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

(c) Post-torture history about the individual’s previous mental health and
psychosocial functioning to form an impression of the
531. This component of the psychological evaluation seeks degree to which the alleged torture or ill-treatment
information about current life circumstances. It is has contributed to the psychological condition.
important to enquire about current sources of stress,
such as separation or loss of loved ones, flight from (e) Medical history
the home country and life in exile. Interviewers should
also enquire about the ability of individuals to be 534. The medical history summarizes pre-trauma health
productive, earn a living, care for their families, engage conditions, current health conditions, body pain,
in social interactions, form trusting relationships somatic complaints, use of medication and its side
and the availability of social supports. Furthermore, effects, relevant sexual history, past surgical procedures
the possible impact of past sexual torture on sexual and other medical data (see paras. 394–399 above).
orientation, gender identity, the ability to enjoy sexual
intimacy and partnership should be considered. (f) Psychiatric history

(d) Pre-torture history 535. Inquiries should be made about a history of
mental or psychological conditions, the nature
532. The pre-torture history should include information of such conditions and whether the alleged
regarding the alleged victims’ childhood, adolescence, victims received treatment or required psychiatric
early adulthood, their family backgrounds, family hospitalization. The inquiry should also cover prior
illnesses and family composition. There should therapeutic use of psychotropic medication.
also be a description of the alleged victim’s
educational and occupational history. It should (g) Substance use and misuse history
also include a description of any history of past
trauma, such as childhood abuse, war trauma 536. The clinician should enquire about substance use and
or domestic violence, as well as the alleged misuse, including the route of use, frequency, amount
victim’s cultural and religious background. and time periods of use, before and after the alleged
torture, changes and evolution of the pattern of use
533. The description of pre-trauma history is important and whether substances are being used to cope with
to assess the mental health status and level of insomnia, pain or psychological/psychiatric problems.
psychosocial functioning of the alleged victim prior Such substances include alcohol, cannabis and opium
to the traumatic events reported. In this way, the but also prescribed medication and regional substances
interviewer can compare the current psychological of abuse, such as betel nut and many others.
status with the one the individual reports for the time
before the alleged torture or ill-treatment and assess (h) Mental status examination
the relative contribution of different experiences,
including the alleged torture or ill-treatment. In 537. The mental status examination begins the moment
evaluating background information, the interviewer the clinician meets the individual. The interviewer
should keep in mind that the duration and severity should make note of the person’s appearance, such
of responses to trauma are affected by multiple as signs of malnutrition, lack of cleanliness, changes
factors. These factors include, but are not limited in motor activity during the interview, mood,
to, the circumstances of the torture, the perception concentration, occurrence of dissociative reactions or
and interpretation of torture by the victim, the social flashbacks, intercurrent reactions on triggers, use of
context before, during and after torture, community language, presence of eye contact, ability to relate to
and peer resources, personal values and attitudes the interviewer and the means the individual uses to
about traumatic experiences, political and cultural establish communication. The following components
factors, severity and duration of the traumatic events, should be covered and all aspects of the mental status
genetic and biological vulnerabilities, developmental examination should be included in the report of the
phase and age of the victim, prior history of trauma psychological evaluation; aspects such as general
and coping mechanisms. In many interview situations, appearance, motor activity, speech, concentration,
because of time limitations and other problems, mood (subjective and objective assessment) and
it may be difficult to obtain this information. It affect, sleep, appetite disturbance, thought content,
is important, nonetheless, to obtain enough data thought process, suicidal and homicidal ideation

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