Torture

In the light of recent allegations associating the actions of the Canadian government and military with torture, it is perhaps worth reviewing its psychological and physiological effects. (From A Health Professional’s Guide to Medical and Psychological Evaluations of Torture)

Psychological Effects:

Re-experiencing the Trauma

• Flashbacks or intrusive memories, i.e. the subjective sense that the traumatic event is happening all over again, even while the person is awake and conscious
• Recurrent nightmares that include elements of the traumatic event(s) in either their original or symbolic form
• Distress at exposure to cues that symbolize or resemble the trauma. This may include lack of trust and fear of persons of authority, including
physicians and psychologists. In countries or situations where authorities participate regularly in human rights violations, lack of trust and fear of authority figures should not be assumed to be pathological

Avoidance and Emotional Numbing

• Avoidance of any thoughts, conversations, activities, places or people that arouse recollection of the trauma
• Profound emotional constriction
• Profound personal detachment and social withdrawal
• Inability to recall an important aspect of the trauma

Hyperarousal

• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance
• Exaggerated startle response
• Generalized anxiety
• Shortness of breath, sweating, dry mouth, dizziness
• Gastrointestinal distress

Symptoms of Depression

• Depressed mood
• Anhedonia: markedly diminished interest or pleasure in activities
• Appetite disturbance and resulting weight loss
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue and loss of energy
• Feelings of worthlessness and excessive guilt
• Difficulty in attention, concentration and memory
• Thoughts of death and dying, suicidal ideation, suicide attempts

Damaged Self-Concept and Foreshortened Future

• A subjective feeling of having been irreparably damage and of having undergone an irreversible personality change
• A sense of fore shortened future: not expecting to have a career, marriage, children or a normal life span

Dissociation, Depersonalisation and Atypical Behavior

• Dissociation: a disruption in the integration of consciousness, self-perception, memory and actions. A person may be cut off or unaware of certain actions or may feel split in two and feel as if observing him/herself from a distance.
• Depersonalisation: feeling detached from oneself or one’s body
• Impulse control problems, resulting in behaviors that the survivor considers highly atypical with respect to his/her pre-trauma personality; a previously cautious individual may engage in high-risk behavior

Physiological Complaints (apart from direct injuries sustained during torture)

Somatic symptoms such as pain and headache and other physical complaints, with or without objective findings, are common problems among torture victims. Pain may be the only presenting complaint. It may shift in location and vary in intensity. Somatic symptoms can be a direct physical consequence of torture, be of psychological origin or both. Typical somatic complaints include:

• Headaches: a history of beatings to the head and other head injuries are very common among torture survivors. These injuries often lead to post-traumatic headaches that are chronic in nature. Headaches may also be caused by or exacerbated by tension and stress.
• Back pain
• Musculoskeletal pain

It is worth noting the abiding irony that in the places and countries where torture is practiced most widely, medical and psychological assistance for its victims is largely unavailable, meaning that for the victims of torture, the punishment is enduring.

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