Treating Survivors of Torture

When psychoanalyst Beatrice Patsalides Hofmann, PhD, began treating asylum seeker and torture survivor Mamadou Bae at the Primo Levi Centre in Paris, the patient didn’t speak to her. Instead, Mr. B, as Patsalides Hofmann refers to him, showed her the scars on his body and acted out his torturer’s movements. Patsalides Hofmann told the story of treating Mr. B in a talk she gave at the Yale Child Study Center on May 23: At the mind’s limit: Can psychoanalysis treat the effects of political violence, torture, and dehumanization? Reflections on the analyst’s dream.

Physical pain is what many people may think of first when they imagine torture, says Steven Marans, PhD, MSW, Harris Professor in the Child Study Center and co-director, with Carrie Epstein, LCSW, of the Yale Center for Traumatic Stress and Recovery. Marans invited Patsalides Hofmann to speak at Yale, and the center sponsored the talk. Through the story of Mr. B, Marans says, Patsalides Hofmann helped the audience to understand how torture affects people’s minds.

Marans, Epstein, and Patsalides Hofmann are working with colleagues in Ukraine to develop and provide trainings on psychoanalytic trauma-focused treatments for mental health clinicians at Lviv Hospital, including a program, sponsored by the Primo Levi Centre, that will train Ukrainian clinicians to work with people who have survived torture during the ongoing conflict between Russia and Ukraine.

In her talk, Patsalides Hofmann described how torture survivors like Mr. B often feel as if they have been invaded by another person who is torturing them from within. This is intentional, she said: Torture that involves sensory deprivation, such as hooding, isolation, and sleep deprivation, is designed to make the prisoner feel that he is torturing himself. This invader, analogous to Freud’s trauma metaphor as “foreign body,” is something that torture survivors can neither get rid of nor accept as their own, she added. Additionally, survivors of torture often struggle as Mr. B did to put their experiences into words.

At the Primo Levi Centre, which provides physical and psychological care as well as social and legal services to people who have survived torture, Patsalides Hofmann often works with people seeking political asylum in France, an extremely difficult process. Asylum seekers must prove in court that they were tortured in their home countries, and neither symptoms of post-traumatic stress disorder nor “declarative elements,” which refer to the patient’s telling of their story, are considered sufficient proof, Patsalides Hofmann said.

Patsalides Hofmann described how making the effort to prove their past trauma impedes patients’ recovery. When Mr. B went to asylum court, for example, “telling the details of his persecution … tore open the psychic wounds that had just begun to heal,” she said. Mr. B later cut himself with a broken bottle in front of a social worker and was hospitalized.

Psychoanalysts are known for analyzing their patients’ dreams, but while treating Mr. B, Patsalides Hofmann had a dream about him. By analyzing her own dream, she was able to better understand her patient. Patsalides Hofmann referred to this as “dream[ing] on the patient’s behalf.”

She dreamed that she jumped into the sea and sank straight to the bottom. There, she felt a sense of non-being. She felt absent from herself. After this absence, which she described as a “cut in the dream,” she found herself in a city and called a cab, which took her back to where she had been. There she saw mountains to cross and a beautiful horizon beyond.

Mr. B’s surname, in French, means “low, down there, on the ground, at the bottom,” she said, which is how she inferred that her dream of sinking to the sea floor had been about Mr. B.

Soon after she had the dream, Mr. B tried to jump out the window during a psychoanalytic session. To Patsalides Hofmann, the point in the dream where she lost her sense of self anticipated this suicide attempt by Mr. B. She pulled him back from the window and called in help.

“My unconscious had thus foreshadowed the work that Mamadou B would have to accomplish to find speech for the unspeakable and let his foreign body emerge, after having abstained from the literal cut that jumping the railing would have executed,” Patsalides Hofmann said. According to her analysis, her calling the taxi in the dream that returned her to the group of fellow human beings represented Mr. B’s seeking help from her and other caregivers.

Patsalides Hofmann concluded that she was dreaming on Mr. B’s behalf not just literally, but also in the figurative sense of imagining a future time on the horizon, away from the confinement of traumatic repetition, where time is arrested in the present moment only. When working with patients like Mr. B, she said, arriving at this might be among the most important results since it implies reestablishing trust in oneself, “the analyst’s first task.”