As Mrs. M. related her story, she told Helen that every day, as she lay on her bed in her lonely hostel room in London, she saw her children sitting near her. They were always there. Talking about the three children of whom she had no news, and had not seen for many months, Mrs. M. cried and rocked. One day, Helen asked her what she said to her children. Did she tell them that she was always with them in her thoughts? Did she tell them what disgusting food she was forced to eat in her hostel? Mrs. M. laughed. It was the first time she had laughed or smiled, in all the weeks she had been coming. And after this, things changed. The two women talked. It was the beginning, a breakthrough. Now Helen hopes that the day will come when Mrs. M. can accept that her children are not with her— and may never be. “But her reality is still that they are sitting on her bed. I cannot destroy that. I can’t delve into her inner world. She wants not to live, but does not know how to die. I can only accompany her.”
Over the years, the Medical Foundation, growing steadily in response to the victims of torturers in Colombia, Sri Lanka, Kosovo, Iraq, Turkey, Zimbabwe, and Liberia, has developed into a loose federation of skills and therapeutic methods, presided over, until her retirement as director in 2003, by Helen Bamber’s accepting and benevolent eye.* Drawn to the work by their feelings of sympathy and recognition, bringing with them disciplines that range from Freudian analysis to cognitive therapy, clinicians have discovered at the Medical Foundation the freedom to listen and treat as they see best, feeling their way into methods that owe as much to instinct and common sense as to orthodox medicine. The Foundation is, say its admirers, one of the last bastions of eclectic medicine, in a field that grows more specialized and narrow all the time. While most clinicians accept post-traumatic stress disorder as a useful label with which to arm their clients in their requests for asylum with the Home Office, few regard it as more than a very broad diagnosis. As a recognizable set of symptoms, shared by many people who have been badly tortured, post-traumatic stress disorder provides a therapeutic base from which to start work. But recognizing the symptoms is just a beginning. The damage done by torture, its particular perversion of human relationships and intimate violations, leaves echoes not easily comprehended or dispelled. Listening always for the nuances of the possible, assessing the degree to which confrontation and direction are wise or premature, becomes part of an everyday process in which to the skills of doctor, psychiatrist, and therapist need to be added those of social worker, housing officer, and lawyer, for the needs of refugees are without bounds. For clinicians trained in precise disciplines, the very flexibility and imaginativeness of their work with clients are extremely attractive.
Though not, of course, to everyone. Some years ago, the senior clinician at the Foundation was a psychiatrist called Derek Summer-field. The longer he worked with clients, the more Dr. Summerfield came to feel that his skills as a doctor were less important in dealing with asylum seekers and refugees than his ability to find them homes and work. Torture, he accepted, is a devastating event, and can and does leave dreadful effects. But most people who came to the Foundation seemed to him to process and handle the experience themselves, with extraordinary resilience. What they needed was not medical help, which perpetuated their sense of being victims, but practical assistance in putting their lives on a tolerable footing. To call them ill was to detract from their many social problems. As his impatience with what he saw as the “medicalization” of the problem grew, Dr. Summerfield decided to leave and forge his own path. Though the Medical Foundation felt bruised by months of debate and discussion, the feeling did not last long. Soon, in the warren of offices and consulting rooms that spread across three buildings in North London, lawyers were taking down initial testimonies and working on submissions to government, physiotherapists were easing the pain of fractured bones, psychiatrists evaluating the effectiveness of different interventions, and therapists guiding clients through the minefields in their minds. To explain about the work of the Foundation, Helen tells this story: A young man from a central American country was sent to her one day, several months after his arrival in England. They started sessions together. He had been profoundly tortured, and been forced to watch others tortured. No one in England, he explained, had been able to imagine the degree of his anguish. Instead, he had found a forest, and there, among the beeches, he would run about and shout and cry. The forest, he said, became his doctor. After some months working with Helen, he told her that the Medical Foundation was now his forest.
In other clinics and counseling rooms, and in some parts of the National Health Service, other doctors, many of whom have done their stints at the Medical Foundation, are attempting to come to grips with the hideous legacies of torture and the long unhappiness of exile. Yet the fact that the Foundation is forced to rely on translators—albeit a team of translators, built up over the years, whose knowledge of the many variations of tortures is enormous—has long troubled some of the specialists, who feel the need for more direct contact. A new center to tackle precisely this question was started in London not long ago, by two women with personal experience of oppression and exile. Josephine Klein is the only daughter of a Polish Jew who fled to Holland at the age of seventeen to escape persecution at home, and who herself became a refugee at the age of thirteen, when the Germans invaded Holland. The family— Josephine, her parents, and her disturbed older brother—fled to England. They had hoped to make their way on to America, but when several convoys lost ships on the crossing, they accepted refuge in a village in the Midlands. England treated Josephine well. All she knew about the country came from The Scarlet Pimpernel, and she was not disappointed. The local authority found her a place in a good school and paid for her uniform; soon, she moved to the top of her class. There followed a successful academic career in psychoanalytic psychotherapy. It was a world in which chaos had been contained and regulated, and she was grateful. Josephine is now in her seventies, a smiling, understanding woman.
