Page 23 - Healing Voices_za sajt

Module 1: Trauma, Recovery and Torture Survivors

by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery
characteristic of MDE. The thought content associated with grief generally features a preoccupation
with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations
seen in MDE. In grief, self-esteem is generally preserved, whereas in MDE feelings of worthlessness
and self-loathing are common. If self-derogatory ideation is present in grief, it typically involves
perceived failings vis-à-vis the deceased (e.g., not visiting frequently enough, not telling the deceased
how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts
are generally focused on the deceased and possibly about “joining” the deceased, whereas in MDE
such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life,
or unable to cope with the pain of depression.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-
induced or are attributable to the physiological effects of another medical condition.
—American Psychiatric Association, 2013

Suicidal ideation or suicide attempts

At times, survivors may feel intense hopelessness and despair. Individuals may have thoughts of
not wanting to live any longer or may pray each night that they will die before morning. At times,
these thoughts go further and individuals begin to consider ways in which they could hurt or kill
themselves. Because of this, the interpreter may observe clinicians doing a suicide risk assessment
upon meeting new patients and also on an ongoing basis. Depending on the level of risk, it may be
necessary to consider hospitalization.

Generalized anxiety

Anxiety is a common effect of torture as well. Generalized anxiety disorder refers to uncontrollable
excessive anxiety and worry that interferes with one’s ability to function in life. Someone may find
that their worries prevent them from focusing on tasks at hand. Anxiety is associated with at least
three of the following symptoms: restlessness or feeling keyed up or on edge, being easily fatigued,
difficulty concentrating or having one’s mind go blank, irritability, muscle tension or having problems
with sleep.

The course of anxiety is often chronic and fluctuating. It commonly gets worse during times of stress.
The predisposition to generalized anxiety can also run in families. It is common to have generalized
anxiety associated with other mood or anxiety disorders or substance abuse, or somatic symptoms
(American Psychiatric Association, 2013).

15