Page 110 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL IV. GENERAL CONSIDERATIONS FOR INTERVIEWS

3. Disclosure of sexual torture or ill-treatment challenge it presents to a person’s gender identity and
sexual orientation or the fear of “honour violence”
274. Disclosure of sexual torture or ill-treatment may be from family or the community. There are unique
so difficult that a person prefers not to talk about difficulties for men, women and others in disclosing
it at all or it may be disclosed only long afterwards experiences of sexual violence. Gender norms are
during therapy. 401 However, without disclosure of such entrenched in most societies and both the victims’
experiences, documentation will be incomplete and an own ideas of their sexual orientation and gender
assessment of resulting health-care needs compromised. identity and the views of the society in which they
It is important that individuals retain control over live may be inextricably bound up in the impact of
their disclosures to minimize retraumatization, the sexual violence experience for them and influence
especially as regards when, how much detail and to disclosure. Sexual violence against men highlights the
whom. A subjective assessment has to be made by victim’s vulnerability and powerlessness, challenging
the examiner about the extent to which pressing for and conflicting with their ideas of masculinity.
details is necessary for the effectiveness of the report Perceptions of sexuality, procreative ability and
in court. Clues indicating that a person has suffered gender identity may also be challenged. 402 The
sexual violence, but not disclosed it, may be found response of submission or freezing, the association of
by exploring gaps in their narrative of events or male rape with homosexual pleasure and the lack of
euphemisms, such as “they did what they wanted”. A recognition and services for sexual violence against
useful question to ask can be: “Did the officers ever men may significantly affect disclosure in men. 403 In
remove their clothes?” Clues in the psychological women, social stigma and concerns about “losing
examination may also raise concerns that sexual one’s honour” and/or being outcast from the family
violence has occurred but has not been disclosed, such or community are often entrenched in societies
as a history of compulsive washing many times a day, and influence disclosure. Sexual violence against
repeated self-harming behaviour and the nature of homosexual individuals similarly has unique impacts
trigger and avoidance behaviour relating to intrusive on the victims and distinct challenges regarding
recall and flashbacks of traumatic experiences. disclosure that must be considered and mitigated.

275. Avoidance, a feature of post-traumatic stress disorder 4. Risk of retraumatization of the interviewee
(PTSD), may also inhibit disclosure. Clinicians need
to be mindful of their own responses to a person’s 277. Interviewers should be aware that clinical interviews
disclosures and that they do not themselves also and evaluations, including recounting past experiences
avoid these important issues. Disclosure of sexual of torture and severe trauma, as well as physical
violence, even in the relatively safe setting of an and psychological examination and common
evaluation, may be intensely distressing and raise procedures and ancillary diagnostic testing, such as
the person’s risk of self-harm and suicide. A risk blood tests, can be profoundly retraumatizing for
assessment of harm to self and from others must be victims, both during the examination and afterwards.
made. If the disclosure is made for the first time in Retraumatization refers to traumatic stress reactions
the context of a medico-legal evaluation, the reasons (emotional and/or physical) triggered by exposure
for not previously making the disclosure should to memories or reminders of past traumatic
be discussed in the report. Victims may feel that events. 404 During the evaluation, retraumatization
others will judge them to be at fault for having put can manifest as anxiety about the interview,
themselves at risk in some way. They may feel that if wanting to avoid discussing particular incidents,
they have not been physically injured then they will minimizing conversation, re-experiencing physical
not be believed or be believed to have consented. or emotional symptoms, symptoms of hyperarousal
or insomnia, numbing of general responsiveness or
276. Disclosure of sexual violence may be inhibited by becoming overwhelmed with memories and emotion.
many factors, including the shame and fear evoked, the Retraumatized individuals may mobilize strong

401 Crime survey data from the United Kingdom of Great Britain and Northern Ireland show that nearly 31 per cent of the rape victims had never disclosed their experience to
anyone and approximately 83 per cent had not reported it to the police. Office for National Statistics, “Sexual offences in England and Wales: year ending March 2017”
(London, 2018).
402 UNHCR, “Working with men and boy survivors of sexual and gender-based violence in forced displacement” (Geneva, 2012), p. 4.
403 Clayton M. Bullock and Mace Beckson, “Male victims of sexual assault: phenomenology, psychology, physiology”, Journal of American Academy of Psychiatry and Law,
vol. 39, No. 2 (2011), pp. 197–205.
404 Melanie P. Duckworth and Victoria M. Follette, eds, Re-traumatization: Assessment, Treatment, and Prevention (New York, Routledge, 2012), chap. 1.

70