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Abstract

Scarring can be understood as a visible bodily entity or a metaphorical internal experience. Each type has liminal qualities, changing in form or intensity over time. The bearer may conceal scarring from others or may share stories that hold varied emotions, from horror or disgust to pride or self-esteem. For people who have survived torture or other forms of violence, and are seeking asylum, scars may take on particular additional meanings as objects that are put to work in official decision-making processes. In this Sociology in Action article, I explore multiple meanings of scars following torturous violence, with a particular focus on asylum-seeking contexts. I contribute to literature on identity and on the narrative potential of scars in survivors’ recovery, as a means of narrative connection between a traumatic past and desired future, in lives that are disrupted or unstable. I consider the work of performing the consistency required in an asylum claim alongside the sense-making that might be achieved through narratives, within dynamic constructions of identity over time. Future narrative research could explore how survivors of torturous violence develop a coherent sense of self while navigating these conflicting strands of identity work, and the impacts of those who scrutinise or support them.

Keywords

asylum-seeking identity work narrative scars stories torture

Introduction

A high proportion of asylum seekers and refugees have survived torture (Ostergaard et al., 2020). Torture is typically understood to be an act by which pain or suffering, physical or mental, is intentionally inflicted on an individual by someone in an official capacity (United Nations, 1988). However, experiences that define torture are open to interpretation. Similar forms of violence may not be included within a narrow lens that relies upon a particular type of state perpetrator, for example when considering sexual or gender-based violence. Canning (2023) offers the alternative concept of torturous violence, bringing our focus directly onto forms of violence and their impacts.

When seeking asylum, those who have survived torturous violence face scrutiny about the factual accuracy and consistency of their claim. Bodily scars and psychological correlates are clinically assessed and documented according to formalised criteria, becoming evidence that is dissected by immigration officials. Where bodily scarring is present, its appearance is judged alongside the likelihood that it is compatible with accounts of torturous experience that are given by the bearer. These accounts may have been documented at different time points and through multiple interactions with a range of professionals, including immigration officials, solicitors, doctors, and psychologists. There is often nothing except for the bodily ‘evidence’ of the individual, on which to base judgements. The apparent alignment between the asylum seeker’s account and their bodily evidence is then taken as an indicator of the overall strength of the claim. Decision makers frequently rely upon perceived narrative inconsistencies as the basis for refusal of claims for protection (Abbas et al., 2021; Herlihy et al., 2012). Ultimately, those bodies that are deemed suspicious or uncertain can be detained in an immigration removal centre (IRC), or removed by deportation (Malloch and Stanley, 2005).

Bodily scars from non-torturous causes have been explored within narratives of identity change, highlighting ways that scars can play a positive as well as negative role in bearers’ lives and are ‘seldom a fixed entity’ (Lowton and Higgs, 2022: 4). Drawing on understandings of identity as a continuous process of reiterating and re-signifying one’s position (Butler, 1990), I consider ways in which scar stories might be put to work in overcoming ruptures that threaten the coherence of lives (Charmaz, 1999; Neimeyer, 2000). Stories about scars from non-torturous causes may contribute to identity work, for example by acting as reminders of people and place, or as markers of strength, or by enabling connections between the past and present (Gunnarsson, 2022; Lowton and Higgs, 2022; Ngaage and Agius, 2018; Weitz, 2011).

A sociology of scars has not yet turned to scarring sustained through torturous violence, where identities may become entangled with medicolegal and immigration structures. As researchers and practitioners, there are also questions about our responsibilities and our impact when asking for accounts of scars from a position of difference, for example, in our ethnicity, language, power, or privilege.

The aim of this article is to explore the potential identity work of torture scar narratives and to highlight areas for future research, specifically in relation to asylum processes. By considering multiple meanings that scars may take, I consider the narrative potential of scar stories following torturous violence and the contrast with official expectations for consistency between accounts within asylum seekers’ claims. I do not include findings from the related extensive research on psychological processes in surviving torture and in asylum-seeking, which examines the challenges inherent in recalling highly distressing, personal experiences (Herlihy et al., 2012; Khan et al., 2021).

