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Healing the wounds - personal reflections

on the evolution of therapeutic methods
for survivors of torture
Inger Agger

Abstract gist with Latin American political refugees

With the arrival in Denmark of torture sur- who had arrived in Denmark and had been
vivors from Latin America in the nineteen exposed to torture and persecution in their
seventies and eighties, therapists faced the homelands. At that time, I was active in the
challenge of how best to accompany the sur- New Left Movement, which assembled activ-
vivors in their healing processes. The New ists who campaigned for social issues such as
Left and Feminism were important political women’s rights and political rights. I wanted
movements which influenced the therapeu- to use my psychology degree politically, pri-
tic approaches discussed at that time. In the marily through a feminist perspective. I was a
author’s meeting with Latin American col- member of a Consciousness-Raising Group
leagues a dialogue about therapeutic methods (CR-G). CR groups were a central and revo-
was further developed with emphasis on the lutionary part of the Women’s Liberation
connection between “Human Rights and Movement and I wrote my master’s thesis
Mental Health”. The civil war in the Balkans on the healing dimensions of CR groups
in the nineties brought new challenges: the with the purpose of analysing how they sup-
development of psychosocial community in- ported women in understanding the relation-
terventions as well as an intensification of the ship between the “private and the political
debate between the “medical” and psycho- spheres”. One of the main subjects in these
social approaches to trauma healing. Coop- groups concerned female sexual oppression
eration during the last decade with NGOs in and how a patriarchal society dominated
e.g., India, Cambodia, and Honduras brought women’s sexuality. In the CR-groups, women
new and more holistic perspectives on therapy gave testimony about their private lives,
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represented by a brief version of Testimonial seeking to see their personal experiences from
Therapy that sought to integrate cultural and a political perspective.
spiritual traditions as well as “third wave” When I met the Latin American refugees
cognitive methods. and torture victims, I found resonance and
political discourse that was familiar. They
From European feminism to Latin America talked about their “life project”, how it had
reality been disrupted and how they longed to return
For me, a reflection on the past should take to their homelands and continue the strug-
its point of departure in 1984, when I started gle for human rights and freedom. Many of
working at the RCT as a clinical psycholo- them were activists. That was why they had

