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

the neuropsychological assessment of PTSD in general. questionable validity. An estimate of IQ is one of
Therefore, the following discussion and subsequent the central benchmarks that allow examiners to
interpretations of neuropsychological assessments place neuropsychological test scores into proper
are necessarily based on the application of general perspective. Within the population of the United States
principles used with other subject populations. of America, for example, these estimates are often
derived from verbal subsets using the Wechsler scales,
552. Neuropsychological assessments as they have been particularly the information subscale, because in the
developed and practised in Western countries rely presence of organic brain impairment, acquired factual
heavily on an actuarial approach. This approach knowledge is less likely to suffer deterioration than
typically involves comparing the results of a battery other tasks and be more representative of past learning
of standardized tests to population-based norms. ability than other measures. Measurement may
Although norm-referenced interpretations of also be based on educational and work history and
neuropsychological assessments may be supplemented demographic data. Obviously, neither one of these two
by a Lurian approach of qualitative analysis, considerations apply to subjects for whom population-
particularly when the clinical situation demands it, a based norms have not been established. Therefore,
reliance on the actuarial approach predominates. 472 only very coarse estimates concerning pre-trauma
Moreover, a reliance on test scores is greatest when intellectual functioning can be made. As a result,
brain impairment is mild to moderate in severity, neuropsychological impairment that is anything less
rather than severe, or when neuropsychological deficits than severe or moderate may be difficult to interpret.
are thought to be secondary to a psychiatric disorder.
554. Neuropsychological assessments may retraumatize
553. Cultural and linguistic differences may significantly those who have experienced torture. Great care
limit the utility and applicability of neuropsychological must be taken in order to minimize any potential
assessments among alleged torture victims. There retraumatization of the alleged victim in any
are many neuropsychological tests available but the form of diagnostic procedure (see paras. 277–280
majority of them have been developed and “normed” above). To cite only one obvious example specific to
in a Western/European context. The examiner neuropsychological testing, it would be potentially very
should be aware of these limitations and should damaging to proceed with a standard administration
adapt the selection of methods and instruments to of the Halstead-Reitan Neuropsychological Battery,
the specific background of the person, including in particular the Tactual Performance Test, and
education, language, culture and familiarity with routinely blindfold the subject. For most torture
testing. 473 Neuropsychological assessments are of survivors who have experienced blindfolding during
questionable validity when standard translations of detention and torture, and even for those who
tests are unavailable and the clinical examiner is not were not blindfolded, it would be very traumatic to
fluent in the subject’s language. Unless standardized introduce the experience of helplessness inherent in
translations of tests are available and examiners are this procedure. In fact, any form of neuropsychological
fluent in the subject’s language, verbal tasks cannot testing in itself may be problematic, regardless of
be administered at all and cannot be interpreted in the instrument used. Being observed, timed with a
a meaningful way. This means that only non-verbal stopwatch and asked to give maximum effort on an
tests can be used and this precludes comparison unfamiliar task, in addition to being asked to perform,
between verbal and non-verbal faculties. In addition, rather than having a dialogue, may prove to be too
an analysis of the lateralization (or localization) stressful or reminiscent of the torture experience.
of deficits is more difficult. This analysis is often
useful, however, because of the brain’s asymmetrical (b) Indications for neuropsychological assessment
organization, with the left hemisphere typically being
dominant for speech. If population-based norms are 555. In evaluating behavioural deficits in alleged torture
unavailable for the subject’s cultural and linguistic victims, there are two primary indications for
group, neuropsychological assessments are also of neuropsychological assessment: brain injury and PTSD

472 Alexander Romanovich Luria and Lawrance V. Majovski, “Basic approaches used in American and Soviet clinical neuropsychology”, American Psychologist, vol. 32, No. 11
(1977), pp. 959–968. See also Robert J. Ivnik, “Overstatement of differences”, American Psychologist, vol. 33, No. 8 (1978), pp. 766–767; and Uwe Jacobs and Vincent
lacopino, “Torture and its consequences: a challenge to clinical neuropsychology”, Professional Psychology Research and Practice, vol. 32, No. 5 (2001), pp. 458–464.
473 Bahrie Veliu and Janet Leathem, “Neuropsychological assessment of refugees: methodological and cross-cultural barriers”, Applied Neuropsychology: Adult, vol. 24, No. 6
(2017), pp. 481–492.

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