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Synopsis
A director of the Harvard Program in Refugee Trauma draws on hundreds of interviews with trauma victims from around the world to make recommendations on how to draw on the examples of others in order to survive and heal after violent experiences. 16,000 first printing.
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About the Author
RICHARD F. MOLLICA, MD, is a Harvard Medical School professor of psychiatry and director of the Harvard Program in Refugee Trauma. He holds an MAR from Yale Divinity School and is a Fulbright New Century Scholar. The recipient of many honors and awards, including the APA Human Rights Award, he lives in Cambridge, Massachusetts.
Reviews
Mollica breaks with what he says is the conventional wisdom that torture victims are untreatable. In limpid prose, Mollica, director of the Harvard Program in Refugee Trauma, celebrates instead "the capacity of persons to recover from violent events and to engage in self-healing." He explains how his clinic offers traumatized refugees to America housing, emotional support, counseling in their own language and participation in therapeutic self-healing programs. Demonstrating the importance of cultural sensitivity, especially to language, and the significant healing power of attuned listening to the "trauma story," Mollica writes: "Survivors must be allowed to tell their stories their own way. We must not burden them with theories, interpretations, or opinions, especially if we have little knowledge of their cultural and political background." Relating harrowing survivor stories from Cambodia, Bosnia, Rwanda and the World Trade Center, among others, Mollica describes the psychological effects of humiliation, cultural annihilation and sexual violence, showing how victims "suffer a divide in their conscious minds" between hope and despair. Mollica advocates moral and emotional discipline in both healer and patient. Passionately endorsing a humanitarian, holistic and culturally sensitive approach to healing, Mollica persuades with pertinent reference to contemporary neuroscience and to ancient and non-Western healing practices. (Dec.)
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As director and cofounder of the Harvard Program in Refugee Trauma, Mollica has born witness to the devastating consequences of the most unspeakable acts of violence humans have conceived. Furthermore, he has seen firsthand how victims of inhumanity have found the inner strength to overcome life-altering trauma with renewed faith and have even regained humor and optimism. After a slow start, Mollica's book reaches a passionate peak as he relates his clients' experiences in the prison camps of the Khmer Rouge, as Bosnian genocide survivors, and as victims of domestic violence. When he describes self-healing techniques, including verbalizing one's own story and the importance of faith, he speaks from the wisdom of his practice not as a healer as much as a guide for those on the road to wellness. His empowering message is that the invisible wounds left by violence are not intractable, that people can and will persevere, and he offers a handful of the necessary skills. Donna Chavez
Copyright © American Library Association. All rights reserved
Excerpt. © Reprinted by permission. All rights reserved.
Chapter 1
Striking Out on a New Path
ALTHOUGH WE ALL KNOW that suffering is a universal human experience, the modern world still does not know how to speak about and understand the terrible experiences that human beings inflict on each other every day. Because of the horror and disbelief associated with human-on-human violence, it is easy to slide into a cynical attitude that nothing can be done to prevent this violence or to recover from it. One reason for this is that the major harms caused by human aggression are invisible wounds. While physical scars can be identified and accounted for by medical science, psychological, spiritual, and existential injuries remain hidden.
I have spent the past twenty-five years caring for people who have experienced human aggression on a societal scale, as refugees, victims of torture or terrorism, and survivors of war. My experiences reveal a new way of thinking about human aggression and the healing of the physical and emotional damage caused by violence. Major insights, which I call scientific epiphanies or revelations, occurred as I interacted with my patients. I proceeded to investigate these conclusions scientifically and, when they were proven valid, to integrate them into my clinical care. These revelations form the basis for the healing practices advocated in this book.
