Originally appearing at http://www.nytimes.com/2011/05/03/health/03torture.html. AMMAN, Jordan — The first time the Iraqi Army arrested him, he said, soldiers burst into his shop in Baghdad, dragged him out in handcuffs and a blindfold, and took him to a filthy, overcrowded prison. Beatings, rape, hunger and disease were rampant, and he expected at any moment to be killed. He was held for four months, until December 2008. During an interview here, the shopkeeper, 35, a balding, stocky man wearing a T-shirt and slacks, was calm and soft-spoken at first, but grew increasingly loud and agitated as he told his story. He described enduring episodes of torture, threats by captors to go to his house and rape his wife, and daily horrors like the suicide of a young prisoner who electrocuted himself with wires from a hot plate after being raped by soldiers. He spoke through an interpreter, and asked to be identified by only his first initial, M., because his relatives were still in Iraq and he feared for their safety. After speaking for an hour, he shook his head and said softly: “What happened is not like what I just said. What happened was much worse.” The interview took place at a treatment center that opened in northeast Amman in December 2008 to help Iraqis who were tortured in their own country or who suffer from other war trauma. It is a branch of the Center for Victims of Torture, a St. Paul-based group that also operates in Africa and since 1985 has treated 20,000 torture victims from around the world. About half of the group’s financing comes from contracts with the American government. Its approach involves intensive talk therapy specifically devised for survivors of torture, using group counseling or individual psychotherapy or both. The group trains local therapists in host countries to take over all treatment within a few years. Researchers say its services are desperately needed: There are many torture victims in the Middle East, but little expert help. Most Iraqi victims in Jordan cannot travel elsewhere for treatment, because they lack money or cannot obtain visas or asylum. The St. Paul organization is among the oldest and largest in the field, treating about 2,750 people a year. Its experts act as mentors and trainers to other programs, and have played a crucial role in developing treatments, according to Dr. Allen Keller, who directs a center for torture survivors at Bellevue Hospital Center in Manhattan. (It is not affiliated with the St. Paul group.) The work requires a deft touch. Research shows that trained therapists can help survivors of torture, but that inept efforts to treat them can backfire. “If all you’re doing is bringing up disturbing memories,” Dr. Keller said, “you can do more harm than good.” Interviews last fall — the first time a journalist was given access to clients and therapists at the center in Amman — provided a grim look at widespread abuses occurring in Iraq as recently as 2010, and their crushing effects on individuals and families. High rates of torture and other forms of trauma have left many Iraqi refugees struggling with emotional wounds, some so severe that people are afraid to leave their homes. About 21 percent of Iraqis in Jordan were “severely traumatized” by attacks on them or their families, according to the International Organization for Migration, a group with 132 member countries. The number of Iraqis who have fled their country is not known; estimates have varied from 500,000 to more than two million, with the highest numbers thought to be in Syria and Jordan. So far, the political turmoil that has gripped the region in the last few months has not brought new clients. Joséphine Anthoine-Milhomme, a French psychologist at the center in Amman, has treated victims of war and natural disaster in Asia, Africa and Central America, but her 15 years of experience did not prepare her for the brutality described by Iraqis. What has shocked her, she said, is “the extreme violence and the intensity and frequency of perpetrations, the layers they might have of traumatic experience, because of the history of their country.” The events described in interviews have not been independently verified, but the clients were closely screened by the center and accepted only if their accounts were plausible and they had clear symptoms of trauma. Their stories are consistent with reports by medical groups that have interviewed other Iraqi torture victims, and with accounts in documents revealed by WikiLeaks and reported in The New York Times and other publications. The clients interviewed were selected by the therapists because their cases were representative of many others at the center, and because the therapists thought these clients would not be harmed by talking with a journalist and might even be helped by the chance to make their stories public. Iraqis at the center have described being kidnapped, beaten, given electric shocks, raped and burned. Some said they saw relatives killed or kidnapped, or were threatened repeatedly with the murder or