Farah Al-Dweik is a senior physiotherapist at CVT Jordan.
This is the first 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 “My Hidden World.”
A Client’s* Story:
It was a dreary Thursday, no different than any day of the week in this dreary country. The fire has been blazing in my city for so long, now; but how long has the fire blazed in the people’s heart?
It was my habit to walk home down the forested road every Thursday, but today I see a kiosk standing in the middle of the forest. Is it a checkpoint? My first thought is how this kiosk breaks the beauty of nature, it seems to distress the trees.
“Give me your ID cards!” yells the guard.
“Here they are, sir,” I respond as steadily as I can.
“Why do you take this road at night?” the guard shouts with his strict voice.
“I have been walking this road for 15 years sir, back and forth to my job,” I answer as the trembling comes to my throat.
“What is your profession? Where do you work? Have you ever seen the man in this picture?”
After fewer than 15 such questions, I find myself handcuffed, blindfolded. Seeing nothing but black.
The darkness in my heart is no less than the blackness I see behind the blindfold.
Why was I imprisoned? I had been thrown in prison because I was young. I was in the third decade of my life, but they did not know that the age of my heart is older by decades after the horrors I have seen.
I never knew what time of year it was in there, but that day seemed very dark outside. Did the night eat the day? Are people still living? Still eating and drinking? Do they know about us, we the half-humans buried beneath the ground? Does my family ask about me? Do they know where I am?
Every time I hear their steps, I feel my breath run away from me. Ah, so it’s winter. The jailers pull us out of that tiny, stinking cell, naked, into an arena. We are forced to stand on our naked feet in the middle of February for more than half a day. A harsh, random beating is delivered to any whose feet betray them, allowing them to fall.
“Look at this daring man, how he stares at me. I will teach you a lesson you will remember for the rest of your life!” the interrogator said.
Those were the last words I heard before I lost everything and closed my shell tightly on myself. The shell that I still wear. The shell that I doubt will ever open again.
Did Thomas Edison know when he invented electricity that it would be applied with vengeance on people like me? What an absurd thought, as I sit on this electric chair, a cap strapped to my head, about to burn me beyond reason. And I am thinking about Thomas Edison. With every new scream of current, I felt each cell of my body cursing its fate that it belonged to this body. I was screaming and begging, but to whom?
Have you ever talked to your knee? In that tiny room, my knees were closer to me than ever. One meter long, one meter high. They forced me into a tightly bound position, closing myself on myself. And when they took me out, my knees refused their commands. I could not convince them to hold me. The result was an unexpected beating, and the jailer forced my knees into position although I was not able to stand.
Two years have passed since I left that prison. Tonight I find myself in Jordan, celebrating alone by burning every piece of paper that identifies me. I burn them all just as my soul burns. My journey to prison was a journey in space, but my journey to Jordan is a journey in time. I am far removed from the people around me. I feel there are 100 light-years of thoughts and emotions between me and everyone in the world. My mind flounders from thought to thought, with no connection. Even my body flounders. My steps are clumsy and unsure. My balance, inside and out, has evaporated.
The sound of a door slamming freezes me. I can’t get my breath. It seems like I haven’t breathed in a lifetime. Did they take my breath from me?
My life since that time has been like waking into a body that does not belong to me. How can I understand what has happened? How can I go through these menial tasks of daily life? I have lost everything, even myself. How can a person mourn the loss of itself? It was around this time that I walked through the doors of CVT.
The journey I would take in this place began from the first welcome at the reception and continued through the long process of therapy. I learned that trauma is not about the event itself, but rather its effect on my brain and my nerves. My body, mind and spirit. And even on my capacity to have relationships. CVT creates a space where the safety begins at first contact.
Kamal Khalifa, CVT associate physiotherapist/trainer, said: “The clinical team’s first goal is to build safety with the client. We accomplish this by following the concepts of trauma-informed care, by fully explaining the process step by step. We help the client understand that here at CVT, they are in control of what we do. They can agree to participate, or not participate, at any time, for any reason. We help them to understand that every piece of their story and their therapy is protected and confidential. And most importantly, we use a collaborative approach to developing our treatment plan and the goals of therapy.” The relationship between therapist and client plays a very important role in the ultimate goal of regulation of the nervous system, which for most clients is “stuck” in a trauma response.
Trauma “lives” in the nervous system, and specifically in the Autonomic Nervous System (ANS). The ANS is responsible for regulating the body’s unconscious tasks including (but not limited to) heart rate, breathing and digestion. The two parts of the ANS are the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). One of the jobs of the SNS is the stimulating effect known as “fight or flight,” which prepares the body for action, while the main job of the PNS is a relaxation effect. When the system is well regulated, these two parts of the ANS work together easily, coordinating their effects to support us throughout our day and night activities. It is not surprising, then, that most of our clients at CVT present with a “fight or flight” response that is in overdrive, and a “relaxation” response that is seemingly non-existent. In one way of thinking, one important goal of therapy is to regulate the nervous system and restore PNS function, and thus restore clients’ ability to sleep, relax, focus, control their emotional responses and return to a life that is functional.
The initial stage of treatment is focused on restoring a sense of safety in their bodies. One way to do this is to teach grounding techniques which reconnect the person with the present, such as asking them to notice all five senses in the moment. These techniques help clients gain control of what can seem like uncontrollable emotions, memories and sensations. Clients are encouraged to use these simple techniques whenever they feel themselves overwhelmed in their daily lives, but also during sessions if they find that any activity becomes too much for them. We also teach breathing techniques, which help restore clients’ control by increasing self-awareness of breathing in response to difficult emotions. Both of these interventions create a relaxation response in the autonomic nervous system, which can prove very useful as a coping mechanism. Regular practice of these techniques helps restore a balance in the nervous system once more, reversing the effects of trauma.
When clients have started to understand their bodies’ responses and restore some level of control, physiotherapists can begin to address specific physical impairments related to their experiences. One example of this is a focus on posture. For many clients who have survived torture, we find that physically, they adapt. There are often more closed and protective postures. This is an issue that we address from many different angles. There are often physical restrictions that must be addressed, such as tight and painful muscles, restricted joint movement and decreased functional strength. But there are also underlying psychosocial implications to a posture that communicates fear, disempowerment and avoidance. Recent discoveries in neuroscience suggest that the simple act of standing, sitting or walking in an upright, confident and unrestricted way can change activation in the brain toward more positive thoughts and feelings.
Balance is another system that is often affected in clients who have survived torture and war violence. Brain imaging has linked activation patterns in the brain during balance difficulty with the patterns of activation associated with anxiety. Although the details are not well understood, there is a link between improvement in balance and decreased generalized anxiety. For this reason, we focus on balance practice gradually, beginning from simple exercises like standing with one’s eye closed, then standing on one leg, and moving to more advanced exercises, depending on the case. This practice helps promote mental/body focus and is a tool to address anxiety.
Only when you drink from the river of silence shall you indeed sing. And when you have reached the mountain top, then you shall begin to climb. And when the earth shall claim your limbs, then shall you truly dance ~Khalil Gibran, from The Prophet
Yes, I reached the bottom of myself through my journey in the jail before I started to trust myself again. Little by little, I have begun to feel safe in my body. At CVT, I discovered that, despite the horror and the loss, I am resilient. It’s my innermost self that will support me through this process; and gradually, slowly, I find I can open up my shell to the external world.
*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.