Like dozens of refugees before him, Jean Marie Siewe went to the comforting environs of Karen Hanscom's office and told a story of torture.
The 25-year-old native of Cameroon smiled as he spoke, the better to hide his fear and shame. But Hanscom, a psychotherapist who has been treating refugees such as Siewe, detected the signs of post-traumatic stress syndrome and depression -- as apparent to her as the acid scars on Siewe's arm and the cuts on his legs.
Hanscom counsels refugees in her role as executive director of a nascent organization called Advocates for Survivors of Trauma and Torture -- a network of professionals treating the unseen maladies of the Baltimore-Washington area's increasingly diverse population of refugees.
The Baltimore agency is one of 14 in the nation specializing in the treatment of torture victims. Although the United States has long been a haven, it recently has begun to expand treatment for the psychological repercussions of torture, some of which emerge long after the physical wounds have faded.
A $7 million grant program, available for the first time this year through the U.S. Office of Refugee Resettlement, will work to expand treatment nationally for torture victims.
The Baltimore group began informally six years ago as the brainchild of Dr. Jim Sanders, a family-practice physician who had worked at the Minnesota Center for Victims of Torture, and Corinne Bowmaker, a physician's assistant and massage therapist who spent nine years working on the Thailand-Cambodian border with survivors of Pol Pot's Khmer Rouge regime.
The group became a formal nonprofit organization in 1997. Hanscom recently moved to an office in Baltimore and hopes to train other professionals to provide treatment.
In the past 15 years, more than 25,000 refugees have settled in Maryland, according to the U.S. Office of Refugee Resettlement. Like Siewe, many of them are from the west coast of Africa, where Amnesty International says the incidence of torture is on the rise.
For those who hear refugees' stories, providing therapy can be painful. "You're hearing the worst that a human being can do to another human being," Hanscom said.
One woman would sweat and shake when she saw a light bulb, reminded of the lone bulb that shone in the room where she was tortured. A man from Somalia cannot bear to see or smell wet clothes because his work assignment while captive was to do laundry.
Some avoid anyone in uniform or other people from their country who might otherwise have been their first friends in the United States. Immigration law prevents asylum-seekers from working during the first six months their cases are pending, adding to their isolation and financial hardship.
Such psychological symptoms can be viewed by the uninitiated -- in court, for example -- as furtiveness and inconsistency. Sometimes people don't want to acknowledge they have been traumatized when that's precisely what might make their case for asylum.
That's where Hanscom steps in. She testifies about those symptoms, sometimes telling the story of torture so that a victim won't have to. She explains confusing behavior, like the smile on Siewe's face captured in hospital photographs of his injuries.
"The psychological trauma of my clients wasn't something I was particularly conscious of," said Maureen A. Sweeney, an attorney who has represented asylum seekers for Associated Catholic Charities of Baltimore since 1995. "Once I learned about what Karen was doing, I started paying attention more to how the client behaved, and I realized the tremendous need."
Siewe said he was arrested or detained six times in as many years after he joined an opposition party in 1993. His first arrest occurred at a meeting, when he and about 60 other people were taken to a detention center, he said.
"We were locked in a small cell where there was no light and no bathroom," he said. "We were beaten on our feet. We were tortured with electricity."
In his last confrontation with authorities, Siewe said, a group of men, several of them in uniform, threw acid on him, which put him in a hospital for two weeks. Siewe then fled the country, arriving in New York in December 1998 and finding his way to the home of a family friend in Suitland in Prince George's County.
But in a recent hearing, immigration Judge John F. Gossart Jr. noted U.S. government reports that challenged the authenticity of documents Siewe had submitted to the court -- documents that said, among other things, that no record was found of the person who signed a warrant for Siewe's arrest.
Siewe acknowledged, under questioning from a government lawyer, that other than the acid burns, most of his injuries had not been severe enough to warrant medical attention.
"Sadly, the respondent comes from a country in which we see, repeatedly, documentation fraud in asylum claims," Gossart said during the hearing. He continued Siewe's case until next month to allow further analysis of documents.
But Hanscom remained confident in her diagnosis, telling the judge that she noticed symptoms in Siewe that are not easily faked and that he was consistent when retelling his story.
"People who have experienced trauma and torture have to work very hard at keeping up a wall," she said.