rape of loved ones. One reported being sent a video of captors killing a family member by drilling into his skull. An 11-year-old girl and her family revealed that she was raped by a group of men who then shaved her head and threw her on a trash heap. A toddler witnessed her father’s murder; a schoolboy saw his teacher and classmates killed. The torturers, clients say, have included the Iraqi Army, American forces, Saddam Hussein’s henchmen, Al Qaeda in Iraq, and the sectarian groups, gangs and militias that continue to terrorize parts of Iraq. Some clients report having been tortured by more than one of these groups. Many clients still fear for their safety, so the treatment center omits victims’ names from its records and uses a code instead. “Torture was like a genie released from the bottle, used for any purpose, not just to get information but to send a message to the community,” said Darrin Waller, the center’s former director for operations in Jordan, who set up the branch in Amman. The consequences can be severe: flashbacks, nightmares, sleeplessness, fatigue, panic attacks, anger, depression, anxiety and a constant state of fear and distrust. Some victims are afraid to go outside or send their children to school. Many have post-traumatic stress disorder, the same illness that afflicts many combat veterans. Some survivors withdraw from their families; marriages suffer and male victims sometimes beat their wives and children. Sometimes the mental stress turns physical, causing pain, nausea or shortness of breath. Some are too depressed to make emigration plans — essential for most, because Jordan makes it difficult or impossible for them to work or become citizens. Psychotherapy can help, but it cannot undo the damage. People find they are changed forever. “I don’t think you can be totally healed,” Ms. Anthoine-Milhomme said. “You’re just different. You try to adjust to your life.” More than 1,000 Iraqis have been treated at the center in Amman, all as outpatients. About 40 percent of the clients have been tortured, and the rest suffered other trauma. Seventy percent are 16 to 60 years old. Over all, there are equal numbers of men and women, but among the torture victims 70 percent are men. About 250 more people are on a waiting list, so the therapy cannot always go on as long as psychologists would like. The organization has opened a second center in Jordan, and about 100 are on a waiting list for treatment there. Why were these Iraqis detained in the first place? Many were thought by their captors to have useful information, but some said they had no idea why they were arrested or kidnapped. “You are captured for no reason, there’s nothing to get out of you,” said Muriel Genot, another French ps
ychologist working at the center. “It broke your life. For nothing.” The abuses, particularly rape and other sexual violations, engender lasting bitterness and hatred. Some Iraqi men say they would rather die than admit to having been raped. “This will not be forgotten, generationally,” said Mr. Waller, who now works for the British Council as the director of an education program in Baghdad. “It will make the process of reconciliation tremendously difficult.” Fleeing ‘to Save My Soul’ The treatment center is in on a busy road in North Hashmi, a poor part of east Amman favored by Iraqis, in one of the countless four-story beige stone buildings that define the city. Across the street is a dusty lot used in winter as a sheep market. In a sunlit, incongruously cheerful room, with his psychologist and a group counselor present, the Baghdad shopkeeper, M., described his arrest and imprisonment by Iraqi soldiers in 2008. He has had weekly therapy sessions with Ms. Genot for three months. On the day of his first arrest, he said, the Iraqi soldiers demanded to know who had shot an American soldier nearby. “I told them I had no information,” M. said, his voice louder with each word. “No information! No criminal record. I was just in my store.” They threw him into a Humvee, drove to his house and searched it, then took him to a prison. He was beaten repeatedly, kicked and hit with fists, sticks, chains and bats, sometimes while he was blindfolded and handcuffed. But, he said, “many people were tortured much more than me.” At first he was kept in a cramped, dark cell by himself; later he was moved to another prison, where 150 men were crowded into a squalid room meant for 50. Food was scarce, and foul. Toilets overflowed. They slept on the floor with shoes as pillows. Only some had blankets. Most caught dysentery and scabies. Sometimes, as punishment, the water would be shut off for a week, so no one could wash. “The filth and dirt were worse than being tortured,” M. said. Group activities were forbidden. He and other prisoners, caught praying together, were blindfolded, handcuffed and forced to perform knee bends for hours in time to a whistle, or be whipped. Gradually, their legs swelled and some began to urinate blood, which can be a sign of kidney or muscle damage. M.’s older brother paid