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PubMed1995

Psychological sequelae of torture and trauma in Chilean and Salvadorean migrants: a pilot study.

Torture has existed since the earliest times, usually as public punishment prior to death. Today it is predominantly used in secret with the aim of destroying the individual's personality. The effects of torture include severe physical and psychological sequelae which have only recently come under scrutiny. In recent years many Chilean and El Salvadorean migrants have left their countries after being tortured and severely traumatised as a result of organised violence. The aim of this study was to pilot an investigation into the psychological sequelae of torture. Subjects were 30 Chileans and El Salvadoreans classified into three groups: torture, trauma and non-torture/trauma migrants. It was found to be feasible to access and interview survivors from a clinical research perspective without causing additional psychological morbidity. The subjects were interviewed and administered three scales: the Post-Traumatic Stress Disorder Scale, SCL-90-R, and the Impact of Event Scale. The results from the scales and the descriptive data presented indicate some support for the hypothesis that torture survivors show higher levels of PTSD, psychosomatic impairment and stress response disturbance than the trauma and non-torture/trauma groups. Methodological issues are discussed. The strengths and limitations of this preliminary study are considered in relation to future research.

Adult↗
PubMedDate not supplied

Part I: Torture and mental health: a review of the literature.

Torture affects a large number of people worldwide and poses a serious threat to mental health. This article presents an overview of torture as a current issue and reviews the literature that addresses the mental health effects of torture. Subtopics addressed include the effects of torture on the individual, the effects of torture on the community, studies of women who have survived torture, the ethics involved in studying torture victims, and the debate over identifying a torture syndrome.

Bioethics↗
PubMed2002

[Sexual dysfunction in torture victims].

Sexual dysfunction is seen in up to 51% of torture victims. The torture victim seldom reports anything about having been tortured but often consults the health care system because of a somatic problem which may seem unrelated to torture. Therefore, it is important that doctors are aware of the possible correlation. Symptoms and findings may be both physical and psychical. The torture may be both sexual and non-sexual as well as physical and non-physical. Social, cultural and individual factors also influence the development of sexual dysfunction in a torture victim. The factors that cause sexual dysfunction and the identification of any direct causal relations are discussed. There are indications that sexual torture has a greater impact on the development of sexual dysfunction than other types of torture and it seems that sexual dysfunction is a result of many factors.

Female↗
PubMed2005

Forensic medical examination of refugees who claim to have been tortured.

The United Nations Convention against torture prohibits repatriation of refugees if there is reason to believe they will be tortured on return to their country. A history of torture is therefore an important factor in making a case for asylum. In this study, the results of the medical examinations of 59 torture victims investigated at the Department of Forensic Medicine, University of Aarhus, Denmark, 1996-2002, are presented and discussed. Variables including age, sex, education, health, torture methods, condition of confinement, torture aftereffects, and findings at the forensic examination were registered in a database (Paradox) and analyzed. In 70%, aftereffects of torture could be documented. These included scars after fixation, burns, incisions, or flogging. Symptoms and signs from joints, muscles, and nerves were common in victims who had been suspended. Many of the victims of phalanga had painful feet and signs of walking impairment. A majority of the victims suffered from posttraumatic stress syndrome. An independent medical report offers an opportunity to evaluate and elaborate the story told by the victim and should be used in disputed cases. We have a duty to protect refugees against torture.

Adult↗
PubMed2004

A utilitarian argument against torture interrogation of terrorists.

Following the September 2001 terrorist attacks on the United States, much support for torture interrogation of terrorists has emerged in the public forum, largely based on the "ticking bomb" scenario. Although deontological and virtue ethics provide incisive arguments against torture, they do not speak directly to scientists and government officials responsible for national security in a utilitarian framework. Drawing from criminology, organizational theory, social psychology, the historical record, and my interviews with military professionals, I assess the potential of an official U.S. program of torture interrogation from a practical perspective. The central element of program design is a sound causal model relating input to output. I explore three principal models of how torture interrogation leads to truth: the animal instinct model, the cognitive failure model, and the data processing model. These models show why torture interrogation fails overall as a counterterrorist tactic. They also expose the processes that lead from a precision torture interrogation program to breakdowns in key institutions-health care, biomedical research, police, judiciary, and military. The breakdowns evolve from institutional dynamics that are independent of the original moral rationale. The counterargument, of course, is that in a society destroyed by terrorism there will be nothing to repair. That is why the actual causal mechanism of torture interrogation in curtailing terrorism must be elucidated by utilitarians rather than presumed

Ethical Theory↗
PubMed1994

Torture survivors: a challenge to nursing practice.

