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militarypsychnewsbot , 8 months ago to psychology

Thank you for the summary Dr. Pope.

HARD TRIGGER WARNING: THIS POST DISCUSSES TORTURE, INCLUDING METHODS.

JAMA Network Open includes a study: “Reported Methods, Distributions, and Frequencies of Torture Globally A Systematic Review and Meta-Analysis.”

The authors are Andrew Milewski, MD, PhD1; Eliana Weinstein, BS1; Jacob Lurie, MD, MPH1; Annabel Lee, BA2; Faten Taki, PhD1; Tara Pilato, MD3; Caroline Jedlicka, MLS, MSW4; Gunisha Kaur, MD, MA1.

Here’s how it opens:

The prohibition of torture is a fundamental principle of international law: 173 states have ratified the 1984 United Nations (UN) Convention against Torture.1 Nevertheless, Amnesty International has documented the practice of torture in at least 141 countries.2 Torture is defined by the World Medical Association (WMA) as “the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.”3

According to the UN Refugee Agency, 32% of the 63 190 submissions for resettlement in 2021 and 27% of the 116 481 submissions in 2022 were “survivors of violence and torture.”4,5 Because these figures include both violence and torture, it is difficult to estimate what proportion of the world’s nearly 100 million refugees have been tortured.6 Nevertheless, as war, climate change, and other global calamities continue to displace 44 000 individuals daily, the number of torture survivors seeking refuge in high-resource countries is rising.6 Health care practitioners globally are increasingly likely to encounter torture survivors in their clinical practices. These patients experience concurrent physical and psychological trauma that is often severe or debilitating.7-10

The methods, distribution, and frequency of torture globally are not well described. Understanding the most common methods of torture encountered by medical professionals—particularly in relation to country or region of origin—may assist in the diagnosis of physical and psychological trauma and can guide appropriate medical treatment of forcibly displaced people. To our knowledge, this systematic review and meta-analysis is the first to rank the commonness of specific torture methods utilized worldwide and identify the regions of the world with which they are associated.

Another excerpt:

 A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor.

Here’s how the Discussion opens:

Notwithstanding the existence of innumerable torture methods, 21 methods accounted for 84% of the reported instances of torture and 10 methods accounted for 78% of the reported instances of physical torture. This study confirms that torture is pervasive and practiced in nearly every region of the world: the 266 included articles—published from 1947 onward—identified instances of torture in 105 countries (within 18 of 22 UN subregions). The articles identified 103 604 individuals who were subjected to torture and demonstrated that perpetrators usually use multiple methods in torturing an individual (conservative estimate of an average of 3.6 [95% CI, 2.6-4.6] methods per person), most often across multiple categories: the individuals in this study were subjected to an average 2 types of physical torture and 1 type of psychological torture; around 1 in 4 individuals were subjected to sexual torture and roughly 1 in 9 to sensory torture.

By mapping the geographic distributions for torture methods, we aim to aid clinicians’ approach to caring for asylum seekers and refugees. Knowing, for example, that a torture survivor emigrated from India should prompt clinicians to ask about exposure to muscle crushing with roller (ghotna) in addition to screening for more ubiquitous torture methods. Despite small regional differences, substantial commonalities are suggested by our estimates for the frequency with which individuals were subjected to each torture method: That just several methods account for the vast majority of the reported instances of torture implies that most individuals are subjected to some combination of the common methods. Although the experience of each torture survivor is unique, common threads exist among the kinds of torture that are perpetrated, which permits meaningful research in what would otherwise be considered a highly heterogeneous population.

Another excerpt:

Analyzing the SI revealed considerable heterogeneity in the articles’ reporting of torture methods and also identified a few clusters of studies devoted to particular torture methods, such as foot whipping. Dedicating several studies to a specific torture method engenders a depth of evidence that affords better understanding of the sequelae arising from that method and enables the development of targeted therapies. Researchers have, for example, identified chronic neuropathic pain as a sequela of foot whipping, permitting pharmacological management of symptoms.280 Evidence-based understanding of the sequelae arising from most torture methods is lacking, and deeper investigations into the common methods are needed to further the standard of care in refugee health.

Here’s how it concludes:

By delineating the most common torture methods and mapping regions within which torture methods are practiced, we can begin to better understand the experiences of refugees who have been tortured. This work is, however, incomplete: a system that tracks the global occurrence of torture, comprehensively delineates the methods used, and identifies the responsible perpetrators is urgently needed. It will also be important to establish causes of perpetrator impunity, particularly in the case of state actors, and investigate opportunities for prevention. To ensure that adequate care is accessible to this vulnerable population, future research should additionally aim to better correlate torture methods with their physical and psychological sequelae, to develop diagnostic tools, and to design effective treatment pathways.

REPRINTS &amp; OTHER CORRESPONDENCE:

Andrew Milewski, MD, PhD, Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 E 68th St M324, New York, NY 10065 ([email protected]).

Ken Pope

Psychological Assessment of Torture Survivors: Essential Steps, Avoidable Errors, and Helpful Resources  
—Ken Pope (International Journal of Law &amp; Psychiatry)

A Human Rights &amp; Ethics Crisis Facing the World's Largest Organization of Psychologists:   
Accepting Responsibility, Understanding Causes, Implementing Solutions  
—Ken Pope (European Psychologist, 2018)

Speaking the Unspoken: Breaking the Silence, Myths, and Taboos That Hurt Therapists and Patients  
—Ken Pope, Nayeli Y. Chavez-Dueñas, Hector Y. Adames, Janet L. Sonne, and Beverly A. Greene (APA, 2023)

“Torture goes against the very soul of our country. We are a democracy, established on the rule of law.”   
—Dianne Feinstein (1933-2023)

@[email protected] @[email protected] @[email protected] @[email protected] #psychology #refugee #torture #ethics #military #counseling #mentalhealth

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