https://doi.org/10.7146/torture.v32i1-2.129580
International Rehabilitation Council for Torture Victims. All rights reserved.
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been imprisoned and tortured. During the Psychosocial and community work: the
Eighties, I also met with Elizabeth Lira and debate in the Balkans
other Latin American colleagues at confer- From 1993 to 1997, during the war in the
ences who brought their books and articles to former Yugoslavia, as the European Union
Denmark. They connected, following Martín- (EU) Coordinator of Psychosocial Programs
Baró, “mental health and human rights” with for war-affected people, we searched for prac-
political oppression and torture. The healing tical and valuable methods to accompany the
processes we created in the dialectical con- suffering population. National and interna-
nection between the private and the polit- tional mental health professionals were feeling
ical spheres. The victims suffering from a overwhelmed and helpless as the first war in
repressive political system. Furthermore, Europe since the Second World War devel-
refugee women from the Middle East and oped and the refugee crisis intensified. Like-
Latin American women also gave testimonies wise, did the battle between the “medical” and
about how patriarchal oppression of women “psychosocial” professionals. How should one
was abused worldwide during sexual torture approach trauma and healing in this new war
(Agger, 1989; 1994). context? The war necessitated other interven-
Colleagues in the South were sending us, tions on a mass scale than what was common
in Europe, a clear message: paternalistic and under peaceful circumstances.
medicalising attitudes were not acceptable Eventually, it was recognised that little
when torture and violence are rooted in pol- healing could be done during the war. The
itics. Evidence of this was the heated debate best approach was to focus on survival or pre-
among professionals working with survivors of vention of the deterioration of the survivors’
torture and state violence in the Nineties. On psychological and social status through com-
one side of the battle were the “medicalising” munity mental health. Eventually, we arrived
people who viewed the distress of torture sur- at the following definition of psychosocial
vivors as an “illness” (Post-Traumatic Stress emergency assistance: The aim of psychosocial
Disorder), which in principle should be cured emergency assistance under war conditions is to
as other types of medical conditions. On the promote mental health and human rights by strat-
other side were the professionals from the egies that support the already existing protective
psychosocial community, which I belonged social and psychological factors and diminish the
to. Part of this debate was reflected in the stressor factors at different levels of intervention
pages of Torture Journal, among other places. (Agger et al., 1995)1. That definition was an
We accused the medical side of neo-colonial- official EU position and, thus, a commitment
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ist approaches and were critical of the wide- beyond the biomedical approach.
spread use of the PTSD diagnosis. Many of The war rapes and sexual torture of both
us did not feel that the symptoms of PTSD men and women in ex-Yugoslavia ignited
could adequately describe the stressful expe- further discussions and reflections. Were there
riences of torture and war. As Chilean col-
leagues emphasized: giving medical diagnoses
to survivors of state terrorism can be viewed
1 The research also concluded that psychosocial
as double victimisation: “blaming the victims” work needs to be accountable, despite the large
by stigmatising them as “mentally ill” (Agger difficulties it might entail to do assessments of
& Jensen, 1996). efficacy of projects implemented in war-torn
communities.
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national or international interests in con- research project from 2008-2010, we2 devel-
structing a rape victim identity of ex-Yugo- oped a particular brief version of Testimonial
slav women or a trauma victim identity of the Therapy (TT)3 that sought to integrate Asian
ex-Yugoslav people? It would seem like the war cultural and spiritual traditions (Agger et
rape and trauma survivors were exploited for al., 2012, Jørgensen et al., 2015). This new
various political purposes. version included a public ceremony at the end
In an evaluation carried out by the EU of the testimony process. This ceremony came
in Bosnia and Croatia in 1995 during the to play an essential role because it connected
last months of the war, we distributed ques- the survivor to his or her community through
tionnaires to 2,291 participants and 165 na- public acknowledgement and mobilisation
tional staff members of psychosocial projects based on the narrative about the human rights
funded by the European community (Agger violations suffered by the survivor.
& Mimica, 1996). The results indicated that Sadly, Testimonial Therapy has in some
the participants were most often exposed to instances been used to justify the expansion
life-threatening events (85%), loss of home of Narrative Exposure Therapy (NET) – a
and property (85%), hunger and thirst (60%), therapy allegedly based on TT with little em-
torture or extremely bad treatment (30%), and phasis on the political context of the traumatic
illness (30%). 80% reported that participa- experience. The emphasis of NET is rather
tion in the project was of considerable help to on narrating in as much detail as possible the
them. Our study illustrated that war trauma is survivors’ painful experiences without refer-
much more than exposure to a single stressful ence to the ideological and cultural meaning
event. It is a long and enduring state of severe or frame within which the torture was perpe-
stress and uncertainty about the future (Agger trated. The lack of a meaningful frame might
& Mimica, 1996). Maybe the true war trauma hinder the process of integrating the trau-
symptoms should have been identified as na- matic experience and in some cases lead to
tionalism, lack of tolerance for differences, and re-traumatisation by repeating the painful ex-
withdrawal into ethnic groups – symptoms of perience without facilitating an understand-
the terror and mistrust that the horror of civil
war had caused in the population. However,
the psychosocial projects, viewed as crisis in- 2 In a cooperation between the RCT and Asian
tervention, seemed to have attained their goal: NGO partners, in particular with People’s
to keep people going even under complicated Vigilance Committee for Human Rights
(PVCHR), led by Dr. Lenin Raghuvanshi,
circumstances.
Varanasi, India. I was in the role of an external
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consultant.
Integrating new ideas towards a holistic 3 Testimonial Therapy is an individual “human
approach to therapy rights” psychotherapy for survivors of torture
and other types of violence that has the narration
Over the last years, interesting new devel- of the survivors’ traumatic experiences and a
opments have been the “third wave” cogni- public ceremony as its central components.
tive methods, which are inspired by Asian The trauma stories are recorded, jointly edited
religious practices and combine elements of by the therapist and survivor, compiled into a
document, and read out in a public ceremony.
meditation and mindfulness with cognitive- The document may be used by the survivor to
behavioural therapy (CBT). In an action raise public and international awareness about
human rights violations (Agger et al., 2012;
Puvimanasinghe & Price, 2016).
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ing of “why this horror happened to me”. included Testimonial Therapy. The leader-
NET can basically be viewed as one more ex- ship of MILPAH emphasized their determi-
posure technique with another label, and not nation to preserve the culture and religion of
much different from the medical model which the Lenca, and during the training the par-
the RCT advocated in the Eighties (Mundt, ticipants designed a Cosmic Circle Ceremony
Wünsche, Heinz & Pross, 2014). which consisted of a circle on the earth made
“Third wave” cognitive methods, which with plants, flowers, water, incense, and four
have emerged recently, focus on holistic pro- colored candles. Standing within this altar,
cesses of well-being in contrast to symptom al- which they had built themselves, the survivors
leviation, and they often incorporate “Eastern” read their testimonies aloud and the Circle,
methods of meditation and spirituality, e.g., thus, became an essential healing element of
Compassion Focused Therapy (CFT), and the modified Testimonial Therapy ceremony.
Culturally-Adapted Cognitive Behavioural The Cosmic Circle incorporated elements of
Therapy (CA-CBT). My research in Bud- nature: earth, air, fire, water, by which the
dhist Cambodia from 2010 to 2012 indi- participants could invoke their ancestors, and
cated that Third Wave methods are becoming the guardians of the rivers and the forest. The
more readily transposable to work not only ceremony also allowed the survivors to invite
with Buddhist torture survivors but also with their relatives and neighbours of the commu-
victims of persecution in other cultural or re- nity whereby their struggle for human rights
ligious contexts. As “Western” practitioners could be reaffirmed and legitimised.
of psychotherapy we have much to learn from As an effect of the COVID pandemic, the
Eastern traditions, e.g., Cambodian notions Cambodian mental health NGO Transcultural
of the importance of “cooling the body” and Psychosocial Organization (TPO)5 has recently
“thinking too much” correspond well with explored the possibilities of including online
Western notions of core “emotion regula- testimonial therapy in its toolbox. An online
tion and distress tolerance skills” and how to ceremony might include up to one hundred
“restore self-regulation” (Agger, 2015). people who could witness the ceremony at a
time when only a few people are allowed to
Integrating indigenous practice attend a ceremony at the local pagoda.
In Honduras in 2017, during training with thir-
teen Indigenous leaders of the Lenca people Final remarks
who were also survivors of state violence, we4 When I look back at the reflections on the
explored and integrated Indigenous cultural evolution of therapeutic methods described
T O R T U R E Vo l um e 3 2 , N um be r 1 - 2, 20 2 2

