← Previous Pages
More Pages →

Training

Interpretation of Findings and Referrals

The forensic examiner should correlate allegations of abuse with the findings of the physical and psychological evaluation and indicate his or her level of confidence in the correlations (e.g., inconsistent, consistent with, highly consistent with, or pathognomonic). A final statement of opinion regarding all sources of evidence (physical and psychological findings, historical information, photographic findings, diagnostic test results, knowledge of regional practises of torture, consultation reports, etc.) and the possibility of torture should be included. The examiner also should provide any referrals or recommendations for further evaluation of and care for the interviewee.

Unfortunately, it is a common misconception among evaluators, attorneys and adjudicators that psychological evidence is of lesser value than “objective” physical findings. The aim and effect of torture is largely psychological. The psychological evaluation is critical in assessing the level of consistency between the alleged trauma and individual psychological responses. In some cases, the symptoms may be either attenuated or exacerbated depending on the meaning assigned to individual experiences.

The forensic examiner should correlate allegations of abuse with the findings of the physical and psychological evaluation and indicate his or her level of confidence in the correlations (e.g., inconsistent, consistent with, highly consistent with, or pathognomonic). A final statement … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Module 6 Presentation: Psychological Evidence of Torture and Ill-Treatment


Download

Download Module 6: Psychological Evidence of Torture and Ill Treatment (PowerPoint Presentation) (ppt)

Toolkit:
Subject:
Issue:
Use:

Circumstances of Detention(s)

If there has been an arrest or any period of detention, the description should include details of the conditions of detention, especially the nature of the accommodation (including size, shape, space, natural and artificial light, temperature, ventilation, and hygiene), the daily routine, and access to water, food, sanitation, health care and the open air. All of these elements of arrest and detention can produce physical and psychological manifestations (e.g. malnutrition, vector-borne disease, anxiety, etc).

Consider the following questions: What time was it? Where were you? What were you doing? Who was there? Describe the appearance of those who detained you. Were they military or civilian, in uniforms or in plain clothes? What type of weapons were they carrying? What was said? Were there any witnesses? Was this a formal arrest, administrative detention, or disappearance? Was violence used, threat spoken? Was there any interaction with family members? Note the use of restraints or blindfold, means of transportation, destination, and names of officials, if known.

If there has been an arrest or any period of detention, the description should include details of the conditions of detention, especially the nature of the accommodation (including size, shape, space, natural and artificial light, temperature, ventilation, and hygiene), the … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Suspension

Suspension is a common form of torture that can produce extreme pain, but which leaves little, if any, visible evidence of injury. A person still in custody may be reluctant to admit to being tortured, but the finding of peripheral neurological deficits, diagnostic of brachial plexopathy, virtually proves the diagnosis of suspension torture. Suspension may last from 15 to 20 minutes to several hours. Suspension can be applied in various forms:

  • Cross suspension or “crusifixion.” Applied by spreading the arms and tying them to a horizontal bar;
  • Butchery suspension. Applied by fixation of hands upwards, either together or one by one;
  • Reverse butchery suspension. Applied by fixation of feet upward and the head downward;
  • “Palestinian” suspension. Applied by suspending the victim with the wrists or forearms bound together behind the back and tied to a horizontal bar or rope.
  • “Parrot perch” suspension. Applied by suspending a victim by the flexed knees from a bar passed below the popliteal region, usually while the wrists are tied to the ankles.

“Palestinian” suspension may produce permanent brachial plexus injury in a short period. There is such an unnatural strain on all the muscles and ligaments of the shoulder girdle that one or both shoulders may dislocate. Victims complain for several days afterwards of inability to raise the arms above the head and sometimes of numbness and weakness of the fingers. For years afterwards they may experience pain on raising the arms, lifting weights or combing the hair. On examination there is usually tenderness in the muscles around the shoulders and scapulae and severe pain on passive movements, especially extension and internal rotation of the shoulders. There is occasionally winging of the scapulae (prominent vertebral border of the scapula) caused by traction on the long thoracic nerve, easily missed unless specially looked for by asking the subject to press against a wall with outstretched arms, and there may be permanent deficit of the lower roots of the brachial plexus, as shown by sensory deficit in an ulnar distribution.

