The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample

Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment.     

Physical Correlates of Torture Exposure in Karen Refugees

We explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research.     

The role of psychological defences in moderating between trauma and post‐traumatic symptoms among Palestinian men

Psychological defences are conceptualized as protective processes that help individuals to maintain their integrity in the face of threat and danger. Accordingly, their role in defending trauma victims from post‐traumatic symptoms was examined. The sample consisted of 128 Palestinian male political ex‐prisoners who had reported various degrees of torture and ill‐treatment. The first aim was to analyze the dimensionality and distribution of different defence mechanisms. The second was to examine which defences would moderate the association between the reported torture and ill‐treatment and the post‐traumatic symptoms (PTS). Third, the direct associations between reported torture and ill‐treatment and defences and between the defences and symptoms were explored. Defence mechanisms were assessed by a 40‐item version of the Defense Style Questionnaire (DSQ), and Post‐traumatic symptoms by the Harvard Trauma Questionnaire (HTQ), and experiences of torture and ill‐treatment by a scale developed for that purpose. The results show, first, that the men used predominantly mature defences such as anticipation, sublimation, suppression, and rationalization, but also relatively frequently somatization and dissociation, which are characteristic responses among trauma victims. Second, the principal component analysis revealed four defence dimensions, differentiated by the level of maturity and the approach to reality: the mature reality‐based, the consciousness‐limiting, the immature reality‐escaping, and the immature reality‐distorting defences. Third, against our hypothesis, the moderating analyses indicated that the reported torture and ill‐treatment were relatively more associated with vigilance, avoidance, and intrusion symptoms if men used consciousness‐limiting defences. Yet as expected, the mature reality‐based defences did not show a protective effect. Furthermore, a high level of reported torture and ill‐treatment was associated with a low level of the mature reality‐based defences, but not with a high level of immature defences. Last, similarly to earlier studies, the immature reality‐distorting and immature reality‐escaping defences associated directly with high, and mature reality‐based defences with low, levels of PTS‐symptoms.     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

The specifi city of torture as trauma: The human wilderness when words fail1

The author attempts to situate the specifi city of torture‐understood as the product of political violence and of totalitarian states‐within the historical framework of the concept of trauma in psychoanalysis. When the mind and social ties are simultaneously affected, the intrapsychic and transpersonal aspects of the suffered damage intertwine in a complex and unique web. The author aims to dismantle the notion of victim, considering it both stigmatizing and inaccurate. The goal is not just to identify the after‐effects and the disabilities suffered by those affected by torture, but also to integrate their experiences and their narratives into a life project. Rather than individual psychopathology, this essay refl ects upon those phenomena of suggestion and hypnosis that are at work in human groups under ordinary conditions and that are exacerbated under social crises, following the Freudian axis developed in Group psychology and the analysis of the ego.     

Treating survivors of war trauma and torture.

Psychologists are in a unique position to assist individuals and groups in the world who have survived torture and war trauma. Symptoms of posttraumatic stress disorder and other psychological diagnoses can be treated effectively by mental health professionals and trained lay counselors in the smallest of communities in the world. This article proposes a model for the treatment of survivors of torture and war trauma. This model has been designed to be useful to mental health professionals and to lay individuals in communities who constitute the front line in treatment: health providers, midwives, ministers, and teachers. The model is presented through examples of its use in the training of mental health counselors in the United States and in the training of promotores (health promoters) and comodrones (midwives) in Guatemala.     

The ethics of trauma: re-traumatization in society's approach to the traumatized subject

The paper starts from a question about the subconscious needs and anxieties which may underlie society's current responses to trauma. In particular, the author argues that the interest in the trauma of torture and man-made violence is a reaction to the increasingly dehumanizing and death-denying culture we live in. After proposing that the various categories of societal responses-the author focuses on evaluation, treatment, and advocacy-to traumatized subjects hide defenses of denial, distortion, refusal, with respect to the challenge of mortality, meaning-making, and mourning, the author then makes the thesis that they can derail and corrupt the project of post-traumatic repair. The paper proceeds with an examination of the ethics and politics that are implicit in contemporary North American society's current approach to trauma. The central argument is that the current approach may contain a collective acting out that often ends up being re-traumatizing to the traumatized subjects.     