My pathway to this work was a circuitous one. Educated in a technical high school with an engineering curriculum of physics, chemistry, and math, I discovered early on that science does not address the moral and humanistic issues of society. These matters are better addressed by the humanities and arts. Although I had never met a doctor except during routine physical examinations, in college I majored in chemistry and religion, fantasizing that in medicine I could apply my interests in science, religion, philosophy, and the arts to better the human condition. While in medical school in New Mexico, I worked in the remote Hispanic villages of northern New Mexico and the Indian reservations of Zuni and Jemez Pueblo, serving poor patients within a rich cultural and natural environment. Subsequently I undertook residency training in psychiatry while simultaneously pursuing an advanced degree in religion and philosophy. Divinity school provided the moral compass for my medical and scientific skills, as well as for my future work with survivors of extreme violence. My interests in the arts and literature have also informed my work, yielding metaphorical insights to mysteries that are beyond the abilities of science and medicine to explain.
A NEW CLINIC
When I arrived at Harvard as a young doctor in the early 1980s, I knew that I wanted to provide the highest quality of medical and psychiatric care to the poorest people in my community, in spite of financial and political barriers. Looking around the Greater Boston area for those who most needed help, I found that newly arrived refugees from Southeast Asia were both extremely poor and almost totally excluded from the existing public, private, and academic medical systems. With the help of James Lavelle, a young idealistic social worker already working for the refugee community, we decided to set up a small free clinic for them in the Brighton section of Boston, initially called the Indochinese Psychiatry Clinic, later the Harvard Program in Refugee Trauma. Our little group unknowingly became one of the first refugee mental health clinics in America.
During this time, medicine and psychiatry were still color- and gender-biased, in spite of the work of individuals such as my mentor, Fritz Redlich, a Yale professor of psychiatry. Redlich showed in a study in the early 1950s that although mental illness was more prevalent in the poor, they received a radically different type of psychiatric care than middle-class and rich patients.1 Poor patients were often given drugs and rarely psychotherapy because they were considered incapable of psychological insights into their mental health problems. Psychiatrists rarely treated these patients; instead they received treatment primarily from paraprofessionals, that is, mental health workers with limited clinical training. Twenty-five years later, I revealed in a follow-up study that treatment biases toward the poor and African Americans remained unchanged, in spite of enormous efforts by the federal government to rectify the situation by providing easy access to community mental health centers. Newly arrived Southeast Asian refugees were still thrown into a large group of low-status patients receiving a low level of health care and mental health care, because they were poor, overwhelmed by social problems, nonwhite, and unfamiliar with American mental health practices, especially psychotherapy.
All refugees entering America have a basic health screening in a government-funded primary health care center. Tens of thousands of Southeast Asian refugees, victims from the war in Vietnam, were flooding through these centers to start their new lives in America. Our team of medical pioneers was waiting in the Brighton clinic to help them with their emotional distress, which was often readily apparent to the primary care doctors who referred them to our clinic. Our staff included Jim Lavelle; Ter Yang, a Hmong chief from the animistic tribes of Laos; Binh Tu, a Vietnamese ex-soldier who had been the “Frank Sinatra” of the Vietnamese army; and Rosa Lek, a young Cambodian woman whose job was drawing blood in a medical laboratory.
The mental health clinic was initially open one half-day a week. Our services were free and none of us were paid. Referrals came flooding in from our medical colleagues at the rate of sometimes twenty refugee patients in a single afternoon. The refugees did not have to be convinced of the value of the clinic; they immediately felt comfortable being greeted by a medical doctor, a social worker, and respected members of their own communities. Our Indo-Chinese colleagues were never used as interpreters; they always functioned as integral elements of our treatment team, in a bicultural partnership that was key to our clinical success.
As I listened to the story of Leakana, an elderly Cambodian woman who was one of the first patients in our clinic, I realized that the conventional psychiatric tools I had been taught would not be sufficient to help her:
During the year of the snake, the God of the Sun came to stay in my body. It made my body shaky all over—and I fainted. Upon awakening, I can remember as I opened my eyes that it was very dark. I then went to the rice fields to find someone to ask them what time it was. A voice shouted 10 o’clock. Suddenly, the owls began to cry and all the animals that represented death were howling all around me. I could also barely see a small group of people whispering to each other in the forest. I became so frightened that I tried to calm myself by praying to all the Gods and the angels in heaven to protect me from danger. I was so paralyzed with fear that I was unable to walk either backward or forward.
