Author(s): J. Carey Jackson, MD

Date Authored: June 29, 2016

This vignette captures the details and brutality of the process of torture.

Patients tend to focus on the “why” of the arrest, that is the political context or the historical details and gloss over the specifics of what happened to their bodies and to those around them in the process of arrest and detainment. They also often get the timelines and duration and order of events contracted or abbreviated in order not to dwell on it. To get a clear sense of the enormity of what the survivor had to endure the history taker often must back them up and shift focus from the political context to the physical context to get them to recall the details. 

Did your parents witness your arrest? Did they see you beaten? The questions must be detailed and sequential. It is painful, the pain it causes this man is evident, but only this way will the full extent of what he suffered be known to us. If his parents witness his ordeal this is another layer of trauma to his family and to him that is endured and carried psychologically. He does not carry this if they did not witness it. 

Did they cut you, burn you, rape you? These are relevant details for work-ups and future trauma work he may skip over. In his case it prompts him to recall the dental torture that was unknown to me. In this man’s case future dental work will always potentially trigger terror. It is key to know here it was not one horrific encounter but psychological and unbearable physical pain that was meted out slowly over many encounters. 

“They took my parents’ home.” This is a detail of financial ruin that may not readily be registered, especially if this is an historical clan/family home of many generations. 

Finally he describes years in a small 3 foot by 9 foot cell he lived in alone for 7.5 years getting out only once a week to clean it. His isolation in pain must be registered. You can see it on his face and he recalls the misery. He lived in this cell with a broken spine from torture for 7.5 years, every step and movement in teeth gritting pain. He would gloss over this if given the option because it is painful and describe instead the “why” of his arrest. The clinician must catalog the memories of what happened to him physically to address them and anticipate painful re-triggering in the future when he is referred for dental work, asked to stay in isolation for assessment of active TB, or immobilized by for a procedure.