The “parrot perch” (pau de arara, the chicken, the bar) is another form of suspension which causes immediate severe pain. It has been commonly used in many Latin American countries but is also seen in Africa. The wrists are bound together in front of the body, the arms passed over the knees and a pole thrust behind the knees. The result may be rupture of the cruciate ligaments of the knees or sensory or vascular damage below the knees. Victims will often be beaten while suspended or otherwise abused. In the chronic phase, it is usual for pain and tenderness around the shoulder joints to persist, as the lifting of weight and rotation, especially internal, will cause severe pain many years later.

There are many other methods of suspension including hanging by the ankles or with the arms tied to a cross-bar as in ‘crucifixion’. Whether there will be any immediate or later ill-effects depends on the method used, the posture of restraint and the distribution of bonds, which may have been not only at the wrists and ankles but at any point of the arms, legs or trunk.

Suspension by the hair can avulse the scalp leading to an immediate cephal­haematoma which may persist and be palpable for months or even years as a boggy swelling. In any event, the scalp is likely to remain tender, sometimes with the scalp attached unnaturally firmly to the underlying skull.

In general, complications in the acute period following suspension include weakness of the arms or hands, pain and parasthesias, numbness, insensitivity to touch, superficial pain and tendon reflex loss. Intense deep pain may mask muscle weakness. In the chronic phase, weakness may continue and progress to muscle wasting. Numbness and, more frequently, parasthesia are present. Raising the arms or lifting weight may cause pain, numbness or weakness. In addition to neurologic injury, there may be tears of the ligaments of the shoulder joints, dislocation of the scapula and muscle injury in the shoulder region.

Various forms of suspension can result in neurologic injury which is usually asymmetrical in the arms. Brachial plexus injury manifests itself in motor, sensory and reflex dysfunction.

  • Motor examination. Asymmetrical muscle weakness, more prominent distally, is the most expected finding. Acute pain may make the examination for muscle strength difficult to interpret. If the injury is severe, muscle atrophy may be seen in the chronic phase;
  • Sensory examination. Complete loss of sensation or parasthesias along the sensory nerve pathways is common. Positional perception, two-point discrimination, pinprick evaluation and perception of heat and cold should all be tested. If at least three weeks later, deficiency or reflex loss or decrease is present, appropriate electrophysiological studies should be performed by a neurologist experienced in the use and interpretation of these methodologies;
  • Reflex examination. Reflex loss, a decrease in reflexes or a difference between the two extremities may be present. In “Palestinian” suspension, even though both brachial plexi are subjected to trauma, asymmetric plexopathy may develop due to the manner in which the torture victim has been suspended, depending on which arm is placed in a superior position or the method of binding. Although research suggests that brachial plexopathies are usually unilateral, that is at variance with experience in the context of torture, where bilateral injury is common.

Among the shoulder region tissues, the brachial plexus is the structure most sensitive to traction injury. “Palestinian” suspension creates brachial plexus damage due to forced posterior extension of the arms. As observed in the classical type of “Palestinian” suspension, when the body is suspended with the arms in posterior hyperextension, typically the lower plexus and then the middle and upper plexus fibers, if the force on the plexus is severe enough, are damaged, respectively. If the suspension is of a “crucifixion” type, but does not include hyperextension, the middle plexus fibers are likely to be the first ones damaged due to hyperabduction. Brachial plexus injuries may be categorized as follows:

  • Damage to the lower plexus. Deficiencies are localized in the forearm and hand muscles. Sensory deficiencies may be observed on the forearm and at the fourth and fifth fingers of the hand’s medial side in an ulnar nerve distribution;
  • Damage to the middle plexus. Forearm, elbow and finger extensor muscles are affected. Pronation of the forearm and radial flexion of the hand may be weak. Sensory deficiency is found on the forearm and on the dorsal aspects of the first, second and third fingers of the hand in a radial nerve distribution. Triceps reflexes may be lost;
  • Damage to the upper plexus. Shoulder muscles are especially affected. Abduction of the shoulder, axial rotation and forearm pronation-supination may be deficient. Sensory deficiency is noted in the deltoid region and may extend to the arm and outer parts of the forearm.

