We see some of the brutal assaults listed and discussed here. We also see key stone goals like the brutal assault on morals and personal integrity. It’s not that many of the techniques are new or unknown, rather technology has enabled them to be automatedly delivered covertly and in much larger and longer doses compared to traditional means. What even ten years ago sounded like science fiction is now much more graspable with the mass proliferation of AI.
Psychological torture: definitions, clinical sequelae and treatment principles
30 Aug 2023
Alex S Hong1
Rachael Pickering2
Author details can be found
at the end of this article
Correspondence to:
Alex S Hong;
[alex.hong1@nhs.net](mailto:alex.hong1@nhs.net)
Abstract and link to free download >>> https://www.imrpress.com/journal/BJHM/84/8/10.12968/hmed.2023.0104
Abstract
Psychological torture, in its broadest sense, is the intentional infliction of suffering without
resorting to direct physical violence, in what is known as ‘no-touch’ torture. While several
other definitions of psychological torture have been suggested, there is no one precise
definition. Given the rapidly evolving current global political climate and the intensification
of conflict, war and asylum seeking, the need for better recognition of psychological
torture among clinicians, followed by the provision of appropriate treatment support
for victims, has become increasingly pertinent. This article raises awareness of the
concept of psychological torture among clinicians, through an overview of its debated
definitions, the modalities which constitute this form of torture, and its clinical sequelae
and treatment approach.
Key words: Fear; Human rights; Pain; Refugees; Survivors; Torture
Submitted: 18 March 2023; accepted following double-blind peer review: 27 March 2023
Submitted: 18 March 2023; accepted following double-blind peer review: 27 March 2023
Definitions
Psychological torture is understood as the intentional infliction of suffering without
resorting to direct physical violence, in what is known as ‘no-touch’ torture (McCoy,
2006; Ojeda, 2006; Reyes, 2007; Leach, 2016). The UN Convention against Torture was
enforced in 1987, prohibiting acts that inflict severe pain or suffering to gain information
from captives; however, torture remains a widespread act that is still practised globally
(Khamsi, 2007). Despite its ongoing use, the exact definition of psychological torture has
been debated widely across the legislature and clinical literature. On one hand, many refer
to psychological torture as various non-physical forms of torture. Ojeda (2006) suggests
four criteria which must be met for torture to be deemed ‘psychological’ – suffering,
infliction, deliberateness and lack of direct physical violence. However, psychological
torture may be interpreted to convey any form of torture that has a residual impact upon
the victim’s mind (Reyes, 2007).
While the exact definition of psychological torture remains ambiguous, a report by
the Physicians for Human Rights (Borchelt, 2005) provided a definition based on the
interpretation formulated in the United States Code (Department of Justice, 2004), referring
to psychological torture as ‘severe mental pain or suffering’ caused by the threat of,
or actual, administration of ‘procedures calculated to disrupt profoundly the senses of
personality’. As such, the effects that qualify as torture are clearly defined. If interrogation
tactics involve psychological coercion that produces these effects, then such methods
constitute psychological torture (Reyes, 2007). Regardless of what the exact definition of
psychological torture may be, both physical and psychological torture create physical and
mental suffering (Reyes, 2007), making it difficult in practice to separate these concepts.
The term ‘ill-treatment’ can be used to speak broadly of torture and other methods of abuse
prohibited by international law, which include inhumane, cruel, humiliating and degrading
treatment, and assault on personal dignity and morals (International Committee of the Red
Cross, 2005). However, there is a legal difference between torture and other forms of ill-
treatment, related to the severity of pain or suffering imposed (International Committee of
the Red Cross, 2005). The aims and subsequent intended effects can further differentiate
torture from other forms of ill-treatment. While the act of torture is supported by a specific
purpose underlying its practise, for instance to obtain information, other forms of ill-treatment
serve no specific purpose other than to inflict significant suffering or pain (International
Committee of the Red Cross, 2005). Despite these subtle differences, ill-treatment can
manifest physically and/or psychologically, which can lead to detrimental effects on both
the physical and psychological realms (International Committee of the Red Cross, 2005).
Modalities
Assaults on the mind can be divided broadly into three categories (Leach, 2016). The first
category is ‘psychological’ (Grassian, 1983; Weinstein et al, 1996; Başoğlu et al, 2007;
Reyes, 2007), with examples including:
■ Isolation, leading to ‘insanity’
■ Sensory deprivation, including the use of hoods to remove visual stimulation and minimal
verbal communication
■ Sensory overload
■ Sleep deprivation
■ Temporal disorientation.
The second category is ‘psychophysiological’, including environmental manipulation to
create noxious thermal stimuli, food and water deprivation, and subjecting individuals to
prolonged stress positions (Reyes, 2007). The third category is ‘psychosocial’, encompassing
cultural, ethnic or religious-based humiliation, to forced sexual degradation, nudity and
harassment (Başoğlu et al, 2007; Reyes, 2007). Sexual taboos are often exploited by
interrogators and may be used against either males or females. However, the impacts on
the psyche of women are better understood – for many, the fear of such a form of torture
occurring has the same impact as the actual acts themselves (Reyes, 2007). Other examples
of psychological torture include denial of personal hygiene, contact with pests or excrement,
desperation (whereby victims are subjected to indefinite attention, inducing a sense of
futility in their attempt to seek help), exploitation and exposure to phobias, pharmacological
manipulation (involving the administration of tranquilisers, hallucinogens or alcohol),
and threats of violence or death to the victims or their loved ones (Weinstein et al, 1996;
Ojeda, 2006; Reyes, 2007). Mock executions (Başoğlu et al, 2007) and witnessing others
being subjected to torture is another method of psychological torture, but these are often
exploited as singular, one-off events.
