Lessons Learned


I will never forget the day I met Noori. He was one of too many psychologists I was interviewing. Each one was what I call, “copy paste”, their CVs had the same wording, even same quotes, they had all been to the same seminar on compiling a CV. My first words to him were “Are you another copy/ paste?” He laughed, he knew the system and swore on his life that he was not. He is not. His life and honor were safe.


I deliberately had Oscar, our, at that time, very untrained rescue dog, in the interview, to see what would happen. Noori and he bonded. The other psychologists had screamed or told me a dog was unclean, forbidden and proceeded to lecture me. Noori was hired.


We have had our ups and our downs. He used the F-word on me once during a staff dinner. My response was to suspend him for one month. “Don’t finish your dinner, go now.” His father begged me to take him back. His wife, his brothers, and his entire tribe begged. My word had to be my bond, a month it was, with no invitation to staff dinners for an additional three months. He accepted his “chastising” with honor, our relationship was sealed for good and good it has been.


Recently we have recalled our communal journey through the “black night of the soul” and his part in the restoration of hope and life. I asked him what the privileges and the dangers are in being a psychologist working with victims of rape, torture and captivity. Yes, the current human catastrophe in Afghanistan was the backdrop to our discussion.


Noori

“It is an honor to be a part of the Springs of Hope Family and to be a psychologist at The Hope Centre. It is my home. I know that I have made some mistakes but I have learned from them and believe me when I say that they will never happen again. It is a privilege to work with those students and families who were in the captivity of ISIS and have now returned. It is my greatest joy when we complete sessions and they no longer need my help.


My room is their holy of holies. All of the center is their safe space but my consulting room is where they share the secrets that they share with no one. My position is both privileged and hard, because I have to be professional, and maintain dignity, and confidentiality, yet working within our society which is still closed to psychological intervention, I have to be the “Big brother”. This is more than a term, it is a position and a role which allows and enables me to enter their story, which a psychologist cannot do.


It is good that you, Miss Lisa, set up all the protocols which are for the protection of both our clients, and my protection. Particularly in our society which is boundaryless, it was wise to put those boundaries in place before we even begin. The patients know exactly what is expected of them and how the management of SOHF will respond if boundaries are not respected. You have given me the safety net that I need in order to do my job.


Lifeline, exposing life traumas

Psychological education on depression

remember my first session. Oh, it was so hard. It was with S. When she began to share, and she shared everything the first time, it just poured out of her. I found it hard to focus, I could hear her words but my mind went back to how my family faced ISIS and managed to escape and find a safe way into Kurdistan. I had to force myself to focus on her story. It was listening to a list of names of the ISIS men who had raped her. I had a knot in my stomach by the end of the session. I went for a walk in the playground, it was hard for me to breathe but I forced myself to overcome and to separate myself from her trauma. I recognized that I was experiencing secondary trauma. That is when I asked you for the key to the playground, so that I could run for thirty minutes at the end of the day and go home, leaving it all behind. I knew that I had to put a practise of self help into place immediately. If not, I would be consumed.


I believe that is why some of our psychologists did not last. They had no support system in place. I do. You have given me excellent support, you debrief with me every day, with every case and every session and my wife is strong in giving me space to talk or to just go with her for a walk and clear my head. Even with my training, it was so hard to hear the stories of rape. I felt embarrassed to be a man. Ashamed of the male sex. S told me that she would never get married, she would never date a boy, that she could never trust again. We did 37 sessions. Then she got married. I will never forget that, she turned up with a wedding invitation, and now she has a baby. These are the moments that I will never forget, that make it all worthwhile. Those are the privileges, seeing the effects of ISIS overcome. Seeing the healing. Seeing the triumph. It is unbelievable and I am so honored to have a part in the healing journey.


One of the difficulties is in getting the families to accept their raped daughters or wives. It’s not just working with the girls, but often working with the families, particularly the fathers or uncles who consider the raped girls to have brought shame on the family name. Look at the conflict we had with X’s family. Nine years old and raped. It is a miracle that she is alive and sane. Her father, who was taken captive and managed to escape, should have known, should have understood the nature of ISIS, but he refused to welcome her home. As you always say, Miss Lisa, everything we do is a learning curve. No one has yet written the book on “What to do after ISIS”. We are figuring each case out as we go along. In the case of X, I went to visit her father (with her permission of course). First time, he didn't even look at me, his position was fixed, she has shamed the family, she cannot come home. Honestly, I was shocked. I decided to go back and try again, for the sake of X who was confused, unhappy, and angry. This time I used the Socratic method, engaging her father in questions which I hoped would cause him to question the basis of his belief system. He received his daughter home. They reconciled and today live in peace. You see X she is amazing, one of our brightest, most well integrated kids.


