CHAPTER VI PSYCHOLOGICAL EVIDENCE OF TORTURE A. 1. General considerations 236. It is important to recognize that not everyone who has been tortured develops a diagnosable mental illness. However, many victims experience profound emotional reactions and psychological symptoms. The main psychiatric disorders associated with torture are PTSD and major depression. While these disorders are present in the general population, their prevalence is much higher among traumatized populations. The unique cultural, social and political implications that torture has for each individual influence his or her ability to describe and speak about it. These are important factors that contribute to the impact that torture inflicts psychologically and socially and that must be considered when performing an evaluation of an individual from another culture. Crosscultural research reveals that phenomenological or descriptive methods are the most rational approaches to use when attempting to evaluate psychological or psychiatric disorders. What is considered disordered behaviour or a disease in one culture may not be viewed as pathological in another.93, 94, 95 Since the Second World War, progress has been made towards understanding the psychological consequences of violence. Certain psychological symptoms and clusters of symptoms have been observed and documented among survivors of torture and other types of violence. The central role of the psychological evaluation 234. It is a widely held view that torture is an extraordinary life experience capable of causing a wide range of physical and psychological suffering. Most clinicians and researchers agree that the extreme nature of the torture event is powerful enough on its own to produce mental and emotional consequences, regardless of the individual’s pre-torture psychological status. The psychological consequences of torture, however, occur in the context of personal attribution of meaning, personality development and social, political and cultural factors. For this reason, it cannot be assumed that all forms of torture have the same outcome. For example, the psychological consequences of a mock execution are not the same as those due to a sexual assault, and solitary confinement and isolation are not likely to produce the same effects as physical acts of torture. Likewise, one cannot assume that the effects of detention and torture on an adult will be the same as those on a child. Nevertheless, there are clusters of symptoms and psychological reactions that have been observed and documented in torture survivors with some regularity. 237. In recent years, the diagnosis of PTSD has been applied to an increasingly broad array of individuals suffering from the impact of widely varying types of violence. However, the utility of this diagnosis in non-Western cultures has not been established. Nevertheless, evidence suggests that there are high rates of PTSD and depression symptoms among traumatized refugee populations from many different ethnic and cultural backgrounds.96, 97, 98 The World Health Organization’s cross- 235. Perpetrators often attempt to justify their acts of torture and ill-treatment by the need to gather information. Such conceptualizations obscure the purpose of torture and its intended consequences. One of the central aims of torture is to reduce an individual to a position of extreme helplessness and distress that can lead to a deterioration of cognitive, emotional and behavioural functions.92 Thus, torture is a means of attacking an individual’s fundamental modes of psychological and social functioning. Under such circumstances, the torturer strives not only to incapacitate a victim physically but also to disintegrate the individual’s personality. The torturer attempts to destroy a victim’s sense of being grounded in a family and society as a human being with dreams, hopes and aspirations for the future. By dehumanizing and breaking the will of their victims, torturers set horrific examples for those who later come in contact with the victim. In this way, torture can break or damage the will and coherence of entire communities. In addition, torture can profoundly damage intimate relationships between spouses, parents, children, other family members and relationships between the victims and their communities. 93 A. Kleinman, “Anthropology and psychiatry: the role of culture in cross-cultural research on illness and care”, paper delivered at the World Psychiatric Association regional symposium on psychiatry and its related disciplines, 1986. 94 H. T. Engelhardt, “The concepts of health and disease”, Evaluation and Explanation in the Biomedical Sciences, H. T. Engelhardt and S. F. Spicker, eds. (Dordrecht, D. Reidel Publishing Co., 1975), pp. 125-141. 95 J. Westermeyer, “Psychiatric diagnosis across cultural boundaries”, American Journal of Psychiatry, vol. 142 (7) (1985), pp. 798-805. 96 R. F. Mollica and others, “The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps”, Journal of the American Medical Association (JAMA), vol. 270 (1993), pp. 581-586. 97 J. D. Kinzie and others. “The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees”, American Journal of Psychiatry, vol. 147 (7) (1990), pp. 913-917. 98 K. Allden and others, “Burmese political dissidents in Thailand: trauma and survival among young adults in exile”, American Journal of Public Health, vol. 86 (1996), pp. 1561-1569. 92 G. Fischer and N. F. Gurris, “Grenzverletzungen: Folter und sexuelle Traumatisierung”, Praxis der Psychotherapie–Ein integratives Lehrbuch für Psychoanalyse und Verhaltenstherapie, W. Senf and M. Broda, eds. (Stuttgart, Thieme, 1996). 45