PART A – The importance of the psycological evaluation in the medical ... high level of tension and, sometimes subsequently, of emotional numbness (Gurris & Wenk-Ansohn, 1997). These feelings may be accompanied by a sense of complete confusion, powerlessness, and of loss of control which can bring about a shattered understanding of oneself, of any meaningful existential system and of the predictability of the world (Fischer & Gurris, 1996; McFarlane, 1995). The outcome of torture is often an intentional destruction of the economic, social, and cultural worlds of the victims (Summerfield, 1995). Torture can damage the victim on several levels (Fischer & Gurris, 1996; Gurr & Quiroga, 2001; Jacobs, 2000; Kira, 2002; Lira Kornfeld, 1995; Shapiro, 2003; Summerfield, 1995): • Physical and psychological integrity and entity • Cognitive, emotional, behavioural, social wellbeing • Personality • Identity • Autonomy • Self actualization • Self respect, self-esteem • Sense of safety and survival • Dreams, hopes, aspirations for the future • Belief system • System of meaning about him/herself and the world • Attachment • Connectedness • Trust • Torture also shatters the victims’ sense of being grounded in a family and in the society • It may cause some secondary problems which deteriorate social, educational and occupational functioning. 7 2. ON THE FAMILY LEVEL “[…]Torture can profoundly damage intimate relationships between spouses, parents, children and other family members, and relationships between the victims and their communities” (Istanbul Protocol, § 235). Torture can traumatize the family, which leads to various forms of family dysfunction and disruptions (Kira, 2002): • Other members of the family may also be traumatized by torture and/or other types of ill-treatment or persecution • Other members of the family may suffer from the secondary traumatization • The repercussions of the physical and psychological suffering of the tortured person within the family can cause an increased level of stress as well as fear, worry, feelings of being terrorized and threatened, and loss of sense of safety and security, affecting the family system and the other members of the family • Torture may change the roles and relationship patterns in the family, it may result in deterioration in the ability to care for children and loved ones, and in parenting capacity • Torture experience may also cause substantial disruption of the quality of life in the family due to health problems, forced change of living place, work loss, diminished social support. All these factors may lead to destructive circular effects inside the family. In most torture assessments, evaluation of the impact of torture on the family system, the family dynamics and on the other members of the family is usually overlooked (Kira, 2002). Although such an assessment could be important, circumstances rarely allow it due to time constraints, limitations of resources, insufficient skills in methods of approaching the family, and sometimes confidentiality issues.