Women and Political Torture:

Although women and children represent 80% of persons who flee their countries for reasons of persecution as refugees, scant attention has been given women in the literature describing severe human rights abuses, including torture. Torture is an extreme form of trauma that involves the strategic destruction of the human being. The torturer uses every aspect of the person's being. In the case of women, their own femaleness is used as a weapon. This paper focuses on special issues faced by women who are survivors of torture. The author directed the first center in the United States providing a multidisciplinary care for survivors of political torture.     

Jungian Perspectives on the Etiology and Treatment of Torture

As increasing numbers of people worldwide suffer the effects of torture and other war trauma, practitioners are challenged to adapt their theoretical backgrounds to their treatment. One such school of thought, Analytical Psychology, contains several premises that can help to decipher the causes of violence and oppression, and provides potentially useful techniques for treating those who have suffered their effects. Practitioners who find themselves in a position to treat survivors of torture and other war trauma can draw upon the basic principles of Analytical ology outlined in this article to enhance their treatment modalities.     

Les normes et standards de la documentation des allégations de torture et autres mauvais traitements selon le protocole d’Istanbul

Torture and ill treatment constitute a serious violation of basic human rights. Health professionals are actors capable of acting, in addition to caring for the victims, for the advent of a world without torture. Thorough investigation and substantiated documentation of allegations of torture can help victims to tell the truth about what has happened to them and support them in their quest for justice and reparation. They help victims to obtain credible evidence that torture has taken place, allowing them to assert their rights. Trained health professionals can document the physical and psychological trauma resulting from torture, and link them to specific torture practices with a very high level of credibility, using the Istanbul protocol, a manual on documentation of torture approved by the United Nations. Victims can use this evidence to formally file a complaint to substantiate allegations in civil or criminal cases, as a basis for their request for rehabilitation assistance, and as an official acknowledgment of the harm they have suffered. This work aims to point out the important role of the doctor in the process of documenting the allegations of torture and other ill treatment and the need for training on the ethical, legal and practical aspects of this intervention in order to participate in prevention, and fight against this crime.     

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.     

The Understanding and Treatment of Immigrant Trauma Survivors: Finding the Right Mix

This paper reviews attempts by three authors to describe psychoanalytic conceptualizations and treatment of torture victims. It argues that because the transference-countertransference configuration with immigrants who have not suffered torture is very similar to that of torture survivors, that no special diagnostic categories, theories, or treatment methods are needed to work with torture survivors. Second, the paper contends that newer psychoanalytic paradigms such as Hoffman's Social Constructivism may assist clinicians to capture the richness and complexity of clinical work with torture survivors better than do traditional analytic conceptions such as neutrality. Via an analysis of the three papers in this volume, I conclude with a consideration of the strengths and the weaknesses of the field of cross-cultural psychotherapy in general.     

Center for Victims of Torture--Guinea 2004-2005 International Mental Health Team: international humanitarian award

Presents the citation for the Center for Victims of Torture--Guinea 2004-2005 International Mental Health Team, who received the International Humanitarian Award "for their outstanding commitment to the healing of torture victims and to educating the world community about torture and war trauma." A brief profile of the Center is presented, as well as the Center's award address, entitled Trauma Healing in Refugee Camps in Guinea: A Psychosocial Program for Liberian and Sierra Leonean Survivors of Torture and War. ((c) 2006 APA, all rights reserved).     

The Purposes of Torture

Abstract

In this essay, I take seriously Jeremy Bentham’s caution against treating torture as though it were a single phenomenon, susceptible to moral justification or condemnation independently of the purposes for which it is used. My aim is to identify the types of torture that occur nowadays. I discuss a number of forms of violence that have recently been identified as types of torture, including interrogational, terroristic, dehumanising and sadistic torture, as well as torture as a form of punishment. To this list of types I add a further, often overlooked, type: ‘spectacular’ torture as described by Michel Foucault. Rather than obsolete, as Foucault’s Disciple and Punish might suggest, I argue that there is no reason why a form of spectacular torture could not take place today. I consider the possibility that the torture that has taken place at Guantanamo Bay is of this kind.     

