day begins at about five in the morning, waking with heart thumping and a tight feeling across her chest, fighting with the bedclothes, possibly screaming. The light is on because she is terrified of the dark. She is frightened to sleep and have the same nightmare yet again, a nightmare of being chased, dogs, and her child in danger.

Fatigued, with a throbbing head, she sits with a cup of tea and some aspirin, trying not to think, as dawn breaks. Avoiding her neighbours, she goes to the one fixed point in the day, her language class. She thinks that if she learned the language of her host country she would not feel so helpless and misunderstood. But she who used to be a teacher cannot learn; her mind wanders and she forgets easily. Gloria sits apart, avoiding eye contact with her classmates. She feels dirty and ashamed, as if she had been raped yesterday instead of several months ago. As the lesson progresses, she gazes out of the window in a world of her own, and the memories flash back, triggered by the siren of a passing police car. Her headache, and now abdominal pain, increase and she leaves abruptly.

Absentmindedly she steps into the road. A screech of brakes and an irate voice yells: 'Watch where you're going, idiot!' People stare. Rushing back to her room, she buries herself under bedclothes and cries for about two hours, which brings some relief, so she sleeps fitfully. She prepares tea, bread and beans, and eats half of it.

Gloria tried hard to blot the past out of her mind. But memories returned unbidden...

She thinks of all she had intended to do that day but cannot face now. Visit her immigration lawyer. Her most dominating fear is of being refused asylum. Her lawyer explained the legal process, but in Gloria's anxious state, they were just words. She thinks they could come for her and send her back at any time. Visit her doctor, again. But what for? The insomnia, fatigue, headache, backache, pain in knees, forgetfulness, feeling crazy, palpitations, breathlessness, hand tremors, nightmares; or should she try and put into words her wish for an examination. Gloria is terrified that she has a serious sexually transmitted disease, but she can't summon up the words to ask for an examination when she sees her doctor, so her fears remain unabated.

The therapeutic task is to restore links, and in Gloria's case this begins with trying to connect the items in her bag with herself. 'What were you given this for?'; 'Terrible headaches'; 'and this?'; 'my back hurts, where it was hit'; 'and this?' . and so on through some 12 items, parts of her body which had troubled her and had been presented to doctors, casualty departments, pharmacies, had been X-rayed and pronounced normal and medicine prescribed, white mixture for stomach, various painkillers, vitamins, sleeping pills, antihistamines, inhalers.

Connections are made between the symptoms and what Gloria believes to be the cause. Slowly a picture develops - of the past brutality, which caused the pain, and of present indifference and uncertainty, which perpetuates and compounds it.

Two important observations about victims of torture have been made. The first is that when they are invited to tell what has hitherto been unspeakable, to someone who listens and believes, and writes it down, there is a marked physical and mental improvement.

The second observation is that victims of torture are particularly unable to access the help that is available in the host country. It is partly for these reasons that specialist services develop.

Gloria was able, through an interpreter, to put into words for the first time many of the abuses that had happened to her after her husband was killed. In particular, she struggled to admit that she had been raped brutally on a nightly basis, as well as interrogated and beaten during the day. That she became pregnant and then nearly died of a miscarriage, before she was taken to a military hospital from where she was helped to escape, only to find her daughter missing. With time and patience a coherent history was put down on paper, Gloria's medicine was rationalized and a shared rehabilitative process was beginning. Making links, starting from the simplest, leads to a measure of control and Gloria found that she could begin to exercise a certain amount of choice, where previously she had been driven by urgent, panicky responses.

In day-to-day living the choices of a refugee are limited, so it is important to recognize where they do exist. She was helped to put into words her wish for and dread of an HIV test, and the decision to attend a clinic was hers. There came a time when Gloria could recognize that her body had healed. Scars were old, she could eat, albeit without much pleasure, and she regained weight. When her heart beat fast she knew what terror she was being reminded of, and instead of rushing into casualty she tried to put into practice relaxation techniques learned in a self-help group. A determined woman, she forced herself to stay on the same side of the street as a passing policeman. In spite of these gains she remained profoundly sad and socially isolated for a long time.

With every step forward there seemed to be a slip back. A move from the noisy hostel to a self-contained apartment improved Gloria's self esteem, until the racism of one nearby family revived fears of violence, and nightmares returned. She mastered the language and found work as a carer, only to return home and cry at night for the family she despaired of ever seeing again. She met a man with whom she felt comfortable and who restored her confidence in her body, but he was no support when she became pregnant. Pregnancy finally convinced her that her body had not been irrevocably damaged. She was overjoyed at the birth of a healthy son, but along with this came a renewal of grief about the daughter she had been unable to trace.

Ten years on Gloria has a lively five-year-old who has started school. This frees her to do part-time caring and study towards an accounting qualification. She takes life seriously and drives herself - and possibly her child - quite hard. She has a sense of a future for herself. Beginning with one understanding lawyer who represented her asylum claim, the good figures in her life (and in her mind) gradually increased to include a welfare-rights caseworker and counsellor - who sorted out the innumerable day-to-day hitches that so trouble asylum seekers, such as housing and income support - her English teacher and a doctor who liaised with specialists at the pace Gloria could manage. It was most important for her that these people were in touch with each other; it felt like a safety net. She risked a relaxation group and a women's group. There she laughed for the first time. Gloria shared the joy of her recovered sexuality with her 'family' as she called them, and turned to them when the departure of her son's father left her with a recurrence of many of her early symptoms.

The dilemma for a victim of torture can be described as a struggle between the wish to forget and the need to remember. There are obvious reasons why Gloria tried hard most days to blot the past out of her mind. However, her forgetting became a 'package deal' and led to confusion and difficulty in making sense of her life. And it did not work, because memories returned unbidden in the form of dreams and flashbacks. With her caseworker, Gloria risked remembering. With help she survived the flood of emotions of anger, fear, grief and shame that were attached to her memories. The need to keep in mind those who had not been as fortunate as herself, to Gill Hinshelwood remember for their sake, for justice, and also because it is why she is where she now is, is vital for her survival.

Gloria's name and
identity have been disguised.

Gill Hinshelwood  is senior physician at the Medical Foundation
for the Care of Victims of Torture in London.

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