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Global Audit of Violence against Children Paints Grim Picture Options
Posted: Saturday, September 6, 2014 12:00:00 AM
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Global Audit of Violence against Children Paints Grim Picture

By the age of 20, one in 10 girls has been raped or sexually assaulted, according to new UN figures, while a third of the world's 15- to 19-year-old girls who have been in cohabiting relationships have suffered emotional, physical, or sexual violence at the hands of their husbands or partners. Boys are also often the victims of sexual violence, though to a lesser extent than girls. For both genders, cyber-victimization is the most common form of sexual violence. Other forms of violence against children are also pervasive, regardless of age, region, religion, ethnicity, or socioeconomic status. More...
JUSTIN Excellence
Posted: Saturday, September 6, 2014 2:51:51 AM

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The United Nations, which coordinated the emergency response, described the relief efforts as the largest relief operation in the history of the organization.
--- H. E. Khunying Laxanachantorn Laohaphan
Ambassador and Permanent Representative of Thailand to the United Nations

Sister Dianna Ortiz (2001), a survivor of torture herself and author of The Blindfold ’ s Eyes: My Journey from Torture to Truth (2002), describes torture as a “soul-searing experience” (p. 13) that not only affects the survivors but also strikes terror in their communities, silencing opposition, and intimidating entire societies into silence. Torture has a profound effect both on a country’s citizens and on its social fabric.

Types of Torture

Torture is a devastating trauma that involves a broad range of techniques. The types of torture are many, limited only by the cruelty of the torturers’ imaginations. Although in some countries torturers use sophisticated equipment for torture, in many others they use common implements, such as fists, heavy boots, branches, bricks, whips, batons, ropes, matches, candles, metal rods, vats of icy water, crude electrical devices, hot tin roofs, trees, or ceiling fans. Torturers often subject their victims to a combination of different forms of torture in order to render them powerless and to break their will to resist.

Torture techniques can be classified as falling into the following categories: physical torture, psychological torture, sexual torture, social deprivation, sensory deprivation, sleep deprivation, nutritional deprivation, hygiene deprivation, and deprivation of medical care..

Psychological Torture

Psychological torture occurs in many forms, some of which are highly subtle, yet quite devastating. Being kept in an overcrowded cell, forced to urinate and defecate in front of others, and living in chronic uncertainty are only a few of the strategies used to break a person down and lower resistance. Survivors report being told convincingly that they will go crazy or will be disabled for life by their torture. Humiliation, verbal abuse , and degradation techniques are pervasive and are aimed at stripping the individual of dignity and any sense of value. Some of these strategies were evident in the photographs that were published of U.S. soldiers mistreating prisoners at Abu Ghraib, such as hooding prisoners, keeping them naked, piling them naked on top of each other, and recording their nakedness and misery in photographs. The Abu Ghraib photographs also illustrated the use of strategies to terrify victims, such as the hanging of electrical wires from their bodies with the implication that they will be electrocuted, or using dogs to attack them while they are shackled and unable to protect themselves.

Threats of death and mock executions convince the victim that he or she could certainly die at the hands of the torturer. Often torturers threaten to arrest, torture, or kill a victim’s family members, including children. Another devastating form of torture is to be forced to listen to others being tortured without being able to intervene, or to witness the torture of others, including family members and friends (Physicians for Human Rights, 1996).

Survivors often say that they could tolerate their own pain, but they could not stand the cries of the person being tortured next door. Survivors report being forced to watch others being raped, both men and women, and experiencing the terror of knowing that they might be next. Often people are tortured in a large room, with different forms of torture being perpetrated on other people in the room; they are told that what is being done to the others will be done to them if they do not comply with the torturers’ demands. A particularly egregious form of torture is to force a person to participate in the torture of others, which can engrave on the soul of the survivor an overwhelming sense of guilt and self-hatred.

Many survivors report being forced to sign false statements and to confess to acts that they never committed, simply to stop their torture. It is a myth that torture will force the victim to tell the truth. Rather, torture forces the individual to say anything that comes to his or her mind that might stop the torture. As a number of survivors have reported, “If I had seen you walking down the street that day, I would have given your name. I would have said anything to stop the torture.” Torturers often force people to violate taboos that lie at the center of their personal or religious ethics, such as to eat foods prohibited by their religion, to be naked in front of others, or for sons to be forced to have sex with their mothers or fathers with their daughters.

Sexual Torture

Sexual torture can cause profound emotional and physical wounds. Sexuality “can be turned into a weapon” against the survivor through leers, degrading comments, and violence to the genitals or anus. Sexual humiliation is a common tactic, consistent with the torturer’s goal of causing his victim to lose all respect for the self. Torturers often force their victims to strip and keep them naked or in their underwear throughout their detention and torture. Survivors report being forced to reveal intimate personal information about their sexual relationships with their spouses and then being forced to simulate what they talked about.

