After the events of September 11, 2001, and at a time in world history when refugees and displaced persons are moving about the world in numbers that are unprecedented (United States Committee for Refugees, 2001), the likelihood of counselors encountering refugees is increased regardless of their treatment settings, from schools to government agencies. Civilians are increasingly at risk for being victimized by organized political violence (Porter & Haslam, 2001), and the United States alone hosts almost half a million refugees (United States Committee for Refugees, 2001). In the article "Refugee Survivors of Torture: Trauma and Treatment," Gorman (2001) illustrated dynamics that may go unrecognized by clinicians who work with these complex individuals and families, and he provided a holistic conceptualization of these dynamics.
Gorman (2001) consolidated liberation theory, multiculturalism, and traumatology into a framework to use in the treatment of refugees who have been tortured. In this framework, he drew from such theorists as Freire (1973); Marsella, Friedman, Gerrity, and Scurfield (1996); and Herman (1992) to define the constellation of issues to be considered. Gorman's article is applicable to refugees as well as to displaced persons. Refugees are those who, for fear of persecution due to membership in a social group or because of a political opinion, are forced to live outside their country of origin. Displaced persons are those who are at risk for the same type of persecution as refugees but who still live within national boundaries. This article focuses on several questions addressed by Gorman: What is the impact of torture on refugees? What multicultural principles are relevant to treatment? and What can sequenced models of trauma treatment offer to the torture survivor? It concludes with suggestions for counselors to consider regarding the acculturation of refugees, their resilience, and the role of mind and body in the treatment of tortured refugees.
WHAT IS THE IMPACT OF TORTURE ON REFUGEES?
Gorman (2001) cited several previous investigators who assessed the proportions of refugee populations that have been tortured to be somewhere between one third and one half of all refugees. The purpose of torture is to break the spirit of individuals or groups through the systematic application of painful physical or mental procedures. Torture victims, their communities, and those who treat the survivor are all affected by the consequences of torture. The paradox for torture victims is that they need to process the pain for healing, while needing to protect the self through numbing or shutting down the experience. This effectively silences tortured refugees after the torture has concluded and can prevent them from actively seeking to improve their health. Cultural backgrounds also influence the process, both positively and negatively, because spiritual perspectives may buffer the trauma and folk mores may encourage people to endure suffering silently for the good of the community.
Even when the torture survivor does address the torture experience with health professionals, the situation is complicated by the natural tendency of helpers to protect themselves from what Jay (1991) called the "terrible knowledge" of human beings inflicting pain on other human beings for political reasons. This defense on the part of practitioners can result in a severe shortage of health practitioners qualified and willing to help. Two related psychological defenses, using professional jargon and equating torture with a mental disorder, risk further alienating or revictimizing the person. A potential crisis exists in terms of increasing numbers of people needing help with decreasing numbers of people who can and will help. Gorman (2001) recommended normalizing whatever coping mechanisms the person has used to survive the profoundly abnormal situation, explicitly acknowledging the cruelty of the political systems that encouraged the torture in the first place. …