Assessing physical evidence following suspension may be complicated by the fact that suspension is often accompanied by beating, so it is impossible to generalise, but if the examiner asks the subject to describe or mime the particular posture and stress he was subjected to, it is possible to decide what areas of skin, joints and muscle groups to concentrate on during physical examination. This entails a detailed search of the skin for marks of bonds, the joints for limitation of movement by pain or, occasionally, tendency to subluxation, and muscle groups for abnormal tension and tenderness as well as a neurological examination for peripheral nerve lesions and the extremities for vascular changes. Abnormalities are likely to be easily found in the immediate aftermath but usually fade with time. Unless the full thickness of skin has been destroyed by tight bonds there is unlikely to be any permanent scarring where bonds have been applied though they must be searched for. Their absence does not negate the allegation. In most cases all signs on the skin fade after a few days, but if abrasions are deep or become infected, there may be permanent scarring, changes in pigmentation or occasionally, only depilation (hair loss). Lesions are usually linear and transverse and most marked over bony prominences. These are suggestive, but only if they are almost completely circumferential round the limbs are they are virtually diagnostic of restraint. Though usually situated at the level of the wrists or ankles, they may be found further up the limbs because bonds may be applied higher or ride higher up. In many cases joint movements remain limited and painful for months or years and tenderness of muscle groups is often persistent. Motor or sensory changes tend to improve with time.

The sooner after injury that treatment can be instituted the better, but it is rare for any professional care to be possible until long after the events. Victims often say that they were treated by traditional methods of massage and exercise, with relief of pain on their release from detention. Late treatment concentrates on physiotherapy with massage, graduated exercises and postural re-education. At first, the therapist must be extremely careful to respect the patient’s fear of contact and may not even be able to touch him until a satisfactory rapport has been established.

Suspension is a common form of torture that can produce extreme pain, but which leaves little, if any, visible evidence of injury. A person still in custody may be reluctant to admit to being tortured, but the finding of peripheral … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Self-Assessment and Quiz

