MODULE 4
Prevention through Documentation Project
Torture Methods and Medical
Consequences
CONTRIBUTORS:
Vincent Iacopino, MD, PhD, Physicians for Human Rights
Önder Özkalıpçı MD, International Rehabilitation Council for Torture Victims
Alejandro Moreno, MD, JD, Boston Center for Refugee Health and Human Rights
Ole Vedel Rasmussen, MD, DMSc, International Rehabilitation Council for Torture Victims
Türkcan Baykal MD, Human Rights Foundation of Turkey
Caroline Schlar, PhD, Human Rights Foundation of Turkey,
Emre Kapnın, Human Rights Foundation of Turkey
Kathleen Allden, MD, Indochinese Psychiatric Clinic
PtD Project (IRCT, HRFT,
REDRESS, PHR)
Module 4 Outline
 Subjective
 Torture
element of suffering
methods
 Psychological
torture
PtD Project (IRCT, HRFT, REDRESS, PHR)
consequences of
The Subjective Element of Suffering

Take into consideration individual factors:
– Gender
– Religion
– Physical and psychological condition
– Age

Meaning of experiences affects degree of
suffering
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Beating

Most common method of physical torture

Practiced with or without instruments

Impacts may cause
– Abrasions
– Lacerations
– Contusions
– Hematoma
– Internal bleeding

Perpetrators may:
– wait for signs to resolve prior to remanding to
judicial custody
– Attempt to limit evidence using barriers (ie blanket)
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Beating
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Falanga
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Falanga
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Ear Trauma
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Eye Trauma
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Restraint, Shackling and
Positional Torture

Characteristically, these forms of torture leave few
external marks or radiological findings, despite
subsequent chronic disability.
– Handcuffs, wrist or ankle ties leave no mark if applied
properly

The use of leg irons is widespread in police stations
and prisons

Many forms of positional torture, all of which tie or
restrain the victim in contorted, hyperextended or
other unnatural positions
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Abu Ghraib
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Suspension

Common form of torture
– produces extreme pain
– leaves little visible evidence of injury

Examples:
– Cross suspension or “crusifixion”
– Butchery suspension
– Reverse butchery suspension
– “Palestinian” suspension
– “Parrot perch” suspension
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Winged Scapula
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Crushing and Stretch Injuries
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Crushing and Stretch Injuries
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Crushing and Stretch Injuries
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Burning
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Electrical Injuries
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Asphyxiation
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Asphyxiation
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Asphyxiation
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Violent Shaking

Acute symptoms
–
–
–
–

headache
disorientation,
altered mental state
If severe:
 cerebral oedema
 haematoma
 retinal haemorrhage
 death
Chronic symptoms of non-fatal brain trauma:
– recurrent headaches
– cognitive impairment
– cervical spine fracture/cord injury/paralysis
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Sexual Assault





Nudity
Verbal threats
Humiliating acts
Molestation/groping
Assault
– Injury to genitals
– Forced sexual acts
– Insertion of objects (vagina, urethra, anus)
– Rape: Penis inserted in to vagina, mouth, anus
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Sexual Assault
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Sexual Assault
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Sexual Humiliation – Abu Ghraib
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Sexual Humiliation – Abu Ghraib
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Sexual Humiliation
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Prolonged Isolation and Sensory
Deprivation
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Sleep Deprivation

achieved through the use of
– stress positions
– sensory overload
– temperature manipulation
– other techniques

causes cognitive impairments including deficits in memory,
learning, logical reasoning, complex verbal processing, and
decision-making

Symptoms of torture
– independently affects clinical outcome
– Affects course of disorder
– associated with independent increase in of suicidal ideation
and action
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Temperature Manipulation
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Sensory Bombardment

practiced with exposure to bright lights,
flashing strobe lights and/or loud music for
extended periods of time
– may cause physiologic distress and
disorientation
– Loud music may cause hearing loss or ringing in
the ears; acute or chronic (chronic tinnitus
more common)
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Threats of Harm
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Threats of Harm
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Psychological Consequences of
Torture