a bribe to get his case moved to court, and finally, after four months, he was released. Without the bribe, M. said, he would never have gotten out. He wanted to leave Iraq, but his brother talking him into staying. A year later, in 2009, Iraqi soldiers arrested him again, in the middle of the night. An Iraqi soldier had been killed nearby, and the area was besieged. His wife was pregnant, and his two children were sleeping. Soldiers dragged him out of bed, took the family’s cellphones and money, and once again threw M. into prison, this time for more than five months. Along with about 20 others ranging in age from 17 to 75, including several army officers, he was accused of belonging to Mr. Hussein’s Baath Party. “We said we did not,” M. recalled. “I was a soldier under Saddam, but was not in the Baath Party.” He had joined the army at 18, he said, because service was compulsory. “They would take you outside without a blindfold and beat you for a few hours, and you would watch others being beaten, to terrify you,” M. said. “Seven of the prisoners were over 50. It was hard for them to be beaten. We felt bad for the older guys.” Word came that someone was trying to get the prisoners released, so they were transferred to a secret prison. For 77 days, they lived eight to a tiny cell meant for two. They took turns sleeping; four would stand so the other four could lie down. “You had to go to the bathroom in there, too,” M. said. “It would overflow.” M. was sprayed with cold water and his arms were bound behind his back with metal wire in a painful position that prisoners called the scorpion. He passed out several times. His captors would then throw him back in his cell, and when he came to they would torture him some more. This was done to all the prisoners, he said. One prisoner lost his eyesight from being tortured. A pregnant woman gave birth in the prison. She had been arrested only because her husband, the person the army really wanted, could not be found. Again it took a bribe to get M. out. This time he fled to Jordan, alone. “I just wanted to save my soul,” he said. At the time of the interview, he was living by himself in a small apartment in North Hashmi. His wife and children were still in Iraq (they have since joined him in Amman). Asked how he felt, he pointed to his psychologist and his psychosocial counselor, and said, “They know more.” But then he said: “I’m not like before. I’ve changed. My personality changed.” Before, he had a sense of humor, and friends. Now, he has none of that. He is easily upset, and holds deep grudges against the army. He had told only his brother and therapists what was done to him; the details would be too much for his wife. He thinks often about what happened. Talking about it can make him break out in a rash; he could feel it erupting on one of his legs during the interview. He’s afraid when he sees soldiers. He needs tranquilizers to sleep, and wakes up with palpitations. “I’m anxious at night,” he said. “I have scary dreams.” Therapy is helping, he said. He hopes his family will be approved for resettlement in the United States — in Phoenix, where he knows an Iraqi couple. He’d like to start a new career, working for a human rights organization. “I cannot forget what happened to me,” he said. Looking Trauma in the Face How can talk therapy help victims of torture? They are not mentally ill, but they are damaged emotionally. For some, group therapy is enough. Group sessions are run by the center’s 14 psychosocial counselors, most from Jordan or Iraq, who also do some individual counseling. People with the most severe problems are referred to one of the two psychologists. The goal of their treatment, an approach called psychodynamic therapy, is not to help clients forget what happened but to make the memories less painful. “We unroll the story, focusing on the trauma,” Ms. Anthoine-Milhomme said. “We work on dreams and nightmares.” Sometimes, she said, the clients’ stories give the therapists nightmares. “Sometimes I feel almost physical pain when I listen to a detailed explanation of what happened,” Ms. Genot said. “I feel it at the level of the skin, almost like my skin is being stretched or removed.” What hit her hardest, Ms. Genot said, was a public presentation by a torture victim who told his story in a matter-of-fact, emotionless way, and then said, “I wonder why they did it.” “It was like a cry of the heart,” Ms. Genot said. The therapists try to help people figure out which events disturbed them most, and why. “We can never force anyone to do this,” Ms. Anthoine-Milhomme said. “They must be ready for it.” One pitfall that therapists have to avoid when treating torture victims, Ms. Genot said, is becoming dominant — someone to be feared or obeyed, whose interpretation of past events should trump the client’s own view. “At no moment should they feel we have power over them, even with good intention,” Ms. Genot said. “They have to have full control over how to narrate.” Feeling that the therapist is in control can take clients back to moments when someone else — a captor or torturer — was in control of them, Ms. Genot said, adding, “It’s a danger zone.” Sometimes, she said, clients seem unconsciously to push therapists toward becoming the power figure, almost as if they are trying to repeat their painful hi