Why should all nurses and student nurses receive instruction in the subject of torture, its purpose, methods and sequelae on body and soul? One reason is because torture is an atrocity, the most perverted and digusting act that exists. Some nurses meet torture survivors and their families in their private lives and at work. Many countries have ratified codes and declarations in relation to torture, and are therefore obliged to educate some professional groups in the subject. This article describes how the subject 'Torture' is dealt with at the School of Nursing in Aalborg, Denmark. Aspects of how the course is planned, the placement of the subject, teaching objectives, content of the lessons, teaching methods and teaching materials are mentioned. This article also underlines why it is so important to educate student and qualified nurses about torture. The conclusion is that nurses can help to alleviate the effects of torture in a merciless and unfeeling world.

Curriculum↗
PubMed1997

Patterns of symptomatology and patterns of torture and trauma experiences in resettled refugees.

OBJECTIVES: The purpose of this study was: (i) to examine the incidence of psychological and medical symptomatology, torture and related trauma in a sample of 191 refugee clients of the Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) in New South Wales (NSW), Australia; and (ii) to identify patterns of current symptoms, patterns of torture and trauma experiences and the relationships between symptoms and experiences. METHOD: Analysis of STARTTS client records permitted the coding of the presence/absence of 41 medical and psychological symptoms and of 33 torture and trauma experiences. Principal components analyses were used to identify patterns of current symptoms and patterns of torture and trauma experiences. Multiple regression analysis was used to identify relationships between current symptoms and traumatic events in the country of origin or en route to Australia. RESULTS: Six factors were extracted for both the symptoms and trauma experiences; the first symptom factor was labelled 'core posttraumatic stress disorder (PTSD)'. Regression analysis showed that threats and humiliation, and being forced to watch others being tortured best predicted scores on this factor. CONCLUSIONS: Although core PTSD is the dominant factor in symptomatology, comorbidity is high, with another three symptom factors emerging as meaningful. However, client reports of threats and humiliation or forced viewing of others being tortured should alert clinicians to the likely development of core PTSD, if it has not already occurred. Other implications of these findings for treatment and service development are discussed.

Adolescent↗
PubMed1988

Rehabilitation of refugee victims of torture and trauma: principles and service provision in New South Wales.

A number of recently-arrived refugees who are suffering from psychological disturbances and physical injuries that have resulted from torture or severe trauma has come to the attention of welfare workers and health personnel in New South Wales. A tentative estimate of more than 2000 refugees in New South Wales who are so affected, and clear evidence of extensive human rights abuses in the countries from which they came, indicate an urgent need for specialized care for the victims. Organized violence, including detention, torture and severe deprivation, is a tool of governments in many countries of the world. The varied forms of torture are all designed to destroy the trust, personality and self-esteem of the victims and to foster dependency, debility and dread, both in the victims and in the societies in which they live. Those persons who survive torture and detention often are affected severely in body, mind and spirit. Many victims exhibit acute and chronic symptoms that are described commonly by the diagnostic categories "post-traumatic stress disorder" and "torture syndrome". Their kin, especially spouses and children, also suffer psychological and familial disturbances frequently, as a result of the arrest, detention and torture of the victim. Their suffering is compounded by the distress of fleeing their home country and the stresses of adjusting to a new country and way of life. In Europe and North America, services have been established to treat and to rehabilitate sufferers of these disorders. Treatment programmes differ in structure and size, but include commonly psychotherapy, physiotherapy, specialized medical care and parallel assistance with resettlement and social adjustment for both the patients and their families. This article cites illustrative case material from New South Wales and summarizes the recommendations for a community-based rehabilitation service for victims both of torture and of other forms of organized violence, such as detention in "re-education" camps or the genocide in Kampuchea.

Health Services↗
PubMed1995

The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. American College of Physicians.

