Farah Al-Dweik is a senior physiotherapist at CVT Jordan.
This is the second article in the Learn to Thrive Among the Rubble series of articles by Farah Al-Dweik, told from the perspective of clients and focused on the power of storytelling for healing survivors of torture through physiotherapy. Read the other articles in this series: “The Red Hat” and “Out of the Shell.“
A Client’s* Story:
Was it a harbinger of the evil approaching? I looked at my white and black pigeons fighting that morning. They were fighting as they never had before – for a moment I thought they would keep fighting until they destroyed each other and vanished into thin air. My pigeons have lived together in the same cage for a while. My eyes always relax when I look at them, and I relax my senses by moving my hands over their feathers. They have become my best friends since my mom forbade me from running and cycling on the village’s muddy roads. She said “You are 17 now. You must learn to behave like a woman.”
The houses in my village are built of wood, bamboo and clay. In the fall, the damp air smells of this mixture, a unique scent of our village. The fall used to be a time for my friends and me to gather every night talking, laughing, sharing our little thoughts, whispering our secret dreams.
“Did you hear what happened in the nearby village?“ Samiah asked.
“Yes. My dad said they burned all the houses and markets,“ I said.
“People were running to save their lives,” Lina said.
“I heard they steal the girls and sell them to officials on the border,“ Samiah said.
The fear penetrated my heart as my friends chatted. I pushed the fear aside by interrupting: “Hey stop talking about this! Our village is safe. I heard my father say we are not involved in any politics.”
Now, in this time of increased caution, we gather in my home. The smell of warm Tabon bread spreads all around. It was my turn to make tea for dinner. We love drinking tea with milk, pouring it in dainty small cups decorated with flowers drawn by the hands of my friends and me. All of a sudden there is a heavy pounding on our door, as if it would break through the solid wood.
“Open! Open, it’s me,” Baba shouted. “They have surrounded the village, and the soldiers are patrolling the streets. It is not safe to go out now. You girls must spend the night here. Tomorrow morning you will return to your homes.“ My father said this with his breath catching in his throat.
If a person could only know his future, I am sure he would have chosen his words with more care. But Baba said to my friends, “Tomorrow you will go to your homes.” He would never know that this would be the longest night, unforgettable for all of us. It was the night that changed everything.
The tension was high at home, but Mom pretended that everything was normal. She brought us dinner. I tried to swallow, but I felt fear moving from my throat down to my stomach. Fear tightened my shoulders, and my legs felt like they were planted firmly to the living room floor. I was afraid even to go to the bathroom. Then we heard cars in the distance, but slowly moving closer. Everyone ran to the windows to peer out from behind the curtains, everyone except me. I froze. “They are coming toward our home,” Momma whispered.
In less than a minute the entire house was shaken from the strength of their blows. They did not even wait for us: they broke down the door.
“We were sent to hunt militia members, but luck has brought us three fresh flowers!” jeered the soldier. My heart dropped as the soldier pointed to me and my friends.
Baba responded by instinct, and I wish more than anything he had not. “Leave them! I am the man here. Talk to me! Take me!” my father cried.
“You consider yourself a man? We did not come here to talk. We are here for action,” the soldier said.
He shouted to take my mother and father away, calling, “Take them outside and leave the flowers here with us. They will be our celebration for tonight.”
Everyone was shouting except me. I was frozen. What happened after that I do not know. All I know is that my soul was pulled away from me. All the power, feeling, humanity, dignity. Gone. They gathered together into an innocent angel and faded from me.
We were their trophies for the night, and they were the embers that burned everything inside us. After they raped us they did not even look back.
I was in unbelievable pain. I felt as though I would drown in the hot blood. I could hear nothing but my own mind screaming “You are dying, you are dying, you are dying…” From somewhere (where?) I saw my mother’s face. Then everything turned to darkness.
