Cross-cultural forensic reports of torture survivors based on the Istanbul Protocol

Authors

  • Pau Pérez-Sales Clinical Director SiRa Center. Hospital La Paz. Editor-in-Chief Torture Journal

DOI:

https://doi.org/10.7146/torture.v34i2.149090

Keywords:

Cross-cultural, Istanbul Protocol, Transcultural, Forensic Assessment, Forensic medical evaluations

Abstract

The text provides an overview of the key considerations for conducting a cross-cultural assessment of a torture survivor. The first part provides an introduction to essential concepts in anthropology, medicine, and cross-cultural psychology and psychiatry. The second part reviews the most relevant elements in relation to a forensic report of a survivor, with a particular focus on cultural considerations regarding the ethical aspects of the Istanbul Protocol. It also addresses aspects related to the encounter with the survivor and the interview, medical aspects including the physical examination with a special focus on pain and suffering, the psychological and psychometric assessment.  It also briefly discusses aspects related to consistency and credibility analysis. In the last section, the text provides an overview of cultural consideration following the outline of the Istanbul Protocol.

References

Abd-Elsayed, A. (2019). Pain. A review guide (A. Abd-Elsayed (Ed.)). Springer International Publishing. https://doi.org/10.1007/978-3-319-99124-5

Alexander, A., Blake, S., & Bernstein, M. A. (2007). The staying power of pain. A comparison of torture survivors from Bosnia and Colombia and their rates of anxiety, depression and PTSD. Torture : Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture, 17, 1–10. https://doi.org/2007-1.2005-0018 [pii]

Bachem, R., Mazza, A., Eberle, D. J., & Maercker, A. (2024). A new approach to cultural scripts of trauma sequelae assessment: The sample case of Switzerland. PLoS ONE, 19(4 April), 1–17. https://doi.org/10.1371/journal.pone.0301645

Baird, E., Williams, A. C. de C., Hearn, L., & Amris, K. (2017). Interventions for treating persistent pain in survivors of torture. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD012051.pub2

Berthold, S. M., Mollica, R. F., Silove, D., Tay, A. K., Lavelle, J., & Lindert, J. (2019). The HTQ-5: Revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations. European Journal of Public Health, 29(3), 468–474. https://doi.org/10.1093/eurpub/cky256

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673. http://www.sciencedirect.com/science/article/B6V5W-3VWPX4H-X/2/d73c43a854e0d0743ca6e854118b6155

Bolton, P., Michalopoulos, L., Ahmed, A. M. A., Murray, L. K., & Bass, J. (2013). The mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, Northern Iraq: a brief qualitative study. Torture : Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture, 23(1), 1–14.

Bovey, M., Hosny, N., Dutray, F., & Heim, E. (2024). PTSD and complex PTSD manifestations in Sub-Saharan Africa: A systematic review of qualitative literature. SSM - Mental Health, 5(September 2023), 100298. https://doi.org/10.1016/j.ssmmh.2024.100298

Bustan, S., Gonzalez-Roldan, A. M., Kamping, S., Brunner, M., Löffler, M., Flor, H., & Anton, F. (2015). Suffering as an independent component of the experience of pain. European Journal of Pain (United Kingdom), 19(7), 1035–1048. https://doi.org/10.1002/ejp.709

Chhim, S. (2013). Baksbat (Broken Courage): A Trauma-Based Cultural Syndrome in Cambodia. Medical Anthropology: Cross Cultural Studies in Health and Illness, 32(2), 160–173. https://doi.org/10.1080/01459740.2012.674078

Chhim, S. (2014). A Place for Baksbat (Broken Courage) in Forensic Psychiatry at the Extraordinary Chambers in the Courts of Cambodia (ECCC). Psychiatry, Psychology and Law, 21(2), 286–296. https://doi.org/10.1080/13218719.2013.809652

Costanzo, C., & Verghese, A. (2018). The Physical Examination as Ritual: Social Sciences and Embodiment in the Context of the Physical Examination. Medical Clinics of North America, 102(3), 425–431. https://doi.org/10.1016/j.mcna.2017.12.004

Davies, J. (2018). The Making Of Psychotherapists. Routledge. https://doi.org/10.4324/9780429482373

de C Williams, A. C., & Baird, E. (2016). Special Considerations for the Treatment of Pain from Torture and War. Current Anesthesiology Reports, 6(4), 319–326. https://doi.org/10.1007/s40140-016-0187-0

Dow, J. (1982). Universal Aspects of Symbolic Healing : American Anthropologist, 88(1), 56–69.

