There are three complimentary approaches for understanding the psychological impact of torture. The personal approach is the individual’s story as told through testimony, oral history, literature, and art. The clinical approach utilizes a medical and psychological paradigm and relies on clinical history, physical exam, and mental status exam. The community approach involves epidemiological studies of traumatised groups and populations. In combination these approaches provide a broad and deep understanding of the impact of torture on human beings. Each approach requires consideration of the context of torture. Torture has unique cultural, social and political meanings for each individual. These meanings will influence an individual’s ability to describe and speak about their experiences. Similarly, these factors contribute to the impact that the torture inflicts psychologically and socially. Descriptive methods, therefore, are the best approaches when attempting to evaluate psychological or psychiatric reactions and disorders because what is considered disordered behaviour or a disease in one culture may not be viewed as pathological in another. While some psychological symptoms may be present across differing cultures, they may not be the symptoms that concern the individual the most. Therefore, the clinician’s inquiry has to include the individual’s beliefs about their experiences and meanings of their symptoms, as well as an evaluating the presence or absence of symptoms of trauma-related mental disorders. For example, intrusive memories may be interpreted as a supernatural experience. Therefore the health professional’s inquiry has to include the individual’s beliefs about their experiences and meanings of their symptoms.
Torture is powerful enough on its own to produce mental and emotional consequences, regardless of the individual’s pre-torture psychological status. Nevertheless, torture has variable effects on people because the social, cultural and political contexts vary widely. Outcomes can be influenced by many interrelated factors that include but are not limited to the following:
- Circumstances, severity and duration of the torture
- Cultural meaning of torture/trauma and cultural meaning of symptoms
- Age and developmental phase of the victim
- Genetic and biological vulnerabilities of the victim
- Perception and interpretation of torture by the victim
- The social context before, during and after the torture
- Community values and attitudes
- Political factors
- Prior history of trauma
- Pre-existing personality
The psychological impact of ill-treatment clearly depends on the individual (see risk factors listed below). For example, someone who is politically active might be able to undergo substantial torture without necessarily developing persistent psychological symptoms because he or she could have anticipated the experience, and put the episode into a personal and political context. However, someone who was arrested simply as a result of being in the wrong place at the wrong time might not suffer much ill-treatment, but could still be devastated by the experience, because the incident was not anticipated and the person was not sustained by a political ideology or religious faith.
Similarly, the consequences are different for a young woman who is raped during torture and is from a culture that attaches a severe negative stigma of impurity to a woman who has been raped, compared with a former military officer who is captured and suffers long-term solitary confinement and multiple beatings. It goes without saying that both types of torture are extremely severe, yet the impact on the individual’s life is vastly different. The young woman might be socially ostracized and condemned even by her own family and community. The former military officer may have brain damage from beatings to the head with resultant long-term disability.