Predictors of Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms in Survivors of Torture Living in the United States.

A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.

Reassessment of the Ireland v. the United Kingdom ECtHR case: A lost opportunity to clarify the distinction between torture and ill-treatment.

INTRODUCTION: In the 1978 Ireland v. the United Kingdom case, the European Court of Human Rights (ECtHR) did not consider that the so called "five techniques" caused enough severity to be considered torture. The intentionality criterion, outlined in the Convention against Torture's definition of torture, was also not fully considered. The Istanbul Protocol, which is critical for evidencing torture, did not exist at that time. Although a re-opening of the case was requested in 2014 by Ireland, forensic documentation using the Istanbul Protocol was not used; in 2018, the ECtHR decided against re-opening the case. OBJECTIVE: By using the Ireland v. The United Kingdom case, this paper aims to map the origins of the five techniques, review whether applying them constitutes torture, analyze the information about the claimants available 30 years later, and explore the ramifications of the ECtHR decision not to revise its judgment. METHODOLOGY: Relevant texts were gathered from the HUDOC database, Cambridge University Press, Wiley Online Library, SCOPUS and MEDLINE /PubMed, and the Library of the ECtHR in Strasbourg. DISCUSSION/CONCLUSIONS: The five techniques, elaborated upon in the case of Ireland v. the United Kingdom, were used well before the incidents in Northern Ireland in 1971 and there is evidence that United Kingdom officials have, subsequently, used the techniques. Furthermore, there is clear evidence that the "Hooded Men" had cognitive, psychological and neurovegetative symptoms as a result of the five techniques, which had long-term effects. The ECtHR did not take this into consideration when it decided not to re-open the case and the full implications of this decision for future cases and victims remain to be seen.

Encapretamento: un mecanismo homicida importado / Incaprettamento: An imported homicide method

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Is torture reliably assessed and a valid indicator of poor mental health?

Torture is thought to confer worse mental health than other war-related traumatic events. However, reliability of torture assessment and validity of torture constructs as indicators of poor mental health have not been systematically evaluated. Study aims were to assess the psychometric properties of 2 common torture constructs. Refugees were assessed for having experienced torture by 1 subjective and 1 objective criterion. A subset was interviewed about definitions and effects of torture. Reliability and validity of torture constructs were assessed with general linear models. Interview data were analyzed for consistency of themes. Reliability of torture constructs was moderate, which paralleled inconsistencies in interview themes. Both torture criteria had similar dose-dependent relationships to mental health. Multivariate analyses showed that torture was not an independent predictor of poor mental health when controlling for the number of war-related events. Further work is needed to define torture from distinct medical and legal perspectives to improve reliability and validity.

Using the International Classification of Functioning, Disability and Health (ICF) to describe the functioning of traumatised refugees.

The aim of this project was to use the International Classification of Functioning, Disability and Health (ICF) to develop an interdisciplinary instrument consisting of a Core Set, a number of codes selected from ICF, to describe the overall health condition of traumatised refugees. We intended to test 1) whether this tool could prove suitable for an overall description of the functional abilities of traumatised refugees before, during and after the intervention, and 2) whether the Core Set could be used to trace a significant change in the functional abilities of the traumatised refugees by comparing measurements before and after the intervention. In 2007, eight rehabilitation centres for traumatised refugees in Denmark agreed on a joint project to develop a tool for interdisciplinary documentation and monitoring, including physical, mental and social aspects of the person's health condition. ICF, developed and approved by WHO in 2001, was found suitable because it offers a common and standardised language and a corresponding frame of reference to describe health and associated conditions in terms of functioning rather than symptoms and diagnosis. Traumatised refugees are in most cases severely affected mentally by the traumas they have been subjected to, physically by injuries suffered during torture and war, psycho-somatically with pain, and socially by cultural uprooting, as well as by social difficulties in the exile community. The rehabilitation perspective thus seems to be more meaningful than the traditional treatment perspective because it takes into account the very complex situation of this group. The aim of the project was to find out whether any functional changes could be monitored using the instrument. The aim was neither to study nor to describe the effect of rehabilitation approaches, such as conditions related to traumatised refugees' networks or environments that might affect the refugees' living conditions. It was also not the intention to discuss the cause of the potential changes of the functional abilities. The project selected a Comprehensive Core Set of 106 codes among 1,464 possible codes (1) used by an interdisciplinary group of international and national experts in rehabilitation of traumatised refugees. The Comprehensive Core Set was furthermore reduced to a Brief Core Set of 32 codes by the interdisciplinary team (key persons) at the centres included in the project. From each centre six clients were randomly selected from those who fulfilled the inclusion criteria. All were scored within a four week period after the start, before any intervention was initiated, and up to a month after the first scoring. The results from this project led us to the conclusion that it is possible to develop an instrument based on the ICF classification. The instrument is useful for a general description of the total health condition (physical and mental functional ability as well as the environmental impact) of traumatized refugees. The tool helps describe changes in the functional abilities used in connection with the preparation of the plan of action. It can also be used to describe the refugees included in the study and their general condition. The ICF Core Set for traumatised refugees has not yet been validated, but the results of the project provide a basis for further development.

