SCARS FADE, MEMORIES DON'T

How a Portland doctor helps survivors of torture put their lives back together.

By Chris Lydgate

One afternoon in December 2000, a civil servant we'll call Samuel Kapanga stepped out of his government office in Kinshasa, the capital of the Democratic Republic of the Congo, and walked to a phone station to call his parents.

Congo was then, as now, in a state of war. Government forces controlled the western part of the country, including Kinshasa. Rebels dominated the east.

As he was talking to his parents, Samuel was arrested by agents of the security agency DEMIAP—the Military Police for the Detection of Unpatriotic Activities. The charge? Samuel's parents lived in the eastern town of Bukavu, and civil servants were forbidden to communicate with anyone in rebel territory. He was found guilty and held in solitary confinement.

On Jan. 16, 2001, while Samuel was behind bars, President Laurent Kabila was shot dead by one of his own bodyguards.

Kabila's assassination was very, very bad news for Samuel.

The alleged killer, Rashidi Kasereka, was an acquaintance of Samuel's. DEMIAP decided Samuel must have been involved in the murder plot. They already had him in their custody. All they needed now was a confession.

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Last week, Amnesty International issued its annual report on human rights around the globe. The conclusions are grim. Torture is on the rise on every continent, and the United Nations seems powerless to stop it.

"There is strong evidence that the global security agenda pursued since 11 September 2001, the US-led 'war on terror,' and the USA's selective disregard for international law encouraged and fuelled abuses by governments and others in all regions of the world," the report states.

Regardless of where you place the ultimate blame—on religious fanatics, American arrogance, Communist dictatorships or tinpot tyrants—the Amnesty report details a catalog of horror. The list starts with Guantánamo and Abu Ghraib and continues through Darfur, Chechnya, Haiti, Palestine, Cote d'Ivoire, Colombia and the Republic of the Congo—and those are just the countries where torture was reported last year.

Torture has, in fact, become so widespread that it has spawned a gruesome new psychiatric specialty—the treatment of torture victims. There are no fewer than 30 clinics across the nation that specialize in treating survivors, and one of the biggest sits on a hill overlooking one of the least tortured cities in the world: Portland, Oregon.

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Deep inside a maze of heavy doors and twisting staircases at Oregon Health & Science University sits an institution that represents both what's good and what's awful about the world we live in. Launched in 2000, the Torture Treatment Center of Oregon and its related clinics employ a couple dozen psychiatrists and counselors who treat more than 750 patients. Most of those patients don't travel to Portland for treatment—they already live here. They include Vietnamese, Cambodians, Laotians, Ethiopians, Sudanese, Iranians, Iraqis, Afghans, Bosnians—the list gets longer every day.

On a recent afternoon, the waiting room bubbled with the staccato syllables of Vietnamese and the soft diphthongs of Khmer. Men in leather jackets idly thumbed through dog-eared magazines on home decor. If you stumbled in by accident, you might think you were in a dentist's office.

But patients do not stumble in here by accident. They come here for a single reason: to escape from their own memories.

"I was beaten like a dog," Samuel says, staring at the floor. "I cannot describe it."

We are sitting in his apartment, which has the transient feel of a motel room. You get the feeling he could pack up everything he owns given five minutes' notice. A gentle soul of 42, short and stout, with a graceful smile, Samuel speaks English with a husky French-Congolese accent. He wears rectangular, gold-rimmed glasses and a short-sleeve checkered shirt that hangs untucked above his black pants.

Samuel has a warm voice and an infectious laugh—it's not hard to imagine him as the lay pastor he was before he joined Congo's Ministry of Information. But his easygoing manner can evaporate in a second. Hearing a knock at the door, he springs to his feet and peers through the peephole for several seconds, crinkling his brow and craning his neck from side to side, like a robin sizing up the neighborhood tabby.

Now he crouches and lies face-down on the floor, crossing his wrists behind his back and bending his knees so his feet point toward the ceiling. "They tie your hands and feet together like this," he says, his voice muffled by the carpet. "So you become like a small thing."

He picks up a black Nike backpack and hurls it to the floor. "Now they can pick you up and they can throw you back on the ground like that!" he says.

He makes a circular motion around his heart. "Your chest hurting there," he says. "Can you see how hard it is?"

His captors attached electrodes to his genitals. "Then they take electrical wires and they push it into your skin. They push it into your penis. Your penis suffer. The electricity makes you jump like—like one of those horses the cowboys ride. You jump like you're going to die."

The interrogators demanded that Samuel give them details of the plot. He told them he was innocent. They put him in a cell whose floor was flooded ankle-deep with water. There was no way to sleep, because he could not lie down without immersing himself.