Life After Rape
Sometimes my eyes catch a stranger’s eyes. Why do their eyes look so big? Is it possible that they can read the story of my life in my eyes, my face? Shame has become my umbrella. I wish I could spin a cocoon, surrounding myself with a cover that hides me, and then, after a time, emerge as something new. A butterfly, something with no memory, no pain. Something that could fly and leave the dirty behind. I feel polluted, the filth moving inside my body. I end the day with a bath, my fourth bath today. It’s the only way I know to remove the dirt, but it does nothing to remove my internal filth.
Why you are so quiet? Why do you keep looking at the floor? Are you crazy? How easily you cry without any reason at all, hysterical woman! Tens and hundreds of whys and no one understands. Remaining silent is easier. How can I answer you when I am dead inside?
And all of you people, what are you capable of behind a closed door? I am with you, I can hear you, but I don’t trust any of you. I hear my tongue protest. It will not be pressed into action. It lies frozen, a strange feeling of numbness. In the bathroom, I spit as strongly as I can, then spit again and again. I want all the pain, the dirt and mold to leave me. But it’s of no use. I find myself sitting on the floor, head bent against the wall, scalding tears rolling down my face.
Pain is my new enemy. I try to shut him down, silence him as I have done with the rest of my body. But my pain is stronger than I am. It’s like a rope around my lower abdomen and back, and on some days it overwhelms me, covering me from head to toe in a sheet of pain.
After that terrible night, my family moved thousands of kilometers away from our village. They fled the shame I brought to my family. We left the whole country.
The little child I once was disappeared that night, but my body still responds like a weak, vulnerable child. Sometimes I move and I can’t control myself. I soil myself with urine like a baby. I sneeze or cough and lose control like a child.
I have lived this way for many years, but today, my mother holds my hand and brings me to a small, simple building somewhere in Amman, Jordan. I have no idea what I am doing here, I didn’t even think to ask this question.
I am preparing for my 10 am client, a new assessment. I purposefully set a morning appointment for this client because I learned from her counseling intake information that she will need some time. I am a physiotherapist by training, and I have worked with CVT Jordan for some time. This client has been identified as a survivor of sexual gender based violence (SGBV). Sadly, these cases are very common in our work.
Empowerment is one of the key goals of our treatment, as the main effects of SGBV are loss of power and loss of control. I strategically design my approach to give the client a variety of options in everything from choosing the session time, to her position in the therapy room, even my position as the therapist. I intentionally make myself and my papers fully visible to her, creating as safe a place as possible. In order to facilitate this sense of power it is essential to build trust with any client, but this is particularly important with a client who has experienced SGBV. Their trauma was violation of person, of intimacy, and it has an enormous effect on their social experience.
“Hello and welcome to our physiotherapy assessment session. Perhaps my colleague from the counseling department shared with you a little bit about our work. I appreciate your attendance today and I hope that we will be able to work together well.” I start with this introduction in order to create an environment of safety and stability, an environment where she can know what to expect and feel she is in control of what takes place here.
“Do you know anything about physiotherapy?” I asked the client.
After a few minutes of silence, I see tears well in her eyes, and she seems unable to make eye contact. I wait a bit longer, but there is a minimal response; her body language is closed, protective. This is very common in such cases. As a therapist, I want to decrease the pressure for her, allowing her time and space, while gently reassuring her of my presence. I choose to kindly offer her the box of tissues.
Our brain is fascinating. It has been created to protect us. One of the most interesting protection mechanisms in the brain and nervous system is what we call the fight, flight or freeze response. It’s our reaction to any perceived threat regardless of the degree of actual danger. Normally our brain is able to recover back to a stable state after the danger has passed and we feel safe. Then our brain is able to function efficiently. When we are in this state, we can tolerate some distress, we can problem-solve challenges, we can learn new approaches. We can say our “window of tolerance” is wide open.
But sometimes, if we have experienced heavy trauma, our brain may not have the opportunity to return to that stable state. Many who have experienced trauma can become “stuck” in the fight, flight or freeze response. When a person is stuck there, the window of tolerance becomes very small. What they might “normally” tolerate as “discomfort” or “annoyance” becomes intolerable.
