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SCIENTIFIC ARTICLE
survivors can be said to be in its infancy in
many respects. Although there is an enormous literature on the field, and the field
has grown considerably since its beginnings
in the 1970s, there is little in the way of evidence-based treatment methods for the psychological disorders that almost invariably
follows torture. Furthermore, most research
on psychological treatment is generated in
treatment centres in countries playing host
to refugees, with markedly fewer studies in
the countries of origin of the refugees.8
In the advent of very large numbers of
victims, as is the probable case in Zimbabwe,
there is a need to find cost-effective methods
of providing psychological assistance to the
victims, and this is an area that has been
given considerable thought. Perhaps the simplest way to think about Zimbabwe currently
is to use the term “complex emergency”.
Although the term is derived mainly to describe situations following war or civil war,
its utility is that it can also be used to describe a wider variety of situations. As used
by Mollica et al,9 following the World Health
Organization,10 the term can be defined as
follows:
T O R T U R E Vol um e 1 9 , N um be r 3 , 20 0 9
A complex emergency is a social catastrophe
marked by the destruction of the affected population’s political, economic, sociocultural, and
health care infrastructures.
There are a small number of studies indicating that psycho-social interventions may be
effective in complex emergencies. A study of
Cambodian refugees showed that opportunities for economically productive activities
could reduce psychiatric morbidity in camp
residents.11 A study in Bosnia-Herzegovina
and Croatia showed higher rankings for
group meetings and shared activities than
for individual therapeutic provision.12 A
case-control study showed a reduction in
intrusive memories and higher self-ratings of
wellbeing in traumatized mothers in Bosnia
who participated in weekly group meetings
compared with those who received a basic
package of medical care.13
In Zimbabwe, there have been attempts
to test brief interventions suitable for the
community setting, and at least one study
has suggested that brief interventions may be
efficacious for the psychological treatment of
torture survivors.14 However, in the situation
of a complex emergency, it is doubtful that
approaches based on individual treatment
would be cost-effective, a conclusion also
reached by Mollica and others. Thus, it was
decided to attempt to implement a groupbased treatment approach that has been previously used and examine its efficacy. Similar
approaches have been used in Namibia with
some success.15
Healing and empowerment of torture survivors
The Tree of Life was originally developed as
an approach for assisting unemployed youth.
It was adapted to the needs of Zimbabwean
political violence victims living in exile in
South Africa in 2002.16 This process was
introduced to victims in Zimbabwe in 2004
as an attempt to address the psycho-social
difficulties faced by survivors in Zimbabwe,
most of whom still live under threat, and
many of whom are internally displaced.
The Tree of Life is a healing and empowerment workshop that combines the
concepts of story telling, healing of the spirit,
reconnecting with the body and re-establishing a sense of self-esteem and community.
This process was developed from traditional
ways of dealing with difficult issues in communities, notably amongst the Native Americans, and shares common features with many
similar circle processes.17 It is usually carried
out over a period of two to three days with
a group living and sharing meals together.