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The Impact of Torture on Mental Health

By Hilda Nyatete and Dr Violet Tamu

 

Background

The Independent Medico Legal Unit (IMLU) as an organization is continuously dedicated to providing torture survivors with rehabilitation resources they need to heal and reintegrate. Critical to the provision of these services to survivors of torture is the need to support victims and their families to regain a sense of normalcy due to the heinous act and violations they have been subjected to. At the core of this support, are the mental health practitioners without whose passion and dedication victims and families would not be able to see light at the end of the tunnel that is the pain and anguish that comes as a result of torture. These mental health practitioners, spanning across 20 counties, provide psychological support at group and individual levels for up to months at a time.

Over the last 25 years, we have supported well over 5000 victims of torture and police violence to receive holistic services which include psychological support. Remarkably, those who consistently and patiently work through the psychological impact of torture, go on to live as normal lives as possible; watching their dedication and willingness to work through the trauma is admirable, but also remarkable to see how lives are changed through therapeutic interventions in supporting victims of torture.

What is Torture?

“Torture is the deliberate and systematic dismantling of a person’s identity and humanity.” The main purpose of torture is to create fear, destroy a sense of community and eliminate leaders. The most common forms of torture are; beatings, psychological torture that does not leave any marks. These psychological types of torture affect victims’ mental health.

Mental health, includes but is not limited to; ”…subjective, perceived self-efficacy, autonomy, competence, intergenerational dependence and self-actualization of one’s intellectual and emotional potential among others...”

While symptoms of mental health and psychological impact of torture are similar, according to McFarlane & Yehuda, (1996) an individual’s reaction to emotional trauma is complex and can be difficult to predict. One’s past experiences, their social environment and or support, upbringing, cultural background, their emotional functioning are some key variables that play a critical role in how one responds to trauma. However many researchers intimate that mental and physical torture do the same psychological harm to a victim and are not easily distinguishable in the long term. Some of these include but are not limited to PTSD and depression. They both result in physical pain. A study on torture survivors sampled from Sarajevo, Banjaluka, Rijeka and Belgrade confirmed this, (Kings College University of London and Clinical hospital Zvezdra, Belgrade and Serbia).

Medical News Today also confirms this and adds that “...Physical torture is at par with psychological torture in terms of instilling fear, feelings of helplessness, loss of control and inducing anxiety”. Some of the physical torture meted on the victims included; sleep deprivation, genital fondling, threats of sexual violence or molestation, violence and witnessing sham executions, rape threats, violence, to mention but a few. Sleep deprivation causes insomnia, headaches, fatigue. In short emotional factors are triggered including other physical complaints like sexual dysfunctions, blurred vision etc. The brain is conditioned by extreme fear and stress, sleep deprivation and all these can change some memory systems.

Psychotic symptoms become prevalent. These include; paranoia, hallucinations, dreams, delusions, bizarre ideations, suicidal, hate, illusions or perceptual distortions. Others develop split personality. They feel they observe self from a distance and have disrupted consciousness, and disrupted self-perception.

Behaviorally, majority of victims present with fear, hallucination, anger, and deterioration in cognitive, emotional and other behavioral functions, many clients we handle exhibit some of these symptoms. Others develop split personality. They feel they observe self from a distance and have disrupted consciousness, disrupted self-perception, memory and action.

Generalized Anxiety Disorder is another symptom. The victim becomes restless, easily fatigued and finds it difficult to concentrate. Such a victim may also be easily irritated and experiences muscle tension. Just like the sleep deprivation one, this victim presents with sleep disturbance. He/she may have difficulties in falling asleep. On the other continuum, he may find it difficult to stay awake. I have met one such victim who easily sleeps anywhere while on duty/safari. He finds a lonely bush and just sleeps there.   Muscle tension are also prevalent. A victim with generalized anxiety disorder also exhibits clinically significant distress and/or impairment in social, occupational or other important areas of function.

Substance abuse disorder: This may develop or for those who were already abusing it, they may become more addicted. This is in their effort to dull their pain and threatening experiences.

Some victims present with Enduring personality change for instance they become socially withdrawn, hostile or distrustful towards the world as a whole, hopeless, estranged and constantly threatened.

Although traumatic events caused by torture are different, their psychological consequences are similar. There is a commonality in the way they are mediated in the central nervous system (Basogllu, 1992a). Livanon, (1998) supports this and adds that human beings respond similarly to particular forms of treatment.

Psychomotor retardation e.g. Diminished inability to think, concentrate and is indecisive. This victim also entertains recurrent thoughts of death, guilt feels worthless and fatigued.

Humiliation propels one to be out of control, develop paranoia and may attempt self - harm. All these acts communicate a disruption in brain function

Torture reports are prevalent in regions affected by political unrest, riots, mass demonstrations, violence, tribal/ethnic clashes, etc.

A case of the psychological Impact of Torture on family

Trauma not only affects the individual both physically and psychologically; it affects those around them-family members, and significant others. One such case was during our engagement with victims of historical torture who for years had not disclosed to their families, and specifically their spouses, the harrowing experiences they were subjected to.