You asked me about the cases of potential suicides. That is weighty. Every case is a responsibility but those who come and who are not psychotic cases (which I refer to a psychiatrist) this is a great responsibility. You know me, Miss Lisa, better than anyone. I speak fast but that is outside my room. Inside my room, every word , everything is measured and is according to protocol. I have had 12 cases this year, four men, and eight women. Thank God, none of my patients have committed suicide although they all had a clear plan. One of our students did kill herself this year, she was not one of my patients, but I took it very hard with a lot of self questioning. We can not put the desire or threat to kill oneself all on ISIS. Some of the cases are directly connected to the honor, shame nature of our society. Some are connected to slandering people in social media and causing them to reach the place where they feel unable to cope, degraded and that life is not worth living. This is a hard culture with no coping skills provided. If you make any mistake, it is so hard to rise again.


You will recall the story I shared with you of Z, how she was receiving calls from her captor who had returned to Mosul and was wanting her to come back to him. She was too scared to tell her family, too scared to tell anyone for fear of them thinking that she wanted to return to him, or wanted connection with him, so she decided that death was the solution. After several sessions of Narrative Exposure Therapy, she had the confidence to tell her family and consequently change her phone number. When we completed our sessions, she told me “You are my Big Brother, without your help and without the help of The Hope Centre, I would still be depressed, living in shame without dignity, living in fear. Today I live as a strong woman, not weak and downtrodden but strong. I can talk about ISIS, I can talk about what happened to me. I want to live. If I need you in the future I will call you. You will always be my Big Brother.“


Noori giving out solar radios in the camp

About the men, you asked me about the men. Well, take K for example. Married and with children he was taken by ISIS into captivity. He was there for one year, then ransomed and returned home. He was beaten every day whilst in captivity. He returned home a broken man, needing to wash himself constantly. He can not be intimate with his wife, he can not play with his children, they can't even come close to him. When his wife or his kids try to get close to him, he has to shower himself anywhere between three and seven times. That means, he has to leave his tent, walk to the washrooms, wait, and shower, and repeat and repeat. I will let you know what happens, we have just begun our sessions. It will take time but I am hopeful.


Then you have G the child soldier with one leg. He looks so peaceful, tranquil as if he has his act together despite the loss of his leg. Inside he is on fire, aggressive and fearful. He was taken to military training for eight months, he was trained on every type of firearm. He was taught every type of one on one killing. He was taught how to remain in the midst of the battlefield, between his camp and the enemy camp, how to remain unmoved and make military decisions. Now, one year plus after his rescue flashbacks and nightmares are beginning. He came to me because his friends have also come for sessions so as a former soldier he did not feel ashamed.


Other cases are not connected to captivity in ISIS but are a result of being in a crowded refugee camp. Things that would appear to be small and insignificant, such as a cat or a dog coming close, take on huge proportions to a damaged psyche living in such conditions for a prolonged period of time. A cat or a dog coming into personal space, such as it is, at the wrong time can take a person over the edge into a place of OCD. Oscar is a great help to me in such cases, where part of the treatment is to introduce a patient to him, and gradually stroke him without the need for a shower or medication after. Socratic questioning is good for these cases, done over a protracted period of time. Oscar is great, he is so patient with these people.



You asked me why I love doing play therapy with the little kids. Actually, to be honest, that is my happy place, that is my therapy. I love these kids, they bring me such joy. I teach them to respect themselves and to come dressed well, wearing shoes, clean and with brushed hair to my sessions. If they don't, I send them home so that they will learn self respect and to present themselves well. These are the sessions where I can switch off, teach them some English, play games that will help them with their cognitive development whilst giving them space to share their narrative.

Since we tiled the patio area of the garden and put the fountain there, I make it a point to take my patients there at the end of sessions. We put lavender oil on our hands in my consultation room, breathe deeply for a few minutes and then go to the garden. They sit in the rocking chairs for five minutes, breathe in the lavender, the oregano and the thyme (you see I do as you suggested) and relax. It is the most wonderfully therapeutic place. Some of my patients ask to go and pick a bag of veg to take back to their tents. Sometimes we find Oscar there and he comes and lies down by our legs, a kind of reassuring comfort.



The Garden is also good for me. Believe me I sit in the rocking chair and listen to the sound of water and feel that all the weight of the day is being washed away. That was the biggest danger, taking all the weight home and carrying it into the next day, and the day after that. I leave all the weight, all the heaviness, here at the fountain and go home to my wife, clean.



About Afghanistan. Humanitarian aid is of course needed but I would say to everyone, you have to give food, and give aid but please don't forget to look inside the person. Your heart will need to grow, and you will need much patience but please go inside. Don’t leave them alone with their inside, with that which is hidden from your eyes.


Be strong, be courageous, keep going, because life is strong and life itself keeps going.


Now Miss Lisa, with your permission, I have to go. Bashiq and I are going to play shesh besh.



As for our Noori, he has one request, one prayer. For his wife to be pregnant and for them to have a baby girl. He loves pigtails, and bunches, and ponytails and all the bows and ribbons. Noori wants a baby girl to go home at the end of a long day of disabling the psychological power of ISIS.