According the to Istanbul Protocol, the psychological impacts can vary depending on a variety of factors: “…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.” Despite this variation, certain psychological reactions have been documented in torture survivors with some regularity, and these evaluations remain key by “…provid[ing] useful evidence for medico-legal examinations, political asylum applications, establishing conditions under which false confessions may have been obtained, understanding regional practises of torture, identifying the therapeutic needs of victims and as testimony in human rights investigations.”
Although there may be considerable variability in psychological effects, torture and ill-treatment often result in profound, long-term psychological trauma. According to the Istanbul Protocol, the most common psychological problems are posttraumatic stress disorder (PTSD) and major depression, but may include the following:
- Re-experiencing the trauma
- Avoidance and emotional numbing
- Hyperarousal symptoms
- Symptoms of depression
- Damaged self-concept and foreshortened future
- Dissociation, depersonalisation, and atypical behaviour
- Somatic complaints
- Sexual dysfunction
- Psychosis
- Substance abuse
- Neuropsychological impairment
As with physical injuries, the absence of a definite mental health syndrome or condition, such as PTSD or depression, does not rule out torture and/or ill-treatment. Whether an individual presents with mental health problems depends on multiple factors, including but not limited to age, gender, mental preparedness, personality traits, degree of psychological trauma, and cultural/religious values.
Such psychological symptoms and disabilities can last many years or even a lifetime. It is important to realize that the severity of psychological reactions depends on the unique cultural, social, and political meanings that torture and ill-treatment have for each individual, and significant ill effects do not require extreme physical harm. Seemingly benign forms of ill-treatment can and do have marked, long-term psychological effects.
The psychological examination should elicit background information about the victim’s life both preceding and following the alleged torture or ill-treatment. Components of the psychiatric evaluation should include: a) history of torture and ill-treatment, b) current psychological complaints, c) post-torture history, d) pre-torture history, e) medical history, f) psychiatric history, g) substance use and abuse history, h) mental status examination, i) assessment of social function, j) psychological testing and the use of checklists and questionnaires, and k) clinical impression. Such information enables examiners to assess the presence of significant psychological symptoms and its relationship to the alleged trauma and other possible causes.
