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

reactions to extreme stress within the cultural and for psychological or medical treatment, a referral
social context of the individual. It is not commonly should be made, independently of the question
used to assess psychological evidence of torture or posed at the time the evaluation was requested.
ill-treatment as the psychological consequences tend
to depend on individual factors. The presence or 4. Neuropsychological assessment
absence of a “typical psychological reaction” should
not be considered any more or less meaningful 549. Clinical neuropsychology is an applied science
or corroborative than the level of consistency concerned with the behavioural expression of
denoted by “highly consistent”. Also, the level of brain dysfunction. Neuropsychological assessment,
consistency denoted by “diagnostic of” is used in particular, is concerned with the measurement
more frequently in the interpretation of physical and classification of behavioural disturbances
evidence of torture or ill-treatment and is rarely used associated with organic brain impairment and
in the interpretation of psychological evidence. neuropsychological tests are designed to assess
deficits in cognitive performance. Understanding the
(l) Conclusions and recommendations nature, the severity and the modality of cognitive
complaints is best served by a neuropsychological
546. Clinicians should formulate a clinical opinion assessment performed by a qualified psychologist
on the possibility of torture or ill-treatment with relevant competencies in neuropsychological
based on all relevant clinical evidence, including, assessments. Such an assessment provides useful
“physical 471 and psychological findings, historical information about the patient’s cognitive functioning,
information, photographic findings, diagnostic test something that is not easy to obtain otherwise.
results, knowledge of regional practices of torture, Neuropsychological evaluations of alleged torture
consultation reports etc.” as stated in paragraph 382 victims are performed infrequently but may be helpful
above and annex IV. The clinician’s opinion on in identifying and quantifying some form of cognitive
the possibility of torture or ill-treatment should be impairment. The following remarks are limited to a
expressed using the same levels of consistency as that discussion of general principles to guide clinicians
used for interpretation of findings: not consistent with, in understanding the utility of, and indications for,
consistent with, highly consistent with, typical of and neuropsychological assessments of persons alleging
diagnostic of. Ultimately, it is the overall evaluation torture. Before discussing the issues of utility and
of all the clinical findings, and not the consistency indications, it is essential to recognize the limitations
of each lesion or symptom with a particular form of neuropsychological assessments in this population.
of torture or ill-treatment, that is important in
assessing the allegations of torture or ill-treatment. (a) Limitations of neuropsychological assessments

547. In addition to providing a conclusion on the possibility 550. There are a number of common factors complicating
of torture or ill-treatment, clinicians should reiterate the assessment of torture survivors in general
current symptoms and disabilities and likely effects on that are outlined elsewhere in this manual. These
social functioning and provide any recommendations factors apply to neuropsychological assessments
for further evaluations and care for the individual. in the same way as to medical or psychological
examinations. Neuropsychological assessments
548. The recommendations resulting from the psychological may be limited by a number of additional factors,
evaluation can vary and depend on the question including lack of research on torture survivors,
posed at the time the evaluation was requested. The reliance on population-based norms, cultural and
issues under consideration may concern legal and linguistic differences and the risk of retraumatization
judicial matters, asylum, resettlement, the need for of those who have experienced torture.
treatment or reparation. Recommendations can be
for further assessment, such as neuropsychological 551. As mentioned above, very few references exist in
testing, medical, psychological or psychiatric the literature concerning the neuropsychological
treatment, custody conditions or the need for security assessment of torture survivors. The pertinent body of
or asylum. Whenever the clinician detects a need literature concerns various types of head trauma and

471 Clinical evaluations that are conducted specifically to assess “psychological evidence” may include some “physical findings”, for example complaints of physical injuries and
symptoms or observations of physical signs during the interview.

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