Sexual torture may include rape, gang rape, or rape with implements such as batons, broom handles, or broken bottles. Victims may be forced to have sex with a person of their own gender, or with their own children. Survivors have reported having their pubic hair burned off with a candle and then being raped with the burning candle.

Psychological Sequelae

The worst sequelae of torture are often psychological. Survivors may experience symptoms of depression, anxiety, social withdrawal, emotional lability, and irritability or rage as a consequence of torture. They often describe having overwhelming feelings of fear, grief, and guilt. Many writers here describes the “shroud of guilt” that many survivors carry — guilt over witnessing someone else’s torture but not being able to intervene, guilt over being forced to participate in someone else’s torture, guilt over surviving when others did not. Cognitive symptoms can include difficulty concentrating, confusion, disorientation, and problems with memory and attention. Sleep disturbances are common, and many survivors report difficulty falling asleep, difficulty staying asleep, and early morning awakening.

The Istanbul Protocol reports that the two primary psychiatric disorders associated with torture are posttraumatic stress disorder (PTSD) and depression, although the survivor’s interpretation of torture may be influenced by unique cultural and political factors. United Nations (UN) state that studies on the prevalence of posttraumatic stress disorder (PTSD) in survivor populations give estimates that vary widely, from 15 to 73 percent. UN reports that PTSD appears to be a component of a “universal reaction to torture”. The survivor’s torture frequently refuses to be relegated to the past but rather continues to plague him or her in the present. Many survivors report having frequent nightmares, so upsetting that the survivor tries to avoid sleep completely.

Night can feel like a very dangerous time. Many describe staying awake most of the night and keeping every light on so that they don’t have to face being tortured again in their sleep. Survivors of torture may suffer from flashbacks, during which they feel like they are vividly reliving their torture. They may describe this experience as “going back there” in their minds and describe having sensory flashbacks during which they can actually hear people screaming while they are being tortured.

Survivors also report having intrusive memories of torture that come into their minds even when they are thinking of something positive. A torture survivor happily attending a party, for example, may suddenly have an intense memory of being raped and have to flee the party, go home, and close herself in her room. Memories are sometimes triggered by something innocuous in the environment that reminds the survivor of his or her trauma. A survivor might turn around and run away from an office building door where occupants had been smoking because the cigarette smoke reminds her of the guards who puffed cigarette smoke in her face before raping her. Sometimes survivors report hating their own bodies or their bodily functions because they serve as reminders of their torture. For example, a survivor might cover up mirrors in his apartment because seeing the scars on his chest from his beatings gives him flashbacks.

Some survivors report restricting their food intake in order to avoid defecating, as the resultant smell is reminiscent of the stench in the prison cell. Or a survivor might avoid the kitchen out of fear that he might see red meat, which is a reminder of the blood he had seen on the bodies of dead people piled on top of one another. Because remembering their torture experiences can be so upsetting to survivors, they often do everything they can to avoid such memorie. Survivors may avoid talking about what happened to them at all costs. This may include avoiding visits to doctors, attorneys, or mental health professionals where they might have to talk about their trauma. One author suggest another explanation for why survivors avoid talking about what happened to them: the torture protocol often contains “embedded messages” that the survivors will never be able to talk about what happened to them, and even if they did, no one would ever believe them.

Many survivors report avoiding certain people because they might trigger memories of their torture. Fear is often engendered by the sight of a policeman, security guard, or military man wearing a uniform, as uniformed men may have been involved in the survivor’s torture. The sight of a physician in a white coat might trigger memories of a doctor who participated in the survivor’s torture. Many survivors report fear of people from their own country, who they feel might endanger them or their family members back home by reporting their whereabouts and activities to their government. Other triggers of trauma memories may include crowded places, police cars, authority figures, people who resemble the torturer in some way, television news programs, enclosed areas, being alone, and even certain times of day.

Sometimes the memories of torture are so incapacitating that the survivor represses parts of the memory. Men and women who are gang raped may not remember how many men raped them, for example, or on how many occasions they were raped. In some cases, the person might not even remember being raped at all, although there is physical evidence to indicate that he or she was. It is also common for survivors not to be able to remember dates or periods of time related to their torture, which could be related both to the severity of the trauma and the fact that normal stimuli for tracking time (such as watches, clocks, or sunlight) are unavailable to them in detention.