I came to settle in east Boston near the ocean. Now when I dream, I always see an American who dresses in black walking along the sea. One day when I was in my sponsor’s house, I had this vision. This year, the year of the cow, I would like the American people to help me build a temple near the seashore. Since the Pol Pot soldiers killed my children, I am so depressed that all I can think about is just to build a temple—that is all. God appeared to me again the other day, and he told me to build a temple. Please help me make my dream come true. If not, I do not think I can live any more.
Leakana had survived the Khmer Rouge labor camps that killed five daughters and four of her ten grandchildren. After fleeing Cambodia into the Thai refugee camps, she and a remaining son and daughter were resettled in America. Psychologically, she was full of fear, anxiety, and despair. Her main medical complaint was that she was dizzy and chronically on the verge of fainting.
At that time I was unfamiliar with Leakana’s culture and language and the extent of the atrocities committed by the Khmer Rouge. Few Americans were then fully aware of the genocide in Cambodia between 1975 and 1979, when more than two million people, out of approximately eight million, died of starvation and murder in the labor camps.
Striking Out on a New Path
ALTHOUGH WE ALL KNOW that suffering is a universal human experience, the modern world still does not know how to speak about and understand the terrible experiences that human beings inflict on each other every day. Because of the horror and disbelief associated with human-on-human violence, it is easy to slide into a cynical attitude that nothing can be done to prevent this violence or to recover from it. One reason for this is that the major harms caused by human aggression are invisible wounds. While physical scars can be identified and accounted for by medical science, psychological, spiritual, and existential injuries remain hidden.
I have spent the past twenty-five years caring for people who have experienced human aggression on a societal scale, as refugees, victims of torture or terrorism, and survivors of war. My experiences reveal a new way of thinking about human aggression and the healing of the physical and emotional damage caused by violence. Major insights, which I call scientific epiphanies or revelations, occurred as I interacted with my patients. I proceeded to investigate these conclusions scientifically and, when they were proven valid, to integrate them into my clinical care. These revelations form the basis for the healing practices advocated in this book.
My pathway to this work was a circuitous one. Educated in a technical high school with an engineering curriculum of physics, chemistry, and math, I discovered early on that science does not address the moral and humanistic issues of society. These matters are better addressed by the humanities and arts. Although I had never met a doctor except during routine physical examinations, in college I majored in chemistry and religion, fantasizing that in medicine I could apply my interests in science, religion, philosophy, and the arts to better the human condition. While in medical school in New Mexico, I worked in the remote Hispanic villages of northern New Mexico and the Indian reservations of Zuni and Jemez Pueblo, serving poor patients within a rich cultural and natural environment. Subsequently I undertook residency training in psychiatry while simultaneously pursuing an advanced degree in religion and philosophy. Divinity school provided the moral compass for my medical and scientific skills, as well as for my future work with survivors of extreme violence. My interests in the arts and literature have also informed my work, yielding metaphorical insights to mysteries that are beyond the abilities of science and medicine to explain.
A NEW CLINIC
When I arrived at Harvard as a young doctor in the early 1980s, I knew that I wanted to provide the highest quality of medical and psychiatric care to the poorest people in my community, in spite of financial and political barriers. Looking around the Greater Boston area for those who most needed help, I found that newly arrived refugees from Southeast Asia were both extremely poor and almost totally excluded from the existing public, private, and academic medical systems. With the help of James Lavelle, a young idealistic social worker already working for the refugee community, we decided to set up a small free clinic for them in the Brighton section of Boston, initially called the Indochinese Psychiatry Clinic, later the Harvard Program in Refugee Trauma. Our little group unknowingly became one of the first refugee mental health clinics in America.
