Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?
OBJECTIVES: To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. DESIGN: Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. SETTING: The internal medicine clinic of a large, urban medical center. PARTICIPANTS: A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. INTERVENTIONS: All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. MAIN OUTCOME MEASURES: Self-reported history of torture. The awareness of primary care physicians of this history. RESULTS: Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. CONCLUSIONS: Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients. (+info)
The role of the pathologist in human rights abuses.
The objective and unbiased statement is much valued in international work against human rights abuses. Pathologists play an increasingly important role. In this article, this role is illustrated by examples and the international set of rules is described. It is emphasised that under no circumstances should physicians assist in procedures, such as torture, which can weaken a human being. There is ongoing research into the sequelae of torture, both by gross and microscopic examination and in the living and dead victims. (+info)
Stressor characteristics and post-traumatic stress disorder symptom dimensions in war victims.
AIM: To evaluate how the type of trauma is related to specific symptom patterns in patients with post-traumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria. METHODS: A total of 136 PTSD patients exposed to war-related traumatic experiences were divided in four groups: 79 veterans, 18 former prisoners (who witnessed or were subject to torture or frequent assaults), 15 victims of rape, and 24 refugees from Bosnia and Herzegovina. Each group was homogenous in regard to traumatic experiences. RESULTS: Significant inter-group differences were found in symptoms listed in the DSM-IV criteria, and under criteria C (avoidance) and D (arousal). No such differences were observed in symptoms listed under criterion B (intrusive symptoms). The results indicate that stressor characteristics may play a role not only in the variety of symptoms exhibited, but particularly in the number of avoidance and arousal symptoms. Victims of rape tended to present with more avoidance symptoms and fewer hyperarousal symptoms, whereas former prisoners and veterans tended to report more hyperarousal symptoms. Rape victims and former prisoners also reported more symptoms than the other groups. CONCLUSION: There is a strong indication that stressor characteristics influence the variety and number of exhibited intrusive, avoidance, and arousal symptoms. More research is needed to precisely define individual symptom dimensions possibly relating to particular stressor characteristics. Additional studies are needed to determine whether PTSD, as it is currently defined in the DSM-IV, is really a homogenous diagnostic category. (+info)
Changes of cytolytic cells and perforin expression in patients with posttraumatic stress disorder.
AIM: To define phenotypic characteristics of cytotoxic T lymphocytes (CTL) and natural killer cells (NK) in peripheral blood, frequency of somatic symptoms, and level of anxiety and depression in 25 patients clinically diagnosed with chronic post-traumatic stress disorder (PTSD). METHODS: Patients were divided into two sub-groups according to the stressor: 18 PTSD patients with the battlefield experience and 7 PTSD patients with battlefield experience who were tortured as the prisoners of war (POW) in Bosnian-Serbian camps. The control group consisted of 15 healthy volunteers matched to the patients by sex and age. We tested all patients using Becks depression inventory, Spielberger anxiety test, and somatic disturbance list, and analyzed their peripheral blood lymphocytes using flow cytometry with the double fluorescence staining of cell surface antigens (CD3, CD4, CD8, CD16, and CD56) and intracellular cytolytic molecule perforin (P), a mediator of cytolytic action at the molecular level. RESULTS: All PTSD patients showed a significant level of anxiety, depression, and numerous somatic symptoms. The only significant difference between PTSD patients with and without POW experience was in the anxiety level (median, 71; range 61-79; vs median, 65; range, 49-77). PTSD patients with POW experience had significantly higher levels of CD16+ cells (median, 37%; range, 16-55%) than those without it (median, 12%; range, 5-37%). Double labeling for intracellular P antigen and cell surface antigens showed the highest levels of CD16+P+ (median, 33%; range, 15-40%; vs median, 10%; range, 3-29%) and CD56+P+ (median, 21%; range, 11-40%; vs median 8%; range, 1-30%) cells in PTSD-POW patients. CONCLUSION: Chronic PTSD patients who survived concentration camps show the most numerous alterations in PBL phenotype, the highest number of perforin-containing cells, and a significantly higher level of anxiety. (+info)
Proceedings of the International Symposium on Torture and the Medical Profession.
... The main topic of this publication is the involvement of professional medical doctors in the course of torture in, generally speaking, the following ways: 1. Medical scientific knowledge and experience is used in the design of the methods and techniques of torture, for example pharmacological torture; 2. Doctors teach the torturers/perpetrators regarding the practical application of these methods; 3. Doctors actively participate in carrying out torture and in executions in relation to the death penalty; 4. Doctors are present -- "passive" -- during the implementation of torture (in more than sixty per cent of cases) for example monitoring the clinical condition of the victim in order to prevent death; are present when the death sentence is carried out, and then write out death certificates. Many of these are later shown by forensic documentation to be false.... This supplement is based on an international symposium, Torture and the Medical Profession, which was held at the University of Tromso in June 1990.... (+info)
Annual report of Council, 1983-1984: medical ethics.(6/107)