Contexts

I draw on interpretations from my own personal experiences of carrying out physical and mental health assessments with people seeking sanctuary in England. As asylum processes and IRCs typically preclude researcher access, ‘insider’ experiences can enable novel understandings that would not necessarily be captured through traditional research methods (Adams et al., 2017; Clark-Kazak, 2017). My interpretations are shaped by particular clinical practices and knowledge of these assessments for the purpose of medicolegal report writing, as well as my sociological interests in the use of narrative methodologies in exploring sense of self and agency (Mäkelä, 2017, 2019, 2021a).

I consider agency to be the freedom to recognise that positioning in discourse practices, by powerful others, cannot determine or delimit one’s identity and instead is ‘a fragmented, a transitory, a discursive position’ (Davies, 2000: 67). Similarly, I view sense of self as ‘not what is, but what might be’ (Davies, 2000: 67; emphasis in original). I am interested in exploring how we make sense of our ‘selves’ and how we can produce a desired sense of self through narration as a social process.

Medicolegal reports are submitted as expert reports in asylum applications (Pettitt, 2011). They document physical and psychological consequences of torturous violence, which is placed in the context of the survivor’s overall history. In producing such a report, clinicians must not only describe and document clinical findings but also make judgements about bodily and psychological scarring, and the plausibility of bearers’ accounts. Bodily scar dimensions, appearances, and locations are depicted on ‘body map’ diagrams, in accordance with the revised (United Nations Office of the High Commissioner for Human Rights, 2022). These internationally recognised standards therefore shape our approach as clinicians, in the examination and reporting of alleged torture and ill-treatment (Iacopino et al., 2022). Clinicians must judge the degree of consistency between each scar (and the pattern of scars, if there are multiple) and the attributions given by the bearer, by applying a categorisation framework from ‘not consistent’ through to ‘diagnostic’ for each cause described.

Broader clinical contexts, outside asylum processes, also hold complexities that can impact survivors’ narratives of torturous violence. Survivors with scarring have reported that they perceive an avoidance of their accounts by professionals, such as when general practitioners have not asked about their scars. This absence of attention may bring ‘feelings of invisibility, and the silence surrounding their stories reinforce[s] their mistrust, during their healthcare encounters’ (Schippert et al., 2021: 9). On the other hand, survivors may have the impression that, ‘in order to ‘pass’ for one of us, they must learn that we do not really want to hear their stories’ (Cubilie, 2022: xii).

When a clinical assessor does directly ask about scarring, and for the scars to be revealed for examination, the interaction itself may then re-traumatise the survivor causing reactivation of fear, intrusive memories, or a sense of reliving traumatic events, during or after the assessment (Schippert et al., 2021). The examination of scars, and the elicitation of accounts of traumatic experience, therefore requires a careful balance to achieve navigation of trust and distrust within the clinical encounter (Mäkelä, 2021b). Each interaction potentially shapes survivor experience, sense-making, and identity, through an ‘ontological choreography’ that unfolds during the interaction (Cussins, 1998: 192).

Multiple meanings

The objectification of bodily scars in asylum processes suggests one of many ways that scars and their stories are put to work (Mol, 2002). The gaze of the immigration official differs to that of the clinician. For the bearer of a scar, its physical appearance is often a changing object. Meanwhile, processes of remembering the circumstances of injury may involve selective interpretations of one’s actions, interactions, and emotional responses. A bodily scar’s symbolic significance may be invoked, adjusted, or suppressed, according to the bearer’s and others’ framings of ‘things worth knowing’ (Burnett and Holmes, 2001: 23), and the opportunities or constraints that are afforded through the particular interaction and relationship to the listener.

In my clinical interactions with survivors of torturous violence, I have listened to the varied ways in which people may start to tell their story differently, as we turn to the examination of the survivor’s bodily scars. Our co-constructed narrative often shifts in pace and depth, alongside the meticulous measuring and documenting of each bodily scar, which I am required to perform in accordance with Istanbul Protocol standards (Iacopino et al., 2022). Purposefully moving from one scar to the next, I examine each and ask for recollections of how each one was sustained, whether the wound was treated by a healthcare professional or how the survivor managed it themselves. I ask what happened over the course of wound healing and whether there have been any lasting symptoms.

