Finding hope after violence

Clinicians are trained to heal, but providing care to refugee patients who have suffered extreme trauma — such as torture, sexual violence and other human rights violations — can be particularly complex. The enormity of the experience may seem overwhelming, and often there is a fear that the patient may never fully recover.

Fortunately, this is not the case. Richard F. Mollica, MD, MAR, (left) member of MGH Psychiatry and director of the Harvard Program in Refugee Trauma (HPRT), has devoted his career to providing mental health services to this marginalized and vulnerable segment of society. Since the program's inception in 1981, Mollica and his colleagues have treated more than 10,000 survivors of mass violence and torture. Based in MGH Psychiatry, the HPRT is affiliated with the MGH Center for Global Health, and the program recently celebrated its 25th anniversary as well as the publication of Mollica's book, Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World.

Mollica stresses that it is the job of the mental health clinician to foster a traumatized patient's innate capacity for self-healing, something he believes all humans possess. To do so, the typical patient-clinician relationship must be shifted so that the patient becomes teacher and the clinician becomes the listener, "an act that is therapeutic for the storyteller and beneficial to the listener," according to Mollica. Also, the patient should perform some or all of three self-healing activities: work, altruism and spirituality. By re-engaging with society in these ways — through actions as well as clinical treatment — the patient sets a foundation for rebuilding his or her life or creating a new one.

Mollica reports that every patient he has treated has possessed some capacity for recovery through self-healing. "Violence, whether domestic abuse or genocide, is often associated with hopelessness," he says. "To know that a patient will recover, and to share this knowledge with them, creates hope where there was none before."