Many families linked to these victims over the years, harbored bitterness and anger towards these men, who had gone through more pain than they could bear to disclose. The joint occurrence of trauma and separation has a significant impact on emotional distress and family relationships, and the support extended to families and loved ones plays a pivotal role as an anchor of emotional stabilization and healing (Aroche, J, & Marin, L, 1994) [9].

It was therefore paramount that their spouses be integrated into the psychological/therapy program where they were taken through ten sessions of group therapy.

The main goal that presented during the onset of the group therapy was supporting the women to vent their anger and frustrations following their loss, especially developmental losses, during their spouses’ arrests and subsequent incarceration. Catharsis[1] was the main approach used during the group sessions and by the end of the sessions, the wives had learnt how to confront and manage the negative emotions that had manifested for years. The women were empowered with the use of relaxation techniques and encouraged to embrace social support (Schauer, et al., 2011) [10] amongst themselves as a way of enhancing healing not only to themselves but to their spouses and children.

For family members of victims of torture, psycho-education on how to support their loved ones becomes a critical part of the therapeutic process. This is key because handling the ripple effects of the ills their loved ones may have suffered is key not only for the victims’ healing, but also for their own coping and healing too.

Some common interventions

There are many interventions e.g., CBT (Cognitive Behavior Therapy), NET (Narrative Exposure Therapy), Family therapy to validate impact of family members on healing, Psychodynamic approaches to tap on history of torture, Solution focused therapy, Dream work, meditating on faith healing verses, hymns of praise, visualization, relaxation, leisurely walk, spirituality and culture play an important role particularly to those who believe in a supreme being. It is a useful resource and even future studies will focus more on these more.

A study carried out on victims who attended spiritual retreats and clinics and those who did not revealed that self-transcendence was increased after the interventions. Those who went for spiritual clinics and retreats had positive impact, therefore when offered concurrently with psychological and   medical interventions, the results can be amazing. However, I must add that it depends on one’s faith and will power. Dr. Nerberg of Marcus Institute of Integrative Health at Thomas Jefferson University, @ Medical news Today add that the retreats increase levels of “feel good” hormones in the brain that change dopamine and serotonin systems of the brain, boost availability of neurotransmitters that enable emotional responses to be regulated by dopamine whereas serotonin helps to control emotions and mood.

 

[1] The release of pent-up feelings and repressed emotions after a subject has begun to talk about problems during analysis.

 

Amy Sironka- Programme Officer- Advocacy and Communications

Simplified Booklets: Prevention of Torture Act 2017 & National Coroners Service Act 2017
02 Jul 2019

Be sure to grab a copies of the summarised versions of the two Acts from our offices. For pdf version checkout the Resources Section!

UN International Day in Support of Victims of Torture (June 26th), 2019
02 Jul 2019

IMLU partnered with Kondele Community Policing Committee, Kondele Justice Centre, community members and Kondele Police Station to commemorate the International Day in Support of Victims of Torture, June 26th, 2019.

Strategic Engament with the National Police Service (NPS)
02 Jul 2019

As part of the police reforms strategy, the PRWG-K held a strategic meeting with the Inspector General of Police Hillary Mutyambai in May, 2019.

It has been 25 years of fighting against torture for IMLU
16 May 2019

The Independent Medico Legal Unit was founded by a doctor and a lawyer in 1995, as an ad hoc voluntary facility whose first work centered on prisons to address cases of politically instigated violence along ethnic lines in the Rift Valley and victims of State despotism, cruel and inhumane treatment; thereafter moving to cases reported in police custody. The work became overwhelming for the two, necessitating their calling for support from doctors from the Kenya Medical Association and lawyers from the Law Society of Kenya. The organization later begun medico-legal documentation, gradually expanding to rehabilitation, advocacy and reforms especially in the security sector.


“We started out as an informal network of volunteers and often around the kitchen table. From time to time we would volunteer in far flung areas in the country; we are grateful that much of our success was based on our networks with the Kenya Medical Association and the Law Society of Kenya, to which 25 years later, our doctors and lawyers are members.”- Dr. Ling Kituyi, one of the founders of IMLU.


Ours has been a journey

In the past years, IMLU has produced evidence based research reports and surveys that are informative in defining a roadmap towards reforming the police. The "National Torture Prevalence Survey, 2011 and 2016" clearly illustrates the fact that state perpetrated torture remains prevalent in Kenya.


In 2011 and 2016 63% and 64.1% of the respondents respectively identified the regular police as the main perpetrators of torture and ill treatment. In yet another IMLU publication- "Violence amongst the Urban Poor Nairobi" 70% of the incidences of torture were attributed to the Kenya Police (Regular Police).


Other publications include "Our Guns: Our Security: Our Dilemma" and "A Cry for Justice: Torture and ill-treatment of Hawkers and Small Scale Traders in Nairobi City County", which highlight key gaps in the state security apparatus related to policy, institutional practices and made essential recommendations to guide the police reform agenda.

