Download Seminar – Victims of Torture and other Trauma Trauma and memory

Seminar – Victims of Torture and other Trauma
Trauma and memory
There is a body of evidence and literature on trauma and memory. People who design and
administer the asylum system need to at very least be aware of how it affects memory. A general
impairment of recall is to be expected in the case of asylum seekers who have been subject to
traumatic experiences and the re-traumatising experience of the asylum process.
Definition of Torture:
“Any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted by or
at the instigation of a public official on a person for such purposes as obtaining from him or a third
party information of confession etc...”
Definition of Trauma:
“Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is
rendered helpless by overwhelming force. Traumatic events overwhelm the ordinary systems of care
that give people a sense of control, connection and meaning. According to the Comprehensive
Textbook of Psychiatry, the common denominator of psychological trauma is a feeling of ‘intense
fear, helplessness, loss of control and the threat of annihilation” (Herman 1992)
Type 1 trauma:
This is a one-time trauma – at a specific time, a specific event on a once off basis e.g. an accident,
natural disaster etc.
Type 2 trauma:
Prolonged trauma – torture, physical/sexual violence, war, life in a prison camp, life as a refugee/in
camp (this is internationally recognised as a trauma), hostage, perpetrator of violence (e.g. child
soldiers). It’s on a systematic basis or used in a systemic way.
Goals of torture:
Intended to kill the soul not the body, destroy identity, humiliate, weaken and destroy personality,
control society through fear and dread.
In a Danish study of asylum seekers, 80% of women and 56% of men have experienced sexual
torture.
Cultural context and barriers to disclosure
Barriers to disclosure include:

Shame;

Fear of dishonour;

stigmatisation (e.g. women may not be ‘marriageable’ if they have been raped);

secrecy (a person abused by the state may have grave difficulties trusting an official of the
state interviewing them);

psychological factors;

the cultural gap.
Impact of Trauma
Impact on the individual:

Debilitation (especially with physical torture and trauma, it’s debilitating physically and in
every way),

dependency (e.g. helplessness, powerlessness, lack of control),

dread,

disorientation (e.g. dissociation etc.).
There is also an impact on family, wider family, society.
Identification/assessment of victims of torture
Spirasi uses the Istanbul Protocol guidelines, 1999. In drafting a medico-legal report (MLR) they
consider whether the experience fits the definition of torture, the person’s own account, allocating
patients to a doctor of an appropriate gender given the gender and experiences of the patient,
allocating appropriate interpreters (e.g. it may not be appropriate to allocate an interpreter from the
same country as it may give rise to issues regarding trust), and avoiding re-traumatisation. Spirasi
has recently changed their one-step assessment process to a two-step assessment process and reevaluated how they draft MLRs in light of feedback on how they are interpreted by ORCA and the
RAT. The first interview allows the person to freely share what they believe are the central elements
of their case. A draft report is presented to the asylum seeker at the second assessment so that
information which is perceived as peripheral to the case can be filled in and gaps addressed. When
the person has been in long term therapeutic care at Spirasi the MLRs will now include expert
testimony from their therapist. These steps will allow reports to be much more specific about what
events lead to specific scars/trauma etc. Spirasi is hoping for feedback on how these changes are
affecting decisions. 26% of Spirasi clients would be first time referrals from solicitors and 74% from
doctors. About 50% of MLRs have the potential to include expert testimony, as the person will have
been in long-term care.
Information processing in the brain
The brain is divided into 3 parts – the cortex/cognition (thoughts), the limbic system / mammalian
(emotions), the sensorimotor / reptilian (our bodies: instinct and basic life functions e.g. breathing,
digestion etc.).
Ability to stay in the present moment comes from a well developed cortex.
Traumatic dis-regulation comes from limbic activity i.e. our bodies dictate our actions much more
than our thoughts. In everyday life cortex/higher levels direct the lower/body/limbic/reptilian levels.
In children the activities are the other way around. They have no way of regulating hunger,
tiredness, anger etc. Traumatised adults are also controlled by lower to higher level processes. Body
sensations and emotions seem to have a life of their own. They are subject to palpitations, panic
feelings etc. We can identify which parts of experiences resurrect such sensations and emotions.
In the normal response to threat, if we have time, the experience is filtered through our cognitive
brain e.g. we rationalise the noise in the dark alley, concluding it’s a cat or we rationalise that the
alarm is actually a drill. We then decide whether we have to fight or flee or there’s no threat at all.
In severe trauma the process is different. It doesn’t have the time to go to the cortex but goes
directly to the amygdala for a fight or flight response. This increases respiration and heart rate.
Normally, when the threat is over the amygdala switches off and exhaustion sets in. The stress
hormones are no longer released and the body returns to balance and rests.
In the case of a traumatic experience, the alarm system in the amygdala does not get turned off
(although not everyone who experiences trauma goes on to develop PTSD). The person continually
acts as if there is a threat. So, in the interview during the asylum process, it brings them back to the
traumatic experience. Even when the interview takes the form of a checklist, the person can’t cope,
starts to slow down and cognitively can’t keep up with it. They are disoriented. They will freeze if
there is no time to flee and they can’t defend themselves. They go into a passive survival instinct,
active defences don’t function, the body gets cold and slows down. The victim enters an altered
state – dissociation. Dissociative states are dangerous because they can lead to psychotic states.
These are all attempts to self-regulate – they lead to constant feelings of helplessness / emptiness /
numbness (hypo arousal) and to temptation (stimulants).
These reactions can all lead to a finding of lack of credibility during a tribunal hearing. If this reaction
happens during the hearing the practitioner must stop, take a break and give the person time to get
air, leave the room and hopefully come back to the present from the dissociated state. If there are
symptoms of PTSD, there should ideally be an adjournment until the person has had psychological
help.