I have often observed how survivors begin to position themselves differently while giving an account of their scarring and the surrounding circumstances. They may start to position themselves with greater agency, despite the often-horrific events recalled, and may even turn towards fleeting glimpses of positivity in the storying of their scars. All this time, we pay close attention to each scar, alongside the story that the survivor chooses to share. Importantly perhaps, stories of scars sustained in other aspects of the survivor’s life (such as through sports, cooking, or work-related injuries) become intertwined with the stories of scars gained through traumatic and sometimes unspeakable circumstances.

Survivors of torturous violence often feel guilt and shame, or may feel as if they have let themselves or their friends and family down (Kirmayer et al., 2018). The telling of scar stories may help by provoking a sense of protection not only when speaking about one’s body, but extending to family, community, and a valued way of life. The scar story may allow a means of connection to moral values and ties, bringing forward particular, desired aspects of remembered social contexts and relationships, and thereby to the social groups that are considered crucial for maintaining identity in the context of adversities (Walsh et al., 2015). The narrative potential of scar stories might draw on these broader memories, which can ‘co-constitute who we are at present’ (Shortt and Izak, 2021: 1694), thereby offering space for personal agency, sense-making, and identity work.

Decision makers’ judgement of the consistency of torture survivors’ accounts is one of the main criteria in rulings on asylum claims (de Bruïne et al., 2023). The underpinning assumption is that survivors can provide a detailed, specific, and unchanging description of an experienced traumatic event (Herlihy et al., 2012). The expectation that bodily ‘evidence’ of documented scars is deemed compatible with survivors’ accounts forms an important component in the assessment of credibility. Such expectations are starkly incompatible with ways that stories can change over time, connecting between the self in the past, present, and future. In the midst of fragmented identity following torturous violence, and displacement from home, family, and community, survivors must somehow navigate between listeners’ expectations and scrutiny while working to maintain a coherent sense of self.

Narrative analysis approaches

Narrative inquiry offers one way of making sense of experience, through the stories people tell about their lives (Connelly and Clandinin, 1990). There is a long tradition of using narrative to understand the self and identity (Bruner, 1987, 1986). Narrative inquiry also offers a means to explore power relations and epistemic injustice, as ‘a wrong done to someone in their capacity as a knower’ (Fricker, 2007: 1). Future narrative research could explore the emotional and identity work of scar stories for survivors of torturous violence, with attention to the interplay between the personal, the social, and the cultural. I illustrate three narrative analytic approaches which hold potential for the investigation of identity work through scar stories. These use lenses of: (1) narrative typologies (Frank, 1995) (2) positioning analysis (Bamberg, 2003), and (3) narrative dimensions (Somers, 1994).

Narrative typologies

Frank (2018) asserts that stories ‘can be acts of making life liveable’ (p. 111), outlining dominant illness narrative structures of chaos, restitution, and quest (Frank, 1995). These structures could be applied to the analysis of narratives following torturous violence. A narrative that seems chaotic may be told by someone who is struggling to make sense of their experiences, or to see a pathway forward, or is facing ongoing challenges of asylum-seeking in the present. The typical restitution narrative seeks to maintain the past but, in the context of forced migration, may involve adjusting, settling, and achieving a sense of belonging in a new environment (Woodgate and Busolo, 2018). By contrast, the quest narrative depends upon acknowledging change, including change in sense of self, for example:

I’ve been raped, I’ve been tortured, I’ve been humiliated, I’ve been stripped off. I used to have a good, wonderful life. I had everything anyone would dream of in the world. Everything was stripped off me within two hours. But yet my life is still intact. How did I come this far? (Taylor et al., 2020: 17)

Analysis using the lens of the quest narrative might inform understandings of ‘post-traumatic growth’, which suggests that people can experience personal growth and strength through the processing of trauma and through struggles with highly challenging circumstances (Jirek, 2017).

