Whether Greek or Roman, European or Arab, whether contemporary or ancient, all those who write of exile describe a world in which the past is safer territory than the present, even when the past was full of horror, for at least the past has already been experienced. One of the most frequent themes of exiles is that of recapturing and reliving their lost past, earlier images providing a solid counter to the fluidity and rootlessness of the present. The native shore, observed Milan Kundera, the Czech emigre writer, is after all the only known shore, but the exile, to survive, has no choice but to step off onto a precarious, rickety bridge, from the land where all is familiar and where he speaks a language known to him from childhood— from, that is, his real world—and grope his way across toward a new country, a world hitherto only of the imagination, in which nothing is understood or familiar. In the process, by some sleight of hand and hope, he must reverse these two worlds, the real and the imaginary, so that all that was once familiar becomes imaginary, and the imaginary becomes real. Both to remember too much and to forget too quickly is perilous; a “fetish of exile,” as Said described it, distances the refugee from “all connections and commitments.” Willing himself to forget his cultural background, he finds that he has nothing to put in its place. The bridge is fragile and terrifying. Yet this profound dislocation of the spirit has to be borne, because it cannot be avoided. When Eva Hoffman used the haunting phrase “lost in translation,” she was describing what it means to live not only linguistically but spiritually in a new language. “The words I hear now,” she wrote, “don’t stand for things in the same unquestioned way they did in my native tongue.” For all of us, the word “exile” resonates as an ultimate image of loneliness and need, touching an atavistic fear of losing all we most cherish, and all that we feel has shaped our identities and continues to define our tenuous image of ourselves. For Mandla Langa, one of the African writers who have put on paper the experience of exile that has dislocated their continent for the last half century, exiles are branded and maimed creatures, condemned like animals who have left limbs in a snare to wander through life “crippled, their minds locked on that fateful moment of rupture.”
It was not until after World War II that systematic attempts were made to link the experience of exile with that of the traumatic events that so often led to it. As the stories of those who had survived the Holocaust became known, so a literature of trauma began to take shape, and with it a realization among doctors that terrifying and destructive events have the power to cripple and maim, even if they left their survivor apparently unscathed, and to reappear later as illness. None of this was new, of course: Freud had written extensively on childhood trauma, and John Bowlby about the lasting effects of loss and bereavement, but something about the intensity and similarity of the symptoms reported by many different patients began to attract attention beyond psychoanalytic circles. Exile, it became clear, particularly when accompanied by brutal experiences, overwhelming loss, and torture, was a potent and disabling event. When Primo Levi and Bruno Bettelheim, who had survived Auschwitz and Dachau, killed themselves at the end of long and productive lives, people were quick to say that the past had finally caught up with them. When the survivors of the concentration camps began to reach retirement, when the huge efforts to keep the past at bay through work and activity began to lessen, their minds were invaded by all that they had lost and endured. It became clear, too, that the aftereffects of the camps were being handed down to a second generation, the heirs of the Holocaust, who seemed to share an anguished collective memory in their dreams and fantasies, waking up at night with terrifying images of gas chambers, firing squads, and extermination camps. They live, as a psychiatrist put it to me, in the reality of their parents’ past, identifying with parental behavior and patterns of thought, caused by a history they feel they share but did not themselves experience.
Like the children of Holocaust survivors, the children of refugees grow up in a world circumscribed by fear, unrealistic expectations, and overprotectiveness, with parents whose profound sense of powerlessness in the face of annihilation and loss expresses itself often as self-blame and guilt. Because they are in limbo, and because all their concentration and energy have to go into surviving and helping their children survive, they feel they have no permission to mourn and grieve. Seen this way, exile and the memory of trauma and loss produce an experience of bereavement many times over: loss of country, status, activity, social networks, reference points, and family, all compounded by a sense of lost time, the lost hopes and ambitions of youth and young adulthood. Yet delay in mourning, psychiatrists have long agreed, is known to increase the difficulties of adjustment. “That which cannot be spoken cannot be treated,” wrote Bruno Bettelheim not long before his suicide in 1990. “If they are not treated, these wounds will continue to ulcerate from generation to generation.”
