Page 167 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

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

(c) Given the fluctuating course of trauma-related the survivor has and the alleged torture, as well as
mental disorders over time, what is the time frame in protective factors and coping mechanisms, should
relation to the torture events? Where is the individual be considered as a whole. The degree of consistency
in the course of recovery? between the alleged torture or ill-treatment and
the entirety of the psychological findings should
(d) What are the coexisting stressors impinging on the be evaluated and described in the report.
individual (e.g. ongoing persecution, forced migration,
exile, loss of family and social role)? What impact do 543. Depending on the legal and jurisdictional
these issues have on the individual? context and requirements under which clinicians
prepare a medico-legal report, the consistency of
(e) Which physical conditions may contribute to the psychological findings with the alleged torture and/or
clinical picture? Special attention should be paid to ill-treatment could be described as follows:
possible evidence of head injury sustained during
torture or detention. (a) “Not consistent with”: the psychological findings
could not have been caused by the alleged torture or
541. Clinicians should comment on the consistency of ill-treatment;
psychological findings and the extent to which
these findings correlate with the alleged torture or (b) “Consistent with”: the psychological findings
ill-treatment. To this end, the emotional state and could have been caused by the alleged torture or
expression of the person during the interview, the ill-treatment, but they are non-specific and there are
reported psychological, psychosocial and social many other possible causes;
impact of the alleged torture, clinical observations,
the alleged history of detention and torture and (c) “Highly consistent with”: the psychological findings
the personal history prior to torture, the onset could have been caused by the alleged torture or
and evolution of specific symptoms related to the ill-treatment and there are few other possible causes;
alleged torture, the specificity of any particular
psychological findings and patterns of psychological (d) “Typical of”: the psychological findings are
functioning, as well as possible interactions, should typically found as a consequence of the alleged torture
be taken into consideration. Likewise, possible or ill-treatment and there are few other possible causes;
reasons for inconsistencies (e.g. memory gaps,
cognitive impairment, dissociation, distrust, feelings (e) “Diagnostic of”: the psychological findings could
of shame or guilt or other factors that may hinder not have been caused in almost any way other than the
disclosure) should be described and discussed (see alleged torture or ill-treatment.
paras. 343–353 above). Physical conditions, such
as head trauma or brain injury, and additional 544. Specifying the degree of consistency is common in
factors should be considered, such as ongoing evaluating physical evidence of torture or ill-treatment
persecution, forced migration, resettlement, difficulty and can be useful for psychological evidence as well.
of acculturation, language problems, unemployment, However, the underlying logic differs as consistency
loss of home, and family and social status. The between psychological findings and alleged torture
relationship and consistency between events and or ill-treatment does not refer to the connection
symptoms should be evaluated and described. between a specific symptom and a specific torture
or ill-treatment method. Instead it refers to the
542. If the person has symptom levels that correspond with connections between a set of traumatic experiences and
a DSM or ICD diagnosis, the diagnosis should be the overall psychological, psychosocial and psychiatric
stated. More than one diagnosis may be applicable. presentation of the person. The primary question is
Again, it must be stressed that, even though a whether these connections make sense and the extent
diagnosis of a trauma-related mental disorder can to which they are explained by the abuse the person
support the claim of torture, not meeting the criteria alleges to have suffered. If the clinician considers that
for a psychiatric diagnosis does not mean that the there are clinical reasons for an inconsistent finding,
person was not tortured. A survivor of torture may this should be discussed (see paras. 343–353 above).
not have the level of symptoms required to meet
diagnostic criteria for a DSM or ICD diagnosis fully. 545. Clinicians should note that the level of consistency
In these cases, as with all others, the symptoms that denoted by “typical of” refers to expected or typical

128