In 1993, after she had given a paper at a memorial conference for John Bowlby, the psychologist famous for his work on attachment, a young woman came up to her. Aida Alayarian was an Armenian refugee from Iran, studying for a master’s degree; she needed a supervisor for her dissertation on torture. It was, Josephine says now, as the two women, interrupting each other frequently and affectionately, tell me their story, her day for good deeds. She promised Aida that when she had a vacancy she would accept her as a student, and she kept her word. It took her just three sessions to realize that Aida, who had trained in Iran in clinical psychology and child therapy, needed not a supervisor but a collaborator. As Aida wrote her dissertation about torture, the two women talked about their own lives, about Josephine’s extended family, almost all of whom disappeared into the extermination camps, and about Aida’s escape from Teheran’s notorious Evin prison, and they told each other how they would like to start a treatment center for traumatized refugees, and how they would recruit and train therapists who could work with clients in their own languages, without need of interpreters. Interpreters, however sensitive and good, it seemed to them, inevitably blunted a process almost too fragile for words, and they were appalled when, in the work they were already doing, they noticed that people would bring and use as interpreters their own children, who had learned English quicker than they had been able to, rather than tell their stories through strangers.
Aida knew all about torture. As an Armenian from a vocal and politically active family in Teheran, she had seen her father imprisoned and lose his sight, and her brother and several cousins executed. Iran in the late 1970s and the 1980s was a brutal and terrifying place, with revolutionary courts and committees presiding over a regime of torture and summary7 executions, many of them carried out in Evin prison. When I was writing about human rights for The Times of London, I spoke one day to an Iranian physicist who had escaped to London. We met in secret; he was too frightened of the long arm of the Iranian secret services to tell me his name. Talking about the months he had sp
ent in Evin prison, he described being taken one day by a guard along a corridor toward the torture rooms. On the way they passed an open door. I have always been haunted by what he said next: “I looked into the room. It seemed to be a hall, stretching for many meters in all directions, with a high ceiling. All I could see were legs and feet, hanging from hooks in the ceiling, rows and rows of them. Men’s legs, with trousers; women’s bare legs; children’s legs and tiny bare feet. Bodies, hanging, dead, dozens of them. I realized that this was where the torture ended.”
When her daughter was four and she was heavily pregnant with her second child, Aida was arrested and taken to Evin. She was tortured. Her guards wanted the names of Armenian activists. When the time came for the baby to be born, nothing happened. She laughs now, sitting in north London, as she recounts her story. “A month passed, and then a second. Still no baby. This is medically extremely rare in human beings, but it happens in bears. When there is danger, they simply hang on to their unborn cubs. When I reached the end of the eleventh month, one of Evin’s doctors took pity on me. He was a young man, and he was terrified of the system himself. They were still torturing me, and I begged him to help me die. Instead, when at last it was clear that my son was going to be born, he diagnosed me with puerperal fever and transferred me to a hospital outside the prison. A guard accompanied me, but he was not allowed inside the women’s ward. The young doctor [from the prison] told me to pretend that I was Turkish, from a village far from Teheran, and that I was a simple peasant girl. When the [hospital] doctors discharged me, I telephoned my sister from the hospital telephone and she came to collect me and the baby from the back. The guard never knew that I had gone.”
After this, heavily veiled and living in hiding with her two children, her mother having forfeited her house on account of Aida’s disappearance, Aida returned to her underground work with refugees and dissidents, until it was finally just too dangerous for her to stay in Teheran. With the help of friends, she and her children escaped to Turkey—she had parted by now from her husband—but as an Armenian in Istanbul she was again suspected of having dissident connections, and again arrested and again tortured. A United Nations commissioner heard about her and secured her release. The family now moved on to Holland, and then, in 1991, to England, where they were given refugee status and where Aida started work with HIV patients and asylum seekers.
By 2001, Aida and Josephine had gathered enough funders and enough volunteers to open the Refugee Therapy Center. They found therapists able to work in seventeen different languages. Both are practical, realistic women and they share a similar vision of the effects of torture. Terrible experiences, they agree, can and do lead to trauma; but trauma is cloudy, not solid like measles, and how it will be experienced owes much to how an individual perceives himself and how resilient his past has made him. Good parenting, they say, that leaves children feeling loved, with a strength that lies beyond words, will make a vital difference to the way a person is able to process torture. For Aida, the help she seeks to provide is all about trust, the breaking of isolation, and allowing people to feel safe. “We provide,” she says, “a space in which people can be while they learn to trust again.” As she sees it, not all people who have been tortured need to or can or want to relive the experience; rather, they need to be helped to build up structures that contain and imprison it. Then they need to learn to live. “Until recently,” she argues, “the accepted view was that in order to get better, people have to talk about what has happened to them. But for some people, the best thing is to build a wall around that particular moment in their past, and then move on.” Aida, too, like Helen, “accompanies” her clients. And they know, she says, when the time has come for them to end their therapy. They get bored and they simply stop coming.