  1. Which of the following do you consider to be important considerations before interviewing Mrs. Asha Ali Yousif?
    1. A safe and comfortable location
    2. Privacy during the interview
    3. Understanding that she must answer all of the questions asked
    4. Understanding that she can take breaks if she wishes
    5. All of the above
  2. Which of the following must be addressed before beginning all interviews?
    1. Making sure that refreshments are available
    2. Obtaining informed consent
    3. Explaining the benefits and risks of the medical evaluation
    4. Ensuring that the translator and alleged victim are the same gender
  3. Who would you consider to be the most appropriate translator for your interview with Mrs. Yousif?
    1. Mrs. Yousif’s daughter
    2. A male village elder
    3. A stranger in Kalma Camp
    4. A stranger from outside Kalma Camp
  4. In the process of eliciting the trauma history from Mrs. Yousif, which of the following interviewing techniques do you think is most appropriate?
    1. Asking simple questions that require brief answers to ensure a coherent and reproducible narrative
    2. Asking questions about the most significant alleged trauma first
    3. Asking open-ended questions and minimize interruptions
    4. The evaluator should use whatever interviewing technique that he or she is most comfortable with
  5. What psychosocial information elicited from Mrs. Yousif’s is most likely to contribute to her to her psychological symptoms?
    1. The killing of her husband and burning of her home and village
    2. That she was poor
    3. Her occupation as a teacher
    4. That she had no prior history of mental problems
  6. Mrs. Yousif’s feelings of guilt are most likely related to?
    1. Not being able to support her family
    2. Failing to fight off her attackers
    3. Failing to protect her daughter’s sexual assault
    4. Exposing herself to further abuse by reporting the torture to the police
  7. In Mrs, Yousif’s case, which of the following factors may interfere with an accurate recounting of past events:
    1. Blindfolding
    2. Disorientation
    3. Lapses in consciousness
    4. Organic brain damage
    5. Psychological sequelae of abuse
    6. Fear of placing oneself or others at risk
    7. Lack of trust in the examining clinician
  8. It is important to document what the perpetrators reportedly said during the alleged abuse as it may help to establish the intent of their actions and provide insight into the meaning an individual assigns to his or her experience.
    1. True
    2. False
  9. If during the course of interviewing an alleged torture victim the individual acknowledges that he or she was sexually assaulted and does not feel comfortable discussing this further, which of the following would you consider appropriate?
    1. Move on with the interview
    2. Explain how common sexual assault is among torture survivors (women and men)
    3. Acknowledge relevant norms of social stigma associated sexual assault
    4. Offer to limit reporting of sexual assault information according to the alleged victim’s wishes, i.e. only to the judge
    5. All of the above
  10. Which of the following questions should you consider to indirectly assess allegations of sexual assault?
    1. What was said by the alleged perpetrators
    2. Removal of clothing of the alleged victim and perpetrator(s)
    3. Duration of the encounter/assault
    4. The use of weapons
    5. Any form of physical contact or touching
    6. Subsequent vaginal pain or bleeding
    7. The possibility of pregnancy or a sexually transmitted disease
    8. All of the Above
  11. Which of the following would you consider to be highly consistent with Mrs. Yousif’s allegations of torture?
    1. History of a right-sided facial droop after being kicked on the right side of her face
    2. Chronic headaches relieved by aspirin
    3. Bruises shaped in parallel lines, but clear in the middle of the lines
    4. No menstrual period since the assault
    5. All of the above
  12. If you examined Mrs. Yousif when she visited Nyala Hospital for medical care, what should have been done ideally?
    1. Conduct a thorough physical examination with particular attention to cutaneous lesions that could have resulted from an assault
    2. Conduct a pelvic examination and document any evidence of sexual assault
    3. Discuss the issues of pregnancy and emergency contraception
    4. Assess for sexually transmitted diseases (i.e. gonorrhoea, chlamydia, syphilis and trichomoniasis, Hepatitis B and HIV) and consider post-exposure prophylaxis
    5. Obtain wet vaginal swabs and dry them for subsequent DNA analysis
    6. All of the above
  13. Does Mrs. Yousif meet diagnostic criteria for PTSD?
    1. Yes
    2. No
  14. The presence of diagnostic criteria for PTSD has greater value for the adjudication of legal cases than understanding the meaning that individuals attach to experiences of torture and ill treatment.
    1. True
    2. False
  15. Which of the following factors may contribute to Mrs. Yousif’s psychological symptoms?
    1. Home and village burned
    2. Husband and father killed in front of her
    3. Difficulty surviving in Kalma Camp
    4. Rape of her daughter
    5. All of the above
  16. Which of the following can help to distinguish Mrs. Yousif psychological symptoms caused by sexual assault experiences versus other traumatic experiences or losses?
    1. The onset and trend in her psychological symptoms
    2. The content of her nightmares and intrusive recollections
    3. Triggers for intrusive recollection, reliving experiences, and avoidance reactions
    4. Feeling responsible for her daughter’s rape
    5. All of the above
  17. Mrs. Yousif should have a pelvic examination at the time of your evaluation to assess possible physical evidence of rape, even though the likelihood of such evidence decreases considerably after the first week of the assault.
    1. True
    2. False
  18. Symptoms of sexual dysfunction following rape may be physical or psychological in origin or a combination of both and include:
    1. Aversion to members of the opposite sex or decreased interest in sexual activity
    2. Inability to trust a sexual partner
    3. Disturbance in sexual arousal and erectile dysfunction
    4. Dyspareunia (painful sexual intercourse in women) or infertility due to acquired sexually transmitted disease, direct trauma to reproductive organs or poorly performed abortions of pregnancies following rape
    5. All of the above
  19. On physical examination (see PPT Module 7, Slides 16-18) Mrs. Yousif is noted to have: 1) a 1 cm hyperpigmented, linear scar above the left eyebrow; and 2) a complex, atrophic scar, approximately 4 x 6 cm over the dorsum of the left hand associated with hypopigmentation and subcutaneous fibrosis. How would you describe the level of consistency between, Mrs. Yousif’s allegations of abuse and these physical examination findings?
    1. Not consistent
    2. Consistent with
    3. Highly consistent with
    4. Virtually diagnostic of
  20. How would you describe the level of consistency between, Mrs. Yousif’s allegations of abuse and psychological evaluation findings?
    1. Not consistent
    2. Consistent with
    3. Highly consistent with
    4. Virtually diagnostic of

