· The doctor ·
Reflecting on women victims of torture and rape today inevitably means being prepared to listen to the unspeakable, it means sharing in the abyss of dehumanization which such violent and deliberate acts have wrenched open in the victims’ hearts.
As a forensic doctor and a clinical criminologist, I have always looked after victims of violence, especially women and minors; with the passing of the years, through the increase in migratory flows this has also meant treating women migrants whose bodies and minds, and indeed especially their innermost hearts, show the wounds of torture and rape.
Who are these tortured and raped foreign women? They are human beings who through the specific wish of others have lost their most intimate essence, their most precious treasure: their humanity. They have represented “a piece of flesh” on which domination and force are imprinted with violence and in a strategy of terror. They have been mere scraps of sex perversely stolen, not so much for the pleasure of the rapist as rather for the precise purpose of turning these women into objects of humiliation, suffering and annihilation. They drag along a body destroyed by pain and a mind shattered into thousands of fragments. They are degraded women who have been robbed of their femininity and their hope.
Associating torture and rape, assuming the burden of the women who suffer either of these traumas, ultimately means making one’s own and putting into practice what the United Nations (UN) has long recognized and spelled out: indeed, on 23 September 1998 the International Criminal Tribunal for Rwanda (which reports to the UN) equated sexual violence with war crimes. In Resolution 1820 of 19 June 2008 the UN included rape [“sexual violence”] among the tactics of war used in conflicts by governments or militias to torture, humiliate, frighten, degrade and destroy. Finally the Istanbul Protocol, promoted by the UN in 2008, ruled that rape is a form of torture and leaves in a person’s psyche the same indelible traces as torture.
Aware of this, I observe migrant women who come to my clinic, the chosen victims of a perverse thought rooted in the dehumanizing action of torture, whether it is physical or specifically sexual.
For me meeting these women has meant dramatically coming to terms with the physical and psychological consequences of a real “organization of evil”. It has meant accepting that there is no limit to the conscious infliction of suffering and to the desire to overpower and dominate through terror and violence.
Torturers lack empathy, emotions, feelings, tenderness, the perception of the pain of others; for a torturer the victim is merely flesh to be used, to be transformed into a lump of pain. The pain and suffering felt by the victims during torture are so acute that frequently their sole desire is to die, for only death can put an end to what they are already living as an end. And yet, in the torturer’s and the rapist’s strategy, the victim’s survival becomes a fundamental element, an essential condition of their power and a warning to other people: the victim of torture must suffer but must not die, must be terrorized, degraded and humiliated, but must continue to live.
It is for this reason that it becomes essential for these women to escape from all this, and surviving it becomes a challenge. The migrant women victims of torture are women fleeing from their country and from their torturers, they are women fleeing from “evil”. They experience the pain of separation and uprooting, nostalgia for their emotional ties, anguish for the past and uncertainty about the future. Not “only” do they have scenes of wretchedness, suffering and war before their eyes, imprinted in their hearts and on their bodies – which in itself would be an “excess of suffering!” – but they themselves have become living tombs of the tortures they have undergone and the rapes they have suffered.
Through meeting others and through the restitution of integrity to their bodies and hearts, they gradually cultivate the hope that a better world might also exist even for them, and question us every day to know whether we too will be part of it, whether we will be that little piece of a better world that will change their lives. Inevitably, beside a woman who has been tortured or raped each of us must decide whether “to bow our head and turn our gaze elsewhere”, or whether to become the protagonist of that change which, starting from us, will restore to the victim the face and expression which the torturer has deliberately destroyed.
Day after day, encounter after encounter, I came to realize that for torture victims the true healing process cannot end in a medical act of a diagnostic and/or therapeutic kind, but that physicians must go beyond this and take upon themselves the commitment to an authentic turning point in these women’s lives. Thus my examination of a woman should not only be a way of ascertaining lesions or treating illnesses or wounds but must inevitably become a healing action which can “humanize what others have brutalized and dehumanized”.
Hence a medical examination can be seen as the restoration of beauty to a body, of tenderness to feelings, of oneness to a face and of the possibility of dreaming.
These thoughts became devastating when I began to practise my profession and realized dramatically that with my own actions of treatment I was about to repeat on these women’s bodies actions which had probably already been done by their torturers. My realization of the evocative and dramatic nature of my actions, which for me were solely curative, made it essential to give treatment a new meaning. In examining a woman victim of torture, I inevitably use actions thattouch her deepest wounds and violate her body once again. And yet my actions can become genuinely therapeutic if in addition to healing the injuries to her body they can restore humanity to the woman herself.
