Torture

According to the United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UNCAT; United Nations, 1984), torture involves mental or physical suffering inflicted intentionally with the aim to obtain information or confessions from the victim. From time immemorial, torture has served political purposes, whereby it has been a means to produce fear and horror in the population at large rather than an interrogation technique that would access valid information not otherwise revealed by the victim. International law as well as the domestic law of most countries prohibits any form of torture (de Wet, 2004) as a violation of human rights. But breach of this statutory regulation is common and has been consistently documented for a variety of countries by nongovernmental organizations like Human Rights Watch or Amnesty International. While Amnesty International’s Report 2008 estimated that “people are still tortured or ill-treated in at least 81 countries” (Amnesty International, 2008), it remains a formidable challenge to estimate the numbers of victims that suffer from torture and political violence. The effects on survivors, however, are devastating and reach far beyond immediate pain, leading to wide-ranging and lasting physical and mental health problems. The trauma can be societal (Bustos, 1990) and transgenerational. Psychological science has significantly advanced our understanding of the effects of exposure to stressors and stress, that is, the subsequent effects on the mind and the body. Resulting mental illnesses include posttraumatic stress disorder (PTSD) and depression (Maercker, Beauducel, & Schützwohl, 2000; Schauer, Neuner, & Elbert, 2005). Brain function (Ray et al., 2006) and with it brain structures are macroscopically altered (Eckart et al., 2011; Elbert et al., 2011; Elbert, Rockstroh, Kolassa, Schauer, & Neuner, 2006). Long-term effects on the immune system (Sommershof et al., 2009) and thereby physical health have been noted in those exposed to life-threatening stress. Based on rigorous science, effective treatment programs have recently been developed to counter the mental adversities of torture (Hensel-Dittmann et al., 2011; Schauer et al., 2005; Schauer, Neuner, & Elbert, 2011). Multidisciplinary teams in rehabilitation centers for victims of torture have begun to provide effective assistance for those who have survived the living hell, focusing on physical and mental health, but also providing legal and social services.

However, in contrast to the abundant practice of torture, empirical research on its consequences has remained scarce. The investigation of torture and work with torture survivors presents several challenges. Official systematic epidemiological or treatment studies are impossible to run in countries that systematically employ torture. Even though the number of victims seeking help is increasing (Gorman, 2001), only a minority of them can overcome their fear and access hot and cold memories alike in order to provide testimonies of their experiences (Schauer et al., 2011). They are often incapable of actively seeking professional help and help-providing professionals themselves are often afraid of hearing victims’ stories or of confronting the patient with his or her own past (Neuner, Schauer, Catani, Ruf, & Elbert, 2006). Torture is systematically planned and used as an instrument to achieve maximum suffering in the victim, and it thus goes beyond most other life-threatening events that can cause trauma-related mental illness. Besides cultural issues, practitioners are confronted with blame, shame, distrust, or fear for those left behind. As stated by Bustos (1990), “the goal (of torture) is to destroy the individual’s personality. Ultimately, it serves to terrorize the entire population and end any resistance to the regime.” Thus, for the understanding of torture and its consequences for the social, political, and legal system, the sick society at large has to be considered.

In this issue, the devastating effects torture can have on the individual are described comprehensively by Hárdi and Kroó (2011), who also outline the development of symptoms as a consequence of the systematic nature of torture in their paper. They give a detailed description of the psychological symptoms following torture and discuss the link between symptoms in torture survivors and the symptom profile of PTSD. A selection of different psychosocial rehabilitation programs is presented, considering the complexity of symptoms and focusing on the therapeutic rationales as well as the interventions’ effectiveness in treatment studies. An important aspect related to impaired functioning is the restoration of a torture victim’s former life as well as their re-integration into society. In this process, reparations are commonly demanded. Hárdi and Kroó discuss the rights and wrongs in the reconciliation process and discuss whether a restoration of well-being can be linked to reconciliation efforts.

A further challenge is linked to the definition of the term “torture.” Above, we provided a common definition of torture by the UNCAT but would different definitions, like those of the World Medical Association’s (WMA) Declaration of Tokyo or the United States’ Torture Victims Relief Act of 1998 (TVRA), have varying theoretical or practical implications? Rasmussen, Crager, Keatley, Keller, and Rosenfeld (2011) discuss the effects of different guidelines on how to operationalize torture. They investigate consequences of various forms of operationalization on the number of positively classified torture victims as well as the number of cases fulfilling a PTSD or depression diagnosis. Their results are based on data of 190 patients attending a New York City torture treatment clinic who immigrated to the United States and either applied or planned to apply for asylum at intake. The authors found a high consistency in the number of cases positively classified with the various guidelines. Moreover, there was no significant difference in the severity of psychological distress experienced by individuals classified as tortured and those who were not under any definition. Based on these results, they suggest that clinicians, researchers, and policymakers use a uniform checklist for classifying torture victims. They present one such checklist applied in their study that is straightforward to learn and to apply and thus helps to reduce confusion and contradiction. Taking into account that two-thirds of the research on torture fails to even define what exactly is meant by the term (Green, Rasmussen, & Rosenfeld, 2010), their offer should attract further interest.