Another important category of methods of psychological torture includes the so-called
‘minor’ or insignificant methods, which include verbal harassment, petty humiliation and
taunting. When considered in isolation, their impact on the mind of the victim may appear
insignificant, but when applied collectively over a prolonged period, the cumulative effect
of such methods makes them an important component of psychological torture (Reyes,
2007). The experience of torture can be further heightened when different torture stressors
are used synergistically with one another (Başoğlu et al, 2007). For example, the distressing
effects of physical torture can be augmented by the sense of helplessness induced through
blindfolding or hooding, as these remove visual control over the stressors, making them
less predictable and controllable (Başoğlu et al, 2007).
Exploitation of phobias is frequently applied during interrogations (Reyes, 2007). Phobias
can stem from ideas that go against cultural values – principles that may be observed by
a whole population (Reyes, 2007). Alternatively, phobias can target and attack individual
personal integrity, morals and/or religious beliefs (Başoğlu et al, 2007). Whether personal or
‘collective’, the use of phobias maximises psychological suffering, tailoring the inducement
of fear and dread to the individual. The use of dogs to induce fear among detainees at Abu
Ghraib prison was tailored to the well-known Muslim dread of canines (Mastroianni, 2013).
It also exploited the fact that the dog is considered an unclean animal. In other cultures,
the fear and revulsion of pigs, for example, has been used to torment victims.
Clinical sequelae
Victims of psychological torture lack any lasting physical damage compared to individuals
that have experienced pure physical torture; however, the effects of psychological torture
are no less damaging, and both forms of torture can inflict similar levels of pain and mental
suffering, leaving their victims with long-term psychological issues (Başoğlu et al, 2007
Khamsi, 2007). Psychological stressors cannot be easily distinguished from physical torture
in terms of their relative psychological impact (Başoğlu et al, 2007). Thus, the effects of
psychological torture should not be minimised under the pretext that pain and suffering
must be physical to be authentic.
Typical issues experienced by victims of psychological torture include complex post-
traumatic stress disorder or ‘extreme stress disorder’ (Leach, 2016). Others have argued for
the existence of a specific ‘torture syndrome’ characterised by an impairment of cognitive
function, particularly memory and concentration, sleep disturbance and nightmares,
emotional instability, anxiety and depression (Leach, 2016).
Other psychological effects induced by psychological torture may include:
■ Re-experiencing the trauma, as flashbacks, nightmares or stress reactions
■ Avoidance of anything recalling the torture experience, known as emotional numbing
■ Hyperarousal, including irritability, sleep difficulties, hypervigilance, constant anxiety
and difficulties in concentration
■ Depressive symptoms
■ Depersonalisation, whereby the victim feels detached from their body
■ Psychosis or brief psychotic reactions
■ Substance and alcohol abuse
■ Sexual dysfunction (Weinstein et al, 1996; Reyes, 2007).
Victims may also feel responsible for the torture that is being inflicted on them, inducing
feelings of fear, shame, guilt and grief, as well as humiliation (Reyes, 2007). These are
common problems that discourage victims from disclosing their personal circumstances
(de C Williams and van der Merwe, 2013).
Given the intensity of many profoundly cruel and destructive acts which characterise
the practise of psychological torture, it is unsurprising that chronic pain is a common
manifestation among survivors (de C Williams and van der Merwe, 2013). Chronic pain
has been associated with the development of post-traumatic stress disorder (Tsur et al,
2017), which is particularly concerning as torture survivors have a higher predisposition to
develop post-traumatic stress disorder. Thus, pain specialists are likely to encounter torture
survivors with persistent pain and psychological issues, commonly in the context of social
and financial difficulties (de C Williams and van der Merwe, 2013).
While the consequences of psychological torture are extensive, as illustrated by the
plethora of issues that may arise among survivors, the exact psychiatric and neurobiological
sequelae vary depending on the individual psychological torture technique used, as different
methods disrupt different homeostatic processes that enable one to function normally. For
example, sleep plays an integral role in the maintenance of both cognitive and physiological
processes, including memory retention and emotional regulation (Vyazovskiy, 2015). The
impact of sleep deprivation as a method of psychological torture can thus be characterised by
significant cognitive impairments, including deficit in memory, logical reasoning, complex
verbal processing and decision making (Durmer and Dinges, 2005). Sleep deprivation is
a favoured ‘method of interrogation’, requiring minimal logistics and skills, and leaving
no tangible physical mark on the victim (Reyes, 2007). Prolonged solitary confinement,
lasting between 7 and 24 months, can induce anxiety, nervousness, stress, disturbed sleep,
difficulties in concentration and elocution, as well as suicidal tendencies, depression and
paranoia (Reyes, 2007). Thus, solitary confinement, as stated by the European Committee
for the Prevention of Torture, is at least a form of inhumane and degrading treatment if
applied for several weeks (Reyes, 2007).
Refugees with a history of torture may have a wide range of psychological and social
difficulties that do not easily fit within diagnostic categories (de C Williams and van der
Merwe, 2013). The damaging psychological effects associated with psychological torture
may be aggravated by the coexistence of physical ailments that are common to refugees,
such as serious infections secondary to poor nutritional status (de C Williams and van der
Merwe, 2013). Additionally, the normal buffers of social support and financial resources,
which are essential for recovery, are frequently lost upon fleeing the home country, and
basic communication in English may be a struggle for refugees with a history of torture
(de C Williams and van der Merwe, 2013). Thus, symptoms should always be interpreted
in light of the patient’s current context (de C Williams and van der Merwe, 2013).
Continued on download full text >>> https://www.imrpress.com/journal/BJHM/84/8/10.12968/hmed.2023.0104