Bodily Effects of Torture and Abuse
By Sam Vaknin
Author of "Malignant Self-love: Narcissism Revisited"
There is one place in which one's privacy, intimacy, integrity and inviolability are guaranteed – one's body, a unique temple and a familiar territory of sensa and personal history. The torturer invades, defiles and desecrates this shrine. He does so publicly, deliberately, repeatedly and, often, sadistically and sexually, with undisguised pleasure. Hence the all-pervasive, long-lasting, and, frequently, irreversible effects and outcomes of torture.
In a way, the torture victim's own body is rendered his worse enemy. It is corporeal agony that compels the sufferer to mutate, his identity to fragment, his ideals and principles to crumble. The body becomes an accomplice of the tormentor, an uninterruptible channel of communication, a treasonous, poisoned territory.
It fosters a humiliating dependency of the abused on the perpetrator. Bodily needs denied – sleep, toilet, food, water – are wrongly perceived by the victim as the direct causes of his degradation and dehumanization. As he sees it, he is rendered bestial not by the sadistic bullies around him but by his own flesh.
Beatrice Patsalides describes this transmogrification thus in "Ethics of the Unspeakable: Torture Survivors in Psychoanalytic Treatment":
"As the gap between the 'I' and the 'me' deepens, dissociation and alienation increase. The subject that, under torture, was forced into the position of pure object has lost his or her sense of interiority, intimacy, and privacy. Time is experienced now, in the present only, and perspective – that which allows for a sense of relativity – is foreclosed. Thoughts and dreams attack the mind and invade the body as if the protective skin that normally contains our thoughts, gives us space to breathe in between the thought and the thing being thought about, and separates between inside and outside, past and present, me and you, was lost."
Repeated abuse has long lasting pernicious and traumatic effects such as panic attacks, hypervigilance, sleep disturbances, flashbacks (intrusive memories), and suicidal ideation.
Victims and survivors experience psychosomatic and “real” bodily symptoms, some of them induced by the secretion of stress hormones such as cortisol: increased blood pressure, racing pulse, headaches, excessive sweating and myriad self-imputed diseases. The victims endures shame, depression, anxiety, embarrassment, guilt, humiliation, abandonment, and an enhanced sense of vulnerability.
C-PTSD (Complex PTSD) has been proposed as a new mental health diagnosis by Dr. Judith Herman of Harvard University to account for the impact of extended periods of trauma and abuse.
In "Stalking – An Overview of the Problem" [Can J Psychiatry 1998;43:473–476], authors Karen M Abrams and Gail Erlick Robinson write:
"Initially, there is often much denial by the victim. Over time, however, the stress begins to erode the victim's life and psychological brutalisation results. Sometimes the victim develops an almost fatal resolve that, inevitably, one day she will be murdered. Victims, unable to live a normal life, describe feeling stripped of self-worth and dignity. Personal control and resources, psychosocial development, social support, premorbid personality traits, and the severity of the stress may all influence how the victim experiences and responds to it… Victims stalked by ex-lovers may experience additional guilt and lowered self-esteem for perceived poor judgement in their relationship choices. Many victims become isolated and deprived of support when employers or friends withdraw after also being subjected to harassment or are cut off by the victim in order to protect them. Other tangible consequences include financial losses from quitting jobs, moving, and buying expensive security equipment in an attempt to gain privacy. Changing homes and jobs results in both material losses and loss of self-respect."
Surprisingly, verbal, psychological, and emotional abuse have the same effects as the physical variety [Psychology Today, September/October 2000 issue, p.24]. Abuse of all kinds also interferes with the victim's ability to work. Abrams and Robinson wrote this [in "Occupational Effects of Stalking", Can J Psychiatry 2002;47:468–472]:
"… (B)eing stalked by a former partner may affect a victim's ability to work in 3 ways. First, the stalking behaviours often interfere directly with the ability to get to work (for example, flattening tires or other methods of preventing leaving the home). Second, the workplace may become an unsafe location if the offender decides to appear. Third, the mental health effects of such trauma may result in forgetfulness, fatigue, lowered concentration, and disorganisation. These factors may lead to the loss of employment, with accompanying loss of income, security, and status."