Einterz, E. (2018). Recognizing culturally related findings on refugee physical examinations. Journal of the American Board of Family Medicine, 31(4), 653–657. https://doi.org/10.3122/jabfm.2018.04.170375

Fabian, K., Fannoh, J., Washington, G. G., Geninyan, W. B., Nyachienga, B., Cyrus, G., Hallowanger, J. N., Beste, J., Rao, D., & Wagenaar, B. H. (2018). “My Heart Die in Me”: Idioms of Distress and the Development of a Screening Tool for Mental Suffering in Southeast Liberia. Culture, Medicine, and Psychiatry, 42(3), 684–703. https://doi.org/10.1007/s11013-018-9581-z

Fox, S. H. (2003). The Mandinka Nosological System in the Context of Post-Trauma Syndromes. Transcultural Psychiatry, 40(4), 488–506. https://doi.org/10.1177/1363461503404002

Greene, M. C., Ventevogel, P., Likindikoki, S. L., Bonz, A. G., Turner, R., Rees, S., Misinzo, L., Njau, T., Mbwambo, J. K. K., & Tol, W. A. (2023). Why local concepts matter: Using cultural expressions of distress to explore the construct validity of research instruments to measure mental health problems among Congolese women in Nyarugusu refugee camp. Transcultural Psychiatry, 60(3), 496–507. https://doi.org/10.1177/13634615221122626

Harris, M. (1976). History and Significance of the EMIC/ETIC Distinction. Annual Review of Anthropology, 5(1), 329–350. https://doi.org/10.1146/annurev.an.05.100176.001553

Heim, E., Karatzias, T., & Maercker, A. (2022). Cultural concepts of distress and complex PTSD: Future directions for research and treatment. Clinical Psychology Review, 93(March), 102143. https://doi.org/10.1016/j.cpr.2022.102143

Hinton, D. E., & Lewis-Fernández, R. (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28(9), 783–801. https://doi.org/10.1002/da.20753

IIDH. (2010). Acceso a la justicia de los pueblos indígenas: los peritajes culturales y la visión de pobreza desde su cosmovisión. Instituto Interamericano de derechos Humanos,.

Jobson, L., & O’Kearney, R. (2006). Cultural differences in autobiographical memory of trauma. Clinical Psychologist, 10(3), 89–98. https://doi.org/10.1080/13284200600939892

Jubany, O. (2017). Screening asylum in a culture of disbelief: Truths, denials and skeptical borders. In Screening Asylum in a Culture of Disbelief: Truths, Denials and Skeptical Borders. https://doi.org/10.1007/978-3-319-40748-7

Kaiser, B. N., Haroz, E. E., Kohrt, B. A., Bolton, P. A., Bass, J. K., & Hinton, D. E. (2015). “Thinking too much”: A systematic review of a common idiom of distress. Social Science & Medicine, 147, 170–183. https://doi.org/10.1016/j.socscimed.2015.10.044

Kaiser, B. N., McLean, K. E., Kohrt, B. A., Hagaman, A. K., Wagenaar, B. H., Khoury, N. M., & Keys, H. M. (2014). Reflechi twòp--thinking too much: description of a cultural syndrome in Haiti’s Central Plateau. Culture, Medicine and Psychiatry, 38(3), 448–472. https://doi.org/10.1007/s11013-014-9380-0

Kaiser, B. N., & Weaver, L. J. (2022). Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology. Transcultural Psychiatry, 59(4), 395–398. https://doi.org/10.1177/13634615221110665

Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Feusner, J. D., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Meuret, A. E., Nemeroff, C. B., Oppenheimer, S., Petzschner, F. H., Pollatos, O., Rhudy, J. L., Schramm, L. P., Simmons, W. K., Stein, M. B., … Zucker, N. (2018). Interoception and Mental Health: A Roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004

Kidron, C. A., & Kirmayer, L. J. (2019). Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. Culture, Medicine and Psychiatry, 43(2), 211–235. https://doi.org/10.1007/s11013-018-9612-9

Kirmayer, L. J., Ban, L., & Jaranson, J. (2018). Cultural logics of emotion: Implications for understanding torture and its sequelae. Torture Journal, 28(1), 84–100.

