G. nated food and water, exposure to extremes of temperature, denial of privacy and forced nakedness; (n) Deprivation of normal sensory stimulation, such as sound, light, sense of time, isolation, manipulation of brightness of the cell, abuse of physiological needs, restriction of sleep, food, water, toilet facilities, bathing, motor activities, medical care, social contacts, isolation within prison, loss of contact with the outside world (victims are often kept in isolation in order to prevent bonding and mutual identification and to encourage traumatic bonding with the torturer); (o) Humiliation, such as verbal abuse, performance of humiliating acts; (p) Threats of death, harm to family, further torture, imprisonment, mock executions; (q) Threats of attack by animals, such as dogs, cats, rats or scorpions; (r) Psychological techniques to break down the individual, including forced betrayals, accentuating feelings of helplessness, exposure to ambiguous situations or contradictory messages; (s) Violation of taboos; (t) Behavioural coercion, such as forced engagement in practices against the religion of the victim (e.g. forcing Muslims to eat pork), forced harm to others through torture or other abuses, forced destruction of property, forced betrayal of someone placing them at risk of harm; (u) Forcing the victim to witness torture or atrocities being inflicted on others. Review of torture methods 144. After eliciting a detailed narrative account of events, it is advisable to review other possible torture methods. It is essential to learn about regional practices of torture and modify local guidelines accordingly. Questioning about specific forms of torture is helpful when: (a) Psychological symptoms cloud recollections; (b) The trauma was associated with impaired sensory capabilities; (c) There is a case of possible organic brain damage; (d) There are mitigating educational and cultural factors. 145. The distinction between physical and psychological methods is artificial. For example, sexual torture generally causes both physical and psychological symptoms, even when there has been no physical assault. The following list of torture methods is given to show some of the categories of possible abuse. It is not meant to be used by investigators as a checklist or as a model for listing torture methods in a report. A method-listing approach may be counter-productive, as the entire clinical picture produced by torture is much more than the simple sum of lesions produced by methods on a list. Indeed, experience has shown that when confronted with such a “packagedeal” approach to torture, perpetrators often focus on one of the methods and argue about whether that particular method is a form of torture. Torture methods to consider include, but are not limited to: (a) Blunt trauma, such as a punch, kick, slap, whipping, a beating with wires or truncheons or falling down; H. (b) Positional torture, using suspension, stretching limbs apart, prolonged constraint of movement, forced positioning; Risk of re-traumatization of the interviewee 146. Taking into consideration that lesions of different types and levels may occur according to the methods of torture practised, the data acquired subsequent to a comprehensive medical history and physical examination should be assessed together with appropriate laboratory and radiological examinations. Providing information and making explanations for each process to be applied during the medical examination and ensuring detailed awareness about the laboratory methods play a significant role (see chapter VI, sect. B.2 (a)). (c) Burns with cigarettes, heated instruments, scalding liquid or a caustic substance; (d) Electric shocks; (e) Asphyxiation, such as wet and dry methods, drowning, smothering, choking or use of chemicals; (f) Crush injuries, such as smashing fingers or using a heavy roller to injure the thighs or back; (l) Pharmacological torture using toxic doses of sedatives, neuroleptics, paralytics, etc.; 147. The presence of psychological sequelae in torture survivors, particularly the various manifestations of PTSD, may cause the torture survivor to fear experiencing a re-enactment of his or her torture experience during the interview, physical examination or laboratory test. Explaining to the torture survivor what he or she should expect prior to the medical examination is an important component of the process. Those who survive torture and remain in their country may experience intense fear and suspicion about being re-arrested, and they are often forced to go underground to avoid being arrested again. Those who are exiled or refugees may leave behind their native language, culture, family, friends, work and everything that is familiar to them. (m) Conditions of detention, such as a small or overcrowded cell, solitary confinement, unhygienic conditions, no access to toilet facilities, irregular or contami- 148. The torture survivor’s personal reactions to the interviewer (and the interpreter, in cases where one is used) can have an effect on the interview process and, in (g) Penetrating injuries, such as stab and gunshot wounds, wires under nails; (h) Chemical exposure to salt, chilli pepper, gasoline, etc. (in wounds or body cavities); (i) Sexual violence to genitals, molestation, instrumentation, rape; (j) Crush injury or traumatic removal of digits and limbs; (k) Medical amputation of digits or limbs, surgical removal of organs; 29