In recent years more and more sophisticated psychological and physical methods of torture are being developed by the torturers world-wide in order to avoid visible body marks.
Physical torture produces well-defined acute symptoms and signs but these resolve spontaneously or after therapy. After few weeks there may not be enough visible physical signs to establish evidence.
Some types of torture, especially those high in intensity, leave chronic and well-defined late physical sequelae.
Contrary to the physical effects of torture, the psychological symptoms are persistent and can last months, years or a lifetime if left untreated.
In the largest world wide investigation to date of 526 torture survivors one found the diagnoses of Post-traumatic Stress Disorder (PTSD), depression and anxiety to be significantly more common in the tortured group compared to non-tortured refugees of same nationality (Shresta et. Al., 1998).
PTSD and personality change after extreme life experience are defined as direct consequences to torture in the ICD-10 classification of mental and behavioural disorders (F62 Enduring personality changes, not attributable to brain damaged and disease). The ICD-10 is the standard diagnostic system of the World Health Organisation, that is obligatory in all evidence-based medical science.
Scientific studies over the last decade have proven the direct and casual link with these clearly defined disorders and neurophysiological basis in survivors of torture and similar forms of extreme violence.
In connection with tortured individuals it is much more important to underline that the threatening of the organism leads to the activation of multiple neuro-biological systems.
Anxiety, depression, insomnia, nightmares, memory difficulties, social withdrawal, irritability, feelings of helplessness, affective numbing, flashbacks, shame, mistrust, ruminations, unexplained pain, the conviction of being permanently injured and changed, many medical complaints, loss of appetite, and loss of sexual desire are some of the most common symptoms and feelings after physical and psychological torture.
Especially the feeling of being a changed person corresponds to the aim of the torturers to destory the victim as a human being through a systematic infliction of severe pain and extreme psychological humiliation.
All of these traumatic reactions are in reality psychosomatic reactions since all psychological symptoms in the human organism have a physiological basis.
The latest neuro-biological and stress research shows that such an extreme stressor as torture alters the central nervous system and the physiological system in general which can explain the symptom of hyper-arousal in torture victims (anxiety, insomnia, rage, irritability, shame, and fear).
Thus, the lasting psychological symptoms are body/mind expressions caused by the violent attacks on the body and the death threat connected with these attacks. Furthermore the violations of body and mind put the individual in a situation where he can neither flee nor fight back, the normal, innate responses to danger and humiliation.
Inability to either fight back or flee before, during and after torture or when re-experiencing the traumatic memories of torture, leaves the individual with enormous physiological arousal.
We must emphasise that in torture one cannot separate the psychological
symptoms from the attacks on body and mind-even when the visible scars
or signs have disappeared.
Delon Human, MD.
Secretary General
World Medical Association.
Inge Genefke, MD., DM. Sc. h.c.
Chair, Section on Psychological
Aspects of Torture and Persecution,
World Psychiatric Association.
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