Torture disrupts the body’s normal way of processing, integrating, and storing information. Dissociative symptoms are not uncommon among survivors of torture, as survivors may experience alterations in consciousness that take many forms. They may experience depersonalization, or a sense of detachment from the self, during which they have difficulty recognizing themselves in the mirror, or have out-of-body experiences. Survivors may also report a feeling of d detachment from their emotions. For example, a survivor reported, “I don’t feel anything at all, ever. And I never cry. Water comes out of my eyes but I don’t cry.” Many survivors have reported hearing voices that did not seem related to psychosis, most commonly the voice of a loved one talking to them, the voice of the torturer, or the screams of people being tortured. Many survivors have reported derealization symptoms, or the feeling that their surroundings are unfamiliar or even unknown to them. Dissociative flashbacks, where the past intrudes into the present, are frequently reported. Survivors also describe having somatic flashbacks, during which they reexperience the trauma in a part of their body but do not have accompanying memories of the trauma.

Many torture survivors are plagued with severely disturbed sleep, difficulty concentrating, irritability, and outbursts of anger or rage that surprise them, as these reactions represent a marked change from how they used to function. These symptoms of hyperarousal are thought to be neurobiological in nature, caused by prolonged exposure to inescapable pain and terror.

In addition, people who have suffered torture and the stress of trying to adapt to a new country without funds or social support often describe symptoms of depression, including a lack of interest in formerly enjoyed activities, lack of many survivors report suicidal thoughts, many claim they would never kill themselves because of their religious beliefs. Survivors who have suicidal thoughts, death may seem like a way to end the unstoppable memories and flashbacks, to alleviate physical and emotional pain, or “to cleanse one’s self ”. However, many survivors feel that suicide would mean that the perpetrators had succeeded in destroying them. Thus “survival is [their] ultimate act of defiance”.

Torture can also have a profound impact on the survivor’s family. Family members may be harassed, interrogated, or tortured because of the survivor’s political activities, and families may be split up as different members seek asylum in other countries. UN cautions that torture’s impact can be seen in the second generation. Often the survivor is separated from his or her family for prolonged periods of time because of the flight into exile. After a long separation, marital relationships may suffer, and children may not remember the parent who has been away. The stresses of resettlement and financial strain combined with the emotional sequelae of torture may impact a survivor’s ability to cope with the stresses of parenting.

Professional Considerations in Emergency Care of the Abused

It is clear that health care providers can reasonably expect to treat a victim of torture at some point in one’s medical career. The first step to effectively treating victims of torture, and those from various cultures in general, is to develop physicians with a sense of cultural competence. A recent meta-analysis by Biggers and disciples showed that cultural competency did improve physician knowledge, but to date has not improved health outcomes for patients seen by these physicians. The authors theorize that this may be due to the relatively small number of physicians who have actually undergone formal training in this area. Small gains made by trained physicians are easily negated by other specialists lacking this educational focus. Traditional culture-based curricula tend to focus on physician interaction with only one culture. Given the multinational nature of immigration today, this model is likely outdated. The curriculum issue is further clouded by the lack of consensus as to exactly what the curriculum should cover, creating an additional educational barrier.

Transcultural competence is more applicable to the immigration situation today. This approach emphasizes that the physician first gathers and analyzes information about the culture of interest instead of relying on previously held beliefs. It is thus critical that the physician inquires about a history of torture as well as conditions in the patient’s country of origin. It is also imperative that practitioners of western medicine realize that many other cultures rely heavily on emotional aspects of healing. By incorporating the patient’s cultural beliefs into the treatment plan the physician not only strengthens the patient–physician relationship but also significantly involves the patient in his/her own care, which may ultimately improve compliance. A creative approach encourages physicians to not only recognize the various components of the survivor's experience, but to tie these events together in a cause–effect relationship. By linking cultural experiences with psychological and physical symptoms, the physician is more likely to develop a treatment plan that addresses not only these needs, but the patient’s social needs as well.

Communication is perhaps the most difficult aspect of treating this patient population, as it is not practical for the physician to learn the multitude of languages that survivors speak. It is estimated that over 150 languages are spoken in New York City, further illustrating the need for translators, preferably those from the victim’s home country. Physician familiarity with local resources available to the survivor population may also facilitate treatment. Depending on the geographical area there may be traditional healers and other ex-patriots that may further enhance the patient’s emotional connection to treatment.

The UNHCR also attempted to provide a means for effectively treating victims of torture. The Istanbul Protocol, released in 2000, is a step-by-step guideline for the evaluation and documentation practices involved with treating victims of torture. However, the document wasn’t widely used by medical professionals. Pincock reports of the European Union’s efforts to implement the guidelines. The RCT and theWorld Medical Association (WMA) were awarded a $1.2 million dollar grant to implement a pilot program in Mexico, Morocco, Uganda, Sri Lanka, and Georgia aiming to train 250 physicians and 125 legal experts in the document’s use. Pincock, along with WMA officials, feels that that for the Protocol to be effective it must be adapted to regional cultures and practices. The grant aims to use demographic data from mentioned studies to create ‘torture practice databanks’ and use this information to make the Protocol more broadly applicable.

