Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World

1. Striking Out on a New Pathway

A lthough we all know that suffering is a universal human experience, the modern world still does not know how to speak about and understand the terrible experiences that human beings inflict on each other every day. Because of the horror and disbelief associated with human-on-human violence , it is easy to slide into a cynical attitude that nothing can be done to prevent this violence or to recover from it. One reason for this is that the major harms caused by human aggression are invisible wounds. While physical scars can be identified and accounted for by medical science, psychological, spiritual, and existential injuries remain hidden. I have spent the past twenty-five years caring for people who have experienced human aggression on a societal scale, as refugees, victims of torture or terrorism, and survivors of war. My experiences reveal a new way of thinking about human aggression and the healing of the physical and emotional damage caused by violence. Major insights, which I call scientific epiphanies or revelations, occurred Chapter 1 as I interacted with my patients. I proceeded to investigate these conclusions scientifically and, when they were proven valid, to integrate them into my clinical care. These revelations form the basis for the healing practices advocated in this book. My pathway to this work was a circuitous one. Educated in a technical high school with an engineering curriculum of physics, chemistry, and math, I discovered early on that science does not address the moral and humanistic issues of society. These matters are better addressed by the humanities and arts. Although I had never met a doctor except during routine physical examinations, in college I majored in chemistry and religion, fantasizing that in medicine I could apply my interests in science, religion, philosophy, and the arts to better the human condition. While in medical school in New Mexico, I worked in the remote Hispanic villages of northern New Mexico and the Indian reservations of Zuni and Jemez Pueblo, serving poor patients within a rich cultural and natural environment. Subsequently I undertook residency training in psychiatry while simultaneously pursuing an advanced degree in religion and philosophy . Divinity school provided the moral compass for my medical and scientific skills, as well as for my future work with survivors of extreme violence. My interests in the arts and literature have also informed my work, yielding metaphorical insights to mysteries that are beyond the abilities of science and medicine to explain. a new clinic When I arrived at Harvard as a young doctor in the early 1980s, I knew that I wanted to provide the highest quality of medical and psychiatric care to the poorest people in my community, in spite of financial and political barriers. Looking around the Greater Boston area for those who most needed help, I found that newly arrived ref8 Richard F. Mollica ugees from Southeast Asia were both extremely poor and almost totally excluded from the existing public, private, and academic medical systems. With the help of James Lavelle, a young idealistic social worker already working for the refugee community, we decided to set up a small free clinic for them in the Brighton section of Boston, initially called the Indochinese Psychiatry Clinic, later the Harvard Program in Refugee Trauma. Our little group unknowingly became one of the first refugee mental health clinics in America. During this time, medicine and psychiatry were still color- and gender-biased, in spite of the work of individuals such as my mentor , Fritz Redlich, a Yale professor of psychiatry. Redlich showed in a study in the early 1950s that although mental illness was more prevalent in the poor, they received a radically different type of psychiatric care than middle-class and rich patients.1 Poor patients were often given drugs and rarely psychotherapy because they were considered incapable of psychological insights into their mental health problems. Psychiatrists rarely treated these patients; instead they received treatment primarily from paraprofessionals, that is, mental health workers with limited clinical training. Twenty-five years later, I revealed in a follow-up study that treatment biases toward the poor and African Americans remained unchanged, in spite of enormous efforts by the federal government to rectify the situation by providing easy access to community mental health centers. Newly arrived Southeast Asian refugees were still thrown into a large group of low-status patients receiving a low level of health care and mental health care, because...