Intervention - This might be seen by the Tribunal as undermining credibility as well because
the person is perceived to be ‘going off to get their story straight’. If it happens in the
hearing how can a lay person (lawyer) claim this is a medical issue and needs further
treatment? Answer: use the symptoms as evidence that this is what is happening. The
Tribunal should be told that there is a body of evidence which suggests this may be a
medical issue and you would like to corroborate it with a professional medical opinion.
We need to invest time in people at the beginning of the process to relate their case.

Intervention - Practitioners may have the file for only a few weeks before the hearing date
so it is not always possible to invest time early on. Where an adjournment is sought, the
Tribunal may refuse to grant it and go ahead with the hearing on the basis that they will
review the medical report afterwards once it’s submitted. Answer: Spirasi has spoken with
ORAC in relation to the difficulties caused by this time pressure and ORAC has agreed that
they will wait to get a report. A similar discussion might need to happen at the RAT stage.
Early identification and detection of torture and trauma survivors is key. A screening process should
be instigated when people first make their asylum claim. This has been previously mooted but was
rejected as too resource-intensive. However, with the marked decrease in applications in recent
years this concern needs to be revisited.
Phenomenon of flashbacks:
During a flashback, the person re-lives the event in the present. Trauma suppresses the
hippocampus which gives events a context in time and place. The events don’t pass into history but
continue to invade the present. They may have panic attacks, anxiety, and depression as a result.
Discussion

How dangerous is it to push hard for the real story as a lawyer, untrained, when you then
have to leave the client without support?
Spirasi - People are sometimes advised not to tell the real story but rather to use certain
fabrications. If we don’t know the real story, the possibility of the person becoming very
angry or dissociative is quite high. Training is very important here to practice skills in this
area.

Often there isn’t time to use these skills and not push hard. Telling a fabrication realistically
ruins their chance of being believed. Traffickers will tell them under no circumstances should
they change their story.
Spirasi - Under the Istanbul Protocol you can state why a person has changed their story and
argue there are very good reasons for this. With the huge decrease in the number of asylum
seekers, giving more time will be more economic and fruitful in the long-term. Also, before
asking anything, give information about the asylum process and spend quite a lot of time on
this. Hear from them what their experiences of this are before. In Berlin they spend 8 – 12
hours in the development of a report because in the long-term it leads to a better process.

Is Spirasi saying it would be wrong in every single case to make a decision without a MLR?
Spirasi - In RC v Sweden, the ECtHR found that if there is any evidence of torture the state
should look for information to corroborate this.

Can you say after a lengthy form of interview that certain scars are for a refugee-related
reason and not e.g. a criminal reason?
Spirasi - It helps. It’s a challenge to say diagnostically that scars are for a specific reason. You
have to take it in context of the entirety of the individual i.e. physical evidence, scarring,
presentation of the claim etc. If you only focus on the traumatic piece you have very limited
perspective. If you focus on the holistic narrative of the person you get a much better
perspective.

The questionnaire is not an appropriate mechanism to get the story given the background
and circumstances of asylum seekers. They get little support. Often it is not filled in by the
applicant but by someone else in the hostel.
Spirasi - The questionnaire should be a tool that assists the decision maker but it’s become
more of a weapon. To expect people who are only in the state for 2 weeks after the kind of
journey they have made and in a new culture to fill in such an extensive document on their
own is incredible. Spirasi has very good practice in using interpreters and provide good
training: 3 hours of initial training and continued support and de-briefing. They have a good
body of professional interpreters. It is amazing how many people go through the system
without adequate interpretation in e.g. courts, doctors, and psychologists.

S.8 interviews are also being used more and more to undermine credibility e.g. you didn’t
say it in the interview so you must have made it up in the hostel. And mistakes are held
against applicants the entire way through the process.

Most RAT members treat the appeal as a de novo hearing but it is undertaken in an
adversarial manner with very hard cross-examination which has increased greatly in length
in the last few years. In many cases it’s virtually impossible to give an applicant a fair hearing
because the evidence needed to support the claim remains in the country of origin. So the
shared burden of proof should place on the state a requirement to inform applicants
regarding how to access the documents they need based on the extensive information and
resources available to the state. Inquiries made by the state in this regard could be made in
a way that doesn’t reveal the name of the person involved e.g. through the Irish embassy in
the country of origin. Given the decrease in asylum applications the resources necessary to
accomplish this would now be less.

Is re-traumatisation always inevitable when you collect information from persons relating to
their trauma experiences?
Re-traumatisation is quite complex depending on the length of time since the trauma,
engagement with therapeutic care, medications and other factors. Really it is always
potentially re-traumatising. It’s a very individual question based on what the trigger is for
the person in question.

Jane Herlihy – re-traumatisation is essentially giving someone such a traumatic experience
now that it becomes part of the chain of traumatic experiences. But it might be more
dangerous to allow the fear of this happening to hamper getting the necessary information.
Sometimes if practitioners avoid questions they can miss something very important and a
sense of reticence on the part of the practitioner can cause the client to be reticent to share
details. Alternatively a client may be waiting for the practitioner to ask about specific issues
which they are hinting at but not stating outright.

Spirasi - the impact of trauma on practitioners and decision-makers is also important. We
need to consider whether they need specific care to enable them to make better decisions.