Page 157 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

B. Psychological consequences not exclude the presence of severe mental suffering
of torture and ill-treatment and disability and is not inconsistent with torture or

ill-treatment having taken place. The psychological
1. Cautionary remarks assessment should aim to reach an understanding
of the multiple short- and long-term psychological,
497. Before entering into a technical description of psychosomatic and psychosocial reactions beyond and
symptoms and psychiatric classifications, it should not limited to a possible psychiatric classification.
be noted that psychiatric classifications are generally
considered to be based on Western medical concepts 2. Common psychological responses
and that their application to non-Western populations
presents certain difficulties. 459 It can be argued that 499. This section describes some of the frequent
Western cultures suffer from an undue medicalization psychological responses to torture. It is not meant to be
of psychological processes. The idea that mental an exhaustive list, as other reactions may occur as well.
suffering represents a disorder that resides in an
individual and features a set of typical symptoms (a) Re-experiencing the trauma
may be unacceptable to many members of non-
Western societies. Nonetheless, there is considerable 500. A person who has experienced torture may have
evidence of biological changes that occur in PTSD unwanted intrusive memories or flashbacks, in which
and, from that perspective, PTSD is a diagnosable the traumatic event is experienced as occurring again,
syndrome amenable to treatment biologically and even while the person is awake and conscious, or
psychologically. 460 As much as possible, the evaluating recurrent nightmares, which include elements of
clinician should attempt to relate to mental suffering the traumatic event in their original or symbolic
in the context of the individual’s beliefs and cultural form. Such episodes of reliving the traumatic
norms. This includes respect for the political context, event cause significant emotional distress and/or
as well as cultural and religious beliefs. Given the physiological reactions and the person may feel or
severity of torture and its consequences, when act as if the event is recurring. The person may also
performing a psychological evaluation, an attitude experience emotional distress and physiological
of informed learning should be adopted rather than reactions on exposure to cues that symbolize or
one of rushing to diagnose and classify. Ideally, resemble the trauma. This may include a lack of
this attitude will communicate to victims that their trust and fear of persons in authority, including
complaints and suffering are being recognized as health professionals, as they might evoke memories
real and understandable under the circumstances. In of the experienced torture and its perpetrators.
this sense, an empathic attitude may offer the victim
some relief from the experience of alienation. (b) Avoidance

498. In most cases, the intensity of trauma-related 501. As the memories of torture are generally accompanied
psychological symptoms changes over time depending by severe emotional distress, often experienced as
on personal trauma processing, the effectiveness overwhelming and uncontrollable, survivors might
of available coping strategies, as well as external avoid circumstances or cues that are likely to trigger
factors. There might be subthreshold symptoms at the these memories. Avoidance can include places,
time of assessment or reported for phases since the persons, activities, conversations, thoughts, feelings
traumatic event that do not amount to a diagnosable or any other cue that arouses a recollection of
mental disorder. The expression of distress may be torture. Avoidance can seriously limit the survivors’
nuanced or mediated by culture and social context, for capacity to participate in daily activities and social
example according to the experience of shame, fear interactions and pursue plans and projects. It may
of reprisals and fear of further stigma or ostracization even lead survivors to avoid seeking help for their
within the family or community. It is important to symptoms and thus inhibit treatment or therapy.
recognize that the absence of a formal diagnosis does

459 Derek Summerfield, “The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category”, British Medical Journal, vol. 322 (2001), pp. 95–98;
and Nimisha Patel, “The psychologization of torture”, in De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition, Mark Rapley, Joanna Moncrieff and
Jacqui Dillon, eds. (London, Palgrave Macmillan, 2011), pp. 239–255.
460 Matthew Friedman and James Jaranson, “The applicability of the post-traumatic stress disorder concept to refugees”, in Amidst Peril and Pain: The Mental Health and Well-
being of the World’s Refugees, Anthony J. Marsella and others, eds. (Washington, D.C., American Psychological Association, 1994), pp. 207–227.

118