Emotional and behavioural problems and trauma exposure of school-age Palestinian children in Gaza: some preliminary findings.

An international research team was established to design and implement a community-based, cross-section epidemiological survey of 669 school-age Palestinian children and their families living in the Gaza Strip. Several psychometric instruments were utilized for measuring mental health outcomes, including the Ontario Child Health Scale (OCHS) for measuring childhood emotional and behavioural problems, and the Child Post-traumatic Stress Reaction Index (CPTSRI) to measure post-traumatic stress disorder (PTSD). Lifetime trauma exposure was assessed by using the Health Reach Modified War Questionnaire. It was found that children and adolescents from age six to 16 have high prevalence rates of conduct, attention deficit-hyperactivity disorders and PTSD. These rates are higher than those reported internationally on children in non-conflict areas. A significant correlation was found between higher rates of lifetime trauma exposure, by frequency and type, and higher prevalence rates of mental health problems. The various state and non-governmental organizations involved in health care services are urged to use a community-based approach to alleviate the burden of suffering, including addressing issues of social justice for Palestinians.

Post-traumatic stress disorder in hostages and victims of torture.

Torture and the taking of hostages for ransom or for political gain have existed since recorded history. Both can produce archetype post-traumatic stress disorder (PTSD) symptoms. Many symptoms, as in the case of those brought on by the Holocaust, can last a lifetime. Torture, although universally condemned, still is used regularly in more than 60 countries, and the stream of refugees to safe havens seems endless. Treatment is effective, specific, and essential but requires extraordinary sensitivity, experience, and patience on the part of therapists. Hostage-taking generates its own unique dynamics on the victims, which again requires experience, understanding, and very specialized knowledge by therapists if they are to provide successful help to these profoundly damaged individuals. PTSD brought on by both torture and hostage taking has been studied extensively in recent years and its similarities and differences from "typical" PTSD are detailed.

Assessment and treatment of torture victims: a critical review.

This paper presents the main issues in the diagnosis and treatment of psychiatric sequelae in torture victims. The concept of post traumatic stress disorder is used to organize literature on psychiatric casualties resulting from massive psychic trauma, e.g., the Nazi Holocaust, the Vietnam and Israeli wars, and the current world epidemic of torture. Torture is a unique human made stressor resulting in category-specific diagnostic symptoms. Medical assessment can be complemented with photographs, x-rays, electroencephalograms, and sleep studies. Individual psychotherapy and group techniques focus on the issues of denial and trust, loss, survivor guilt, and reparation. Programs of psychological and social rehabilitation and treatment with benzodiazepines, tricyclic antidepressants, and other compounds are reviewed. Future research needs include the conceptualization of the trauma of torture and its sequelae in broader terms, the application of standardized measurements to facilitate international comparisons, and the testing of various approaches to intervention in an experimental design. An ethical physician must resist the pressures of totalitarian governments to assume neutrality in the presence of human rights violations affecting his/her patients.

Women as torture victims.

This paper reports a retrospective study of the frequency, severity, modalities and mental health consequences of torture in 28 Latin American refugee women in Toronto. The data on these women and a comparison group of male torture victims were retrieved from case records in a hospital outpatient clinic. The results support the hypotheses implicit in the scanty literature available that the frequency and effects of torture in women differ from those found in men. In female victims, as in their male counterparts, the severity of the torture was related to the degree of their political involvement. However, torture was more frequently sexual, and its consequences more often affected the women's sexual adaptation.

PIP: This study investigates the frequency, severity, modalities, and mental health consequences of torture in 28 Latin American refugee women in Toronto, Canada. Information on these women was gathered from case records in a hospital outpatient clinic. The case histories of 28 male Latin American refugees and victims of political persecution and torture were used as control for this study. The findings support the hypotheses presented. Women, who are politically persecuted, are tortured less frequently than men are. There is also an association between the sex of the victim and the techniques employed in torture. Findings also indicate that the occurrence and severity of torture in women depend on the degree of political participation. Lastly, sexually tortured women manifest greater psychological and sexual dysfunction.