"You stand for as long as you can, then you try to rest by crouching on your hands against the wall. They hurt you. The blood comes out, but nobody takes you to the hospital. No one takes care of you. No one knows where you are. No one has access to you. You are taken there to die—that's all."

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Dr. J. David Kinzie has probably listened to as many stories of torture as any psychiatrist in America. His patients have been gouged with broken bottles. They have seen their husbands murdered before their eyes. They have been beaten, raped and starved.

Asked to describe the trauma his patients have suffered, he pauses for several seconds. "It's awful," he sighs.

With a slight stoop, thin graying hair, and a wry, asymmetric smile, Kinzie projects the air of an absent-minded professor. His desk is a swamp of papers, books and journals. He struggles to remember the name of filmmaker Michael Moore—"that guy who made the movie about Bush." There's mud on the cuff of his pants. His jacket is rumpled, his shirt is rumpled, even his teeth are rumpled.

Beneath the whimsical charm, however, Dr. Kinzie has a brilliant, probing mind. Over the course of 27 years, he has written 59 professional articles about treating torture survivors. "He's highly respected," says Uwe Jacobs, director of Survivors International, a similar clinic in San Francisco. "He is one of the veterans of this field."

"He's a pioneer," says Dr. Jose Quiroga, medical director of the Program for Torture Victims in Los Angeles. "He's an excellent researcher who has made many significant contributions to our knowledge about the consequences of trauma."

"He is one of the most unique and outstanding figures in the national scene," says Dr. James Shore, chancellor of the Health Sciences Center at the University of Colorado. "He's a treasure."

Kinzie began his medical career as a general practitioner in Vietnam in 1964. His patients were Vietnamese civilians, some of them villagers injured by American bombs.

"I saw a lot of things in Vietnam," he says. "I never got over it."

He went back to medical school in Seattle and trained to be a psychiatrist. Later, when the first wave of Indochinese refugees arrived in the United States, he felt compelled to do something. "I wanted to help the Vietnamese," he says. "And I had some guilt about the U.S. role in the war."

In 1976, Kinzie joined OHSU's psychiatry department. The next year, he founded the Indochinese Psychiatric Program to treat southeast Asian refugees suffering from war-related trauma. As political conflict descended on different parts of the globe, and as immigration patterns began to shift, the clinic's patient list swelled to include refugees from Europe and Africa, and it was renamed the Intercultural Psychiatric Program. In 2000, Kinzie launched the Torture Treatment Center to focus specifically on patients who meet the federal definition of torture, which involves physical violence perpetrated by agents of the government. Other patients who do not meet the strict federal criteria are treated at the IPP.

The biggest problem most torture survivors face is not the physical suffering they endured, but the psychological aftershock. Throughout history, human beings exposed to traumatic events have responded in a distinctive way. The Athenian general Thucydides described it among soldiers who served in the Peloponnesian War. The Irish potato famine produced a condition known as "famine disease." In the Civil War, the diagnosis was "soldier's heart." In World War I, it was "shell shock." In World War II, it was "combat fatigue." Among the survivors of the Nazi concentration camps, it was "KZ Syndrome."

Psychiatrists today usually refer to the syndrome as post-traumatic stress disorder, or PTSD. The symptoms include nightmares, insomnia, trembling and flashbacks, which in turn stoke isolation and social withdrawal. PTSD is the glassy stare, the twitching eye, the startle reflex. It is the mental videotape that loops over and over when darkness falls and the mind craves sleep. It is the sound of your brother screaming your name and the sensation of being buried alive and the smell of charred corpses and the compulsion to replay the one part of your life you would do anything to forget—over and over again.

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Samuel was interrogated—and tortured—repeatedly until Jan. 30, 2001. That night, two guards came to his cell. They said they had worked for Samuel at the Ministry of Information years before. Now they wanted to help him escape. They would let him out of the cell—all he had to do was scale the 10-foot wall enclosing the jailyard and he would be free.

Samuel was suspicious. He didn't recognize the guards. He worried that it was a trick, that they would shoot him as he tried to escape. But he was also desperate. As they unlocked his cell, he was shaking with fright. They walked out to the jailyard. "I am waiting for them to shoot me," he says. "I am certain they are going to shoot me." Then the guards lifted him up and he clambered over the wall to freedom. He fled to Zambia, made his way to South Africa and, in April 2001, arrived in San Francisco as a stowaway.

Like many torture survivors, Samuel then applied for political asylum, a complex bureaucratic process that can drag on for years. A casual acquaintance suggested he visit Portland. He spent his last few dollars on a Greyhound bus ticket and wound up at the Salvation Army's Harborlight Shelter on Burnside.

In a fairy-tale world, things should have started looking up for Samuel at that point. But they didn't. He had no energy. He kept getting vivid flashbacks, triggered at random—the honking of a horn, or the booming of a car stereo.