During this time, medicine and psychiatry were still color- and gender-biased, in spite of the work of individuals such as my mentor, Fritz Redlich, a Yale professor of psychiatry. Redlich showed in a study in the early 1950s that although mental illness was more prevalent in the poor, they received a radically different type of psychiatric care than middle-class and rich patients.1 Poor patients were often given drugs and rarely psychotherapy because they were considered incapable of psychological insights into their mental health problems. Psychiatrists rarely treated these patients; instead they received treatment primarily from paraprofessionals, that is, mental health workers with limited clinical training. Twenty-five years later, I revealed in a follow-up study that treatment biases toward the poor and African Americans remained unchanged, in spite of enormous efforts by the federal government to rectify the situation by providing easy access to community mental health centers. Newly arrived Southeast Asian refugees were still thrown into a large group of low-status patients receiving a low level of health care and mental health care, because they were poor, overwhelmed by social problems, nonwhite, and unfamiliar with American mental health practices, especially psychotherapy.
All refugees entering America have a basic health screening in a government-funded primary health care center. Tens of thousands of Southeast Asian refugees, victims from the war in Vietnam, were flooding through these centers to start their new lives in America. Our team of medical pioneers was waiting in the Brighton clinic to help them with their emotional distress, which was often readily apparent to the primary care doctors who referred them to our clinic. Our staff included Jim Lavelle; Ter Yang, a Hmong chief from the animistic tribes of Laos; Binh Tu, a Vietnamese ex-soldier who had been the “Frank Sinatra” of the Vietnamese army; and Rosa Lek, a young Cambodian woman whose job was drawing blood in a medical laboratory.
The mental health clinic was initially open one half-day a week. Our services were free and none of us were paid. Referrals came flooding in from our medical colleagues at the rate of sometimes twenty refugee patients in a single afternoon. The refugees did not have to be convinced of the value of the clinic; they immediately felt comfortable being greeted by a medical doctor, a social worker, and respected members of their own communities. Our Indo-Chinese colleagues were never used as interpreters; they always functioned as integral elements of our treatment team, in a bicultural partnership that was key to our clinical success.
As I listened to the story of Leakana, an elderly Cambodian woman who was one of the first patients in our clinic, I realized that the conventional psychiatric tools I had been taught would not be sufficient to help her:
During the year of the snake, the God of the Sun came to stay in my body. It made my body shaky all over—and I fainted. Upon awakening, I can remember as I opened my eyes that it was very dark. I then went to the rice fields to find someone to ask them what time it was. A voice shouted 10 o’clock. Suddenly, the owls began to cry and all the animals that represented death were howling all around me. I could also barely see a small group of people whispering to each other in the forest. I became so frightened that I tried to calm myself by praying to all the Gods and the angels in heaven to protect me from danger. I was so paralyzed with fear that I was unable to walk either backward or forward.
I came to settle in east Boston near the ocean. Now when I dream, I always see an American who dresses in black walking along the sea. One day when I was in my sponsor’s house, I had this vision. This year, the year of the cow, I would like the American people to help me build a temple near the seashore. Since the Pol Pot soldiers killed my children, I am so depressed that all I can think about is just to build a temple—that is all. God appeared to me again the other day, and he told me to build a temple. Please help me make my dream come true. If not, I do not think I can live any more.
Leakana had survived the Khmer Rouge labor camps that killed five daughters and four of her ten grandchildren. After fleeing Cambodia into the Thai refugee camps, she and a remaining son and daughter were resettled in America. Psychologically, she was full of fear, anxiety, and despair. Her main medical complaint was that she was dizzy and chronically on the verge of fainting.
At that time I was unfamiliar with Leakana’s culture and language and the extent of the atrocities committed by the Khmer Rouge. Few Americans were then fully aware of the genocide in Cambodia between 1975 and 1979, when more than two million people, out of approximately eight million, died of starvation and murder in the labor camps.
Copyright © 2006 by Richard F. Mollica
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or transmitted in any form or by any means, electronic or mechanical,
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Requests for permission to make copies of any part of the work
should be submitted online at www.harcourt.com/contact or mailed
to the following address: Permissions Department, Harcourt, Inc.,
6277 Sea Harbor Drive, Orlando, Florida 32887-6777.
"About this title" may belong to another edition of this title.
- PublisherHarcourt
- Publication date2006
- ISBN 10 0151010366
- ISBN 13 9780151010363
- BindingHardcover
- LanguageEnglish
- Edition number1
- Number of pages277
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