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VI. PSYCHOLOGICAL EVIDENCE OF TORTURE AND ILL-TREATMENT ISTANBUL PROTOCOL

behaviour or a disease in one culture may not unintentionally and are likely to affect or alter the
be viewed as pathological in another. 452 victims’ ability and capacity to recall and present
what they have experienced, which in turn may affect
494. In recent years, the diagnosis of PTSD has been their ability to participate and testify in various forms
applied to an increasingly broad array of individuals of legal proceedings, including adjudication related
suffering from the impact of widely varying types to the investigation of torture. 456 Assessment and
of violence. However, the utility of this diagnosis documentation of these barriers to full participation in
has been questioned on many grounds, including legal proceedings as a consequence of the sequelae of
its universal applicability. Nevertheless, evidence torture can help prevent inaccurate conclusions being
suggests that there are high rates of PTSD and drawn in legal proceedings by lawyers and judges. 457
depressive symptoms among traumatized refugee
populations from many different ethnic and cultural 496. What can be asked about and documented safely
backgrounds. 453 A cross-cultural study of depression will vary considerably and depends on the degree to
provides helpful information. 454 While some which confidentiality and security can be ensured.
symptoms may be present across different cultures, For example, an examination in a prison by a visiting
it is important to consider culture-specific ways of clinician that is limited to 15 minutes cannot follow
experiencing, expressing and describing psychological the same course as a psychological evaluation in
distress in order to recognize and document the a private office that may last for several hours.
broad range of suffering that may remain invisible Additional problems arise when trying to assess
if the PTSD concept is uncritically applied. Such whether psychological symptoms or behaviours are
expressions of distress shaped by culture might be pathological or adaptive. When a person is examined
more relevant to the survivor than PTSD symptoms. while in detention or living under considerable threat
or oppression, some symptoms may be adaptive.
2. Context of the psychological evaluation For example, diminished interest in activities and
feelings of detachment or estrangement would be
495. Evaluations take place in a variety of political contexts. understandable in a person in solitary confinement.
This results in important differences in the manner Likewise, hypervigilance and avoidance behaviours
in which an evaluation should be conducted. The may be necessary for persons living in repressive
clinician must adapt the following guidelines to the societies. 458 Despite the possible limitations imposed
particular situation and purpose of the evaluation by the conditions in which the interview is conducted,
(see para. 185 above), maintaining under any every effort towards adherence to the guidelines
circumstances the highest ethical standards, as set forth of the Istanbul Protocol should be pursued. It is
in chapter II above. Psychological evaluations can help especially important in difficult circumstances
to identify post-traumatic conditions (e.g. memory that the Governments and authorities involved be
problems, flashbacks, avoidance and dissociation), 455 held to these standards as much as possible.
which may cause victims to act unconsciously or

452 H. Tristram Engelhardt, Jr., “The concepts of health and disease”, in Evaluation and Explanation in the Biomedical Sciences, H. Tristram Engelhardt, Jr. and Stuart F. Spicker,
eds. (Dordrecht, D. Reidel Publishing Co., 1975), pp. 125–141. See also Joseph Westermeyer, “Psychiatric diagnosis across cultural boundaries”, American Journal of
Psychiatry, vol. 142, No. 7 (1985), pp. 798–805.
453 See Richard F. Mollica and others, “The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border
camps”, Journal of the American Medical Association, vol. 270, No. 5 (1993), pp. 581–586; Kathleen Allden and others, “Burmese political dissidents in Thailand: trauma
and survival among young adults in exile”, American Journal of Public Health, vol. 86, No. 11 (1996), pp. 1561–1569; J. David Kinzie and others, “The prevalence of
posttraumatic stress disorder and its clinical significance among Southeast Asian refugees”, American Journal of Psychiatry, vol. 147, No. 7 (1990), pp. 913–917.
454 Norman Sartorius, “Cross-cultural research on depression”, Psychopathology, vol. 19, No. 2 (1986), pp. 6–11.
455 Andrea R. Ashbaugh, Julia Marinos and Brad Bujaki, “The impact of depression and PTSD symptom severity on trauma memory”, Memory, vol. 26, No. 1 (2018), pp. 106–116.
456 Karen E. Krinsley and others, “Consistency of retrospective reporting about exposure to traumatic events”, Journal of Traumatic Stress, vol. 16, No. 4 (2003), pp. 399–409;
Amina Memon, “Credibility of asylum claims: consistency and accuracy of autobiographical memory reports following trauma”, Applied Cognitive Psychology, vol. 26,
No. 5 (2012), pp. 677–679; Hannah Rogers, Simone Fox and Jane Herlihy, “The importance of looking credible: the impact of the behavioural sequelae of post-traumatic
stress disorder on the credibility of asylum seekers”, Psychology, Crime & Law, vol. 21, No. 2 (2015), pp. 139–155.
457 Belinda Graham, Jane Herlihy and Chris R. Brewin, “Overgeneral memory in asylum seekers and refugees”, Journal of Behavior Therapy and Experimental Psychiatry,
vol. 45, No. 3 (2014), pp. 375–380; Urs Hepp and others, “Inconsistency in reporting potentially traumatic events”, British Journal of Psychiatry, vol. 188, No. 3 (2006),
pp. 278–283; Jane Herlihy, Peter Scragg and Stuart Turner, “Discrepancies in autobiographical memories – implications for the assessment of asylum seekers: repeated
interviews study”, British Medical Journal, vol. 324 (2002), pp. 324–327; and Cohen, “Errors of recall and credibility” (see footnote 412).
458 Michael A. Simpson, “What went wrong?: Diagnostic and ethical problems in dealing with the effects of torture and repression in South Africa”, in Beyond Trauma: Cultural
and Societal Dynamics, Rolf J. Kleber, Charles R. Figley and Berthold P.R. Gersons, eds. (New York, Plenum Press, 1995), pp. 187–212.

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