So it is that my meetings with victims of torture in my clinic acquire the hues of a new challenge: to transfer Lévinas’ marvellous teaching, it becomes imperative to restore to them a face and an expression in order to humanize what the “perverse torturers” have on the contrary dehumanized. At the outset most of these victims are in a severe state of shock, they are terrified and do not know whether they can trust us. They are silent, closed, hostile and far from willing to tell their stories, especially if they have been victims of rape.
Then, little by little, very gradually, they begin to reveal painful experiences in which we find, with variations, the deprivation of food and water, inhuman prison conditions, serious beatings with blunt objects of every kind, blows on the soles of their feet or the palms of their hands, torture by suspension or by positional stress, burns caused by boiling liquids, acid or red-hot instruments of every kind, electric shocks, the pulling out of nails or teeth, attempts at suffocation or drowning, rape and every other form of perverse sexual aggression. They tell of having seen people of the same race or of their own family tortured or killed, they relive the horror of their own powerlessness in the face of the screams of pain and cries for help and embody a sense of guilt for having survived all this.
They have experienced such traumatizing physical and sexual violence that they often develop a simple or complex Post-Traumatic Stress Disorder (ptsd), depressive disorders, psychosomatic reactions linked to the trauma and anxiety and sleep disorders which aggravate a picture which is already in itself complex. Not last among their problems, they are victims of what we professionals call manifestations of “secondary retraumatization”.
For women migrants, victims of torture, suffering retraumatization exponentially multiplies the psychopathological effect of the trauma, aggravating their symptoms or giving rise to new ones, to the point of making their clinical progress worse (only in appearance is all this not connected with the original traumatic event). If the torture or rapes, the original traumatic events, must have extremely serious characteristics, the retraumatizing events may even be minimal and yet they can trigger a huge post-traumatic reaction. An encounter with staff in uniform (medical or military), being placed in closed rooms, the sound of sirens, a change in tone of voice, particularly pungent odours and hundreds of other situations of commonplace daily routine can be experienced by tortured women as a myriad of retraumatizing experiences. Thus examining a woman victim of torture means, first and foremost, patiently giving life to an encounter between people in order to undo what the torturers had made simply a violent clash between a dominant figure and a subjugated one.
It becomes essential to seek patiently for moments in which to build a relationship based on a new dialogue; indeed, never does the therapeutic relationship need so much “to see and listen with the heart” as in these cases, establishing a dialogue in which words, and above all silences, become the dimension of the one towards the other. Dialogue and listening, which presuppose closeness, that closeness which is the movement of my mind and my heart towards the other: only in this way can dialogue and listening give a voice to those who have no voice, making the invisible visible.
Beside dialogue and listening an explosive new dimension of time emerges, understood as thesubstance of our lives; with the women victims of torture the duration of the examination will inevitably be marked by them to the point that it assumes the dimension of a restitution of awareness and self-determination. There is time for the relationship with the other and for listening to the other as a tangible sign of her humanization and my placing myself next to her, time as a dimension of my not merely professional involvement. Dialogue, listening and time are therefore essential dimensions of the clinical-therapeutic relationship which enable the tortured or raped woman to speak of herself, they help her to tackle both silences and words, they enable her to weep and be comforted, they allow her to overcome her sense of guilt, they bring her to life. Only in this way, in a slow process of humanization through the restitution of a face, of an expression and of a physicality robbed and violated can the clinical relationship become authentically therapeutic.
Recognizing women migrants, victims of torture, taking responsibility for them, giving them competent and protective medical responses, making the medical act a first step towards uncovering the violence suffered will truly enable us to build – for them and with them – processes which are diagnostic, therapeutic, and rehabilitational but which are above all humanizing. In fact, we know almost nothing about them, we do not know who they are or where they come from, we do not know their stories nor where they will go but we do know that each one of them is a sister, mother, friend, daughter, partner, we know that their sufferings are our sufferings, their hopes are our hopes. We know, and we are certain of this, that the deepest meaning of our action becomes an authentic value through their faces and their eyes, because our action always represents a human journey of competent treatment, solidarity and hope.
Maria Stella d’Andrea
St. Peter’s Square
Dec. 12, 2017
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