Unflinching Empathy: Counselors and Tortured Refugees

In the article “Refugee Survivors of Torture: Trauma and Treatment,” W. Gorman (2001) consolidates liberation theory, multiculturalism, and traumatology into a treatment framework that draws from P. Freire (1973); A. J. Marsella, M. J. Friedman, E. T. Gerrity, and R. Scurfield (1996); and J. L. Herman (1992). This article focuses on several questions addressed by Gorman: What is the impact of torture on refugees; what multicultural principles are relevant to treatment; and what can sequenced models of trauma treatment offer to the torture survivor? It concludes with suggestions for counselors to consider regarding acculturation, resilience, and the role of mind and body in the treatment of tortured refugees.     

The conflicting influences of religiosity on attitude toward torture

This research examines the thesis that religiosity has conflicting influences on Americans' attitudes about the use of torture on terrorism suspects: an organic influence favoring opposition to torture and a discursively driven influence favoring support of torture. In each of two national samples, religiosity had both a direct effect toward opposition to torture and an indirect effect-via conservative political alignment-toward support of torture. Multiple-group analyses revealed that the direct effect toward opposition to torture did not vary across Americans with differing levels of exposure to political discourse, whereas the indirect effect toward support of torture via conservative political alignment was much stronger among Americans highly exposed to political discourse. Among such individuals, the indirect effect was so strong that it completely counteracted the competing direct effect. Discussion focuses on the competing influences that a single nonpolitical psychological characteristic may have on a political preference.     

Torture — The Case for Dirty Harry and against Alan Dershowitz

abstract Can torture be morally justified? I shall criticise arguments that have been adduced against torture and demonstrate that torture can be justified more easily than most philosophers dealing with the question are prepared to admit. It can be justified not only in ticking nuclear bomb cases but also in less spectacular ticking bomb cases and even in the so‐called Dirty Harry cases. There is no morally relevant difference between self‐defensive killing of a culpable aggressor and torturing someone who is culpable of a deadly threat that can be averted only by torturing him. Nevertheless, I shall argue that torture should not be institutionalised, for example by torture warrants.     

The juncture of law and morality in prohibitions against torture

Conclusion The right to be secure from torture, a right that encompasses moral as well as legal strictures against the practice, is supported by increasingly stringent human rights instruments. In this essay, I have discussed the principal instruments and their place in the anti-torture field considered broadly. The phenomenon of these international instruments foreshadows an ever-widening range of legal initiatives against torture, and is emblematic of the increasing importance attached to respect for human life and human dignity. The diversity of international treaties providing against torture such as, for example, The Convention on the Prevention and Punishment of the Crime of Genocide (1948), The Supplementary Convention on the Abolition of Slavery (1956), The International Convention on the Elimination of All Forms of Racial Discrimination (1965), and The International Convention on the Suppression and Punishment of the Crime of Apartheid (1973), indicates the interconnectedness of a wide range of human rights issues.The boundaries that have been drawn around the violation constituted by torture are clearer at present than are those bounding many other rights. Rights commonly categorized as of an economic nature - the right to food and to development, for example - are undergoing processes of definition and implementation. One challenge of this paper is to generate procedures presently attached to such specific human rights violations as torture to rights with less clear parameters. In this way, the growing effectiveness of procedures against torture can serve in the long term to strengthen the bases of international human rights law while in the short term helping to expand the armory of procedures for the protection of less clearly-defined, rights. International human rights law offers a practical tool towards eliminating torture from states' instruments for governing and provides a model for the development of procedures in other categories of rights, while bringing universally declared moral aspirations and legal authority into closer alignment.     

The Effects of Moral and Pragmatic Arguments Against Torture on Demands for Judicial Reform

Torture can be opposed on the basis of pragmatic (e.g., torture does not work) or moral arguments (e.g., torture violates human rights). Three studies investigated how these arguments affect U.S. citizens' attitudes toward U.S.‐committed torture. In Study 1, participants expressed stronger demands for redressing the injustice of torture when presented with moral rather than pragmatic or no arguments against torture. Study 2 replicated this finding with an extended justice measure and also showed the moderating role of ingroup glorification and attachment. Moral arguments increased justice demands among those who typically react most defensively to ingroup‐committed wrongdoings: the highly attached and glorifying. Study 3 showed that the effect of moral arguments against torture on justice demands and support for torture among high glorifiers is mediated by moral outrage and empathy but not guilt.