Acute paranoid reaction (bouffée délirante) in Canada.

The syndrome of acute paranoid reaction is studied within the Canadian context. The main purpose of the study is to clarify its nosology and diagnostic criteria so that its diagnosis becomes more reliable and true epidemiological rates may be established. The historical development of the concept is briefly outlined in a review of the world literature, with particular attention being paid to its defining characteristics. The differential diagnosis with schizophrenia and paranoid states is of great importance given the different prognosis and treatment. Evidence from the literature is presented to show the role of sociocultural factors in the causation and diagnosis of this syndrome. Canadian data of first admissions to mental hospitals with diagnoses of reactive psychosis, including acute paranoid reaction type, for the years 1969-1973, in selected provinces, are presented. Rates of reactive psychoses as proportions of all admissions and all admission psychoses are compared with rates available for other European and Third World countries. Canadian national rates are lower and it is argued that the lower incidence is partly attributable to misdiagnosis which in turn is due to psychiatric training and to the neglect of the role attributed to sociocultural factors in the genesis of this condition.

Ethical and psychiatric aspects of torture: a Canadian study.

In the last two decades widespread use of torture by totalitarian governments has been reported in over 60 countries. This situation concerns physicians who are sometimes called upon to see the victims. This paper reports the psychiatric findings in a group of 41 Latin American refugees who arrived in Canada from 1977 to 1979 and alleged to have been subjected to political persecution and torture under the military rulers of their own countries. Most of them, young educated men, were apprehended violently and imprisoned under conditions below the minimum international standards. Systematic physical and psychological torture was the rule, including blindfolding, beatings, electrical shocks, sexual abuse and threats of execution or sham executions. These experiences were followed by a cluster of psychiatric symptoms and physical evidence of trauma compatible with the history given. This pattern constitutes the torture syndrome included under category 308 and 309 of the DSM-III and ICD-9. The alleged professional conduct of 19 doctors who saw 21 of these patients is discussed. A list of codes of medical ethics, intended to guide and protect doctors confronted with this difficult problem, is included.

Psychiatric services in China: or, Mao versus Freud.

Reportedly, the People's Republic of China has made great progress in health care services, particularly at preventive, primary and community levels. Information on their psychiatric services is still scarce. A group of 12 health professionals visited the country for three weeks in July 1977. This paper provides a description and an analysis of the network of mental health services using a sample of one mental hospital, six general hospitals and a number of health units in cities, factories and communes. The basic principles of policy and administration are those of a collective socialism with strong central guidelines and considerable local administrative initiative. Admissions to the mental hospital in Shanghai reveal that 83% are young acute schizophrenic cases and very few are neurotic or non-psychotic. This distribution stands in great contrast with admissions to mental hospitals in the West, as is the case in Canada, where schizophrenics represent only 12% of all first admissions to mental hospitals and non-psychotic or minor conditions amount to two-thirds. An impressionistic survey of Chinese traditional medicine rooms in general hospitals revealed that a good proportion of their cases (60-70%) are diagnosed as suffering from minor organic or vague organic conditions without evidence of organic pathology and which in the West would be considered as neurotic or psychosomatic conditions. Outside the institutions, in the communes of the rural and urban areas behavioural, interpersonal and family problems are not defined specifically as mental health problems, but handled within the moral and political ideology prevalent in the country. None of the general hospitals visited had a psychiatric unit, but every patient in every hospital or health unit in the cities and countryside received a combination of traditional Chinese medicine (herbal preparations, acupuncture and moxibustion) besides the Western or modern type of treatment. Officially mental illness is not considered a major problem and it is given very low priority in medical school curricula or in the planning of health services. It is concluded that psychiatric services in China are concerned primarily with cases of psychosis and severe neurosis, that neuroses are viewed as general health problems, and personality and behaviour disorders are considered social or community matters.