The purpose of this chapter is to introduce the reader to the complex interaction between biological, psychological, and social factors that coverage to produce and perpetuate the long-term consequences of trauma. Whether by cruel intuition or by trial and error, the torturer has learned through the ages to exploit those factors which are most effective in producing a state of helplessness and submission in his victims.
The principles by which torture produces its damaging consequences are those which underlie the effects of other, varied forms of catastrophic trauma. Thus, while the after-effects of torture are so frequent and uniform that those who work with its victims have identified a 'torture syndrome' (Kosteljantes & Aarund, 1983; Lunde, 1982; Hougen, 1988; Goldfeld et al, 1988), similar immediate reactions and long-term consequences also occur in response to combat, rape, kidnapping, concentration camp experiences, spouse abuse, child abuse, and incest (for reviews, see Horowits, 1986, and van der Kolk, 1987a, 1988). These events share common features which elicit a common psychological response, a response which is also affected by such features as the subjective meaning of the event and the social and interpersonal matrix in which the event occurs. By understanding the principles of the trauma response, one is in a better position to undo its damage. Thus, our discussion will also outline the treatment implications of this model.
The essence of trauma is that it overwhelms the victim’s psychological and biological coping mechanisms. This occurs when internal and external resources are inadequate to cope with the external threat. There are four primary features of traumatic events which account for the overwhelming nature of trauma and the overwhelming impact of the torture experience.
Traumatic events lie outside the normal range of human comprehension. Cognitive schemas serve as a buffer against being overwhelmed. When there are no existing cognitive schemas which allow the meaning of an event to be processed, the individual reacts with speechless terror. The inability to make sense of the experience overwhelms the victim's psychological capacity to cope. This exacerbates the state of exctreme physiologic arousal indiced by the stress. Such levels of arousal disrupt and disorganize cognitive processes and this interferes further with processing the meaning of the event (van der Kolk and Ducey, 1989; Fish-Murray, Koby, and van der Kolk, 1988). As a result, the traumatic experience is left unassimilated and is alternately denied and then compulsively relived with its original horrific intensity (Horowits, 1986; van der Kolk, 1988). This may occur visually through nightmeres and flashbacks, motorically through behavioural reenactments, or by reexperiencing dissociated fragments of the trauma through any sensory modality, through somatic symptoms, rage reactions, or panic states.
The traumatic experience cannot be assimilated in part because it threatens basic assumptions about oneself and one's place in thw world(Janoff-Bullman, 1985). These assumptions include: personal safety, security, integrity, worth, and invulnerability, a view of the world as orderly and meaningful, and a view of others as helpful and good. Incomprehensible traumatic events may be dissociated from awareness in the service of preserving some of these assumptions about oneself and the world. However, by contrasting their view of reality the trauma usually shatters cognitive assumptions, leaving the subject in a state of inner confusion. Rieker and Carmen (1986) state that, ' confrontations with violence shallenge one's most basic assumptions about the self as invulnerable and worthy and about the world as orderly and just. After abuse, the victim's view of self and world can never be the same again: it must be reconstructed to incorporate the experience.' This reconstructed sense of self is usually negative, experienced by the victim as helpless, ineffectual, and unworthy. Victims may blame themselves and direct their anger inward in order to preserve a sense of inner control and to avoid helplessness.
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Human beings have a biologically based need to form attachments with others (Bowlby, 1969; also for review see Eagle, 1987, Chap.2).
Children need a safe base in the form of secure attachments in order to explore their environment and develop socially (Field, 1985), and adults continue to be dependent on social supports for a sense of safety, meaning, power, and control (Bowlby, 1969, 1973; Kohut, 1977; MacLean, 1985).
The need to attach to others increases in times of stress and danger. Pain, fear, fatigue, and loss all evoke efforts to attract increased care from others (Becker, 1973; Fox, 1974; Rajecki, Lamb & Obmascher, 1978). People whose internal resources are inadequate to cope with a threat may cling to others to regain a sense of predictability and security. Stable attachments help to limit overwhelming physiologic arousal (Reite, Short & Seiler,1978; Coe, Glass & Wiener, 1983; Field, 1985). Other people also validate the individual’s experience and help make meaning out of what has happened. Some authors have credited surviving the concentration camps and similar extreme circumstances to the capacity to preserve attachment bonds, even when bonds with others are internalized abstractly in the forms of values and other cultural ties (for review see Eagle, 1987,Chap.18).
Traumatic rupture of interpersonal attachments is integral to the torture experience as well. Victims are kept in isolation and their captors threaten them with the capture and death of family and friends (Gonsalves, 1990). Torture survivors are often exiled after their release and feel alien and estranged (Fischman & Ross, 1990; Gonsalves, 1990). As outcasts from their society they do not receive the validation and support from their countrymen needed to overcome traumatization. This may be just one contributing factor to why they show persistent interpersonal dysfunction and increased divorce (Gonsalves, 1990). Traumatized people often show enduring difficulties in forming subsequent relationships (Lindy, 1987) and tend to alternate between withdrawing socially or attaching impulsively and maladaptively. This undermining of interpersonal resources perpetuates the traumatic situation.
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The betrayal of these expectations, and thus loss of this form of attachment, compounds the impact of torture.
Given the role of attachment in overcoming trauma, we suspect that strong inner ties to groups which share plitical or religious ideals that give meaning to the suffering may to some degree buffer the controling influence of torture.
One of the most pernicious effects of torture is that in their attempt to maintain attachment bonds, victims turn to the nearest source of hope to regain a state of psychologic and physiologic calm. Under situations of sensory and emotional deprivation they may develop strong emotional ties to their tormentors (Bowlby, 1969; Rajecki, Lamb & Obmascher, 1978; Dutton & Painter, 1981; Ochberg & Soskis, 1982; Finkelhor & Brown, 1985; Kempe & Kempe, 1987).
This ‘traumatic bonding’ is thought to occur among hostages, abused children, and abused spouses (Bettelheim, 1943; Dutton & Painter, 1981; Kempe &Kempe, 1978).
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Persistent autonomic arousal
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