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Caring for Victims of Torture

Edited by James M. Jaranson, M.D., M.A., M.P.H., and Michael K. Popkin, M.D.

  • ISBN 978-0-88048-774-0
  • Item #8774

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Since its beginnings in the 1970s, the field of torture rehabilitation has grown rapidly. A growing awareness about the practice of torture (more than 100 countries today practice government-sanctioned torture) and its effects on victims is leading to an increasing number of dedicated treatment centers. The health care professionals on the staffs of these centers need the best, most up-to-date information and advice they can get. This book delivers it.

Caring for Victims of Torture contains all the collective wisdom of some of the most respected international experts in the treatment of victims of government torture—all distinguished physicians—including pioneers in the field of traumatic stress. Contributors discuss the most recent advances in knowledge about government-sanctioned torture and offer practical approaches to the diagnosis and treatment of torture victims. Organized into six main sections, this annotated volume provides an overview of the history and politics of torture and rehabilitation; guidance in identifying and defining the sequelae of torture; a framework for assessment and treatment; specific treatment interventions; and a discussion of ethical implications. In the final section, physicians working in the field offer firsthand accounts and address how they are trying to balance politics with caregiving.

Focusing on the physician's role, this book is chiefly a clinical guide. But for advanced-level students, it serves as a thorough, up-to-date text and reference work. Religious leaders, lawyers, politicians, human rights advocates, and torture victims themselves will find it a valuable resource as well.


  • Section I: History and Politics.

    Torture: history, treatment, and medical complicity. The science and politics of rehabilitating torture survivors: an overview.

    Section II: Identifying and Defining Sequelae.

    Diagnosis of governmental torture. Three categories of victimization among refugees in a psychiatric clinic.

    Section III: Framework for Assessment and Treatment.

    The physician's role in assessment and treatment of torture survivors. How medical assessment of victims of torture relates to psychiatric care.

    Section IV: Specific Treatment Interventions.

    Psychoanalytically oriented psychotherapy with torture survivors. Behavioral and cognitive treatment of survivors of torture. Conceptual models and psychopharmacological treatment of torture victims.

    Section V: Ethical Implications.

    Countertransference and ethical principles for treatment of torture survivors. Preventing the involvement of physicians in torture.

    Section VI: Voices From The Field: Politics and Caregiving.

    Forced disappearance: a particular form of torture. Caring for survivors of torture: beyond the clinic. Caring for victims on site: Bosnian refugees in Croatia. Index.

About the Authors

James M. Jaranson, M.D., M.A., M.P.H., is Director of Medical Services and Research, Center for Victims of Torture, in Minneapolis, and founder of the International Mental Health Program in the Psychiatry Department of St. Paul-Ramsey Medical Center (now Regions Hospital) in St. Paul. He is also Assistant Professor, Department of Psychiatry, University of Minnesota Medical School, and Director of the Cultural Psychiatry Training Program. He was a faculty member of the University of Minnesota Refugee Mental Health Technical Assistance Center, funded by the National Institute of Mental Health. He is a member of the International Rehabilitation Council for Torture Victims, headquartered in Copenhagen, Denmark. His academic background includes an M.D., an M.A. in anthropology from the University of Minnesota, a master's degree in Public Health from Harvard University, specializing in psychiatric epidemiology, and board certifications in both psychiatry and general preventive medicine.

Michael K. Popkin, M.D., is Chief of Psychiatry at the Hennepin County Medical Center, Minneapolis, and Professor of Psychiatry and Medicine at the University of Minnesota Medical School. Dr. Popkin was a member of the Minnesota Governor's Task Force that advocated the development of the Center for Victims of Torture, and he served on the Center's Board of Directors from its 1985 inception to 1989. Dr. Popkin is a graduate of Princeton University and the University of Chicago Pritzker Medical School. He interned at Bellevue-NYU Hospitals and received his psychiatric training at Massachusetts General Hospital. He is past President of the Academy of Psychosomatic Medicine, has been Vice-Chair of the DSM-IV Organic Disorders work group, and was Chair of the NIMH Mental Health Services Research Review Committee. He reviews for more than a dozen medical journals and has written more than 120 papers and chapters on a range of topics dealing with the interface of psychiatry and medicine.