stories. “It’s important to realize it and resist being pushed into this corner, or it becomes a repetition with no chance to escape,” Ms. Genot said. She recalled one session in which a client, describing his captivity, suddenly clasped his hands behind his chair, as if they were cuffed. She backed off on her questioning. It is not uncommon for clients to be troubled and guilt-ridden over their inability to save someone else from being tortured or killed. Still, one thing the therapists strictly avoid saying is “You couldn’t have done anything.” A reassuring remark like that may seem kind, Ms. Genot said, but in reality it can stop clients from processing their thoughts and emotions. People must be allowed to discuss what they feel they could or should have done, and make peace with it. She and Ms. Anthoine-Milhomme said one purpose of torture was to destroy victims mentally and emotionally, sometimes by attacking fundamental aspects of their identity — their manhood, religion or occupation. “The intention of the perpetrator is long-lasting impact,” Ms. Anthoine-Milhomme said. Regarding M.’s account during the interview, Ms. Genot said later: “I think there are still things he did not say. It was really factual. He was at a distance.” She and his counselor, Fatima Jarrar, said his loud, rapid speech during the interview seemed out of character at first. Then they decided it might have been his way of trying not to weep. “Why does one human being want to break the soul of another?” Ms. Jarrar asked. She said M.’s Muslim faith seemed to helped him. “He accepts his destiny as something that’s written,” she said. “God knows, and will make justice someday. Maybe not in this life.” Dreaming of a Stolen Son Zahra Farhan, 72, with a lined face and sad, haunted eyes, sat in the living room of an apartment here, beside a table holding a framed photograph of her son Nather. In 2006, when he was 38, he and another of her sons were kidnapped from her home in Baghdad by the Mahdi Army, the Shiite militia loyal to the cleric Moktada al-Sadr; Ms. Farhan said they were taken because they were Sunnis. One son staggered home four days later, covered in bruises, his shoulder broken. He had been allowed to live, the family was told, to carry a message to other Sunnis in the region: Get out. Nather never came back. Friends found his body in the street. They washed it, photographed it and showed Ms. Farhan the pictures so she would know he was dead. He had been tortured and shot, she said, weeping. Strips of his skin had been torn off, his teeth yanked out. The family left Iraq in 2006. Ms. Farhan went first to Syria, and then in 2009 to Jordan, where she lives with her widowed daughter and grandchildren. Her two surviving sons have moved to the United States. Ms. Farhan said she thought of Nather all the time, and kept reliving his abduction — cars roaring up to the house, men shooting in the air and pointing pistols at her and her young grandchildren, her sons being beaten, blindfolded and thrown into the trunk of a car. “As if it happened at this moment,” she said. She said she lies awake at night; when she can sleep, she suffers from nightmares. Or she dreams of Nather. “How am I supposed to not think of him?” she cried. But she declined offers of treatment from the center for torture victims. She has trouble walking, and thought the trip to the center, a few miles away, would be too difficult. Her husband died long ago, and she brought up her sons alone, saw them graduate from college and marry. “I raised them with the tears of my eyes, and look how these devils came and took them,” she said. “They were just gone, overnight.” Unrelenting Torment Another client at the center, a 37-year-old man who asked to be identified only as R., said that in 2009 he was kidnapped from a street in Mosul — blindfolded, handcuffed and thrown into the trunk of a car by assailants he thought were members of Al Qaeda in Iraq. Speaking through a translator, he said he was taken because his sister’s husband worked as an interpreter for the American forces; the husband had already been given asylum in the United States. A sign had been posted on their home: “This is the house of the interpreter.” Neatly dressed in an ironed, long-sleeved shirt, light-colored pants and leather shoes, R. said he had worked in his family’s meat and poultry business. He spoke in a soft, expressionless voice, sometimes rubbing his fingers together or plucking at the fabric of his pants. His face was the picture of sadness. He was held in a small room jammed full of prisoners, including a woman, Mariam, whose husband was an interpreter for the Americans. She was tortured in front of the other prisoners. The captors beat her, threw water and salt on her and tied her