Which of the following do you consider to be important considerations before interviewing Mrs. Asha Ali Yousif? A safe and comfortable location Privacy during the interview Understanding that she must answer all of the questions asked Understanding that she can … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Limits on interrogation

Article 11 of the Convention against Torture requires states to keep under systematic review interrogation rules, instructions, methods and practises as well as arrangements for the custody and treatment of persons under arrest, detention or imprisonment. The Human Rights Committee has stated that: ‘keeping under systematic review interrogation rules, instructions, methods and practises as well as arrangements for the custody and treatment of persons subjected to any form of arrest, detention or imprisonment is an effective means of preventing cases of torture and ill-treatment.’[1] The Committee has also stated that, ‘the wording of Article 14(3)(g) — i.e. that no one shall be compelled to testify against himself or to confess guilt — must be understood in terms of the absence of any direct or indirect physical or psychological pressure from the investigating authorities on the accused, with a view to obtaining a confession of guilt. A fortiori, it is unacceptable to treat an accused person in a manner contrary to Article 7 of the Covenant in order to extract a confession.’[2]

[1] Human Rights Committee General Comment 20, para. 11.

[2] Kelly v Jamaica, (253/1987), 8 April 1991, Report of the Human Rights Committee, (A/46/40), 1991; Conteris v Uruguay, (139/1983), 17 July 1985, 2 Sel. Dec. 168; Estrella v Uruguay, (74/1980), 29 March 1983, 2 Sel. Dec. 93.

Article 11 of the Convention against Torture requires states to keep under systematic review interrogation rules, instructions, methods and practises as well as arrangements for the custody and treatment of persons under arrest, detention or imprisonment. The Human Rights Committee … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Module 3: Interview Considerations

Objectives

  • To understand the key role of the interview in conducting medical evaluations of torture allegations
  • To be familiar with conditions necessary for an effective interview
  • To understand and develop interview process skills such as empathy and earning trust
  • To learn effective and appropriate techniques of questioning
  • To understand the effect of the interviewing style on the interview process and the alleged victim
  • To develop the capacity to elicit a detailed narrative account of alleged experiences
  • To be familiar with possible difficulties of recalling and recounting elements of torture experiences
  • To understand how and why difficulties may arise during an interview
  • To be familiar with possible transference and counter-transference reactions
  • To develop awareness to possible vicarious traumatisation and burnout and discuss strategies to address their effects
  • To examine individual reactions to hearing a recording of an interview with a survivor of torture

