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During the last two decades an increasing body of research and theory has been
produced in many, mainly Western countries where torture and sexual torture victims
amongst refugees have been investigated as concerns their mental health. The surviving
victims, if not succumbing to their injuries or killed purposely, may lose bodily health, work,
family, status in the family and in society, and finally, if exiled, lose of country, language
and cultural environment (Millica). The most commonly reported symptoms of mental
suffering in many different parts of the globe are: anxiety, depression, irritability, emotional
liability, cognitive memory and attention problems, personality changes, behavioural
disturbances, neuro-vegetative symptoms as lack of energy, insomnia, nightmares, sexual
dysfunction. (Arcel et al. 1995, Arcel 1998). At an early state it was concluded by the RCT
that the worst sequel of torture were psychological, confirmed by other international
studies. (allodi 1980, Kordon et al. 1988). Researchers claim the issue of infliction of
deliberate violence from one human being to another with the aim of destruction as being
very influential to the formation of symptoms. (Somnier, Kastrup and Genefke 1996).
Gelinas supports this point by differentiating between “facticity” (e.g. to break a leg in an
accident) and “agency” as causes of trauma. The malevolent intention of the perpetrator
entails, according to Gelinas, the most extreme trauma. (???)are, are not clearly
differentiated from torture as etiological factor to distress. The importance of other
traumatic events as additive to torture stress is often not investigated.
Sexual assault is currently included in the psychiatric diagnostic Manual DSM-R as a type
of traumatic event that can precipitate the full pattern of PTSD. PTSD is a psychiatric
syndrome consisting of symptoms of extreme irritability, social withdrawal, avoidance of
situations that can resemble elements of a torture situation, nightmares, frightening
flashbacks of the traumatic situations. PTSD is affecting seriously the social adjustment of
the individual. A growing number of studies confirm that rates of PTSD following
completed sexual assault are very high and higher comparing with any other crime
(90%). Current results on the strongest predictors of PTSD symptoms in sexually
assaulted women are: experienced threat to their life, actual physical injury in genitals or
other body parts, completed rape, pretorture depression (In Wilson and Keane 1997).
Other important factors for long-term PTSD is the quality of social support that a woman
receives in her postcaptivity environment, her religious faith or political involvement.
Kilpatricke et al. observed life-long PTSD in 57% cases of completed rape. PTSD is not
the only disorder that may occur following sexual assault. There is increased risk of major
depressive disorder, increased rates of suicidal ideation, and suicide attempts, anxiety
disorders and substance abuse. A decreased frequency of sexual relations is the most
often reported change after rape (59%). High levels of experienced violence result in an
Intense and debilitating fear of social situations or of being alone. Employed women tend
during the first period after rape, to experience more problems after rape than
unemployed women, possibly because employed women are forced to be in social
situations before they have had a chance to recover from their experiences. Victims tend
to view their husbands/boyfriends as attackers (Resnik & Newton (1992)). The women
with chronic PTSD have more problems in social and vocational adjustment. Many mental
health workers have identified a cluster of symptoms labeled The Rape Trauma
Syndrome that consists of two distinct phases. (Burges&Holmstrom 1975). The Acute
phase one is immediately after the rape lasting from a few days to a few weeks. The main
emotional reactions during this phase is fear and thoughts about death, she expresses
that she would rather be dead, she feels unclean and ashamed. Somatic complaints are
often expressed, sleep is disorganized and decreased appetite. Genitourinary problems
are often found. In the second phase depression is prominent, flashbacks and nightmares.
These symptoms can vary over a long time. Important for coping is a family and social
support. Almost all torture survivors seeking treatment, both refugees and others, will need
practical assistance along with medical and psychological treatment needs. Focusing on
the survivor’s current life situation, family, personal values, existential dilemmas created
by her eventual ideological disillusionment or the opposite, advantages and disadvantages
in her engagement in her country’s political situation, are for torture victims of equal
importance to the medical assessment and treatment.
Major goals for rehabilitation and treatment of sexually tortured and degraded women are:
1) to reduce their anxiety; 2) to alter their perceived threat related to physiological,
emotional and cognitive responses associated with the traumatic memories of violence; 3)
to help them increase their feeling of safety, self-worth and hope for the future; 4) to
reduce their guilt, shame and self-blame; 5) to help them restore their social and
vocational adjustment. Counseling and couple therapy can prevent breakdowns of
communication in couples. Victims feel increasingly dependent on their partner, and can
be chronically fearful and anxious which puts stress on a couple’s life. Sexual torture
is in medical and psychological literature considered as a very important life stress event
that causes many other stress events. Concluding Torture without a doubt places people
at risk for psychiatric symptoms and social problems. The prolonged, repeated, man-made,
unpredicted, and inflicted with malevolent intent, traumatic experience of torture results in
the most serous psychiatric disorders. Prolonged and repeated sexual torture is the most
traumatizing human experience of all.
Posted on 2002-11-11
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