Transitory Ischemia as a form of white torture: a case description in Spain.

Transitory Ischemia is a form of torture that has been insufficiently described and studied in forensic and psychiatric studies of torture. It is usually left out of medical evaluation reports and not explored in detail under the Istanbul Protocol. Although ischemia, when experienced during brief periods of time, does not produce any detectable sequelae, prolonged periods of ischemia can be detected by either clinical examination or electromyography. The authors describe the use of brief periods of ischemia as a torture technique against a non-violent activist in Seville (Spain).

Defining torture: a review of 40 years of health science research.

The current review critically examines the body of torture research (N = 209), focusing on the definition and operationalization of the primary construct. Almost three-quarters (69.9%) of the studies reviewed did not reference any definition of torture. Few studies identified important contextual variables related to defining torture such as identities and motivations of perpetrators and severity of abuse. Definitional ambiguity further impacted how individuals were queried about their experiences and the extent to which torture was distinguished from other forms of maltreatment. Although there are notable exceptions, the methods used in the torture literature are variable and often undefined, impacting the interpretation of findings of risk factors, consequences, and treatment of torture events.

The diagnostic value of clinical examination after falanga--a pilot validation study.

Medico-legal documentation of alleged exposure to falanga torture warrants a high diagnostic accuracy of the applied clinical tests. The objective of this study was to establish data on the validity of palpatory examination of the footpads and the plantar fascia and to assess the distribution of observations among selected cases and non-cases in a small study sample. Calculated estimates of sensitivity and specificity of the individual diagnostic tests are reported and, in general, did not meet the authority-based criteria of an 80% cut-off point. The observed total number of true tests in this study was 65 %. It is concluded that future studies of the reliability of clinical examination and assessment of the variability of observations among unselected cases and non-cases should be conducted in a larger cross-sectional study population.

Diagnóstico diferencial de la tortura en restos esqueletizados: presentación de tres casos / Differential diagnosis of torture in skeletal remains: presentation of three cases

Si bien el diagnóstico de la tortura en restos humanosse ha concentrado principalmente en el examen devictimas vivas y en cadáveres poco o nada ha sido hechoen restos esqueletizados. Este trabajo discute el rol delos traumatismos torácicos como un indicador de lesionesno accidentales causadas con el fin de incapacitarmás no matar a la victima de violaciones a los DerechosHumanos. Para ilustrar el diagnóstico diferencial a lesionesatribuibles a “tortura” y a otros mecanismos se presentantres casos, dos de los cuales podrían ser clasificadoscomo tortura y uno que es excluido por mostrar uncuadro lesivo compatible con un accidente de tráfico(AU)

While the diagnosis of torture has been primarilyconcentrated in the examination of living victims andcadavers, little or no work has been undertaken inskeletonised remains. This paper discusses the role of nonaccidentaltoracic trauma as an indicator of inflicted lesionswith the aim of incapacitating but not killing certain victimsof Human Rights violations. In order to illustrate differentialdiagnosis of injuries attributable to “torture” as well as othermechanisms three cases are presented in which could beattributed to torture and one is an exclusion of thatscenario and is more consistent with a road traffic accident(AU)

Radiology of torture.

PURPOSE: Although there are different definitions of torture, there is no contradiction that torture exists. Changes resulting from torture are shown to demonstrate which findings can be visualized with X-rays. MATERIAL: The findings come from rehabilitation centers for victims of torture, collections of others and from personal observations. They are documented with plain films, scintigraphy, computed tomography, and MRI. RESULTS: On fingers, hand, and arm, and on toes, foot and leg, imaging can visualize changes and pathologies which are characteristic for preceding torture. On head, neck, and trunk, this is only rarely the case; this is understandable, when one considers that force having been directed against these regions of the body will more often be deadly than that applied on limbs only. Special forms of torture with the use of water and electricity are also described. It is pointed out that multiple forms of torture do not leave traces, which might be made visible by diagnostic imaging. The cases are part of a selection: the victims have survived (which means that these types of torture permitted survival; injuries of hand and foot do not endanger the survival as opposed to stab wounds to the head, chest, and abdomen, into the anus and the genitals, which are often mortal. Mutilation by torture motivates the torturer to eliminate any proof of his actions and to kill the victim. Public interest induces a selection of methods, which leave no traces. Possibly (and hopefully) some special forms of torture, which use chemical substances that act on the psyche and the central nervous system, might become visible by functional MRI in the near future. CONCLUSION: Torture is likely to occur when findings are seen to be typical or characteristic forms of torture, when age of fractures and pattern of beatings and other injuries corroborate the indications of the victim, and when these findings correspond to the procedures known from the region of application the organization/group/militia, which is said to have executed the torture.

