Especially those in uniform, such as hospital staff, police, immigration officials, etc.
Especially if they state that false declarations may result in prosecution, fines or imprisonment, cautions that survivors cannot take lightly.
Including date of birth, residential address, etc.
especially psychiatric hospitals, which may resemble prisons
Doctors in prison may have advised the torturers about how much abuse the victim could endure or how to cause maximum pain without killing the victim.
Fear that staff will report their activities to government security agencies that will pass the information on to representatives of the governments from which they fled.
Providers may fail to consider the possibility that their clients may have been tortured. They also may feel helpless or over-identify with the client and, as a result, avoid investigation of traumatic material, or even deny that torture occurred. Providers need to be aware of the effects of torture and develop skills to respond appropriately using the principles of trauma-informed care. They should also be aware that torture is a widespread practice and consider torture and related trauma as possible causes of health problems.
It can be challenging to identify a client who is a survivor of torture and it often goes unrecognized in general clinical settings (Crosby et al., 2006). Not all forms of torture result in physical scars or injuries that are apparent during a medical examination. Clinicians can elicit a history of torture in the context of a safe environment, trusting relationship and empathic interview (Eisenman et al., 2000) (Madrid, 2021). They can also structure their interactions to reduce potential stress and encourage open responses from survivors of torture.
Create a comfortable setting that is not cell-like in any way.
Ensure all objects are in view (no screens).
Be aware that seemingly innocent objects can be triggering.
Be aware that waiting or appointments can be triggering of memories of waiting for torture.
Explain who you are, your role and the interview and examination process to reduce anxiety.
Allow clients a sense of control by taking washroom or other breaks.
Question gently.
Question tactfully but directly. For example: “People with memory problems or bad dreams have often been tortured or traumatized. Is this something that has happened to you?”
Acknowledge the difficulty of disclosing.
Educate clients regarding symptoms and reassure them that these symptoms are “normal reactions to abnormal events.”
Address misperceptions about torture.
Adding to the challenge of identifying torture survivors is the fact that many avoid volunteering information about a history of torture due to common emotional responses such as guilt, shame, fear of not being believed or a generalized mistrust of others (Eisenman et al., 2000) (United Nations, 2017). Survivors may also be unaware that retelling their story and sharing their difficult experience could be a key component of them enjoying certain rights and benefiting positively from therapeutic experiences. Finally, language and cultural misalignment with providers can prevent torture survivors from speaking fully about their experiences (United Nations, 2017).
Although torture is intended to destroy victims' personalities, sense of identity, confidence and ability to function socially, some experts maintain that the psychological effects of torture should be seen as “meaningful conditional reactions for a sound and forceful constitution that makes survival possible in a very pathological situation” (Somnier et al., 1992). In other words, the psychological symptoms resulting from torture are indicators of the individual's strength and ability to survive horrific experiences.Indeed, many PTSD symptoms, such as numbing, hypervigilance, social withdrawal, grief and loss, can be appropriate means of coping with profoundly abnormal circumstances. These symptoms are rendered even more psychologically harmful, however, due to their perpetration into the future, being aggravated by new stressors (Gorman, 2001).
Evidence suggests that providers often fail to identify a history of torture in a patient simply because they do not consider the possibility that their patients have been tortured.