Toward the end of the 1970s, there came a move to encapsulate this experience of breakdown, to give the condition a name and a label. As more and more clinicians saw patients who had suffered traumatic events, either recently or far in the past, whether of sudden unexpected horror or consciously self-inflicted harm, they began to document a number of specific emotions. Their patients told them of feeling depressed, fearful, sleepless, irritable, unable to concentrate; they said that they felt estranged from other people and that they kept forgetting the most obvious and important things. They reported flashbacks of great intensity, and terrifying dreams that woke them night after night. They returned, again and again, to their feelings of guilt about the people they had left behind, and those they had failed to save. A new diagnosis, posttraumatic stress disorder, was invented to cover all these symptoms, which seemed to occur, disappear, and then reoccur, sometimes with no apparent reason, sometimes triggered by a smell, a few notes of music, an unexpected encounter. Most people reported a feeling of profound worthlessness. Some spoke of suicide. Others came to their doctors complaining of headaches and constant pains in their arms, legs, necks. Others again described seeing shadows or hearing screams. They spoke of “frozen memories,” obsessive and intrusive thoughts that came back, unchanged, again and again. Many had panic attacks. A few became hostile, and paranoid, and turned to alcohol or drugs. Some wanted to talk, and then could not stop talking. Some said little, preferring to retreat into silence, where the past was buried deep. “Some stories,” wrote Anne Michaels in her book, Fugitive Pieces, “are so heavy only silence helps you to carry them.” When physiological studies were made, changes were found to have taken place in neurotransmitters, hormones, and the immune system. And these various symptoms, twice as common in women as in men, and particularly present in women who had been raped, seemed to occur in people from every different ethnic and cultural background. Rape has its own particular horror, especially among people whose culture views it as extreme dishonor: to overcome the feelings of shame, to survive in a new world where there is no shame attached to rape, may mean rejecting the culture and faith of the past, and with them much that once lent comfort and support.
By the 1980s, post-traumatic stress disorder was attracting the attention of many researchers, drawn not least to the apparent existence of a disorder that seemed, uniquely among mental illnesses (though not, of course, unique to refugees), to be triggered by a trauma from a single specific event. Patients appeared to alternate between reexperiencing their traumatic memories and avoiding them. They were using different defense mechanisms to keep away what felt so acutely painful, to lock into the unconscious what they could not bear to experience. But then the moment would come when the conflicting need to integrate this information into their existing cognitive world became too powerful, and memory broke through these defenses and into the conscious again. These two tendencies, argued the psychiatrist M. J. Horowitz in the early 1980s—the tendency to complete what was missing and the tendency to repress—led traumatized people to oscillate. When they proved incapable of processing the traumatic material, so that it remained permanentl
y in active memory, chronic post-traumatic reactions followed. Criticized for failing to explain how it is that some people seem to survive traumatic events relatively unscarred, while others react to the same situations by becoming disturbed, Horowitz’s theory found interested supporters in a world in which terrifying and destructive events seemed to be such a feature of the times.
Nowhere, perhaps, is the term “post-traumatic stress disorder” more used than among those who work with refugees. They argue that the asylum seekers of modern days undergo some of the most extreme events that life can deliver: torture, killings, violence, loss. Lamine’s story is not unusual in its horror or despair, and this fact explains the difficulty people experience in believing the stories of asylum seekers, preferring to find them exaggerated or untruthful simply because they are too painful to absorb or comprehend. Exile, once the fate of individuals, is today the fate of millions—some 40 million people, perhaps, between those driven abroad and those displaced within their own countries.