Through the distinct and diverse voices of the contributing authors, this well-crafted and readable volume achieves a rich and broad portrayal of the themes that are paramount to the field of torture and refugee trauma and to all who engage in providing health care to survivors. . . . Staying impartial while reading this volume will not be possible. Rather the reader will be stirred, challenged, provoked, and educated and in Jaranson's words, 'left with more questions than anwsers' (p. 34) yet with the knowledge to formulate better questions—a commendable achievement for editors and contributors alike.—The Journal of Nervous and Mental Disease

This book is a welcome addition to the field of torture and trauma rehabilitation. It enables health care workers and physicians from a range of disciplines to understand the complexities of working with this population group at the individual, family, and community levels. It enables emerging practitioners to update their knowledge quickly and directs them to the skills required to be competent in this field. The book addresses questions and issues of relevance to the torture rehabilitation and trauma rehabilitation industry itself, enabling discussion and review of current clinical and service development approaches and political issues within the movement itself. It proposes the need for an openness and collaboration between medical and scientific approaches and alternative community-based and group work approaches. I highly recommend this volume not only for practitioners but also for medical students, psychotherapists, health workers, and other health professionals interested in moving into this field.—Margaret Cunningham, .S.W., Churchill Fellow, Lecturer, School of Community Medicine, University of New South Wales, Sydney, Australia

In this tumultuous world, torture is still a method of totalitarian control. Clinicians often underestimate the actual torture that immigrants have experienced. . . . This important volume reviews the nature of the effects of torture and methods of treatment. A wide range of interventions are reviewed that include both psychotherapy and psychopharmacology. This volume is essential for all mental health professionals who treat such patients. It links the dark side of geopolitical facts with our psychiatric knowledge. The clinical vignettes and clear approaches to assessment and treatment of these victims make this volume an invaluable source of clinical wisdom.—Thomas N. Wise, M.D., Editor-in-Chief, Psychosomatics

This book presents a fascinating and comprehensive review of the currently established knowledge about the clinical presentation and treatment of torture survivors. The contributors are top-notch international experts. This book clearly presents the state of the art in the young science of torture treatment and should serve as a guide for future directions.—Brian E. Engdahl, Ph.D., Department of Psychiatry, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota

Jaranson and Popkin have assembled a virtual Who's Who in the field of torture and refugee trauma to contribute to an authoritative yet very readable text. It belongs in the libraries of all clinicians who seek to provide health care to survivors of torture. This book will improve services to torture survivors and advance the status and recognition of this field. It will bring enormous benefit to health care professionals and the people they serve.—Terence M. Keane, Ph.D., Director, Department of Veterans Affairs' National Center for PTSD—Boston, Professor and Vice Chairman of Psychiatry, Boston University School of Medicine

This is an important addition to the medical literature. The volume deals with an important—and often overlooked—topic, the long-term psychological sequelae of people who have been subjected to torture. This volume identifies and defines the sequelae of torture, provides physicians with a framework for assessment and treatment of victims, and provides specific treatment interventions, including psychotherapy, behavioral and cognitive treatment, and psychopharmacological treatment. It addresses the ethical implications of care rendered to victims of torture and deals with practical issues relating to the politics of caregiving. It specifically addresses forced disappearances and caring for survivors in ethnic areas and in the field in sites such as Croatia. The volume is written by contributors who have had significant experience and has been carefully edited by Dr. Jaranson and Dr. Popkin. It is an important addition to the treatment literature of psychiatry. The individual chapters are concise, well written, and clinically useful. They lend considerable insight into posttraumatic stress disorders and appropriate treatment for the most severely affected survivors of man's inhumanity to man.—Richard C. W. Hall, M.D., Clinical Professor of Psychiatry, University of Florida, Gainesville, Florida

Torture is part of human history. Some people believe that means we will never see the end of it. Providing care for survivors—recovering the leadership stolen by repressive governments—is a relatively new idea. Jaranson and Popkin prove it is an idea whose time has come. Both the breadth of experience and the depth of knowledge demonstrated in this book give hope to survivors and new powers to those who work against torture.—Douglas A. Johnson, Executive Director, The Center for Victims of Torture, Minneapolis, Minnesota

[T]he overall coverage and topicality are commendable, and indeed some of the more clinical chapters will be found most useful by any professional dealing with this problem. I would like to see this well produced volume in the libraries of all those in this very challenging field.—Behaviour Research & Therapy

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