Haiti is an island of contrasts and extremes: rich cultural traditions and oppressive poverty, polluted filth and beautiful landscapes, fine artistry and unbearable suffering. The history of Haiti is one of bloodshed, oppression, and an ongoing struggle for liberation that still continues. One of the most tragic outcomes of this state of affairs is the suffering experienced by children.
The case study presented here describes my work with a former street child — one of an estimated 300,000 street children in Port Au Prince alone — who is also a survivor of torture. He was found on the streets several years ago by members of a program called “Wings of Hope” (WOH). WOH run a group home for abandoned children who are also emotionally and physically challenged.
The work described in this case study derives from the fields of somatic psychology and dance movement therapy (DMT). Somatic psychology posits that mind and body are not separate, but are unified, and dance movement therapy is based on the belief that emotional and psychological well-being is directly related to an individual’s movement repertoire because movement reflects our inner states. The theory supporting the interventions presented in this case study were described in the article called, “Healing the Relational Wounds of Torture Through Dance Movement Therapy” in the May 2001 edition of Dialogus (Vol. 5, No. 1).
Case Study:
George is a 17-year-old boy who is severely undersized from malnutrition and abuse. He was found on the streets of Port Au Prince, Haiti in 1996, tied and bound at his wrists and ankles, where he stills bear scars from the tight ropes. He was repeatedly tortured and beaten for many years.
I worked with George at a home for mentally and physically challenged children in Haiti. When I first met him, he would not participate in group activities. His body posture was fixated in the position he was found and tortured in. He was tightly bound in a twisted fetal position on the floor, and always faced the wall with his head turned to the right. He never interacted with the environment or other people. He was mute and constantly gazed downward. He sat for hours and days in this state, only eating or preparing for bed when approached.
George responded to only one invitation; if he were approached from his left side he would grab the outreached hand and push hard into the person approaching him. He would then push his companion around the periphery of the home, up and down all the stairs, and through every room, never crossing through the center space. He always remained peripheral, and he always pushed with force. When he was approached from the right side, he turned away, evidence of a boundary rupture on this side. It bears noting that George’s single-armed pushing pattern (homologous push) was a very early developmental movement that appeared to be truncated at a fixated, frozen shoulder.
Initially, I allowed George to push me to get a sense of his movement patterns. One day I decided to push back, and did so with resistance. He immediately spun his body to the right and into me, completely merging his body with mine and burying his head into my abdomen. This was evidence of boundary rupture, and after we repeated this interaction several times, I learned that George could not negotiate anything other than an isolated or a fused boundary. He either pushed away and isolated, or enmeshed and fused. The right side appeared to be the site of the strongest rupture. Following this interaction I encouraged George to differentiate from me by allowing him to push me around the space in his usual way. In our next session, I tried something different: I met his push with a different intention. Rather than push back in resistance, I received his push. I realized my resistant push may have too directly mirrored his push, re-activating the relational wound. His merging response may also have indicated forced fusion with the perpetrator.
Initially, this new way of relating appeared to confuse him. He froze, then began to turn left to right and right to left, as if he were a dancer twirling in my arms. He attempted to wrap himself around me again, spinning to the right. I was prepared. I gently steered him to the left in a non-threatening, compassionate manner, and turned him to face away from me. I rested my hands softly on his shoulders in a gesture of support. He stood there for awhile, as if contemplating this, then tried to wrap himself into me again. When I gently encouraged him to keep a healthy distance from my body, he tried to push me around the space. I allowed him to do this briefly to regain control, but after we had walked the entire periphery I began to meet his push again, steering him gently to center. At this point he followed me, and as we moved through the center of the home a tiny smile appeared on his face.
In subsequent sessions, I introduced a tuning board as a transitional object and physical boundary between us. As we did our “push and twirl” dance, I wedged the board between us. The tuning board, developed by Darrell Sanchez, is a pliable, circular object, brightly colored and usually pleasing to children. It is used to restore fluidity in a fixated, traumatized body. Transitional objects support a safe holding environment. He seemed to enjoy the board as it became more familiar. I carried it with us on our walks, and when we returned we sat against the wall with it between us, always on his left side. He began to smile more. The fixation in his upper body was relaxing and a stronger spinal push was evident. Two things changed notably in his posture: he was extending his legs more in front of him, and while he still faced right, he did not face directly to the wall. His posture and movements appeared more relational.
At this point, I began to supplement our walks with range of movement exercises to gently encourage George to bridge more with his environment. As we walked, I raised my arm up, or squatted low, or opened my arms wide, inviting him to join me. As he became more comfortable with these movements, he begin to increase eye contact with an occasional peek at me. He began to smile more, evidence of increasing emotional expression.
As George grew more comfortably relational with me, we began to play ball. Initially, he would catch it if I threw it, but not return it. Eventually, he began to roll it back to me with a strong homologous push, a developmental move that precedes reaching. I created the ball game to introduce another transitional object, and to encourage George to face me more directly. Each time he looked at me, I said his name softly. I was beginning to acknowledge that I saw him.