Besides the definition of torture, the involvement of psychologists in interrogations as well as the role of associations that represent practicing and research psychologists are of outstanding public and political relevance as they contribute to the public perception of psychology. As outlined by Pope (2011) the American Psychological Association (APA) adopted ethics policies for psychologists with regard to detainee interrogations in settings such as the Abu Ghraib, Guantanamo Bay, and Bagram detention centers set up to bolster US national security after 9/11. The APA policies were based in part on claims that psychologists would make important contributions to eliciting information that can be used in the prevention of violence. Due to the impact that statements and press releases issued by such large professional organizations can have on public attitudes, the author discusses the importance as well as the responsibility psychologists have to carefully and critically question policies, claims, methods, approaches, and assumptions. As can be seen in the ongoing discussion regarding Guantanamo Bay, the question to which extent ill-treatment took place beyond legal legitimatization is politically charged and has gained considerable media attention. Those who work with victims of organized violence and who are also involved in interrogation methods should be aware that they also shape public opinion and influence political decisions. It is therefore mandatory that they reflect moral and ethical considerations even more carefully than work with human beings usually requires.

O’Mara (2011) presents an outstanding viewpoint dealing with folk beliefs, that is, popularly held views on torture. According to O’Mara, a very popular belief about torture fostered by the picture drawn in the media is that torture is a useful tool in the forced extraction of information intentionally withheld. However, the author argues that current cognitive and neurobiological evidence suggests the opposite of what has been assumed in the media reports: Extreme stressors impair the recall of stored information and damage cortical structures associated with the storage of memory contents. Consequently, exposure to torture can be expected to impair rather than facilitate memory performance. O’Mara gives a comprehensive introduction to folk beliefs, the definition of stress and its influence on the human brain, and enhanced interrogation methods applied by the United States. He discusses the linkage between these elements and, using the examples of water boarding and sleep deprivation, provides arguments that the reasoning commonly employed is likely counterfactual.

Elbert and colleagues (2011) compare the brain activity of 41 victims of torture and related forms of organized violence with that of controls with the same ethnic background. They demonstrate how torture fundamentally alters brain functioning in response to repeated exposure to traumatic stressors. The mere exposure to traumatic stress lowers the threshold for cues, even when only vaguely associated with stressful events, to trigger the memory of torture events and thus elicit a corresponding defence response, ranging from fear and flight to dissociation (Schauer & Elbert, 2010). Magnetoencephalogram data reveal that visual stimuli that have a negative valence and are emotionally arousing, including cues of violence such as blood or weapons, are processed differently in victims of organized violence than in healthy controls. The activation pattern in frontal and limbic areas of the brain is qualitatively different in terms of spatial patterns, indicating the emergence of hyperarousal responses at the earliest stages of information processing. The symptoms that can be found in victims of organized violence suffering from PTSD, such as recollection of traumatic memories and increased arousal, are in line with the altered neurobiological functioning presented in this study.

The more difficult it is to document the extent of torture and provide victims with access to professional assistance, the more difficult it is to investigate the perpetrators in terms of wrongdoing and motivation for the malpractice. While reasons have been elaborated as to why torture is used as a political weapon, the individual-level motives for people to engage in torture and turn cruel have remained obscure. Outstanding experimental studies like those of Zimbardo, Haney, Banks, and Jaffe (1972) and Milgram (1974) have revealed dramatic examples for conditions in which people may behave with cruelty and perpetrate even the severest interpersonal violence. These impressive studies have demonstrated that social factors can make people violate their moral beliefs under distinct circumstances. Recognition of the importance of social factors led to theoretical frameworks for understanding torturers’ tendencies to behave with cruelty (Fiske, Harris, & Cuddy, 2004) and promoted further research exploring mechanisms that help to overcome social cognitions and moral behavior. The failure of the torturer to feel empathy or behave in a moral sense may be founded in an impaired theory of mind or a dehumanized perception, as suggested by Harris and Fiske (2011). The authors present two studies adducing evidence that members of social groups rated relatively low in terms of warmth and competence (such as the homeless or drug addicts) induce a failure or at least a reduction in social cognitions in the perceiver. In their first study, they present dehumanization by the perceiver in the subjective ratings of individuals classified as socially on a lower level, and corroborate their results by functional magnetic resonance imaging data in the second study. Thus, social influence can constitute cruelty but may also be used to prevent it. A general human tendency toward the biological preparedness for a fascination with violence as well as a readiness for aggressive behavior and its importance for the perception of inflicted barbarity have to be taken into account but, so far, have largely been neglected in empirical research (see Elbert, Weierstall, & Schauer, 2010). To date, most of the knowledge about intrapsychic processes in torturers is based on a few single-case studies and no larger sets of empirical data are available.

Torture is living hell, it touches the essence of what we are as human beings and is thus a highly relevant topic. The understanding of clinical symptoms in victims, the political, ethical, and legal issues related to torture, work with perpetrators of violence, its prevention, and public education on the matter, are all issues of obvious importance that have determined and will determine the fate of humankind. This topical issue can only offer a window onto the field with a hope of inspiring future work, to gain more insights and new perspectives.