Classifying the torture experiences of refugees living in the United States.

Few research studies have systematically categorized the types of torture experienced around the world. The purpose of this study is to categorize the diverse traumatic events that are defined as torture, and determine how these torture types relate to demographics and symptom presentation. Data for 325 individuals were obtained through a retrospective review of records from the Bellevue/NYU for Survivors of Torture. A factor analysis generated a model with five factors corresponding to witnessing torture of others, torture of family members, physical beating, rape/sexual assault, and deprivation/passive torture. These factors were significantly correlated with a number of demographic variables (sex, education, and region of origin). Post Traumatic Stress Disorder, anxiety, and depression symptoms were significantly correlated with the rape factor but no other factors were uniquely associated with psychological distress. The results offer insight into the nature of torture and differences in responses.

Producing medico-legal evidence: documentation of torture versus the Saudi Arabian state of denial.

Five British men were detained and allegedly tortured in Saudi Arabia in 2000 and 2001. Two were sentenced to death and three were sentenced to 12 to 18 years of imprisonment. They received clemency in 2003 and were deported to England. After their homecoming, the men have unsuccessfully attempted to sue Saudi Arabian officials who had been responsible for their false accusations and human rights abuses. Saudi Arabia denies any form of torture and ill treatment of the five men, who maintain their allegations against the authorities responsible in Saudi Arabia. This article provides medical documentation of torture of the five British men by comparing: 1. Alleged torture methods, 2. Histories of immediate effects of torture, 3. Objective medical observations using clinical examinations as well as ultrasound scans of the victims' feet. The article concludes that there is a high degree of consistency between the claims of torture and observations, despite Saudi Arabian denial.

Especificidad de la tortura como trauma. El desierto humano cuando las palabras se extinguen / Specificity of torture as a trauma. The human desert when words run dry

El autor procura situar la especificidad de la Toruta- como expresión de la violencia política y del estado totalitario- en el marco histórico del concepto de Trauma en psicoanálisis. En la afectación simultánea de la mente y del lazo social, los aspectos intrapsíquicos y transpersonales del daño se entretejen en una trama compleja y singular. El autor apunta a desmontar la idea de víctima por estigmatizante e incorrecta. El objeto de estudio no es solamente identificar las secular y minusvalía de los afectados, sino integrar su experiencia y su relato en un proyecto de vida. Más que a una psicopatología individual, la reflexión apunta – siguiendo el eje freudiano de Psicología de las Masas y Análisis del Yo- a estudiar los fenómenos de sugestión e hipnosis, que operan en los grupos humanos en situaciones ordinarias, y se exacerban en condiciones de crisis social (AU)

The autor endeavours to sitúate the specificity of Torture- as an expression of political violence and of the totalitarian state- within the historical framework of the concept of Trauma in psychoanalysis. In simultaneous affectation of the mind and of the social bond, intrapsychic and transpersonal aspects of damage/harm intertwine in complex and singular plot. The author favours dismounting the idea of the victim, as stigmatizing and incorrect. The aim of the study is not only to identify consequences and detriment of values of those affected, but also to integrate their experience and story in a life project. Rather that an individual psychopathology, these thoughts favour a study of the phenomena of suggestion and hypnosis –following the Freudian axle of Group Psychology and the Analysis of the Ego- which are operative within human groups in ordinary situations, and which exacerbate in conditions of social crisis (AU)

[Medical aspects of objectifying torture sequels]. / Medizinische Aspekte der Objektivierung von Folterfolgen.

Migration, civil wars and other conflicts in various regions of the world have led to a drastic increase in the number of displaced persons and refugees. Associated with this development is an increase in the number of torture victims seeking asylum. This means that the medical personnel is increasingly confronted with the evaluation and therapy of torture victims. The methods of verification of sequels of torture are of utmost importance in the work-up of treatment centres for survivors of torture. Since each organ can be affected by torture, a multidisciplinary cooperation is mandatory for the examination of torture victims. In this paper we shall discuss some aspects concerning the diagnosis of injuries caused by torture which are essential for interviewing and examining torture victims in order to objectify sequels of torture.