In Brief: Torture by any other... Health Article

In Brief

Interviews with torture survivors in the former Yugoslavia have shown that humiliation, attacks on personal integrity, and other kinds of abuse have much the same effect as torture that involves the infliction of physical pain. All forms of physical and psychological abuse work in the same way — by causing severe distress and a sense of helplessness — and all have similar short- and long-term psychological effects.

Researchers administered a clinical interview and a special questionnaire to 279 men and women an average of eight years after their experiences during the conflicts that followed the breakup of Yugoslavia. They had been soldiers, prisoners of war, internees, refugees, and displaced persons. The questions covered more than 40 kinds of abuse, including beatings, forced nudity and standing, isolation, rope bondage, sexual humiliation, and deprivation of sleep, water, and food.

The interview subjects rated each type of ill treatment for the severity of the resulting distress and for the degree of controllability, as measured by the capacity to make use of distraction and other coping techniques. They were also examined for social and occupational disability, depression, and posttraumatic stress disorder.

On a scale of 1 to 4, the average distress rating for physical torture (beatings, electric shock, and more) was 3.2 to 3.8. Sixteen other forms of abuse were in the same range. In particular, prolonged isolation, sham executions, witnessing the torture of others, and threats of rape caused as much distress as physical torture. Psychological manipulations and physical pain created equally intense feelings of helplessness.

Of those interviewed, 75% had had posttraumatic stress disorder (PTSD) at some time, and 56% had current PTSD; 17% had past and 17% had current major depression. The greater their loss of control during torture and the more severe their distress, the more likely survivors were to develop PTSD and depression. But the risks were not correlated with the intensity of physical pain they suffered. People subjected to the most severe physical torture did not have a higher rate of PTSD or depression than others.

Several years ago a United States Justice Department memorandum recommended a definition of torture that would permit techniques that cause mental pain and suffering, as long as this suffering is not "severe." The memorandum added that "severe mental pain or suffering" required proof of "prolonged mental harm," such as PTSD.

The authors point out that this definition of torture would exclude the experience of most of the people they interviewed. In any case, it is impossible to predict which victims will develop PTSD (or chronic depression), and the definition of torture should not be made to depend on some merely possible future consequence of the act.

The United Nations Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment defines torture as any "act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person…by, or at the instigation of, or with the consent or acquiescence of, a public official or other person acting in an official capacity."

The Geneva Convention on the treatment of prisoners of war includes torture on a list of prohibited acts; it also includes "outrages upon personal dignity, in particular, humiliating and degrading treatment." All the forms of ill-treatment revealed in the interviews involved that kind of suffering.

The authors believe it is meaningless to single out certain forms of cruel, inhuman, humiliating, or degrading treatment and call them torture. International conventions, they say, should avoid labels that are subject to political abuse and instead should reflect an understanding of torture based on the experience of its victims.

Basoglu M, et al. "Torture Versus Other Cruel, Inhuman, and Degrading Treatment: Is the Distinction Real or Apparent?" Archives of General Psychiatry (March 2007): Vol. 64, No. 3, pp. 277–85.

Miles SH. "Science and Torture," Archives of General Psychiatry (March 2007): Vol. 64, No. 3, pp. 275–76.