The torture victim and the dentist: The social and material dynamics of trauma re-experiencing triggered by dental visits
DOI:
https://doi.org/10.7146/torture.v32i3.125290Palabras clave:
oral health, dental treatment, torture survivors, PTSD, rehabilitationResumen
Introduction: The flow of refugees towards Europe over the past decade has placed increased demands on the health care services. A significant proportion of refugees have been subjected to torture involving their mouth or teeth, still the importance of oral health challenges is often overlooked or underestimated in the rehabilitation of torture victims. In this qualitative study, we set out to explore the processes that complicate torture victims’ ability to engage in and tolerate dental procedures.
Methods: Ten resettled refugees with experience of torture were recruited among patients affiliated with specialized clinics for oral health rehabilitation in Norway. Data were collected through semi-structured exploratory interviews, and analyzed using a qualitative content analysis approach.
Results and discussion: We present an exploration of what we have called the social and material anatomy of the triggering event; the process through which trauma-related reactions are produced in torture victims in the course of undergoing dental treatment. All professionals who work with torture survivors should be aware that these individuals often suffer from oral health problems that may affect both their physical and their psychological quality of life. However, although dental treatment is essential, it may still represent a major challenge. Our data suggest, we propose, that dental treatment often involves an experience being suspended, albeit temporarily, in an objectified position, acted on by subjects capable of producing deeply undesirable mental, emotional or bodily states. Three main categories emerged as the most prominent factors with such an agentic capacity: 1) pain, 2) traumatic memories and 3) the dentist. Submitting to dental treatment hence requires the patient’s willingness to give in to the actions of these factors, and avoiding treatment may therefore, in this situation, represent a means of retaining control.
Citas
Abu-Awwad, M., Al-Omoush, S., Shqaidef, A., Hilal, N., & Hassona, Y. (2020). Oral health-related quality of life among Syrian refugees in Jordan: a cross-sectional study. International Dental Journal, 70(1), 45-52. https://doi.org/10.1111/idj.12521
Armfield, J. M., Slade, G. D., & Spencer, A. J. (2008). Cognitive vulnerability and dental fear. BMC Oral Health, 8, 2. https://doi.org/10.1186/1472-6831-8-2
Basoglu, M. (2009). A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments: implications for an evidence-based definition of torture. American Journal of Orthopsychiatry, 79(2), 135-145. https://doi.org/10.1037/a0015681
Bernstein, J. M. (2015). Trust as a Mutual Recognition. In J. M. Bernstein (Ed.), Torture and Dignity: An Essay on Moral Injury (pp. 218-223). University of Chicago Press.
Bhusari, S., Ilechukwu, C., Elwishahy, A., Horstick, O., Winkler, V., & Antia, K. (2020). Dental Caries among Refugees in Europe: A Systematic Literature Review. International Journal of Environmental Research and Public Health, 17(24). https://doi.org/10.3390/ijerph17249510
Burris, J. L., Cyders, M. A., de Leeuw, R., Smith, G. T., & Carlson, C. R. (2009). Posttraumatic stress disorder symptoms and chronic orofacial pain: an empirical examination of the mutual maintenance model. Journal of Orofacial Pain, 23(3), 243-252. https://www.ncbi.nlm.nih.gov/pubmed/19639104
Close, C., Kouvonen, A., Bosqui, T., Patel, K., O'Reilly, D., & Donnelly, M. (2016). The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health, 12(1), 47. https://doi.org/10.1186/s12992-016-0187-3
de Jongh, A., Fransen, J., Oosterink-Wubbe, F., & Aartman, I. (2006). Psychological trauma exposure and trauma symptoms among individuals with high and low levels of dental anxiety. European Journal of Oral Sciences, 114(4), 286-292. https://doi.org/10.1111/j.1600-0722.2006.00384.x
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345. https://doi.org/10.1016/s0005-7967(99)00123-0
Fredriksen, T. V., Softestad, S., Kranstad, V., & Willumsen, T. (2020). Preparing for attack and recovering from battle: Understanding child sexual abuse survivors' experiences of dental treatment. Community Dentistry and Oral Epidemiology, 48(4), 317-327. https://doi.org/10.1111/cdoe.12536
Høyvik, A. C., Lie, B., & Willumsen, T. (2019). Dental anxiety in relation to torture experiences and symptoms of post-traumatic stress disorder. European Journal of Oral Sciences, 127(1), 65-71. https://doi.org/10.1111/eos.12592
Isakson, B. L., & Jurkovic, G. J. (2013). Healing after torture: the role of moving on. Qualitative Health Research, 23(6), 749-761. https://doi.org/10.1177/1049732313482048
Keboa, M. T., Hiles, N., & Macdonald, M. E. (2016). The oral health of refugees and asylum seekers: a scoping review. Global Health, 12(1), 59. https://doi.org/10.1186/s12992-016-0200-x
Keller, A. S., Weiss, J., Resnick, S., Berkowitz, L., Soeprono, A., Sullivan, M. J., Granski, M., Cere, E., & Wolff, M. (2014). Lessons in health and human rights: providing dental care to torture survivors. Journal of the American College of Dentists, 81(1), 36-40. https://www.ncbi.nlm.nih.gov/pubmed/25080669
Kisely, S. (2016). No Mental Health without Oral Health. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 61(5), 277-282. https://doi.org/10.1177/0706743716632523
Larijani, H. H., & Guggisberg, M. (2015). Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation. Int J Dent, 2015, 452814. https://doi.org/10.1155/2015/452814
Lenk, M., Berth, H., Joraschky, P., Petrowski, K., Weidner, K., & Hannig, C. (2013). Fear of dental treatment--an underrecognized symptom in people with impaired mental health. Dtsch Arztebl Int, 110(31-32), 517-522. https://doi.org/10.3238/arztebl.2013.0517
Schreier, M. (2012). Qualitative Content Analysis in Practice. Sage.
Sigvardsdotter, E., Vaez, M., Rydholm Hedman, A. M., & Saboonchi, F. (2016). Prevalence of torture and other warrelated traumatic events in forced migrants: A systematic review. Torture, 26(2), 41-73. https://www.ncbi.nlm.nih.gov/pubmed/27858780
Singh, H. K., Scott, T. E., Henshaw, M. M., Cote, S. E., Grodin, M. A., & Piwowarczyk, L. A. (2008). Oral health status of refugee torture survivors seeking care in the United States. American Journal of Public Health, 98(12), 2181-2182. https://doi.org/10.2105/ajph.2007.120063
Speers, R. D., Brands, W. G., Nuzzolese, E., Smith, D., Swiss, P. B., van Woensel, M., & Welie, J. V. (2008). Preventing dentists' involvement in torture: the developmental history of a new international declaration. Journal of the American Dental Association, 139(12), 1667-1673. https://doi.org/10.14219/jada.archive.2008.0109
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302(5), 537-549. https://doi.org/10.1001/jama.2009.1132
Svenaeus, F. (2015). The phenomenology of chronic pain: embodiment and alienation. Continental Philosophy Review, 48, 107-122. https://doi.org/https://doi.org/10.1007/s11007-015-9325-5
Taylor, B., Carswell, K., & Williams, A. C. (2013). The interaction of persistent pain and post-traumatic re-experiencing: a qualitative study in torture survivors. Journal of Pain and Symptom Management, 46(4), 546-555. https://doi.org/10.1016/j.jpainsymman.2012.10.281
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2021 Torture Journal
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.