The Impact of Torture on Mental Health
By Hilda Nyatete and Dr Violet Tamu
The Independent Medico Legal Unit (IMLU) as an organization is continuously dedicated to providing torture survivors with rehabilitation resources they need to heal and reintegrate. Critical to the provision of these services to survivors of torture is the need to support victims and their families to regain a sense of normalcy due to the heinous act and violations they have been subjected to. At the core of this support, are the mental health practitioners without whose passion and dedication victims and families would not be able to see light at the end of the tunnel that is the pain and anguish that comes as a result of torture. These mental health practitioners, spanning across 20 counties, provide psychological support at group and individual levels for up to months at a time.
Over the last 25 years, we have supported well over 5000 victims of torture and police violence to receive holistic services which include psychological support. Remarkably, those who consistently and patiently work through the psychological impact of torture, go on to live as normal lives as possible; watching their dedication and willingness to work through the trauma is admirable, but also remarkable to see how lives are changed through therapeutic interventions in supporting victims of torture.
What is Torture?
“Torture is the deliberate and systematic dismantling of a person’s identity and humanity.” The main purpose of torture is to create fear, destroy a sense of community and eliminate leaders. The most common forms of torture are; beatings, psychological torture that does not leave any marks. These psychological types of torture affect victims’ mental health.
Mental health, includes but is not limited to; ”…subjective, perceived self-efficacy, autonomy, competence, intergenerational dependence and self-actualization of one’s intellectual and emotional potential among others...”
While symptoms of mental health and psychological impact of torture are similar, according to McFarlane & Yehuda, (1996) an individual’s reaction to emotional trauma is complex and can be difficult to predict. One’s past experiences, their social environment and or support, upbringing, cultural background, their emotional functioning are some key variables that play a critical role in how one responds to trauma. However many researchers intimate that mental and physical torture do the same psychological harm to a victim and are not easily distinguishable in the long term. Some of these include but are not limited to PTSD and depression. They both result in physical pain. A study on torture survivors sampled from Sarajevo, Banjaluka, Rijeka and Belgrade confirmed this, (Kings College University of London and Clinical hospital Zvezdra, Belgrade and Serbia).
Medical News Today also confirms this and adds that “...Physical torture is at par with psychological torture in terms of instilling fear, feelings of helplessness, loss of control and inducing anxiety”. Some of the physical torture meted on the victims included; sleep deprivation, genital fondling, threats of sexual violence or molestation, violence and witnessing sham executions, rape threats, violence, to mention but a few. Sleep deprivation causes insomnia, headaches, fatigue. In short emotional factors are triggered including other physical complaints like sexual dysfunctions, blurred vision etc. The brain is conditioned by extreme fear and stress, sleep deprivation and all these can change some memory systems.
Psychotic symptoms become prevalent. These include; paranoia, hallucinations, dreams, delusions, bizarre ideations, suicidal, hate, illusions or perceptual distortions. Others develop split personality. They feel they observe self from a distance and have disrupted consciousness, and disrupted self-perception.
Behaviorally, majority of victims present with fear, hallucination, anger, and deterioration in cognitive, emotional and other behavioral functions, many clients we handle exhibit some of these symptoms. Others develop split personality. They feel they observe self from a distance and have disrupted consciousness, disrupted self-perception, memory and action.
Generalized Anxiety Disorder is another symptom. The victim becomes restless, easily fatigued and finds it difficult to concentrate. Such a victim may also be easily irritated and experiences muscle tension. Just like the sleep deprivation one, this victim presents with sleep disturbance. He/she may have difficulties in falling asleep. On the other continuum, he may find it difficult to stay awake. I have met one such victim who easily sleeps anywhere while on duty/safari. He finds a lonely bush and just sleeps there. Muscle tension are also prevalent. A victim with generalized anxiety disorder also exhibits clinically significant distress and/or impairment in social, occupational or other important areas of function.
Substance abuse disorder: This may develop or for those who were already abusing it, they may become more addicted. This is in their effort to dull their pain and threatening experiences.
Some victims present with Enduring personality change for instance they become socially withdrawn, hostile or distrustful towards the world as a whole, hopeless, estranged and constantly threatened.
Although traumatic events caused by torture are different, their psychological consequences are similar. There is a commonality in the way they are mediated in the central nervous system (Basogllu, 1992a). Livanon, (1998) supports this and adds that human beings respond similarly to particular forms of treatment.
Psychomotor retardation e.g. Diminished inability to think, concentrate and is indecisive. This victim also entertains recurrent thoughts of death, guilt feels worthless and fatigued.
Humiliation propels one to be out of control, develop paranoia and may attempt self - harm. All these acts communicate a disruption in brain function
Torture reports are prevalent in regions affected by political unrest, riots, mass demonstrations, violence, tribal/ethnic clashes, etc.
A case of the psychological Impact of Torture on family
Trauma not only affects the individual both physically and psychologically; it affects those around them-family members, and significant others. One such case was during our engagement with victims of historical torture who for years had not disclosed to their families, and specifically their spouses, the harrowing experiences they were subjected to.
Many families linked to these victims over the years, harbored bitterness and anger towards these men, who had gone through more pain than they could bear to disclose. The joint occurrence of trauma and separation has a significant impact on emotional distress and family relationships, and the support extended to families and loved ones plays a pivotal role as an anchor of emotional stabilization and healing (Aroche, J, & Marin, L, 1994) .
It was therefore paramount that their spouses be integrated into the psychological/therapy program where they were taken through ten sessions of group therapy.
The main goal that presented during the onset of the group therapy was supporting the women to vent their anger and frustrations following their loss, especially developmental losses, during their spouses’ arrests and subsequent incarceration. Catharsis was the main approach used during the group sessions and by the end of the sessions, the wives had learnt how to confront and manage the negative emotions that had manifested for years. The women were empowered with the use of relaxation techniques and encouraged to embrace social support (Schauer, et al., 2011)  amongst themselves as a way of enhancing healing not only to themselves but to their spouses and children.
For family members of victims of torture, psycho-education on how to support their loved ones becomes a critical part of the therapeutic process. This is key because handling the ripple effects of the ills their loved ones may have suffered is key not only for the victims’ healing, but also for their own coping and healing too.
Some common interventions
There are many interventions e.g., CBT (Cognitive Behavior Therapy), NET (Narrative Exposure Therapy), Family therapy to validate impact of family members on healing, Psychodynamic approaches to tap on history of torture, Solution focused therapy, Dream work, meditating on faith healing verses, hymns of praise, visualization, relaxation, leisurely walk, spirituality and culture play an important role particularly to those who believe in a supreme being. It is a useful resource and even future studies will focus more on these more.
A study carried out on victims who attended spiritual retreats and clinics and those who did not revealed that self-transcendence was increased after the interventions. Those who went for spiritual clinics and retreats had positive impact, therefore when offered concurrently with psychological and medical interventions, the results can be amazing. However, I must add that it depends on one’s faith and will power. Dr. Nerberg of Marcus Institute of Integrative Health at Thomas Jefferson University, @ Medical news Today add that the retreats increase levels of “feel good” hormones in the brain that change dopamine and serotonin systems of the brain, boost availability of neurotransmitters that enable emotional responses to be regulated by dopamine whereas serotonin helps to control emotions and mood.
 The release of pent-up feelings and repressed emotions after a subject has begun to talk about problems during analysis.