Dr. Donald Payne likes out-of-the-way places. Last November, the 75 year-old psychiatrist left the Beach for a trip to Myanmar. He went to Iceland in July.
Payne got his start as one of four doctors at a hospital in Baie Verte, Newfoundland – then a fishing village that had just boomed thanks to an asbestos mine.
It was 1965, the year Newfoundland built its first road across the province.
Payne remembers a nine year-old who got sent from her home in the outports to the big hospital in Corner Brook. She came back talking about elevators.
“People were amazed,” he said. “You were in this little box, it moved, and you were in a different world.”
Since he entered psychiatry, Payne has met hundreds of people who have fled to Canada from far away, and troubled, places.
He has treated more than 1,500 people who were victims of torture abroad.
Payne said he left Newfoundland to study psychiatry in Toronto partly because he was seeing a lot of mental health issues there, but also because at a time when much of medicine was growing more technical, psychiatry offered more time with patients, and a more philosophical approach.
After a residency, and three years at the Queen Street Mental Health Centre, Payne began a private psychiatry practice. In 1978, he replied to a request for psychiatrists in the Amnesty International newsletter.
Amnesty needed doctors who could help substantiate refugee claims. At the time, Canada was receiving many refugees from military-ruled Chile – they had been tortured, but didn’t always bear physical signs.
It was the beginning of a long career helping refugees and others who have been victims of torture, including Maher Arar, in whose case Payne acted as an expert witness.
Generally, Payne said, the guidelines for treating victims of trauma recommend some kind of re-exposure.
That might work for the victim of a car accident, he said, or for other situations where someone’s life remains relatively the same.
But refugees’ entire lives have changed, he said. They’ve fled to a new country, often with a new language. And re-exposure can be much worse than for others suffering from post-traumatic stress.
“With refugees, we almost cut out that centre section – dealing with the torture – it’s much more about getting on with their lives, and dealing with issues as they come up around their past,” he said.
“Sitting down and talking about their torture all the time – that’s not helpful.”
Payne remembers meeting 13 men who had been held in a concentration camp and tortured during the war in Bosnia. They came to Canada as part of a prisoner exchange.
When he met them, a week after they arrived in Toronto, not one of them mentioned their detention.
“Their main concern was, ‘Our wives are not here,’” said Payne. “‘The government promised our wives would be here.’”
Payne remembers a similar story from Clare Pain, a psychiatrist at Mount Sinai Hospital (“She’s a real pain – P-A-I-N,” he joked).
Her patient was a man in his 20s who had been badly tortured, and showed significant anxiety.
“It was easy to say torture was the problem – he’d had enough to back it up,” said Payne.
But it turned out the young man’s immediate problem was that he’d never learned to cook or keep house, and he was sharing an apartment with another refugee where he was expected to look after things.
He got signed up for a cooking class, and his situation improved.
Often, said Payne, the best help for refugees is finding good housing, and having a job.
“In our Western culture, there is a sense that talking about things is the thing that helps,” he said. “But people have a multitude of needs.”
“I guess it’s part of the whole medical thing, of seeing people beyond their diagnosis,” he said. “That’s part of their lives, but there is life beyond.”
Asked if he might write a book about his practice, Payne said the history he’d like to write is about all that the medical network of Amnesty International, the Canadian Centre for Victims of Torture, and the Canadian Medical Association have been able to achieve for torture victims and on related ethical issues, such as the death penalty.
As a doctor who grew up in the 1950s, Payne said he’s seen a shift in the culture of medicine.
“In the early days, when I was in medical school, politics and medicine were seen as entirely separate things,” he said.
“The young guys are much more aware of the world now.”