Content

  • Preliminary Considerations
    • Purpose of medical evaluations
    • Interview settings
    • Trust
    • Informed consent
    • Confidentiality
    • Privacy
    • Empathy
    • Objectivity
    • Safety and security
    • Procedural Safeguards for Detainees
    • Risk of Re-traumatisation
    • Gender Considerations
    • Interviewing Children
    • Cultural and Religious Awareness
    • Working with Interpreters
    • Transference and Counter-Transference Reaction
  • Conducting Interviews
    • Types of Questions
    • Cognitive Techniques
    • Summarising and Clarifying
    • Difficulties Recalling and Recounting
    • Assessing Inconsistencies
  • Interview Content
    • Identification and Introduction
    • Psychosocial History- Pre-Arrest
    • Past Medical History
    • Summary of Detention(s) and Abuse
    • Circumstances of Detention(s)
    • Prison/Detention Place Conditions
    • Allegations of Torture and Ill-treatment
    • Review of Symptoms
    • Psychosocial History (post-arrest)
    • Assessments of Physical and Psychological Evidence
    • Physical Examination
    • Closing
    • Indications for Referral

Discussion Topics

  • Play audio (MP3 file [2] [1]) of National Public Radio interview with Sr. Dianna Ortiz (about 15 minutes) and discuss relevant interview considerations: confidentiality, informed consent, privacy, safety, objectivity, impartiality, creating a climate of trust, courtesy, honesty, empathy, the effects of interviewing style, appropriate use of open-ended and closed questioning, the risks of re-traumatisation and how to minimize the risk of re-traumatisation.
  • Discuss individual responses to the interview with Sr. Dianna Ortiz and discuss strategies for managing such reactions and limiting secondary trauma and “burn-out”
  • Discuss what you find most challenging about interviewing survivors of torture and ill treatment

Teaching Formats

  • Group Activity:
    • Listen to the audio (MP3 file [2] [1]) of National Public Radio interview with Sr. Dianna Ortiz (about 15 minutes) as a class.
    • Divide the class into several groups and have each group address the first two Discussion Topics above
    • A facilitator should be identified to moderate the discussion and rapporteur should be identified to record the group’s findings and report them when the class reconvenes.
    • After 20-30 minutes of group discussion, the entire class should reconvene
    • Rapporteurs should briefly report on their group’s findings
    • Open class discussion
  • Individual Research/Assignment:
    • Research ways in which clinicians who work with survivors of torture deal with secondary trauma. Write a series of recommendations for colleagues who conduct medical evaluations of alleged torture victims on a regular basis, but are unaware of counter-transference issues
  • Journal Entry: (Instructor to assign Write a few paragraphs — no more than a page)
    • Consider your response to the audiotape of interview with Sr. Dianna Ortiz. Provide a series of recommendations to effectivel address these reactions and possibly others.
    • Discuss what you find most challenging about interviewing survivors of torture and ill treatment

Primary Resources

  • The Istanbul Protocol
  • The Medical Documentation of Torture
  • Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
  • Psychological Evaluation of Torture Allegations: An International Training Manual
  • Audio of interview with Sr. Dianna Ortiz [3]. National Public Radio. 1996.
  • Trainers’ Guidelines for Health Professionals: Training of Users
  • Torture Reporting Handbook, Part II – Documenting Allegations

Quelle

  • [1] https://phrtoolkits.org/downloads/?did=34
  • [2] https://phrtoolkits.org/downloads/?did=34
  • [3] https://phrtoolkits.org/downloads/?did=34

Objectives To understand the key role of the interview in conducting medical evaluations of torture allegations To be familiar with conditions necessary for an effective interview To understand and develop interview process skills such as empathy and earning trust To … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Self-Assessment and Quiz