to metal bars that were attached to the wall and electrified via a generator. “They raped her more than once in front of us,” R. said, looking down as he spoke. “We wanted to help her. We gave her water. But we could not help her, because they were there. I gave her water. She was probably Christian. “And then she died, two or three days after she was raped. There were four guys who raped four of us. They asked for information about my sister’s husband.” When R. said he had no information, the captors tortured him with electric shocks, using the same apparatus they had used on Mariam. During the interview, R. stood up, turned and partly removed his shirt to reveal a fist-size lump between his shoulder blades — a result, he said, of having his hands tied behind his back and then jerked up and hung from a bar in the wall. Nearly a month into R.’s captivity, American forces attacked the building where he was being held. Amid fierce fighting, the captives discovered that the door had been left open. Some, including R., decided to make a run for it. He escaped, and then fled to Jordan with his wife and daughters. “I was destroyed,” he said. He felt cut off from everyone around him, even his family. He stopped shaving and cutting his hair, and sat around the house in a cloud of despair. “I was tortured and raped more than once,” he said. “It feels as if something is missing. I don’t mingle at all with people.” The sight of police officers frightens him, because terrorists sometimes wear uniforms. He cannot sleep at night. His wife still does not know the details of his torture, or that he was raped. Only the therapists know, he says. Even with them, he initially only hinted at it. “I am ashamed,” he said. The treatment has gone on for more than a year, far longer than usual. “Maybe I’m the longest staying,” he said, glancing at the therapists and smiling for the first time during the interview. But he said he was still depressed and frustrated. “It’s as if I am now an emotionally damaged child,” he said. “I don’t sleep. I think a lot. I’m smoking and drinking coffee.” His wife asks him what is wrong, but he does not tell her the whole truth. “This is personal,” he says. “I’m a father, I have two daughters. I don’t dare to talk about it.” Between Heaven and Hell Jamal, a 43-year-old farmer from Fallujah, said he was arrested by American forces in December 2003 at the home he shared with his wife and three small children, one of them disabled by spina bifida. He was arrested, he was told, because the soldiers thought a sniper was firing at them from his house or one nearby. He was taken away without shoes, a great humiliation for an Arab man. During an interview at the center for torture victims, Jamal — trimly built, bearded, with strong hands, and dressed in jeans and a knit sports shirt — displayed a copy of a document in English and Arabic that recorded his imprisonment. It was a “Mul
tiNationalForces MNF-1 verification of detention” card bearing his name and a serial number. It said he was detained from Dec. 15, 2003, until May 1, 2005. For the first week, he said, he was held standing up in a tent with a hood over his head, and the soldiers guarding him were ordered to let him sit for only five minutes an hour. The hood was removed only when he was fed. But he said two soldiers were kind, giving him water and letting him sit when the officer in charge was not around. Three times he was taken to an officer to be interrogated. The first time, the Americans asked him about terrorists they were looking for. He knew nothing. They took his clothes off, supposedly to look for tattoos. In the second interrogation, he said, the officer hit him with a baseball bat. Recalling the encounter, Jamal demonstrated, sliding from his chair to the floor. The officer made him sit with legs apart and hit him repeatedly in the genitals with the bat, he said. During the third interrogation, he said, the officer used an “electric stick” on his arms and legs. After seven days he was transferred to another military camp, about an hour’s drive away. Before he went, he recalled, one of the soldiers who had been kind shook his hand and apologized. At the new camp, he was allowed to use the bathroom only twice a day, and soldiers went with him. On the way, if he raised his head instead of looking down, they would hit him. After leaving him in the bathroom for only a minute or so, they would throw stones at the door or barge in before he could cover himself. Two men and a woman interrogated him. His wrists were tied together and fastened to the wall above his head, and he said men in uniform hit him. He was left in that position all night in a corridor, and periodically beaten. The next day, he said, the female interrogator shouted and hit him. She sat on a table close to his chair and rested her legs on him so that his head was between her thighs, near her crotch. She wore pants. She told him that because of him she had had to leave her children and come to Iraq. She cursed at him in Arabic. Jamal said he knew