PART E – Interpretation of the findings – clinical impression The history of detention and torture, pre-torture conditions, post-torture conditions, behavioural, cognitive and emotional aspects of the individual observed during verbal and non-verbal communications and symptoms with details should be evaluated as a whole. All these findings should be considered altogether. The relationship of individual components with each other should also be taken into consideration. The relationship and consistency between events and symptoms should be evaluated and described, taking into account the possible influence of psychological symptoms, culture, and physical symptoms such as brain trauma on concentration, reporting, and memory recall, as discussed in more detail above. If the interviewer relies solely on a collection 39 of psychiatric symptoms as reported by the tortured person, this might prevent a sufficient appreciation of the qualitative, narrative and observational aspects in assessing the trauma of torture (Jacobs, 2000). Behavioral, cognitive and emotional aspects of the individual observed during verbal and non-verbal communication should be noted with all the details. Clinicians should comment on the consistency of psychological findings and the extent to which these findings correlate with the alleged abuse. Factors such as the onset of specific symptoms associated with the trauma, the specificity of any particular psychological findings and patterns of psychological functioning should also be noted. (See chapter VI, section C.3 (k), and chapter IV, section L, in the Istanbul Protocol.) II. DOES THE ABSENCE OF A DIAGNOSABLE PSYCHOPATHOLOGY MEAN THAT THE PERSON WAS NOT TORTURED? HOW SHOULD THE FINDINGS BE INTERPRETED IN THAT CASE? “It is important to recognize that not everyone who has been tortured develops a diagnosable mental illness” (Istanbul Protocol, § 236). It must be stressed that even though a diagnosis of trauma-related mental disorder supports the claim of torture, not meeting criteria for a psychiatric diagnosis does not mean the person was not tortured (Istanbul Protocol, § 289), The absence of physical and/or psychological signs and symptoms does not invalidate an allegation of torture (Peel et al., 2000). The medico-legal investigations require understanding of the whole psychological phenomena, not only a diagnosis (Allnutt & Chaplow, 2000). The interpretation of the findings should not depend solely on the collection of signs and symptoms and if there is a diagnosis, the interpretation should not be limited to stating this. Besides these considerations, the clinician should also take into consideration the possibility that an absence of symptoms can be due to the episodic or often delayed nature of PTSD or to denial of symptoms because of shame, or other difficulties mentioned above (Istanbul Protocol, § 277).