"You are compressed," he explains. "Your mind and your heart is full. You think you must be crazy, you must be a fool. It's very hard to accept that situation. You have no future. You are just going day to day."

He felt like a ghost. At night he had terrible, feverish dreams. He was back in jail, trying to scale the fence. But instead of giving him a leg up, the guards were gunning him down. He would jolt awake, his heart pounding.

Samuel worried that he was going insane, but he had no one to talk to. In fact, the only person he had ever told about his experience was his attorney.

Then he heard about Dr. Kinzie.

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PTSD is a stubborn, chronic condition that can persist for decades—ask anyone who served in Vietnam. It is aggravated by stress and by the sense of alienation that refugees invariably encounter in the United States. Psychiatrists cannot cure PTSD—but they can treat it.

Fixing his blue-green eyes on a reporter, Kinzie explains his central message: "What happened to you is awful. It should never happen to anyone. We cannot bring back your country, your husband, or your children. But we will help you with your sleep, with your nightmares. Your life will never be the same. But we can help you adjust in this country as best you can. And you will feel better."

Therapy at the Torture Treatment Center consists of three elements. First, counseling from top psychiatrists and counselors from the survivors' own culture. Second, drugs to ease nightmares and restore sleep. And third, support groups in which survivors can find acceptance among others with similar experiences.

Kinzie prescribed medication to help Samuel sleep. The psychiatrist taught him the importance of taking care of himself, of eating regularly, of keeping his mind active (as he recounts his story to a visitor, Samuel proudly proffers his library card).

"Dr. Kinzie has been like a father to me," he says. "If we were in Africa, I would call him my father. In America, you don't say that. But he has been so helpful, so helpful to me."

Bit by bit, Samuel began to put his life back together. He worked as a taxi driver for Broadway Cab. In terms of social status, the job was a comedown—in the Congo, he employed a driver to take him to and from work—but it was honest work and helped him save money.

"I went to the clinic without life," he says. "I came back with life. That's the way I explain it. With the help of the doctors, you can get your life back together. You can see the meaning of life again."

Then, last December, disaster struck. Samuel picked up a couple of fares on Southeast Gladstone Street who wanted to go to Molalla. They robbed him at gunpoint. When he pushed the panic button, one of the passengers fired a shot into the dashboard. Samuel jumped out of the cab at a traffic light, whereupon the passenger fired two more shots at him, missed, and drove away in the cab. The robbers are still at large.

Samuel hasn't been able to drive a taxi since then. "I don't like the cab business," he shrugs. He has been taking classes in conflict resolution at Portland State University but worries he won't be able to find a job in that field. He also worries that if the government denies his request for asylum, he'll be deported—back to the Congo. "It's very hard," he says. "Very hard."

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Torture, like pornography, is surprisingly hard to define.

The methods are legion: They range from beating to sleep deprivation to sticking a hose in the victim's mouth and turning on the tap. Increasingly, interrogators are turning to methods that leave no scars, such as beating victims on the soles of the feet or restraining them in unbearable body positions.

Reed College professor Darius Rejali, a political scientist who is working on a book about torture, lists three essential ingredients: The deliberate infliction of physical pain, by a public authority, for the purpose of confession, information or intimidation. The key element in the definition is the idea of violence that is in some way sanctioned by the state (or a group seeking to take over the state, such as a rebel army). But in today's world, the teams don't all wear uniforms—and it's difficult to know whether a particular atrocity was ordered by an Army colonel or was a spontaneous act of sadism by a clutch of bored prison guards.

In therapeutic terms, however, establishing the identity of the perpetrator is unnecessary. "We are not strict in requiring them to prove they've been shot at by a government agency," says Kinzie. "In modern warfare, you can't always know what's government-sponsored violence and what isn't. As long as they had the traumatic experience and have major symptoms, we'll treat them."

Kinzie has wrestled with these problems over the course of three decades. His office is filled with exotic tchochkes: A wooden elephant from Somalia. An ornate bowl from Bosnia. A jade Buddha from Cambodia. Each is a gift from one of his thousands of patients.

Ordinarily, psychiatrists are not supposed to accept gifts from their patients. But Kinzie rewrote that rule for torture survivors. He did it for a specific reason—the gift is a signal that the icy grip of withdrawal is beginning to crack.

"When they start giving to other people," he says, "that's when you know they're coming out of it."

Samuel, meanwhile, is still struggling to make sense out of his suffering. He's reading a biography of Martin Luther King Jr. In a late-night phone call, he mentions that he's thinking about a career as a counselor.

"I would like to have a job where I can share my story," he says. "I would like to help the victims of violence. They do suffer, because of how their lives were cut up."

Originally published on WEDNESDAY, 6/1/2005