When Touch Is Like Tourture

Even when touch is intended to be therapeutic, it can bring back memories for those it can bring back painful memories for those who have been tortured

By Bernard J. Colan

Meho looked like his face had been used as the ball in the Great American Sport.

But it was Bosnia, not America, where his face and body had been used for batting practice almost daily by anonymous soldiers in his tumultuous homeland.

The experience showed mostly in his face because the bones there had never been set properly and his crushed sinuses made his breathing labored. His eyes seldom made contact with other human eyes when he entered the Marjorie Kovler Center for the Treatment of Survivors of Torture in Chicago, where Andrea Gundersen, CMT, began treating him.

According to Alison Duncombe, PT, OCS, who had herself worked for years with survivors of torture, Gundersen is a certified massage therapist who has the empathetic demeanor and the knowing hands that can best help such people who have washed up on the shores of the Land of the Free.

These people, inflicted with the most inhumane agonies devised by human minds to maim the body and the spirit, are generally composed of perceived dissenters from more than 100 countries around the world, countries whose authorities practice very literal torture that can leave both internal and external scars that distort the world and a victim's ability to function in it. In the case of Meho, the multitude of scars had distorted his body, but had not destroyed his spirit.

Gunderson has worked as a volunteer at the Marjorie Kovler Center for about seven years, employing both her yen to perform humanitarian services and her belief in the power of human touch to heal trauma.

"I love having that connection with people from other cultures," she said. "I feel like it's something I can do to counter the existence of torture in the world. It feels like a contribution I can make in the world to people who have suffered so much."

Her treatment depends, first of all, on her subjects allowing themselves human contact when it is associated with such painful experiences. "I never assume that people are prepared to be touched when they come in. I basically put them in charge and allow them to call the shots, beginning with what clothing they want to have on and where they allow the touch to occur."

Providing Deep Touch

When they give that permission, "they appreciate deep touch," said Gunderson.

She said she has primarily worked with Central Americans and Bosnians who have lived in third-world conditions with a maximum of physical activity and a minimum of comfort so they "have strong bodies and appreciate deep touch, which is good because we're often trying to break down scar tissue on old wounds. On the other hand, if wounds are fresh or still painful, we can't depend on verbal communication if we don't have a common language, so watching body language and learning some vocabulary, like the words for, 'Does it hurt?' are very important."

Gunderson recalled that "it was scary in the beginning to look at and be with people who had been so severely invaded and wounded by other humans--and it's still not easy to this day--but [that uneasiness] is balanced with the amount of relief that people can gain when they get good body work."

First, she cautioned, they must take the risk to trust again. In the case of Meho, he did learn to trust and his determination brought him to the Kovler Center every other week for a year, where Gunderson worked to unlock the muscle patterns in unset bones so that Meho could learn to function more normally and less painfully.

Some of the scars are harder to see, but no less painful for survivors of torture, said DeCourcy Squire, PT, who is a volunteer at The Center for Victims of Torture in Minneapolis, another one of eight services dedicated to treating a population estimated at about 400,000 in this country.

Less Obvious Scars

Squire, who is a staff PT in the lymphedema treatment program at Fairview Medical Center at the University of Minneapolis, said that although some survivors present with "pretty drastic injuries," many others may have been subjected to torture that is more sophisticated and leaves less obvious scars.

Electricity applied to some of the more tender body parts is common, as is "falanga," which entails delivering blows to the soles of the feet to the extent that for years afterward many victims find walking difficult.

People who have been tortured have an experience that is different than even the deadliest conditions more commonly treated, because although patients who are ill must often overcome difficult obstacles to recover their health, torture is a malicious aim to inflict harm. It is
used not merely to punish or obtain information, but to destroy a person's identity.

Because of that, "we need to be much gentler and less aggressive in our treatment approach than for other patients who develop even the most terrible conditions in a far different way," Squire said. "People don't come here tortured by accident. They have a different experience so that they may be afraid that you will cause them pain even though they know consciously that your behavior is benevolent."