Kirmayer, L. J., Rousseau, C., & Lashley, M. (2007). The place of culture in forensic psychiatry. Journal of the American Academy of Psychiatry and the Law, 35(1), 98–102.

Kleinman, A. (1988). Rethinking Psychiatry: From Cultural Category to Personal Experience. Free Pres.

Kohrt, B. a, & Hruschka, D. J. (2010). Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Culture, Medicine and Psychiatry, 34(2), 322–352. https://doi.org/10.1007/s11013-010-9170-2

Lasch, K. E. (2000). Culture, pain, and culturally sensitive pain care. Pain Management Nursing, 1(3), 16–22. https://doi.org/10.1053/jpmn.2000.9761

Leff, J. (1988). Psychiatry around the globe: A transcultural view. Gaskell/Royal College of Psychiatrists.

Levi-Strauss, C. (1964). Anthropologie structurale/Structural anthropology. Penguin.

Lewis-Fernández, R., Aggarwal, N. K., & Kirmayer, L. J. (2020). The Cultural Formulation Interview: Progress to date and future directions. Transcultural Psychiatry, 57(4), 487–496. https://doi.org/10.1177/1363461520938273

Lin, K., & Lin, M. T. (2015). Psychopharmacology: Ethnic and Cultural Perspectives. Psychiatry, 2041–52.

Marsella, A. J. (2005). Culture and conflict: Understanding, negotiating, and reconciling conflicting constructions of reality. In International Journal of Intercultural Relations (Vol. 29, pp. 651–673). https://doi.org/10.1016/j.ijintrel.2005.07.012

Meger, S. (2010). Rape of the Congo: Understanding sexual violence in the conflict in the Democratic Republic of Congo. Journal of Contemporary African Studies, 28(2), 119–135. https://doi.org/10.1080/02589001003736728

Moreno, A., & Peel, M. (2004). Posttraumatic seizures in survivors of torture: manifestations, diagnosis, and treatment. Journal of Immigrant Health, 6, 179–186. https://doi.org/10.1023/B:JOIH.0000045255.64395.d1

Nicolas, G., Wheatley, A., & Guillaume, C. (2014). Does one trauma fit all? Exploring the relevance of PTSD across cultures. International Journal of Culture and Mental Health, March 2015, 1–12. https://doi.org/10.1080/17542863.2014.892519

Patel, A. R., & Hall, B. J. (2021). Beyond the DSM-5 Diagnoses: A Cross-Cultural Approach to Assessing Trauma Reactions . Focus, 19(2), 197–203. https://doi.org/10.1176/appi.focus.20200049

Pedersen, D., Kienzler, H., & Gamarra, J. (2010). Llaki and Ñakary: Idioms of Distress and Suffering Among the Highland Quechua in the Peruvian Andes. Culture, Medicine, and Psychiatry, 34(2), 279–300. https://doi.org/10.1007/s11013-010-9173-z

Pedersen, D., Tremblay, J., Errázuriz, C., & Gamarra, J. (2008). The sequelae of political violence: Assessing trauma, suffering and dislocation in the Peruvian highlands. Social Science and Medicine, 67(2), 205–217. https://doi.org/10.1016/j.socscimed.2008.03.040

Perez-Sales, P. (2004). Psicologia y Psiquiatria Trasncultural. Bases prácticas para la accion. Desclee de Brower.

Pérez-Sales, P., Durán-Pérez, T., & Herzfeld, R. B. (2000). Long-term psychosocial consequences in first - degree relatives of people detained - disappeared or executed for political reasons in Chile. A study in Mapuce and Non-Mapuce persons. Psicothema, 12(SUPPL. 1).

Raingruber, B., & Kent, M. (2003). Attending to Embodied Responses: A Way to Identify Practice-Based and Human Meanings Associated With Secondary Trauma. Qualitative Health Research, 13((4)), 449–468.

Ramcharan, B. G. (1998). How Universal Are Human Rights?. A Debate About Power Rather Than Rights. IPG, 423–438.

