The brutal treatment of journalists in Iran continues, new research has shown. In a study of 114 Iranian journalists, almost 60 percent had been arrested and 20 percent reported having been tortured – resulting in high levels of depression and symptoms of Post-Traumatic Stress Disorder (PTSD).

In Denmark, the institute DIGNITY specializes in the rehabilitation of people traumatized by the experience of being tortured. Sanne Wass spoke to David Oehlenschläger – a psychologist and Director of Rehabilitation at DIGNITY – about the work the organization does to help victims of torture and trauma. He also gives advice as to how torture survivors and their families can best deal with the situation.

In our recent study, 20 percent of the Iranian journalists polled had experienced torture. What do you think when you hear this?

Sadly, it doesn’t surprise me at all. Many of our patients are torture survivors from Iran; it’s one of the largest groups we work with. So we know how the Iranian authorities treat people who are questioning the regime – and we see that they are consistently using torture. The figure is fairly similar to other studies.

What symptoms do the torture survivors you work with have?

The picture is usually very complex. The torture survivors might first of all suffer from physical injuries, depending on which methods of torture they have been subjected to. These injuries often evolve into chronic pain, which impairs their mental well-being.

Secondly, there are many psychological effects. They might suffer from PTSD symptoms such as flashbacks or nightmares. Often they try to avoid thinking about the unpleasant experience, which means they tend to isolate themselves. They generally have increased stress levels that don’t go away. They continue to be on high alert, have trouble sleeping, difficulties concentrating, and they easily become irritable. They might also suffer from depression: Feeling sad and hopeless; having negative thoughts about themselves.

Consequently they end up with a lot of social problems, especially when they move to another country. All these issues are mutually reinforcing. The physical, mental and social symptoms reinforce each other.

Many also have a loss of self-esteem and confidence, and a sense of shame associated with having these symptoms. Especially journalists, who are used to being competent and knowledgeable in a field, and suddenly they experience difficulties in social situations. It affects their identity and self-understanding.

But it’s also very important to mention that these people are often very strong people. They knew there was a risk associated with the kind of work they were doing, and yet they dared to do it. Working as a journalist in Iran requires a lot of strength.

What happens if a torture survivor doesn’t get professional help?

We frequently have patients who have fled their home country and lived in Denmark for maybe 10 years before we are put in touch with them. Many have developed strategies to deal with their issues, and they manage to get along: They learn the language, find a job, and their families are doing all right.

But often, if they haven’t received any help or treatment, then at some point in their lives, everything suddenly breaks down. There may be certain things that trigger it, something happening in their family or in their own life. Or it may just be that the stress has built up over time, and the symptoms become more and more prominent.

Regardless of whether they receive treatment or not, it is for many people a chronic condition. But the earlier they start taking care of their symptoms, the greater the chance is of succeeding.

A large number of the Iranian journalists in our study have left Iran. How does leaving one’s home country affect a trauma or torture survivor?

Fleeing your home country can in itself be a traumatic experience. People usually don’t leave their country voluntarily, and they usually leave something behind that meant a lot to them, such as their families. So there are many losses associated with being a refugee.

At the same time, life in exile is very tough. You live in a foreign country with a very different culture, you have to learn a new language and get to know a new system. There is a huge pressure on you to find a job and integrate. So as a torture survivor you have to cope will all these challenges – while you suffer from physical and psychological problems. Thus, a life in exile is often a huge burden.

Briefly, how do you treat torture survivors at DIGNITY?

We have almost 30 years of experience in this field. One of our core principles is our interdisciplinary approach: The patients’ multiple problems interact with each other, and therefore you can’t reduce their problems to a single diagnosis. It’s not enough just to look at one problem and try to fix that. If you have chronic pain or social problems, it affects how you feel mentally, and then it’s not enough just to talk to a psychologist.

One of the core symptoms of PTSD is that you try to avoid memories or recollections of the traumatic experience. But this often amplifies the problem. So we help them to deal with it and talk about what they have experienced, so that the fear and discomfort related to the memories decreases over time.

Another important part of the treatment is that we help to give people faith and hope that their condition can change. Because there is no doubt that it is a demanding process, and they have to do a lot of hard work themselves. Our work is based on cognitive principles, and it’s all about getting the patient to work with their own condition. We help them understand their own symptoms, and we always give them exercises to do at home.

How long does the treatment usually last?

First we examine the social, physical and psychological problems the patient has, and then we make a treatment plan for them. A treatment course usually takes 10 to 12 months, during which they come to us once or twice a week. Typically they meet with psychologists and physiotherapists every week, and doctors and social workers as needed. And if they have family, the family also gets involved and the treatment will focus on them as well.

How are the family members affected by living with a torture survivor and what do you do to help them?

Many problems can occur in the family. Family members will usually do their best to help, but at the same time many of their own needs are being ignored. It is especially hard for the kids, and it is not good for their development. Many children are neglected, they suffer from anxiety, and their needs are not met. The kids might start suffering social and mental issues themselves.

We have family-based treatment, where we work with the family as a whole, their dynamics and relationships to each other, how they communicate and interact, and how they deal with the symptoms in the family. And we work very specifically with the children and help to manage the symptoms they have developed.

What is your best advice to family members of trauma or torture survivors?

Often these issues are a taboo in a family context. Torture survivors rarely talk with their family about it, and they try to ignore the problems. They need to break the taboo in the family. Keeping something hidden will not make their condition better.

Another very important piece of advice is to pay attention to the children and listen to them. One of the myths, which many torture survivors believe, is: “My children know nothing and are not affected by this.” It is a myth. All children are affected by living with a parent who is traumatized. So I would really recommend that they speak with their children about it. They shouldn’t talk about the torture, because the children can’t cope with that. But telling them that their parent has experienced something bad, and that he or she has some reactions to it, that is an important step.

What is your best advice to trauma or torture survivors?

My first recommendation is to seek help. When it’s something that has been going on for some time, then it will benefit you to talk to a professional about it.

Secondly, you shouldn’t be so hard on yourself. Many torture survivors feel really bad that they are in this condition. But they should know that many feel the same way. PTSD is a natural reaction to something unpleasant. There is nothing unusual about it; it’s not a sign that you’re crazy or mad. And it’s something that can be improved.

What are the chances that their condition will improve?

In my experience everyone gets better. But how much better, we can’t say in advance. There are many other factors that come into play. And it’s really hard work. We have many patients who start up in treatment, drop out, start up again and so on, because it’s hard. Unfortunately I can’t promise that it will be easy and that it will be better immediately. It takes time. But most people will get better.

Will a torture survivor be able to get back to working as a journalist as they did before?

It is not certain, unfortunately. Torture degrades and destroys people and not everyone recovers. All torture survivors have to live with it the rest of their lives. The question is how much it will affect them. But even though they may not be able to work fully as before, they can have a better life and I believe that all torture survivors have important things to live for and to give to people around them and society.

Related stories:

New Research: High Levels of Depression and PTSD Among Iranian Journalists​

Tortured in Syria: “The flashbacks are worse than reality”

"I was surprised by the high levels of stress among Iranian journalists" (part 1)

"According to my research 20 percent of Iranian journalists were tortured" (part 2)