Before treating each patient, Squire said, it is important to carefully go over the medical history so that she may learn about the mechanism of injury without surmounting language difficulties only to trigger a flashback to a painful experience. She also wants to make sure she doesn't ask a client to get into a position similar to that which may have been forced upon them by human rights violators.

"For example, if a torture involved having people lie on their stomachs, I would not want to replicate that in my treatment," she commented.

As a volunteer, she said, her treatment time is more concentrated because she doesn't have to worry about filling out tedious paperwork to third party payers, and after more than two years she has become more confident about treatment approaches that defy "cookbook" applications.

"Sometimes I feel that physical therapy makes a dramatic difference in the lives of people who are having trouble walking across the room before I see them, and after treatment can walk in a pain-free way," she said. "Other times, it seems that I'm helping nature work a little more quickly. But even if I'm a part of helping someone come back to a place that's safe, and where people can recover the sense that there is a part of the human community that's good, I feel that I'm making a real difference."

But Squire pointed out that the resources are limited at the center. They often use makeshift modalities and few medical professionals are available for treatment referrals. "I would like to help develop a network of physical therapists in the area who might not be able to come here but might make room for some of our clients in their clinics," she said.

PT Needed in Treatment

In preparation for this story, ADVANCE called most of treatment centers in this country and in Canada that claim to help people recovering from human rights violations. Most of them simply did not have physical therapists on staff. Some stated they had no need for PTs.

"I find that physical therapy is the forgotten child in the medical profession, because, for instance, when I volunteered at a homeless clinic where they had nurses and doctors on staff they actually asked me how physical therapy could help their clients," Squire said. "...A lot of people in the health professions don't have a clear idea of what PT has to offer."

Squire is joined on the staff of the center by Laura Pizer, PT, MPH, who has been a volunteer there for the past five years, and is employed full time by the Amherst H. Wilder Foundation in St. Paul.

She told ADVANCE that she first became aware of how PTs could help victims of torture while volunteering at a Hmong refugee camp in Thailand. The Hmong people had fought on the side of the United States against the Vietnamese and sought refuge after being persecuted in their homeland.

The therapist had worked as a volunteer in several of the less-trod localities of the world, stopping off at India, Israel and Ethiopia where "people of different cultures seem to understand the universal language of healing and exercise," she recalled.

"I know it sounds trite, but I enjoyed working with these people because it was so uplifting, and even fun, because they were survivors and I could give them the opportunity to help themselves make their own futures better. You have to understand that the basic message of torturers is that nobody cares about what happens to their victims, and it's so rewarding to see those victims just blossom when we can give them the opportunity to help themselves live fulfilling lives." She accomplishes that by teaching this population home programs dedicated to promoting relaxation and self-management of their conditions, which often requires deep empathy and communication.

Pizer indicated that it takes special qualities to treat this population, foremost among which are flexibility, sensitivity and creativity. In her own experience at the center, she has found that "complementary" therapies, such as craniosacral and therapeutic touch, are increasingly valuable in the treatment of each client. All clients are interviewed by psychologist and other medical staff with the help of an interpreter who carefully records their histories and makes them available to the PTs and other health professionals at the center. Although she said she's tried to refer clients to other specialists, she hasn't had much success because they are usually not insured, and there is no surplus of medical professionals volunteering to treat people who have been tortured.

Employment Over Volunteering

"Having paid PTs on the staff would be ideal because then we could attend team meetings and educate the staff more and possibly find more resources to whom we can refer our clients. It seems that when you tell people you do pro bono work, you're not really viewed as an equal, so it might give us a little more credibility [if they were paid].

"Volunteering can be challenging," Pizer said, "but our skills are so needed and there are not enough physical therapists to go around. I can get into a rut in just being a regular PT, but after working with the homeless and making such a difference to people who have been tortured, sometimes I come home so inspired that I'm rededicated to the work I've chosen as a physical therapist."

Bernard J. Colan is on staff at ADVANCE.