The prevention of torture and the treatment of survivors are issues that concern an increasing number of physicians in their daily work. Every day, thousands of men, women, and children are subjected to violence and are forced to flee their homelands. There are more than 18 million refugees in the world and hundreds of thousands of persons seeking asylum, many of them in the United States. Physicians are often the first to interview these victims of abuse. Torture has serious and long-lasting health consequences. Thus, physicians can play a key role in documenting and preventing many forms of abuse and in treating survivors. In some areas, physicians may become the targets of arrest because of their work as clinicians or as influential members of their communities. They may also face disturbing ethical dilemmas as they witness torture or its results. As members of the medical profession, physicians have an obligation to their peers around the world. This report reviews the current state of physicians' involvement in the prevention of international torture and in the treatment of its victims. We propose ways in which physicians can become involved by caring for survivors of torture and by providing expert testimony on behalf of victims who seek asylum. We discuss how the medical profession complements the efforts of individual physicians by providing an infrastructure to support and guide their work. Medical organizations can adopt and disseminate ethical principles that specifically address human rights and their violation. They can coordinate letter-writing networks for human rights, organize or sponsor fact-finding missions, and develop continuing medical education courses on topics such as the identification and treatment of victims of torture. We conclude that physicians can make a difference, both as clinicians and as advocates for the health of the public and the protection of the human rights. The American College of Physicians will continue to advocate for the rights of persons and communities to live in dignity and peace, free of the fear of unjust imprisonment or torture.

Adult↗
PubMed2000

Torture--a plague to the world-society.

In this article the authors discussed about government-sanctioned torture, methods of torture, diagnosis of torture along with its modern history, the effect of torture, post-traumatic stress disorder in torture survivors, prevention of torture, impunity and entered into their conclusion based upon more than 20 years of professional medical and psychological work against torture.

Crime Victims↗
PubMed2002

Evidence of torture in the mid west region of Nepal.

INTRODUCTION: The aim of this study was to find evidence of torture in the Mid West Region of Nepal. METHODOLOGY: Interview and clinical examination of self-reported torture-survivors in the Mid West Region of Nepal in the area of Nepalganj, which is on of the most important city in that region. Thirty-four persons (group A) were examined according to a programme performed by Physicians for Human Rights, Denmark. Furthermore, twenty-nine persons (group B) were interviewed according to an abbreviated programme performed by a local group of doctors. RESULTS: Testimonies of exposure to physical and psychological violence were validated, assessing the consistency between the reported exposure, reported ensuing symptoms and the results of clinical examinations. CONCLUSION: Torture has probably existed in Nepal for decades. The main reason given for torture is suspicion of political activity. Most of the torture takes place in District Police Offices, by the police. Episodes of torture performed by the Communist Party of Nepal, known widely as "the Maoists", have been reported. This investigation substantiates that torture is severely traumatizing for the survivor.

Adolescent↗
PubMed2003

[Specific psychopathologic reactions in refugee populations and victims of torture].

AIM: Examine differences and specificities of psychological symptoms as a response to the trauma of torture and displacement. METHOD: The sample includes two groups of 50 subjects. The first group experienced the trauma of displacement, and the second group beside the displacement experienced also the trauma of torture. RESULTS: The drop in social and economic status is much more profound in torture victims compared to refugees. All nine SCL 90-R suscales show statistically significant difference in more pronounced psychopathological responses in torture victims relative to refugee population. The Mississippi questionnaire shows significant differences in PTSD between the two groups and higher scores for torture victims. CONCLUSION: Based on the results torture is the most intense form of trauma leading to intensive psychopathological responses including chronic PTSD. Results show that the psychopathological response is most intense and most frequent in the population of torture survivors compared to the refugee population.

Adult↗
PubMed2005

[Efficiency of the short group psychotherapy in rehabilitation of female's victims of war sexual torture].

AIM: Aim is to show the efficiency of short group psychotherapy of females victims of war sexual torture, suffering from chronic consequences of torture. METHOD: 15 female's victims of war sexual torture were included in this research, all of them suffering from chronic consequences of torture. Before including into group psychotherapy all of them were interviewed by psychiatrist. Initial testing was done before beginning of group psychotherapy with following instruments. General Questionnaire, MANSA Questionnaire for registration of Quality of life, and Multidimensional Instrument for assessment of psychological symptoms SCL R-53. Short group psychotherapy lasted three (3) month. Sessions were organized weekly and lasted 90 min. Group was leaded by two cotherapists both female. Working technique was supportive-expressive psychotherapy. During the group psychotherapy cycle clients have received general medical treatment, physiotherapy, gynecological treatment and dental treatment. When indicated they were treated with medications. After three month of therapy they were retested with MANSA and SCL-53 Questionnaires. RESULTS: Retest results after three month of treatment on MANSA Questionnaire are showing the significant improvement of quality of life. On SCL-53 Questionnaire there is reduction in all psychopathological symptoms, except on scale of obsessive compulsive symptoms, but it is statistically significant on subscale of paranoid ideation p<0.05, and on subscale of anxiety is on the border of significance p=0.054. CONCLUSIONS: Short group psychotherapy has shown efficiency in treatment of chronic psychological consequences with the females victims of sexual torture in the war. Chronic psychological consequences of torture are reduced after three month of treatment. Group experience helped to sexual torture survivor's to establish the better quality of life.