Continued attempts to involve George in group activities were initially unsuccessful. On one of my last days, however, we began with our usual dance, which by now was a familiar greeting. George then took my hand and lead me to the wall, where we sat down with our backs against the wall. He placed the tuning board between us and extended his legs fully out in front of him with a homolateral reach, a yet more advanced and relational developmental movement. Several of the staff noticed this and expressed surprise. They had never seen him do this. He continued to sit facing into the room, and when other children began to gather around and play with balls and balloons, he remained. I initiated our ball game, and shortly another child joined us. The three of us played ball. The director of the center commented that he had not seen George interact like this in his two years there.
George’s kinesphere had expanded so that he bridged more with his environment, which was beginning to include other people. His timid eye contact indicated an increased comfort level with being seen, and his shy smiles were a sign of increasing affect. He was pushing with less fixation, and had begun to reach out in relationship. He was less protective of his right side, and was beginning to allow me to approach him from there, as long as he could see me. His ruptured boundary was healing, and he was learning to orient himself towards others more relationally. When it came time for me to return to the United States, I trained all the staff in the use of the boards and balls so that George’s work could continue.
Discussion:
This is a particularly interesting case of DMT because our work was entirely non-verbal. We did not speak one another’s language, and while George did not speak at all, he understood Haitian Creole. Our communication consisted entirely of movement.
My initial evaluation of George indicated a child with severe developmental trauma caused by torture. His virtual isolation in a tiny kinesphere and his inability to oscillate in and out of relationship made me suspect that he had not known healthy boundaries in relationship since he was an infant, if ever. These relational dynamics shifted significantly in our time together.
While my first instinct to push back may have challenged George, it provided me with useful assessment information. George had most likely internalized his early experience of torture in a body frozen and fixated, defensively and fearfully. On the rare occasions that he moved, he did so only by keeping a safe distance from his companion. His life was literally peripheral and isolated.
As our movement dialogues continued and he began to expand his individual movement range, his interaction with the environment and other people eventually increased. His increased use of developmental movements such as homologous pushes and homolateral reaches, early neurological actions that a healthy child moves through as s/he attunes to and explores his/her environment, facilitated this relational shift. I believe his increased use of these movements was restoring his developmental integrity as he reconnected with the primary movements that constitute healthy development. This could indicate early disruption to his developmental process and to his ability to sequence experience normally. As George explored more of his environment, he showed increased affect as evidenced by his slight smiles and gradual attempts at eye contact. The process of gradually being met and seen was a healing one for him. Ultimately, George was able to maintain his presence in a group of very active children, and to look at me almost directly and smile, expressing perhaps some satisfaction at being in relationship.
Conclusions and Recommendations:
It has been said that it is through dance that the history of a people is enacted. If this is true, it can also be said that the history of an individual is enacted through the body. Dance/Movement therapy honors the powerful connection that the human body has to life experience. Because it is the body that suffers in torture, it is also the body that heals and rehabilitates. Working with, and through, the experience of the body and its expressive voice of movement, survivors of torture are welcomed home.
The complex relational dynamic that is present in the act of torture creates a need for a modality as powerful as DMT to be carefully paced, or titrated. It is often necessary to build a survivor’s resources before he/she can actually move through the experience. Children are especially vulnerable to suffering permanent fragmentation and relational scars after being tortured. Internalizing the experience of torture impacts their developmental process, and the resultant sequelae require that the therapeutic process be a careful negotiation of boundaries and of internal and external experience.
The survivor described in this paper benefited from his work with DMT. Recent correspondence from Haiti indicated that George continues to make progress, uses his legs more, and actually allowed himself to be photographed with a large group of children. This was another first for him.
There are several recommendations that arise from this case material. The first is the importance of an integrated treatment for survivors of torture who have already suffered tremendous fragmentation. This requires flexibility in our roles as caregivers, and may require that one person fill several roles to integrate the healing process. It may also require extensive teamwork. A second is the recognition that a goal of this work will almost always be the reconstruction of relationship. For many survivors, the therapeutic relationship is the one that initiates the healing process, but the work must continue with members of the survivor’s family, community or environment. It is often advisable for survivors to enter group therapy to begin this larger relational healing.
Child survivors present an additional challenge, and relational and/or group work is particularly appropriate for them. Their vulnerability and malleability make them susceptible to long-term suffering and permanent psychological scarring if they are not given adequate, compassionate treatment and an opportunity to reconstruct their experience of the world. Finally, the survivor’s relationship with his/her own body suffers following torture, because a familiar place has become disconnected, unfamiliar and even unfriendly. All rehabilitative work with survivors of torture must take this into account. Recognition that the body is an earthly and sacred site for individual and collective human experience facilitates the reintegration and reclamation of body, mind, heart, and spirit.