Rasmussen, A., Katoni, B., Keller, A. S., & Wilkinson, J. (2011). Posttraumatic idioms of distress among Darfur refugees: Hozun and Majnun. Transcultural Psychiatry, 48(4), 392–415. https://doi.org/10.1177/1363461511409283

Rechtman, R. (2000). Stories of Trauma and Idioms of Distress: From Cultural Narratives to Clinical Assessment. Transcultural Psychiatry, 37(3), 403–415.

Rees, S., & Silove, D. (2011). Sakit Hati: A state of chronic mental distress related to resentment and anger amongst West Papuan refugees exposed to persecution. Social Science and Medicine, 73(1), 103–110. https://doi.org/10.1016/j.socscimed.2011.05.004

Shoeb, M., Weinstein, H., & Mollica, R. (2007). The Harvard Trauma Questionnaire: Adapting a Cross-Cultural Instrument for Measuring Torture, Trauma and Posttraumatic Stress Disorder in Iraqi Refugees. https://doi.org/10.1177/0020764007078362

Simons, R. C., & Hughes, C. C. (2012). The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest. Springer Science & Business Media.

Sökefeld, M. (1999). Debating self, identity, and culture in anthropology. Current Anthropology, 40(4), 417–447. https://doi.org/10.1086/200042

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma: Bessel van der Kolk MD: 9780670785933: Amazon.com: Books. (n.d.). Retrieved May 9, 2014, from http://www.amazon.com/Body-Keeps-Score-Healing-Trauma/dp/0670785938/ref=sr_1_1?s=books&ie=UTF8&qid=1399676469&sr=1-1

Theidon, K. (2004). Entre prójimos: El conflicto armado interno y la política de la reconciliación en el Perú. In Instituto de Estudios Peruanos (Vol. 1, Issue 1).

Trang, K., Hiott, C., Rahim, A. K., Rahman, S., & Wuermli, A. J. (2024). A qualitative study of cultural concepts of distress among Rohingya refugees in Cox’s Bazar, Bangladesh. Conflict and Health, 18(1), 1–11. https://doi.org/10.1186/s13031-024-00606-4

Tsakiris, M., & Preester, H. De. (2019). The interoceptive mind. From homeostasis to awareness. Oxford University Press.

UNHR. (2022). Istanbul Protocol. Manual on the effective investigation and documentation of torture and other cruel, inhuman o degrading treatment or punishment. Office of the High Commissioner of Human Rights. https://doi.org/10.2307/j.ctt207g8gw

Vargas-Forman, R., Viera-Bravo, P., & Pichún-Collonao, J. (2022). Pueblo mapuche vs Estado de Chile ante la Corte Interamericana de Derechos Humanos: experiencia del lof Temulemu. Revue Québécoise de Droit International, 2022-June(Special issue), 81–104. https://doi.org/10.7202/1091081ar

Vargas, R. (2017). Pewmas / Sueños de Justicia. Lonkos y dirigentes mapuche vs Chile en la Corte Interamericana: Testimonios y evidencia de los efectos psicosociales de la Ley Antiterrorista. LOM Ediciones.

Weathers, F. W., Huska, J. A., & Keane, T. M. (1991). The PTSD Checklist-Civilian Version (PCL-C). National Center for PTSD – Behavioral Science Division.

Weaver, L. J., Krupp, K., & Madhivanan, P. (2022). Conceptual and methodological challenges in idioms of distress research: Common questions and a step-by-step guide. Transcultural Psychiatry, 59(4), 399–412. https://doi.org/10.1177/13634615211042235

WHO. (1996). WHOQOL-BREF introduction, administration, scoring and generic version of the assessment [document on the inter- net]. Geneva: World Health Organization; 1996. www.who.int/mental_health/media/en/76.pdf

Williams, L. H. (2021). Negotiating languages of suffering in northern Uganda. Qualitative Studies, 6(1), 142–157. https://doi.org/10.7146/qs.v6i1.124456

Yoder, H. N. C., de Jong, J. T. V. M., Tol, W. A., Duncan, J. A., Bayoh, A., & Reis, R. (2021). Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions. Child and Adolescent Psychiatry and Mental Health, 15(1), 1–15. https://doi.org/10.1186/s13034-021-00370-w

Front page

Downloads

Published

2024-09-25

How to Cite

Pérez-Sales, P. (2024). Cross-cultural forensic reports of torture survivors based on the Istanbul Protocol. Torture Journal, 34(2), 3–21. https://doi.org/10.7146/torture.v34i2.149090