  1. If you were called upon to evaluate Mr. Adam while in custody and one of the detaining police officers was present in the examination room, what should be your initial course of action?
    1. Allow the police officer to remain to ensure your safety
    2. Request the police officer to remain outside the examination room and/or out of earshot
    3. Document the presence and identity of the police office and continue your evaluation
    4. Refuse to conduct the examination
  2. After you complete your evaluation of Mr. Adam in custody, you must provide the attending police officer with a copy of your evaluation.
    1. True
    2. False
  3. It is acceptable for clinicians to examine detainees in hand and leg shackles as long as it is the policy of the detention facility.
    1. True
    2. False
  4. Obtaining information on Mr. Adam’s past medical/psychiatric history is necessary to distinguish pre-existing physical and mental conditions from possible torture-related sequelae.
    1. True
    2. False
  5. The information obtained for Mr. Adam’s psychosocial history is not particularly relevant to the assessment of medical evidence of torture and ill treatment?
    1. True
    2. False
  6. In Mr. Adam’s case, which one of the following factors is most likely to interfere with an accurate recounting of past events:
    1. Blindfolding
    2. Disorientation
    3. Lapses in consciousness
    4. Organic brain damage
    5. Psychological sequelae of abuse
  7. Mr. Adam’s lapses in consciousness warrant which of the following?
    1. Neuropsychological testing
    2. Diagnostic imaging of the brain (CT Scan or MRI)
    3. A complete neurological examination including a mental status examination, cranial nerves, CNS and PNS
    4. Electroencephalogram (EEG)
  8. Mr. Adam spontaneously alleged that he was stripped naked and given electric shocks to his penis while suspended. There is no need, therefore, to inquire about additional forms of sexual assault.
    1. True
    2. False
  9. What is the most likely cause of Mr. Adam’s difficulty having erections?
    1. Psychosomatic
    2. Neurologic damage due to electric shocks
    3. Peripheral vascular disease
    4. None of the above
  10. After you complete your medical evaluation of Mr. Adam, you should order an EMG (electromyogram) study to assess the possibility of a brachial plexus injury
    1. True
    2. False
  11. The absence of penile lesions on examination is inconsistent with Mr. Adam’s allegations electric shock torture.
    1. True
    2. False
  12. What factors may account for the relative paucity of Mr. Adam’s psychological symptoms?
    1. The meaning of his experience in relation to his political beliefs and activities
    2. Fear of reprisals from police
    3. Support from his family members
    4. Lack of exposure to psychological methods of torture
  13. How would you describe the level of consistency between, Mr. Adam’s allegations of cigarette burns and physical examination findings of multiple hyperpigmented circular scars (about 1 cm in diameter) with indistinct margins and no central palor or atrophy?
    1. Not consistent
    2. Consistent with
    3. Highly consistent with
    4. Virtually diagnostic of
  14. It is not possible that Mr. Adam’s cigarette burns were self-inflicted?
    1. True
    2. False
  15. How would you describe the level of consistency between, Mr. Adam’s allegations of “rope burns” from suspension torture and his physical examination findings of hyperpigmented, circumferential scars above both wrists?
    1. Not consistent
    2. Consistent with
    3. Highly consistent with
    4. Virtually diagnostic of
  16. In the course of presenting the following photographic evidence of Mr. Adam in court, the cross examining attorney states that the alleged injuries were, instead, self-inflicted.

    Which of the following may help to explain why the Mr. Adam’s findings are not likely to be the result of self-inflicted?

    1. The “tram-track” marks are characteristic of blunt trauma from significant blows with a rectangular or cylindrical object such as a police baton
    2. The location of the lesions are not consistent with self-inflicted injuries which require considerable force
    3. The repetitive nature of the injuries suggest a common defensive position during beatings and intentional rather than incidental use of force
    4. While it is possible that the injuries could have been inflicted by another person following detention, this is unlikely given all of the physical and psychological evidence in Mr. Adam’s case
    5. All of the above
  17. If you were to note the findings illustrated below on Mr. Adam’s physical examination, and Mr. Adam indicated that he hadn’t noticed the axillary marks until after he was tortured, what would you consider the most likely cause of the findings to be?
    1. Subucutaneous fibrosis resulting from alleged suspension torture
    2. Circumferential abrasions from ligatures
    3. Scars from lacerations
    4. Striae distensae
  18. How would you describe the level of consistency between, Mr. Adam’s allegations of abuse and his psychological evaluation findings?
    1. Not consistent
    2. Consistent with
    3. Highly consistent with
    4. Virtually diagnostic of
  19. Given Mr. Adam’s minimal endorsement of psychological symptoms, the examining clinician should administer psychological instruments for anxiety, Major Depressive Disorder and PTSD.
    1. True
    2. False
  20. Which of the following considerations would support the clinical assessments of Mr. Adam’s credibility and argue against the possibility of malingering or simulation?
    1. Lack of over-endorsement of physical and/or psychological symptoms
    2. Lack of a suspiciousness or defensiveness
    3. Consistency between Mr. Adam’s observed affect and the content of the evaluation
    4. Consistency between Mr. Adam’s pre-torture personality and the meaning he assigns to his torture/ill treatment experiences
    5. All of the above