Adult↗
PubMedDate not supplied

Treatment of torture survivors and their families: the nurse's function.

Torture has always existed. Whereas it was previously practiced publicly to warn citizens of a similar fate if they violated the law, today torture takes place mostly behind closed doors. The responsible authorities and governments deny its existence. And the survivors rarely talk about what they have been exposed to. Thus a wide misbelief as to the real extent of torture and the ensuing physical and psychological problems of the torture survivors who are in dire need of professional help. In keeping with ICN's concern for human rights and its emphasis on the ethical responsibilities of nurses, ICN requested the following article on torture and the nurse's role in the treatment of torture survivors and their families. It is hoped that it will stimulate discussion by nurses and be used as a basis for teaching about torture in nursing schools.

Denmark↗
PubMed1996

Torture and war trauma survivors in primary care practice.

Close to 1 million refugees from around the world have entered the United States, fleeing repression, war, terrorism, and disease. It has been estimated that among these are thousands who have experienced torture. Many refugees and immigrants will appear in the offices of health care professionals with symptoms that may be related either directly or indirectly to torture. Both physical and psychological torture may result in long-term sequelae. Physical effects may be found in every organ system, but psychological effects are most commonly manifest in the symptoms of the post-traumatic stress disorder. For physicians to recognize how torture can affect health status, it is important to understand that history taking may be difficult and that little information may emerge that would explain the origins of scars, fractures, or disabilities. Recognizing the clues to a torture history allows physicians to assist patients in describing the trauma. In addition, knowing the subacute and chronic signs and symptoms of torture enables physicians to diagnose and treat often obscure symptoms with a much clearer understanding of the sources of the difficulty. Paying special attention to the interview process will support torture survivors in detailing often horrific events.

Adult↗
PubMed1997

[The treatment of torture and war victims].

Torture is a means of repression in non democratic societies. Although banned, it is widely practised. About 30% of the refugees recognized 1987 in Switzerland were tortured. Torture and war lead to severe bio-psycho-social sequels which are described as "post traumatic stress disorder" (PTSD). This can be treated. Several centres for treatment of torture victims were recently established in many countries since health workers and health care providers felt helpless facing the consequences of torture and asked for professional support. The foundation of the Swiss Red Cross Therapy Centre for victims of torture was the response to their demand in Switzerland. The centre offers a wide range of therapies for victims of torture and training for health personnel. It further aims to facilitate the establishment of more institutions of this kind.

Adolescent↗
PubMed1991

Proceedings of the International Symposium on Torture and the Medical Profession.

... The main topic of this publication is the involvement of professional medical doctors in the course of torture in, generally speaking, the following ways: 1. Medical scientific knowledge and experience is used in the design of the methods and techniques of torture, for example pharmacological torture; 2. Doctors teach the torturers/perpetrators regarding the practical application of these methods; 3. Doctors actively participate in carrying out torture and in executions in relation to the death penalty; 4. Doctors are present -- "passive" -- during the implementation of torture (in more than sixty per cent of cases) for example monitoring the clinical condition of the victim in order to prevent death; are present when the death sentence is carried out, and then write out death certificates. Many of these are later shown by forensic documentation to be false.... This supplement is based on an international symposium, Torture and the Medical Profession, which was held at the University of Tromsø in June 1990....

Codes of Ethics↗
PubMed1988

Physical and psychological sequelae to torture. A controlled clinical study of exiled asylum applicants.

The study comprised 24 male Lebanese refugees living in Denmark. Twelve of them alleged having been tortured in Lebanon during the period 1981-85. The remaining twelve had neither been imprisoned nor tortured and thus acted as control persons. All the testimonies were found to be valid according to a method previously used by the author. The most common forms of torture were blows against the head, body and foot soles, suspension and asphyxiation. Threats and solitary confinement were frequent, and sexual violations were also reported. At the time of examination (March-November 1986), the main complaints were headaches, various cardiopulmonary symptoms, sleep disturbances with nightmares, impaired concentration and memory, and emotional lability. Suicide attempts were reported. Prior to the torture all the probands had been healthy except for several cases of gunshot wounds. The clinical examination revealed different scars possibly related to torture in nearly all the cases. Missing or fractured teeth, peripheral nerve damage and mental depression were also found. The 12 controls had several mental and physical complaints, but significantly fewer than the probands. Almost all of them had scars from gunshot wounds. The present study clearly indicates that torture plus exilation has a more deteriorating effect on the health status than exilation alone.

Adolescent↗