Special problems in the assessment of psychological sequelae of torture and incarceration

Abstract

The medicolegal assessment of the mental sequelae of torture and incarceration is often difficult since the symptoms themselves can present an obstacle to adequate exploration and thus to a correct evaluation. This is illustrated by two case reports from the casebook of a psychiatric assessor at the Berlin Centre for the Treatment of Torture Victims. The fact that assessment of the psychological sequelae of trauma can differ widely from one specialist to another would seem to result partly from the neglect of trauma and its mental sequelae in psychiatric training to date, as well as partially from the extreme countertransferential positions that assessors, just as psychotherapists, can experience when relating to their relationships with survivors of torture. The tendency shown by survivors of torture to withdraw and isolate themselves, their mistrust of the world and their frequently passive and resigned basic attitude must be countered by assessors with an active willingness to engage with and show interest in their stories and fate, coupled with an understanding of the special significance of the trauma for their lives as a whole.