If you were called upon to evaluate Mr. Adam while in custody and one of the detaining police officers was present in the examination room, what should be your initial course of action? Allow the police officer to remain to … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Access to a lawyer and respect for the functions of a lawyer

The general right of those who have been arrested and detained to have access to legal advice is recognised in Article 14 of the ICCPR and a variety of other instruments relating to the right to a fair trial. The promptness of access to a lawyer is also most important from the point of view of preventing torture and ill-treatment. The Human Rights Committee has stressed that the protection of the detainee requires prompt and regular access be given to doctors and lawyers[1] and that ‘all persons arrested must have immediate access to counsel’ for the more general protection of their rights.[2] Counsel must communicate with the accused in conditions giving full respect for the confidentiality of their communications.[3] The authorities must also ensure that lawyers advise and represent their clients in accordance with professional standards, free from intimidation, hindrance, harassment, or improper interference from any quarter.[4]

[1] Human Rights Committee General Comment 20, para. 11.

[2] Concluding Observations of the Human Rights Committee: Georgia, UN Doc. CCPR/C/79/Add.74, 9 April 1997, para. 28.

[3] Human Rights Committee, General Comment 13, Article 14 (Twenty-first session, 1984), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 at 14 (1994), para. 9.

[4] Ibid.

The general right of those who have been arrested and detained to have access to legal advice is recognised in Article 14 of the ICCPR and a variety of other instruments relating to the right to a fair trial. The … Continue reading →

Toolkit:
Subject:
Issue:
Use:

Psychological Symptoms

For a detailed discussion of psychological symptoms and assessment of psychological evidence, see Module 6. Despite the variability due to personal, cultural, social and political factors, certain psychological symptoms and clusters of symptoms have been observed among survivors of torture and other types of violence. The diagnosis of Posttraumatic Stress Disorder (PTSD) has been applied to an increasingly broad array of individuals suffering from the impact of widely varying types of violence. Although the utility of this diagnosis in non-western cultural groups has not been clearly established, evidence suggests that there are high rates of PTSD and depression symptoms among traumatised refugee populations from multiple different ethnic and cultural backgrounds.

The core symptoms and signs of severe trauma and torture across cultures have become increasingly clear. Many are physiological reactions that can persist for years. The main psychiatric disorders associated with torture are PTSD and Major Depression. One does not have to be tortured to develop PTSD and/or Major Depression because these disorders appear in the general population. Similarly, everyone who has been tortured does not develop PTSD and Major Depression.

The course of Major Depression and PTSD varies over time. There can be asymptomatic intervals, recurrent episodes, and episodes during which an individual is extremely symptomatic. Therefore, when conducting an evaluation of a torture survivor, one must consider the following questions:

  • What is the timeframe of onset of symptoms; did symptoms occur immediately following the traumatic events or were they delayed for weeks, months or even years?
  • Is there a history of recurring episodes of symptomatology?
  • How do problems and symptoms emerge over time?
  • Where is the survivor in the recovery process at the time of the assessment?

For a detailed discussion of psychological symptoms and assessment of psychological evidence, see Module 6. Despite the variability due to personal, cultural, social and political factors, certain psychological symptoms and clusters of symptoms have been observed among survivors of torture … Continue reading →

Toolkit:
Subject:
Issue:
Use:
← Previous Pages
More Pages →