The image of victim and survivor is always present in this field. Doctors who work over long periods of time with people who have been tortured marvel at the spirit and dignity of their clients, and at their enormous powers of self-regeneration. Much, they note, depends also on the expectations of torture victims. “When people come from societies where repression is severe and where torture is routine,” says Dr. Michael Peel at the Medical Foundation, “where they have witnessed others disappear and heard stories of torture, these people tolerate it better. It is not a catastrophe, striking from nowhere. It is part of their map. They assimilate it because it does not shatter their feelings of what is predictable.” Cultural differences have become important to him, as has the need to gauge, person by person, what works best. For many, it is a question of reducing the traumatic past into “bite-sized chunks,” which can be absorbed and, one by one, assimilated.
And people find their own strategies to survive. Helen told me about a man in a Middle Eastern country who had been arrested and severely tortured. One day, he was made to watch a friend being tortured. Afterward, he tried to comfort the friend. “Old man,” he said, “we cannot strike them back now. But while we are here in prison I shall teach you to read and write, and that will be our victory over them.”
• • •
THE FIRST TIME Michael Korsinski saw Lamine, he was lying on the floor of Korsinski’s office at the Medical Foundation, scrunched up like a fetus, racked with pain. He could neither sit in a chair nor walk normally around the room. That day, the two men, Lamine an Algerian former military cadet and refugee in his mid-forties, Michael an American therapist some ten years younger, embarked on what would become a very long and very arduous program of work, the therapist, a tall, thin, gangling man who uses his hands a lot, lounging in his chair, his client crouched over and cramped, or shuffling around the room, looking at his feet, unable to meet the therapist’s eye. In prison, as Lamine would tell me, there is no horizon, and to look into people’s eyes is to invite trouble. Michael is an ideal example of the Foundation’s eclecticism: he is a dancer, who learned about physical pain through a bad accident; a practitioner of the Alexander technique who came to Jungian analysis through his need to bridge what he saw as an uncomfortable gap between his own mind and body; a somatic psychotherapist who came to the work not through the theories of earlier doctors and analysts treating functional disorders as Reich and Charcot did, but through his own interest in the body. At the Medical Foundation, among people stunned into chronic pain and despair by torture, Michael discovered the setting he needed in which to do his work. In the early 1990s, recruited by Helen, he began to listen to people’s bodies.
In many ways, Lamine was also Michael’s ideal client. He was a clever, articulate, reflective man who had reached a moment of such profound desperation that the vast edifices of his defenses were weakened just enough to allow them to be breached. Safe, at last, from threat and danger, he could permit himself to collapse. He was caught, as Michael saw it, in that quasi-world familiar to all who work with tortured refugees, in a state of pain that is neither all physical nor all mental but some complicated amalgam of both, trying to dissociate himself from his body so that he might survive as a psychic entity; the two, the mental and the physical, needed to be brought together again. While Lamine rocked and groaned, Michael got down on the floor next to him and did exactly what his instincts told him to do: he took hold of Lamine’s head and supported it. “I could feel this huge tension,” Michael says. “I had to do something to release this unbearable physical pain.” For Lamine, the moment was both shocking and intensely moving. He felt humiliated; but he also felt comforted. Never, he says now, had he lain on the floor in this abject fashion, not even during the worst of the torture. However, lying on his bed in his bleak hotel room in King’s Cross, he had decided against suicide and he knew that he needed help: medical help, for his old injuries, and above all mental help, though he could not imagine that he would ever meet anyone he could trust. Particularly not in this alien country, where he could not speak to anyone and where he felt permanently cold. Through Michael’s hands, in a room full of the brightly colored rubber balls and odd objects that are among the to
ols of his trade, with a translator looking on, Lamine wondered whether he had found his man.
Nothing happened quickly. It had been luck that had taken Lamine to the Medical Foundation, luck in the form of a perceptive nurse at his local doctor’s office in King’s Cross: she remarked on his wounds and suggested that he try the place up the road, which she believed looked after people who had been tortured. It took great courage to go there. Helen’s flash of humor helped release Mrs. M.’s story: now it would be Michael’s willingness to stick by him until he got better that would open Lamine’s first door. “He promised me something. And he kept his word.” Lamine did not expect people to keep their word. He had been betrayed since early childhood. That sudden feeling of trust became his key.
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