she was trying to do the most humiliating things possible to him as an Arab man. The worst thing, he said, was not knowing what to expect, whether he would be tortured more or killed. After the fourth day, he was taken to a prison: Abu Ghraib. The soldiers used markers to write serial numbers on the back of the prisoners’ necks. His greatest hope was to be allowed to use the bathroom in peace. Despite the widely reported abuses at Abu Ghraib around this time, Jamal said he was treated better there than in the previous camps. But it was winter, and the prison was crowded and muddy. The water for showers had turned to ice. There were two meals a day: bread and cheese, then rice and soup. He was cold and so hungry that he sometimes ate toothpaste and chewed scraps of newspaper. With no shoes, he could barely walk. For four months, he knew nothing about his family, and they had no idea what had become of him. The prison came under fire by Iraqi forces shooting at the Americans, and he saw prisoners killed. It terrified him. Then he and many other prisoners were moved to another prison, Buqa. In April 2005 he was taken to Ramadi, given underwear and a long robe called a dishdasha, and released. The American and Iraqi forces gave a party for the prisoners who were being let go, he said, laughing harshly at the memory. They gave him $20 and a piece of cake, and sent him on his way. He had been imprisoned for one year, four and a half months. He returned to his family, but was terrified that the Americans would arrest him again. He slept with his shoes in case they came for him during the night, so that he would not be taken away again with his feet bare. He became depressed. His livelihood was gone: he had been renting a plot of land that he planned to farm, but the family gave it up after he was taken away. His son’s spina bifida needed treatment. “My life was destroyed,” he said. He and his family came to Jordan in 2008. It was like moving from hell to heaven, he said, but he still had vivid nightmares of jail. He overstayed his visa — like virtually every Iraqi here — and was terrified of being sent back to Iraq. He began hitting his sons. Therapy at the center for torture victims has helped, he said. He told therapists that the torture “killed him inside.” He tries to forget his imprisonment, but at times every detail still seems clear in his mind. Even so, he considers himself lucky. Other prisoners died, had broken bones, became ill or were handed over to the Iraqis. “American jails are a million times better than Iraqi ones,” Jamal said. He has considered filing charges against the Americans who tortured him, he said, but does not think he can manage it from Jordan. And, he added, in order to be released he was compelled to sign a document saying he had not been abused. Because Jamal did not want his full name revealed, the United States Department of Defense could not comment on his claims. But a spokeswoman, Lt. Col. Tanya J. Bradsher, said by e-mail: “It was and continues to be against the law and DoD policy to mistreat detainees no matter where they were held. The U.S. takes all credible allegations of mistreatment seriously and fully investigates them.” Jamal receives money from the United Nations to help support his family. Last fall his son was flown to Boston for spina bifida surgery. He has stopped hitting his other children, and he no longer sleeps with his shoes. He hopes to move to the United States, but so far his applications have been denied. Last week, Ms. Anthoine-Milhomme said that new Iraqi clients were continuing to arrive “in very severe psychological condition” from episodes of torture, some quite recent.
On Monday, May 2, The New York Times published a major story about Iraqi refugees in Jordan with PTSD. Iraqi refugees are some of the people we are anticipating will be subjects in our Jordanian study of MDMA-assisted psychotherapy for PTSD once it’s finally approved by the Jordanian FDA, which seems likely to be soon. Sadly, it seems that there will be no shortage of subjects for our 12-person Jordanian study. In our US MDMA/PTSD study, we’re working with US veterans with war-related PTSD from either Iraq, Afghanistan, or Vietnam. We’ve already enrolled 4 subjects so far in this study, all from service in Iraq and/or Afghanistan. MAPS is working toward the day when MDMA-assisted psychotheray will be widely available to help treat people around the world with PTSD.
According to UK psychiatrist Ben Sessa, M.D., “[This story] illustrates how trauma–and particularly the trauma of war and conflict–has no international borders or political persuasions. In an analogous fashion MDMA is a substance that bridges the gap between psychopharmacology and psychotherapy like no other treatment we know as psychiatrists, a truly innovative new direction for mental health that we all hope can offer a significant breakthrough for the future management of PTSD.” Sessa is working with MAPS to acquire funding for a possible UK-based study of MDMA-assisted psychotherapy for PTSD.