In 2015, we embarked on a program on police-public partnership in public safety and security, a key pillar in the police reforms. The focus was to support Nyeri, Nakuru and Isiolo Counties to establish the County Policing Authorities (CPAs) which cascade down to the County Policing Committees (CPCs) and County Forums (CPFs) at the lowest levels. The aim of the project was to set up a citizen platform to work with the respective counties in promoting citizen-centered policing.

Community policing has improved the relationships between police and the public in Nyeri; this is evident through the community voices’ whole undertaking a monitoring and evaluation exercise in all the nine stations. This has seen improved service delivery. The public have now a deeper understanding of their role in policing.

“Nyeri is no longer the same. We have learned a lot about security; we are able to interact easily with the police. I can share a lot on security with women groups where I am a member. I encourage them to interact freely with the police” Margaret Nyathogora, CPA member, Nyeri County. Adding that the main problem was the fear the public had towards the police.

 

Recently, the PRWG-K was admitted to the Multi-Agency Policing Reforms Task Force by the Ministry of Interior under which the National Police Service falls, as a key player in the security sector reforms. As a result, we have had several meetings with other stakeholders and that culminated in major reforms at the National Police Service (NPS) this year (2018) and which included the issue of welfare for police officers.

We initiated a litigation case against the Government of Kenya in the wake of human rights atrocities caused by the armed forces in Mt Elgon; we were able to create interests and sensitised various actors on the case and this enabled IMLU gain the support of other human rights actors in the country and in the region. Some of these included the International Commission of Jurists (ICJ) and the Pan African Lawyers Union (PALU), based in Tanzania.

The support has also enabled us take critical analysis of our systems and overall work. For instance in 2012, we subjected ourselves to a holistic peer review exercise in the Civil Society of the Year Awards (SOYA) and which interrogated including inter alia clarity of purpose, corporate social responsibility and our governance systems. Overall, we emerged the first runners up and this was contributed to the advocacy strategies we had employed to highlight cases of torture and efforts towards reforms, with the support from KIOS.

Through this support, we have also spearheaded a number of studies which indicate that the scale of torture remains high with the police being the main perpetrators. In a nutshell, the drivers of torture include but are not limited to; culture of impunity and corruption, weak legal frameworks that address issues of torture, poverty and associated vulnerabilities, discrimination and sectarianism especially for persons with different sexual orientation. However, with the President’s assent to the Prevention of Torture and National Coroner’s Service Bills in 2017 turning them into laws, the country now has great hopes in advancing the response to cases of human rights violation, but also on issues of accountability on the part of the state and state agents.

With these changes still, there is need for continued innovative responses founded on the right legal environment. Cognisant of the above, we have overseen a number of dynamic interventions targeted at prevention and response through holistic service delivery. These include the launch of the mobile application dubbed “Ripoti” (Swahili word for the verb ‘report’) in a bid to leverage on technological advancements in encouraging the general public to report cases in a more secure and effective manner and to increase monitoring of police conduct.

Externally, IMLU has worked with various international mechanisms and made case for Kenya at the UNCAT. We are currently finalising an alternative report that will be presented in Geneva to assess the human rights situation in Kenya.

Lisa Wangari, one of the torture victims, (holding microphone), narrates her ordeal in the hands of police officers during the International Day in Support of Victims of Torture, June 26,2018. IMLU provided her holistic support and that lead to the court awarding her Ksh.9M in 2013, an amount that has not been fully disbursed to her to date.

As part of our success and with the help of experts, we also managed to develop and launch the first ever Forensic Medico-Legal Manual for East Africa. The manual has attracted a lot of interest especially from stakeholders who are interested in the field some of which include the Independent Policing Oversight Authority (IPOA), the Internal Affairs Unit of the National Police Service and the Law Society of Kenya (LSK).

To this end, we have trained the Internal Affairs Unit (IAU) and the Independent Policing Oversight Authority (IPOA) officers on the forensic medical documentation and how to work with forensic experts in investigations. This paved way for discussions on the need for entrenching forensic training at the NPS training colleges and adoption of best practices on forensic documentation in Kenya.

Through this journey, we launched our 2017-2021 Strategic Plan, christened Vision 2021, and that anchors our operations on building movements. This calls for more a departure from ‘transactional’ relationships and networks to one that focuses on service delivery and service to humanity. In this line, we have partnered with the Social Justice Centres’ Working Group in a bid to build the capacity of human rights defenders across the major informal settlements in Nairobi.

By Hilda Nyatete & Steve Biko

Community Policing: Enhancing public-police partnership
16 May 2019

Pursuing safer communities through public-police partnership and in accordance to Article 244 of the Kenyan Constitution on citizen participation on policing matters.

Quest for justice for victims of torture
16 May 2019

Through engagements with the National Police Service, Independent Policing Oversight Authority (IPOA) and the Internal Affairs Unit (IAU), we continue to advocate for the right to compensation and reparations for victims of torture.

Movement building with lawyers in the coastal region
10 May 2019

As a strategy to get a strong foothold in the coastal region, we held a training for lawyers from the region and who have since been admitted to the IMLU network of pro bono lawyers. They will provide support to victims and survivors of torture, violence and discrimination.

Collins Wafula- Monitoring, Evaluation, Accountability & Learning (MEAL) Associate

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