Question is whether it is possible for the examiner to truly remain neutral in the face of significant human suffering. This case report serves as a reminder of the importance of debriefing of the clinicians involved to maintain some semblance of neutrality throughout the asylum process and to prevent emotional exhaustion in health care providers working with this patient population. Similarly, the risk of interpreters experienced transformative reactions. This group is particularly at risk considering that the majority of translators used inWestern nations are refugees themselves. This study showed that while interpreters occasionally had some emotional response to the therapy session, these reactions were not disruptive to the therapy session or to the overall well-being of the interpreter. The authors do recommend paying particular attention to the well-being of the interpreter as well as assuring that the interpreter continues any therapy he or she was receiving.

Physicians workingwith victims of torture may also face persecution themselves. Biggers report the case of two Turkish physicians persecuted by the
Turkish government. While the two physicians in this example were ultimately cleared of all charges, the case highlights the potential risks associated with treating victims of torture, particularly in countries where torture is still extensively practiced.

Further Reading:

~ Bustos, E. (1990). Dealing with the unbearable: Reactions of therapists and therapeutic institutions to survivors of torture. In P. Suedfeld (Ed.), Psychology and torture. New York: Hemisphere Publishing Corporation.

~ Gonsalves, C. J., Torres, T. A., Fischman, Y., Ross, J., & Vargas, M. O. (2013). The theory of torture and the treatment of its survivors: An intervention model. Journal of Traumatic Stress, 6 (3), pp. 351–365.

~ Physicians for Human Rights (1996). Torture in Turkey and its unwilling accomplices: The scope of state persecution and the coercion of physicians. Boston: Physicians for Human Rights.

~ van der Veer, G. (2008). Counselling and therapy with refugees and victims of trauma (2nd ed.). Chichester, UK: John Wiley & Sons

~ Pincock S. Exposing the horror of torture. Lancet. 2003; 362: 1462–3.

~ Bohannon J. Laying abominable ghosts to rest. Science. 2004; 304(5678): 1735–6.

über laboratorium dauernd zur Naturtreue
Posted: Saturday, September 6, 2014 7:55:51 AM

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Moral of the story: men are sickos.
Posted: Saturday, September 6, 2014 8:59:53 AM

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As a woman, a part of me agrees with Mechpebbles' statement:
Moral of the story: men are sickos.

As a human being, I think there are plenty of sickos, male & female.

This article was disturbing, but the video showed some hope. When we consider how much human rights we've gained over the last 100 years, things are getting better. Sometimes we just have to step back & look at the larger time frame.

When you make an assumption, you make an ass of u & umption! - NeuroticHellFem
Posted: Saturday, September 6, 2014 11:01:32 AM

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I also think it does a disservice to true victims of violence and torture, to have actions such as spanking, speaking harshly to someone, and cyber bullying included in the definition of violence. These, to my mind, come nowhere close to adult or child, rape, torture, or mutilation.

NeuroticHellFem is right. We have made a great deal of progress, but we still have a long way to go. The species Human is a vicious one, but has the potential to be better.

We should look to the past to learn from it, not destroy our future because of it — FounDit
Posted: Saturday, September 6, 2014 11:23:46 AM

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Considering the people I grew up with, much of the purported violence and assault was consensual. Going against the grain, I still think that doesn't make it right.

Make every post as if it was the first one in the thread.
Fredric-frank Myers
Posted: Saturday, September 6, 2014 5:45:16 PM

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I had hoped to see some improvements within my lifetime, but with the sick Republican-Christian-Right allowed to carry power within the U.S. of A., I must sadly say there will never be any positive change, until they are gone.
Posted: Saturday, September 6, 2014 7:10:31 PM
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The worst crime.
Posted: Saturday, September 6, 2014 7:46:43 PM

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Child abuse is the psychological, physical, or sexual maltreatment. It harms the survival, self esteem, development of the child, among others. Unfortunately, most of these children are going to be abusive when they grow up. I wonder, when is this going to stop? I think, violence against children is the worst human vile deed.
Posted: Saturday, September 6, 2014 8:03:08 PM

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Fredric-frank Myers wrote:
I had hoped to see some improvements within my lifetime, but with the sick Republican-Christian-Right allowed to carry power within the U.S. of A., I must sadly say there will never be any positive change, until they are gone.

Ri-g-g-h-t. If only we could kill off all those sick Republican-Christian-Right-Wingers! What a wonderful world it would be! Why, there would be no one left but kind and considerate people like --- YOU!...Applause Applause Applause

We should look to the past to learn from it, not destroy our future because of it — FounDit
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