Counselling victims of torture sounds grim as a career choice, but according to Bermudian Brian Rosorea it is not nearly as grim as being stuck in the wrong career.

This summer, Mr. Rosorea became Dr. Rosorea when he graduated with a doctoral degree in clinical psychology from the Wright Institute in Berkeley, California. Dr. Rosorea previously worked in the business and hotel industry in Bermuda, but now works in San Francisco, California counselling victims of trauma, particularly combat veterans, refugees and victims of torture.

"Clinical psychology was a major career change in my early 30s," said Dr. Rosorea who was back on the Island during the Christmas period.

"A host of factors led to that, but the one that was most apparent was that I was working in a challenging environment, but I wasn't suited for it. I wasn't feeling personally fulfilled. The decision to change careers was aimed at personal growth and realigning my interests with my profession."

He had been fascinated by psychology since he was an undergraduate in college, but when he was younger he directed himself towards the areas and skills he thought would be useful in Bermuda such as business.

"I didn't allow myself to be a little bit more creative when I was younger," he said. "It took a few years to realise I was probably more suited to something like psychology."

Dr. Rosorea managed to achieve his degrees, do an internship and a dissertation in just four years, half the time that many people take.

"Trauma is becoming one of my specialities just by virtue of how many populations I have worked with that have suffered from trauma," said Dr. Rosorea. "I worked in San Francisco General Hospital for my internship.

"That is a major public trauma hospital in San Francisco. I worked with a lot of refugees and domestic violence cases and trauma of a general nature."

Dr. Rosorea also worked with combat veterans and survivors of war who were suffering from post traumatic stress disorder (PTSD) at the San Francisco Veterans Administration Hospital.

He is currently finishing up post doctoral work in San Francisco at Survivors International, a charity that deals mostly with refugees and victims of torture.

"Its mission is to assist refugees and specifically victims of torture in getting their lives back," said Dr. Rosorea. "That can mean putting them in touch with places that can provide them with food and shelter and ways to learn the language. They look at medical needs, whether it is medication or documenting someone's injuries. These are people who are fleeing their countries. They may come across the border, they may come in on flights, ships, any way that is possible for them to get there."

Many of Survivors International's clients are seeking political asylum in the United States.

"Often these people would be working with an attorney helping them with an immigration appeal," said Dr. Rosorea. "Where it is helpful for me as a psychologist to be involved would be to sit with someone and do either an intake or an extended evaluation. Often they take a number of sessions and a number of hours because of the intensity of the trauma."

It is also part of Dr. Rosorea's job to determine, to the best of his ability, whether the client is credible, whether their claims of torture are true, and document the psychological impact of the torture. Then he puts together a report that is essentially a forensic psychological evaluation documenting the manner in which the client has been effected psychologically or emotionally by the trauma they are reporting. The medical team at Survivors International also documents any physical evidence such as injuries or scars.

"The organisation has been seeing as many as 25 to 35 people per week in the past," said Dr. Rosorea. "Whether that is from the perspective of giving medical assistance or psychotherapy or performing these evaluations. They come from countries around the world.

"Within the last couple of weeks I have worked with people from Tibet, Armenia, various African countries, Guatemala, El Salvador, and the Philippines, just to name a few."

He said it is helpful for him to keep up with world events, but the wide range of nationalities of his clients sometimes makes this difficult.

"The attorney needs to be able to say if this person is returned to their country, are they in danger," he said. "Are the situations in the country still what they were when the person was fleeing the country? We also have to be aware of cultural variables."

Two of the most common symptoms he sees is major depression that goes along with someone being estranged from their family and post traumatic stress disorder which is a description of many of the ways that people respond to an enormous trauma in their lives.

"These are very intense instances of trauma," he said. "However, more broadly said, much of psychotherapy has to do with some sort of trauma or another whether it is very small childhood traumas or severe acute major traumas."

He said there are four components to major trauma.

"To start with there has to be an event or stresser, something that has created a sense of deep helplessness and fear in the person. People have several general ways of responding. One way has to do with avoidance."

Dr. Rosorea said many of his clients try to cope by avoiding any thoughts of the traumatic event, avoiding certain relationships or turning to substance abuse to numb the pain.

"They may become very involved in a career," he said. "I saw that with many Second World War veterans. When they came back from war they would be very successful in their careers.

"It wasn't until they stopped working or there was a death of a spouse that many of their dormant trauma symptoms resurfaced," he said. "So avoidance is one of the main characteristics. Another is re-experiencing of the trauma."

An example of re-experiencing would be nightmares, or dissociative episodes or flashbacks while they are awake.

"I worked with Vietnam veterans," he said. "On one occasion we were in the VA hospital and there was a July 4 event where low flying airforce planes came over the roof of the building. Almost everyone in the group ducked down under the table. The whole group was on the floor thinking they were being back in the combat experience even though it was many years past.

"The third area that is common among trauma survivors is arousal where someone expects something bad to happen to them almost all the time," Dr. Rosorea said.

"Their central nervous system is so keyed up that they might have what is called an exaggerated startle response. Someone might come into the vicinity and they jump. A loud noise may startle them. Many of the people who come into our agency who are survivors immediately sit with their back to the wall and their vision on available exits. They will be monitoring an escape route but it creates obvious stresses on someone's central nervous system."

Dr. Rosorea's task, in many instances, is to help someone realise what is happening to them and to reassure them that they are not going crazy. He tries to help his clients deal with any shame or guilt they may be feeling relating to their own victimisation. He also tries to educate them about the nature of PTSD.

"The relief this small bit of knowledge may provide the victim is very rewarding to see," he said. "For example, I worked with a soldier who had seen extensive combat. He presented with many symptoms including being disturbed by occasional visual hallucinations and feared that he was 'going crazy'.

"It became apparent however that these visual distortions were occurring on the periphery of his left and right vision, where he occasionally saw shadows, when under stress. His combat experience included driving a truck along a very dangerous supply route in addition to 'walking point', being the lead soldier in a small patrol. Both situations involved the need to be intensely aware of potential ambushes from either side which did sometimes happen.

"His hallucinations were occurring in the context of intrusive remembering of these war time situations, and could be understood as a form of extreme hyper-vigilance as opposed to a more pervasive psychotic process. Without consideration of the context and meaning of his symptoms, this man might simply and inappropriately have been labelled a paranoid psychotic."

Although Dr. Rosorea often deals with sad situations, he said it is rewarding to help someone therapeutically by providing a safe environment in which they can address their past and document their torture, if necessary.

"This process is often very difficult and may be accompanied by increased symptoms such as more nightmares, but is important as it may lead to their being granted political asylum and not being deported back to an unsafe environment," he said.

"I am fortunate that my clinical training has provided me with the ability to facilitate a therapeutic environment of safety from which the trauma survivor can be aided in their efforts to re-construct their life, to feel again, to put the pieces of their life back together."

Dr. Rosorea hopes to return to Bermuda when his doctoral work is over wherever the work is.

"I have also been working with a variety and cross section of the community, but have found it rewarding working with trauma patients," he said. "If I came back to Bermuda I would like to be able to draw on some of the skills where relevant."