Positioning analysis

In contrast to Frank’s narrative typologies, positioning analysis offers a lens to examine stories more closely in terms of what is said, how it is said, and effects on (and from) the social world (Harré et al., 2003). Telling a story positions the self and others, in relation to the storylines. This relational story-telling is referred to as positioning (Davies and Harré, 1990). Positioning analysis is used widely in narrative research on identity. It offers an alternative lens for the analysis of scar stories, by enabling exploration of ‘sense of self, the ideas and metaphors with which we think, and the self-narratives we use to talk and think about ourselves’ (Burr, 2003: 124). Bamberg (2004) proposes distinct levels of positioning: (1) the effects of the world upon the self, compared to the self onto the world; (2) the differentiation or ‘othering’ of the self from others; and (3) how the self is presented as continuous or discontinuous across time. Positioning analysis may open up sites of narrative struggle for agency and coherence in sense of self, and their negotiation within scar stories.

Narrative dimensions

The third analytic approach acknowledges the varied ways that narratives of identity formation are situated within power relations of the local setting, where broader forces shape language and experience (Langellier, 1999; Squires et al., 2015). Narrative inquiry could explore the significance of dimensions (or layers) within scar stories by applying the four categories identified by Somers (1994): (1) ontological stories, in which narrators draw on accounts of personal attributes and experiences to make sense of events; (2) public narratives, which are attached to cultural and institutional structures across levels such as families, organisations, and nations; (3) meta-narrativity, which contains the master narratives or explanatory schemes in which narrators are embedded (e.g. nationhood as a master narrative of state control); and (4) conceptual narrativity, which acknowledges the conceptually guided co-construction of narrative by social researchers. Narrative analysis of scar stories could attend to the location of bodies and identities within wider relational and temporal networks that are personal, local, and global (Phibbs, 2008), acknowledging the multi-layered ways that stories are told ‘within narratives rarely of our own making’ (Somers, 1994: 606; emphasis in original).

Conclusion

The status of refugee or asylum seeker is both legally determined and a subjectivity, which is shaped by and through storied experience. In this Sociology in Action article, I have considered narrative inquiry as a means to bring forward survivors’ stories following torturous violence, paying attention to the ways in which these stories are embedded within social and cultural contexts. I have illustrated narrative approaches that might be used to investigate scar stories and their intersections with institutional processes, power relations, and personal agency. Future areas to explore include the effects of scrutiny applied within the ‘rigid plotlines’ of claiming asylum (Woolley, 2017: 4), and the constraints of clinical assessment where accounts are ‘not necessarily the stories survivors would tell if we listened differently’ (Cubilié, 2005: xii). A further area for exploration is the contribution of scar stories to the co-navigation of emotions within interactions that hold risk of re-traumatisation.

Further research into identity work and sense-making through scar stories may not only inform practices of bodily scar assessment but also interactions with survivors of torturous violence where bodily scars may not have been sustained, such as in sexual or gender-based violence (Oxford, 2023). Survivors may become re-traumatised when practitioners do not ask for these stories, or may feel invisible, or sense that their stories are deemed unimportant (Schippert et al., 2021). Further research could also attend to overlooked factors that may complicate narratives, such as cognitive or emotional changes following traumatic brain injury sustained during torturous violence (McPherson, 2019). Finally, narrative inquiry offers a means to uncover the varied ways in which practitioners might facilitate survivors’ (re)-storying of traumatic experiences, at the same time as their own navigation of the ‘judging’ that is required of them, to adhere to medicolegal reporting standards.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Petra Mäkelä

Author biography

Petra Mäkelä is a Health Services Researcher interested in inquiry into marginalised people’s needs, and their health and care interactions. Clinically trained as a physician in neurorehabilitation, Petra also works with a non-governmental organisation providing medical support to people seeking sanctuary in England.

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The Identity Work of Torture Scars

Abstract

Keywords

Introduction

Contexts

Multiple meanings

Narrative analysis approaches

Narrative typologies

Positioning analysis

Narrative dimensions

Conclusion

Footnotes

Funding

ORCID iD

Author biography

References