Torture survivors may have difficulties in recalling and recounting the specific details of the torture experience and other parts of the history for several important reasons. Clinicians should be familiar with such factors as they can manifest as inconsistencies in the interview. Difficulty recalling and recounting may be related to factors:
- Factors directly related to the torture experience
- Factors related to the psychological impact of torture
- Cultural factors
- Factors related to interview conditions or barriers of communication
It is extremely important for clinicians to clarify all inconsistencies prior to the report writing or testifying in court. Inconsistencies that are attributable to an individual’s torture experience may, in fact, support his or her allegations of abuse, rather than undermine it. Sometimes an individual’s account may conflict with one given previously, for example, to a legal adviser or other nonmedical interviewer. The medico-legal report should identify these inconsistencies and, if they are relevant, explain them. The report is a legal record of the interviews and should not be amended to minimise these inconsistencies if this reduces the report’s accuracy.
Sometimes a individual will say that an injury was caused by torture when clearly that is not the case. This may be because of a misunderstanding. For example, the person might not be aware of scars across the upper back from childhood chickenpox. When these are pointed out by a health professional, the might say they are the result of torture, believing all scars were a consequence of torture. Another individual may be claiming deliberately that a wound was caused by torture, knowing this is not the case. Perhaps he or she has no scarring from torture but thinks he or she will not be believed without some physical evidence. In this situation the health professionals should document the individual’s attribution, the heath professional’s opinion, and the likely reasons for the difference of opinions. In the context of a complete medical evaluation of both physical and psychological evidedence, the presence of other corroborating physical and psychological evidence will aid in assessing the overall veracity of an individual’s allegations. A false opinion supporting the individual’s attribution must never be given.
It is sometimes suggested that physical evidence is the result of self-inflicted injuries. True self-inflicted wounds are usually of two main types. One is where a person is deliberately harming him- or herself to support a false claim of assault. Such wounds are generally superficial and within easy reach of the dominant hand. Very rarely an accomplice might be asked to cause a wound in a place the person cannot reach, such as in the middle of the back. The other form of self-harm is where the person has a mental illness. Such wounds can be complex, but generally the underlying mental health problem can be identified during the interview. Occasionally a person will have wounds from an unsuccessful suicide attempt in detention, perhaps a desperate response to an intolerable situation. Although the person might be unwilling initially to disclose the true cause of the wounds, if the clinincians responds by using sensitive questioning, he or she will normally say what happened.