Peace of mind

SCHOOL OF IRAQ Mental health workers training in Dohuk, Iraqi Kurdistan.

Chicagoan Scott Portman deals with the aftereffects of torture on a regular, hands-on basis. Since 2004 his organization, Heartland Alliance—which offers social services to people in the Chicago area—has been sending physicians, psychologists, therapists and social workers to Iraq to train Iraqi health professionals to treat victims of the same types of torture that have recently been making headlines here in the U.S.: waterboarding, simulated suffocation, prolonged exposure, stress positions, hypothermia.

“There are no clinical social-work schools in Iraq—maybe about ten actual psychologists with some clinical experience,” says Portman. As Heartland’s director of international programs, he travels to Iraq about every three months to oversee the outreach to civilian survivors of Saddam Hussein’s regime and victims tortured by Iraqi militia units. Portman’s staff works with the Iraqi Ministry of Health training physicians and medical assistants to treat depression and post-traumatic stress disorder (PTSD).

Heartland’s training and supervision of Iraqi health professionals has given way to hands-on work with victims. “Recently we’ve opened a torture treatment center in Sulaimaniyah, where we provide one-on-one treatment,” Portman says. “We work with the families, develop strategies for suicide prevention, and try to remedy the common symptoms torture survivors experience: nightmares, panic attacks, flashbacks, hyperarousal and sleep problems. Many survivors only sleep two to three hours a night,” he says. “Torture tends to cause the way the body regulates stress to get out of whack,” Portman explains, “and creates a feedback loop, where the person continues to react in certain ways—biologically and physically, as well as psychologically.”

To most effectively treat patients, Heartland Alliance tailors its mental-health programs to be culturally sensitive, Portman says, because “different cultures have different beliefs, which translate to differing [ideas about] depression and PTSD. Also, the roles of religion, family and relations within the community are much more important to Iraqis. In the U.S., we tend to be more of an individualistic culture—the focus in therapy here is usually on the individual. In Iraq, oftentimes the focus [is] on the family. For instance, suicide prevention involves safety planning with the family, destigmatizing suicide so that the family doesn’t blame the victim.”

Some victims have had family or friends assaulted in front of them, and even some of Portman’s Iraqi staff are torture victims. “[They] can be symptomatic at the same time they’re treating others, which can exacerbate their own symptoms,” he says.

“Among Iraqis, there’s a deep cultural desire to just forget and move on, to not openly recognize and look at torture directly,” Portman observes. This leads to reluctance among health professionals to deal with torture as a health issue. “But these things can haunt an entire generation. The effects of this violence can persist through children of survivors, as with the Holocaust,” Portman says. “But at least with survivors, there’s still a story there to be continued. There’s still a future to be written.”