Forms of ill treatment during captivity that do not involve physical pain--such as psychological manipulation, deprivation, humiliation and forced stress positions--appear to cause as much mental distress and traumatic stress as physical torture, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.
Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.
The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.
To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.
Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."
Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.
The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."
(Arch Gen Psychiatry. 2007;64:277-285. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: No Difference Between Torture, Other Forms of Maltreatment
The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.
"Baþoðlu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.
"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."
Human rights-respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."
(Arch Gen Psychiatry. 2007;64:275-276. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.