Outline:
– Risk factors
– Goals of torture
– The Paradox of psychological
–
–
–
–
consequences
Psychological Consequences
Social, Political and Cultural Context
Risk factors for refugees
Psychological Symptoms
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Risk factors for survivors of
torture
Torture
 War
 Political oppression
 Imprisonment
 Witnessing or experiencing atrocities
 Loss/separation from family
 Distortion of social relationships

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Goals of Torture

Primary goal : destroy the victim psychologically
(not physically)

Reduce to helplessness (break person’s will)

Damage intimate relationships in families

Damage relationships of victims and communities

Damage coherence of entire communities by
setting horrific examples
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First Paradox of
Psychological Consequences
of Torture

Most personal and enduring consequences

Affect the victim, family and community.

Psychological scars are invisible; there are
no objective signs.
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Second Paradox of
Psychological Consequences
of Torture

Extreme trauma such as torture does not
always produce psychological problems

Absence of mental problems does not mean
that the individual was not tortured
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consequences of torture
TORTURE CAUSES TRAUMA
SOCIETY
FAMILY
INDIVIDUAL
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Consequences of Torture

INDIVIDUAL

FAMILY

SOCIETY

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can terrorize entire
population
creates an atmosphere
of pervasive threat,
chronic fear, terror,
inhibition, hopelessness
creates repressive
ecology: a state of
generalized insecurity,
lack of confidence and
rupture of social fabric.
can break or damage
will and coherence of
entire communities
Consequences of Torture

INDIVIDUAL
– different forms of
family dysfunction
– disruptions in course of
family development
FAMILY

SOCIETY
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Can lead to family
traumas that cause:
Assessing the effects
of torture on survivor’s
family dynamics can be
important in torture
assessment
Consequences of Torture
INDIVIDUAL

On individual

On relationship between
individual and his/her
intimate relationship

On relationship between
individual and society
FAMILY
SOCIETY
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Psychological Consequences of Torture
Torture is a complex phenomenon that
can traumatize, damage;
body
personality
cognitive, emotional,
behavioral functioning
dreams, hopes,
aspirations for the future
self actualization
Beliefs
system of meaning about
himself and the world
the autonomy
Sense of being grounded
in a family and society
Attachment
sense of safety and survival
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Connectedness
relationships between
spouse,
parents,
children,
community
Psychological Consequences of Torture
There is a complex relationship between
torture and its symptomatology.
The psychological responses to torture are
affected by multiple factors.
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SOCIAL CONTEXT
BEFORE, DURING, AFTER
TORTURE
MEANİNG OF TORTURE
BELIEF SYSTEM
PREPAREDNESS
SUPPORT SYSTEM
CONDITIONS OF TORTURE
PSYCHOLOGICAL
RESPONSE
PREVIOUS
TRAUMAS
ADDITIONAL LOSSES
AGE,
DEVELOPMENTAL
PHASE
PRE-EXISTING
PSYCHOLOGICAL
DISORDERS
COPING CAPABILITIES
PHYSICAL HEALTH
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Risk Factors for Refugee
Populations
Trauma
 Migration
 Acculturation
 Poverty
 Prejudice
 Cultural beliefs and traditional roles

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Psychological Symptoms

Despite variability, clusters of symptoms
and psychological reactions have been
observed frequently among survivors
– PTSD and Major Depression most common

However:
– One doesn’t have to be tortured to develop
PTSD or Major Depression
– Everyone who has been tortured does not
develop PTSD and Major Depression
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Psychological Disorders Associated
with Torture and Severe Trauma
Posttraumatic Stress Disorder
 Major Depression
 Anxiety Disorders
 Substance Abuse
 Enduring Personality Change
 Somatoform Disorders
 Dissociation
 Psychosis

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