practices of the Lenca into a local design of here, there seems to be a direction going
a psychological trauma healing process which

5 Especially through the Cambodian Psychologist

4 The Honduran Psychologist Arely Alvarado and Phaneth Sok. Testimonial Therapy carried out by
I cooperated in the framework of the Danish TPO was adopted by the UN-supported Khmer
NGO “Nunca Más – International Network for Rouge Tribunal in 2014 as one of the reparations
Human Rights and Psychosocial Response” and made available to survivors (Lesley, 2021; Esala
in collaboration with “MILPAH” (Movimiento & Taing, 2017). The tribunal was established in
Independiente Indígena Lenca de la Paz- 2006 to bring to trial senior leaders and those
Honduras), an indigenous Honduran human most responsible for crimes committed during
rights group. the Khmer Rouge regime from 1975-1979.
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ECHO.
from a rather radical one-sided view in the Agger, I. (1994). The blue room: Trauma and testimony
early Eighties towards a broader spectrum of among refugee women. London: Zed Books.
approaches that includes diverse aspects of Spanish edition (1994). La pieza azul: Testimonio
femenino del exilio. Santiago de Chile; Cuarto
human existence in the political, social, phys-
Proprio.
ical, spiritual and cultural spheres. A long Agger, I. (1989). Sexual torture of political prisoners.
journey shared with people and communities Journal of Traumatic Stress, 2 (3), 305-318.
in many different contexts and positions. Esala, J.J. & Taing, S. (2017). Testimony therapy
with ritual: A pilot randomised controlled trial.
Journal of Traumatic Stress, 30 (1), 94-98.
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Agger, I., Igreja, V., Kiehle, R., & Polatin, P. (2012). Jørgensen, M. M., Modvig, J., Agger, I., Raghuvanshi,
Testimony ceremonies in Asia: Integrating L., Khan, S. S. & Polatin, P. (2015). Testimonial
spirituality in testimonial therapy for torture therapy: Impact on social participation and
survivors in India, Sri Lanka, Cambodia, and emotional wellbeing among Indian survivors of
the Philippines. Transcultural Psychiatry, 46(3-4), torture and organized violence. Torture, 25(2),
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Agger, I. & Jensen, S.B. (1996). Trauma and healing Mundt, A.P., Wünsche, P., Heinz, A. & Pross,
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de Chile: CESOC. Pérez-Sales, P. (2021). Personal communication.
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