In a field known to be short on reliable statistics, a few figures nonetheless stand out: depression has been observed in up to 90 percent of people who have been displaced, and post-traumatic stress disorder in about 50 percent; many people who have been tortured have also suffered injury to the brain from beatings to the head, suffocation, near drowning, and starvation. There is, it appears, something singularly traumatic about the combination of forced exile and extreme violence. At no moment is that combination of experiences more disabling than at the moment of arrival in a safe place, when the asylum seeker, frozen in a state of insecurity, not knowing whether he will be allowed to stay or be deported, denied access to work or study, assailed by memories of loss and brutality, oscillates on his bridge, unable to go back or to proceed. And it continues to be disabling, during the long limbo of the asylum process, when those who wait, condemned to passivity and uncertainty, experience feelings of being disliked and despised, which in turn feed existing feelings of failure and valuelessness.
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TORTURE IS NOW documented to take place in 124 countries. Two thirds of those are recognized by the United Nations, whose Convention Against Torture most have signed and ratified. Torture alone—physical pain and degradation inflicted as gratuitous punishment, in order to achieve social control through terror and coercion, to obtain information, or as an expression of loathing—is enough to produce consequences; but the severity of these consequences will be influenced by the duration and severity of the ill-treatment, by the age of the person being tortured, by his biological vulnerabilities and his personality, by his expectations and perception of torture, and by the models of the world that he brings to the experience. Victims of torture are individuals, but they are not alone. As with the survivors of the Holocaust, the effects of their torture will be felt on wives and husbands, parents, children, neighbors. As with the Holocaust, torture involves societies that appear on the surface to be civilized, societies in which people who could be expected to treat their fellows as human beings instead turn on them, brutally stripping them of all dignity, safety, and humanity while continuing to behave apparently normally in other ways. This duality and the way that seemingly mindless persecution destroys the deepest-rooted expectations about human behavior are understood to be among the cruelest aspects of torture. Helplessness and pointlessness, the inability to protect either oneself or others—these are what refugees who have been tortured talk about.
In May 1984, two doctors from the Chilean Medical Association traveled from Santiago to Washington to appear before the House of Representatives Committee on Foreign Affairs. They had come to testify about the activities of some of their colleagues who were collaborating with the military dictatorship in the practice of torture. As the torturers beat their captives into unconsciousness, the two doctors explained, suspending them by the arms and shoulders from poles and hooks, clamping electrodes to their testicles, and stubbing out cigarettes on their bare arms, so these medical colleagues stood by to make certain that the prisoners did not die, but instead lived on to be tortured another day. Disgusted by what they had heard, the committee issued a report. It called for a worldwide campaign to make these facts known, so that torturers everywhere would be shamed into abandoning the practice; and it urged doctors to study the long-term mental and physical effects of torture itself, and to set up centers where those effects could be documented and treated.
As it happened, the committee’s words, though important politically, had already been heeded. Eleven years earlier, in 1973, Amnesty Internationa] had organized a conference on torture. It was held in Paris; to it came interested doctors, lawyers, and researchers from many parts of Europe and North America. Among them was a Danish doctor called Inge Kemp Genefke, who set up the world’s first medical center for the study of torture, in Denmark; others soon followed, in Canada, America, and France. Bit by bit, torture’s insidious legacy was unfolded: by leaving physical scars, deformities, and pain that prolong it far into the future, torture also destroys the mind. Some physical injuries were discovered to be susceptible to treatment, but others were not. Few victims, it was found, had been tortured in only one way; most had known many variations. Listening, recording, analyzing, doctors began to discover how clever torturers had become, tailoring their methods so as to cause most pain and distress while leaving the fewest traces. They learned that while the Turks preferred falaka, beatings on the soles of the feet, the Chileans liked to administer electric shocks. Soon, they came to certain conclusions. Three quarters of people who have been tortured suffer from severe mental consequences, and often these take the form of and are accompanied by extreme physical pain. They discovered, also, that treatment to mitigate the effects of torture is virtually always difficult.
