16 A practical guide to the Istanbul Protocol – for psychologists these circumstances. Indeed, dissociation has been frequently observed in torture survivors and should be expected to interfere during the evaluation. Torture strategies are often intentionally constructed in such a way as to confuse, to give wrong information, or to create disorientation in time and space, and this must be seen as a special problem when trying to get an unequivocal or complete report on events. Perpetrators’ efforts to discredit the survivor and to hide the atrocities can contribute to difficulties in a later assessment. Impaired recall can therefore be a major obstacle to history taking and any possible legal procedures, but it can be also an indicator of sequels which should be considered in the evaluation (Burnett & Peel, 2001b; Wenzel, 2002). 1. POTENTIALLY INTERFERING FACTORS WHEN REPORTING ONE’S STORY OR WHEN TAKING THE HISTORY Factors directly related to the torture experience: • Factors during torture itself, such as blindfolding, drugging, lapses of consciousness, etc. • Disorientation in time and place during torture due to the nature of torture or extreme stress experienced during torture • Neuro-psychiatric memory impairment resulting from head injuries, suffocation, near drowning, starvation, hunger strikes or vitamin deficiencies • Experiencing repeated and similar events may also lead to difficulties in recalling clearly the details of specific events. Factors related to the psychological impact of torture: • Impaired memory secondary to trauma- related mental illnesses, such as depression and post-traumatic stress disorder. PTSD-related memory disturbances recalling the traumatic event or intrusive memories, nightmares and the inability to remember important details of the event • Some coping mechanisms which can be protective in these particular circumstances such as denial and avoidance • Other psychological symptoms such as concentration difficulties, fragmentation or repression of traumatic memories, confusion, dissociation and amnesia • High emotional arousal. Cultural factors: • Cultural differences in the perception of time • Culturally prescribed sanctions that allow traumatic experiences to be revealed only in highly confidential settings • Feelings of guilt or shame. Factors related to interview conditions or barriers of communication: • Fear of placing oneself or others at risk • Lack of trust in the examining clinician and/or interpreter • Lack of feeling safe during the interview • Environmental barriers such as lack of privacy, comfort of interview setting, inadequate time for the interview • Physical barriers such as pain or other discomforts, fatigue, sensory deficits • Socio-cultural barriers such as the gender of the interviewer, language and cultural differences • Barriers due to tranference/counter-tranference reactions during the interview • Misconducted and/or badly structured interviews. (See §§ 142-144, § 253 and § 290 in the Istanbul Protocol and Iacopino, 2002; Mollica & Caspi-Yavin, 1992; Sironi, 1989; van der Kolk & Fisler, 1995; Wenzel, 2002.)