Still, it is hard to generalise. Victims are not a uniform lot. In some cultures, abuse is commonplace and accepted as a legitimate mode of communication, a sign of love and caring, and a boost to the abuser's self-image. In such circumstances, the victim is likely to adopt the norms of society and avoid serious trauma.
Deliberate, cold-blooded, and premeditated torture has worse and longer-lasting effects than abuse meted out by the abuser in rage and loss of self-control. The existence of a loving and accepting social support network is another mitigating factor. Finally, the ability to express negative emotions safely and to cope with them constructively is crucial to healing.
Typically, by the time the abuse reaches critical and all-pervasive proportions, the abuser had already, spider-like, isolated his victim from family, friends, and colleagues. She is catapulted into a nether land, cult-like setting where reality itself dissolves into a continuing nightmare.
When she emerges on the other end of this wormhole, the abused woman (or, more rarely, man) feels helpless, self-doubting, worthless, stupid, and a guilty failure for having botched her relationship and "abandoned" her "family". In an effort to regain perspective and avoid embarrassment, the victim denies the abuse or minimises it.
No wonder that survivors of abuse tend to be clinically depressed, neglect their health and personal appearance, and succumb to boredom, rage, and impatience. Many end up abusing prescription drugs or drinking or otherwise behaving recklessly.
Some victims even develop Post-Traumatic Stress Disorder (PTSD).
Contrary to popular misconceptions, Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (or Reaction) are not typical responses to prolonged abuse. They are the outcomes of sudden exposure to severe or extreme stressors (stressful events). Yet, some victims whose life or body have been directly and unequivocally threatened by an abuser react by developing these syndromes. PTSD is, therefore, typically associated with the aftermath of physical and sexual abuse in both children and adults.
This is why another mental health diagnosis, C-PTSD (Complex PTSD) has been proposed by Dr. Judith Herman of Harvard
University to account for the impact of extended periods of trauma and abuse. It is described here:
One's (or someone else's) looming death, violation, personal injury, or powerful pain are sufficient to provoke the behaviours, cognitions, and emotions that together are known as PTSD. Even learning about such mishaps may be enough to trigger massive anxiety responses.
The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps re-living the experience through recurrent and intrusive visual and auditory hallucinations ("flashbacks") or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically re-enacts the event while being thoroughly oblivious to her whereabouts.
In an attempt to suppress this constant playback and the attendant exaggerated startle response (jumpiness), the victim tries to avoid all stimuli associated, however indirectly, with the traumatic event. Many develop full-scale phobias (agoraphobia, claustrophobia, fear of heights, aversion to specific animals, objects, modes of transportation, neighbourhoods, buildings, occupations, weather, and so on).
Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations, or people who remind them of the traumatic occurrence ("triggers").
This constant hypervigilance and arousal, sleep disorders (mainly insomnia), the irritability ("short fuse"), and the inability to concentrate and complete even relatively simple tasks erode the victim's resilience. Utterly fatigued, most patients manifest protracted periods of numbness, automatism, and, in radical cases, near-catatonic posture. Response times to verbal cues increase dramatically. Awareness of the environment decreases, sometimes dangerously so. The victims are described by their nearest and dearest as "zombies", "machines", or "automata".
The victims appear to be sleepwalking, depressed, dysphoric, anhedonic (not interested in anything and find pleasure in nothing). They report feeling detached, emotionally absent, estranged, and alienated. Many victims say that their "life is over" and expect to have no career, family, or otherwise meaningful future.
The victim's family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy, and of having sex (due to her post-traumatic "frigidity"). Many victims become paranoid, impulsive, reckless, and self-destructive. Others somatise their mental problems and complain of numerous physical ailments. They all feel guilty, shameful, humiliated, desperate, hopeless, and hostile.
PTSD need not appear immediately after the harrowing experience. It can – and often is – delayed by days or even months. It lasts more than one month (usually much longer). Sufferers of PTSD report subjective distress (the manifestations of PTSD are ego-dystonic). Their functioning in various settings – job performance, grades at school, sociability – deteriorates markedly.
The DSM-IV-TR (Diagnostic and Statistical Manual) criteria for diagnosing PTSD are far too restrictive. PTSD seems to also develop in the wake of verbal and emotional abuse and in the aftermath of drawn out traumatic situations (such a nasty divorce). Hopefully, the text will be adapted to reflect this sad reality.