In London lived a medical secretary who had gone into Belsen with the Allies in 1945 as a nineteen-year-old volunteer, and stayed on for two years to work with the survivors, then spent the next seven helping children who had been through Auschwitz. She had long been interested in the aftereffects of horror and grief. Her name was Helen Bamber; she was rather short, with a pretty, innocent face and a light, soft voice. Volunteering in her spare time for Amnesty International in the 1980s, she set up a medical group to document the stories of refugees arriving in England from countries like Argentina and Greece. Amnesty was a campaigning organization; it could lobby and collect material, but it could not treat. So, in 1985, Helen found the backers and the money to open the Medical Foundation for the Care of Victims of Torture, and when I first met her, she was working in two rooms in the National Temperance Hospital not far from Euston and King’s Cross stations.
Because she believed so passionately in what she was doing, because she is a persuasive and remarkable woman, she was soon a magnet for a whole range of doctors, psychiatrists, and therapists, who came to her after their days in hospitals and clinics to treat, for free, people with dislocated shoulders and disfiguring burns, with agonizing pain in the soles of their feet, and with terrors and flashbacks that stalked them day and night. “The majority of those tortured do not survive,” Helen would tell people who came to hear about the work of the foundation. The testimonies of those who do survive “cast a shadow on us all.” Arthur Koestler, waiting in a prison to be executed during the Spanish Civil War, described himself as so restricted in time and space, so deprived of hope by the imminence of death, that he lacked even the substance to cast a shadow. Helen borrowed his image. The shadows of those who had been tortured, ethereal miasmas of agony and loss, pain so real that it had destroyed the will to live, needed addressing. In her quiet, soft, reasonable voice, Helen would explain how it was our duty, as people who had not suffered this way, to bear witness, to reclaim time and space for those who had lost both, and in the process to counter what she calls the “climate of disbelief” that colors the attitude of the West toward those who seek asylum. The people who came to work with her would document the experiences of those who had been tortured and wo
uld help them to live again. The question for Helen, though torture itself is full of nuances and ambiguities, has always been fundamentally simple: how do you coax back to a bearable existence people whose bodies have been attacked, whose brains and memories have been weakened by blows to the head, whose privacy and pride have been invaded by rape and sexual assault, who have seen their families destroyed and have lost everything that once mattered to them, though they have done nothing wrong? Torture, she would say, is about isolation and chaos, about the disintegration of the psyche. Tortured people have to be helped to reclaim their lives; they have to be freed, not cured, for the concept of cure is seldom appropriate; they have to learn to cope again.
Those she could not immediately see how to heal, those for whom the scars of memory were so deeply embedded that they obscured all possibility of brighter realities, these she would “accompany.” Accompanying, traveling alongside, in Helen’s view, is a crucial part of the process.
When I went to see her, early in 2003, Helen talked about a middle-aged Rwandan woman who had been referred to her not long before. For several weeks, Mrs. M. did not speak. She cried, she rocked, but she said nothing. Helen sat and held her. Week after week, she appeared in Helen’s room, at the appointed time and on the correct day, and cried and rocked. Then one day she began to talk. She said that she was a Hutu, the wife of a Hutu businessman who sold spare parts for cars, and that she had three children, a girl of thirteen and two boys of ten and six. In 1994, some years before the birth of her youngest child, civil war came to her village. One day Tutsi soldiers arrived. They assumed that her family had been responsible for the deaths of Tutsis. They killed her father and her two brothers, with knives and machetes. Then they attacked her, using machetes and bayonets, and slashed her from side to side, almost amputating her right foot, and leaving her stomach and groin with open gashes. They raped her, vaginally and anally. Leaving many villagers dead or mutilated, they dragged her husband away with them. Later, she heard that they were holding him in a prison, and later still he suddenly appeared at home, having escaped. For a while, the family lived quietly, without trouble. But one day the soldiers came back and, finding her husband there, beat him very badly and took him away with them. Mrs. M. was again raped, by four men. When she fought off a fifth, she was again slashed and beaten. Her husband did not come back; a neighbor told her that he had been killed. One day, a villager came to tell her that the soldiers were on their way to get her. Mrs. M. fled. She hid in the bush, and then with friends, until money was raised to send her abroad. She left her children with her mother.
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