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Torture and its after-effects


Postgraduate student Bahrie Veliu is working on test instruments to distinguish PTSD from brain injury among refugees.

Lalman Rai spent 11 months as a political prisoner sleeping on the cement floor of a Bhutanese jail, his feet in chains, his wrists in cuffs. He now lives in suburban Christchurch.

He is one of the approximately 2000 refugees – 750 of them by quota – who settle in New Zealand every year.

They come from Bhutan, war-torn Afghanistan, junta-ruled Myanmar, the failed nation state of Somalia, bringing personal histories of dislocation and tragedy on a scale most us would have difficulty comprehending.

But postgraduate student Bahrie Veliu might. Now working towards a Diploma in Clinical Psychology, Veliu lived through the trauma of Kosovo and in the years since has worked with refugees in Indonesia.

Veliu has chosen for her dissertation subject the neuropsychological sequela of torture and for her sample population has turned for help to Refugees as Survivors (RAS Wellington).

What constitutes torture? The World Medical Association defines it as the

… deliberate, systematic, or wanton infliction of physical or mental suffering… to force another person to yield information, to make a confession, or for any other reason.

Is being shackled night after night to a concrete floor, as Lalman Rai was, torture? Under this definition, certainly. And many refugees have suffered worse. Experiences of torture are common among refugees, as are its consequences: most predictably post traumatic stress disorder (PTSD), a condition which has been much studied, but also traumatic brain injury (TBI) sustained during torture.

These are conditions it would be useful to distinguish from one another, as the treatments are different. But a number of factors make this difficult. The refugees do not carry medical records with them, and if they have suffered a traumatic brain injury they may not remember the event having taken place. “After a traumatic brain injury, memory loss of the immediately preceding events is common, and, indeed, if you can’t remember what happened to you, that is probably quite good,” says Leathem, who, together with Professor Nigel Long, is supervising Veliu.

(In fact, Leathem explains, there is an ongoing argument as to whether these unremembered events – the horror of the approaching train or the attacker – can in fact cause PTSD. )

So how do you separate out the overlapping effects of PTSD and brain injury while allowing for the variations in culture, education, language and literacy among a disparate group of people?

Veliu and Leathem are working on putting together test instruments – in multiple translations – and protocols that will allow psychologists to make that discrimination.

At writing, nine refugees have been interviewed, and already the project is raising other questions that warrant exploration.

What is the best way for psychologists to work with interpreters, for example. “Most of the neuropsychological literature is about working with Native Americans or Spanish-speaking people, whereas we are generally working with people who are speaking Arabic and Burmese.”

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