People can respond in various ways, either as increased irritability, sensitivity to things like pain, sound, and touch. We call this hypervigilance or hyperarousal. But the body can also respond with a “freeze” response (hypoarousal), having an inability to respond to danger, a feeling of disconnection to the world and/or themself. The body is trying to adjust and protect itself from danger with these responses, sometimes alternating between responses. The response depends on many factors: childhood experiences, trauma history, the nature of the current danger, etc.
For my client, the freeze response is her brain’s reaction to protect her. It’s a state of emotional numbness, emptiness. The body and mind are one, working together. Physically, I note low energy, sluggish movement, shallow breathing and a guarded position: legs crossed, arms folded, as if she wants to make herself so small she becomes invisible.
A Few Sessions Later
The client’s symptoms are just like an iceberg, with the larger part hidden below the surface, belied by the small visible part. Sometimes as a therapist, we need to acknowledge that invisible part. We do not dig up the iceberg. We don’t reveal it, making it vulnerable to harm. We don’t melt it forcefully, and thus create an imbalance of its power. We just act as a guide to support the client, knowing there is more trauma below the surface.
I greet her by saying, “Welcome back, dear. Today we will open our session with a simple practice called self attunement. I invite you to join me in this practice . Let’s start with simple breathing, and paying attention to our breathing. Don’t try to change anything about how you breathe, just observe it as if you are watching a TV show.”
Then I ask her, “On this paper, I want you to write down any body sensation or feeling you notice at this moment. Try not to name it, or explain it, or judge it in anyway. Just recognise it and write it down.”
Session by session, we repeat this simple exercise at the beginning of the session, or sometimes before or after an exercise. Little by little, I can see that is easier for the client to connect with herself and her body. I see it as she moves with more freedom, learns new activities more readily, or sometimes through her questions which reflect curiosity.
What did the client have to say about her experience?
She told me, “I feel something heavy over my chest; it feels like the air is stuck in the middle of my chest. My breath can’t go deeper. And today when I closed my eyes, I felt there is a strong and hot red light coming from my lower back, surrounding my waist and continuing down to my legs. I feel I want to turn that light off but I can’t reach it.”
“It’s a very good sign that you are able to recognise your feelings and sensations. Our bodies love to work in harmony, but when you have been through a bad experience, our bodies are forced to respond. And often our bodies adapt to this, and it changes the way it works.” I said.
“Do you mean my body is not working well?” she asked, concerned.
“Actually, those changes in our bodies were meant to protect us. This is a very good response from a strong body! But maybe those changes have stayed with us too long. The good news is that many of these changes are reversible,” I tell her. The healing is underway.
For many days after that night, I wished to wake up and find myself turned into a pigeon, their bodies obscured by feathers, hiding the details of their body deep underneath. How I wanted to obscure myself even from myself. But this morning I feel different. It’s the first time since I can’t remember when that I feel my inner body calling to me. I close my eyes and listen to her without judgment. It is not easy, my breath is fast but I FEEL it! My palms are sweating but I touch them. And I visualize my pelvic area. I imagine it as a black and gray area and I am a painter, with color returning as the brush touches my pelvis. Each day is a new color. Today, I see pink. With each contraction of my pelvic muscles, I see the pinkness deeper, and more shining. I open my eyes and reach for the diary from my physiotherapy session. I felt so strange about it in the beginning, but my curiosity nudges me to try to record my thoughts for the exercise.
A few weeks later and I am more and more interested in my body, my feelings, my sensations. Each time I practice the body attunement exercise, I discover something new. I am trying to be curious toward my body. My relationship with my body is starting to improve and I find it easier to view myself, my body with kindness.
And how amazing that even my eyes have become more confident. They have found their power to connect with others since I learned to trust my body again.
your cure is within you, but you do not sense it your sickness is from you, but you do not feel it you consider yourself a small entity, but within you is enfolded the entire universe
~Ali Bin Abi Talib
*Some details have been changed for security and confidentiality.
Funding for CVT’s work in Jordan is provided by the United States Department of State’s Bureau of Population, Refugees and Migration and the United Nations Voluntary Fund for Victims of Torture.