The Mental Health Consequences of Torture

, by Gerrity, Ellen; Keane, Terence M.; Fuma, Farris; Tuma, Farris

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ISBN: 9780306464225 | 0306464225
Cover: Hardcover
Copyright: 2/1/2001

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In 1997 the National Institute of Mental Health assembled a working group of international experts to address the mental health consequences of torture and related violence and trauma; report on the status of scientific knowledge; and include research recommendations with implications for treatment, services, and policy development. This book, dedicated to those who experience the horrors of torture and those who work to end it, is based on that report.

The Impact of Torture
Introduction	p. 3
Mental Health Consequences of Violence and Traumatic Stress	p. 3
Background	p. 4
Conceptual and Definitional Concerns	p. 5
Organization of the Book	p. 8
References	p. 11
The Survivors' Perspective: Voices from the Center	p. 13
Torture and Related Trauma	p. 14
Victim Versus Survivor	p. 15
The Changed World of the Tortured	p. 15
A Shroud of Guilt	p. 17
Humiliation: How Could I Let That Happen?	p. 18
Contamination: Evil Dancing Within	p. 18
Misdiagnosis	p. 19
Suicide: To Live or Not?	p. 20
Faith: To Believe or Not?	p. 22
Resilience of Survivors	p. 23
Transitional Survival Skills	p. 23
Reclaiming Control	p. 24
Normalizing Life Through Denial	p. 24
Therapy	p. 26
Effects of Torture on the Family	p. 29
The Culture of Denial	p. 30
Research Recommendations From the Survivors' Perspective	p. 33
References	p. 34
Torture and Mental Health: A Research Overview	p. 35
Prevalence of Torture	p. 36
Physical Effects of Torture	p. 37
Psychological Effects of Torture	p. 38
A Review of Studies on Torture	p. 38
Evidence for a Torture-Specific Syndrome	p. 45
Social and Economic Consequences of Torture	p. 45
Discussion and Conclusions	p. 48
References	p. 57
Conceptual Models for Understanding Torture
Psychosocial Models	p. 65
Learning Theory: Classical and Instrumental Conditioning	p. 65
Cognitive-Behavioral Theories: Information Processing	p. 66
Social-Cognitive Models	p. 67
Social Support Models	p. 68
Developmental Models	p. 68
Learned Helplessness	p. 69
Recommendations for Future Research	p. 69
References	p. 70
Neurobiological Models of Posttraumatic Stress Disorder	p. 73
Sympathetic Nervous System Alterations in PTSD	p. 74
The Hypothalamic-Pituitary-Adrenal Axis	p. 76
Stress Sensitization	p. 77
Fear Conditioning	p. 78
Enhanced Memory for Aversive Events	p. 80
Other Considerations	p. 82
References	p. 83
Economic Models	p. 89
Conceptual Framework	p. 90
Major Analytic Questions	p. 91
The Role of Economic Burden Measures	p. 104
Conclusions	p. 104
References	p. 105
Torture and the Trauma of War
Refugees and Asylum-Seekers	p. 111
Scope of the Problem	p. 112
Studies of Psychological Problems in Refugee Populations	p. 113
Biological, Social, and Cultural Effects of Torture and Trauma	p. 115
Research Recommendations	p. 116
References	p. 117
Veterans of Armed Conflicts	p. 121
Scope of Participation in Armed Conflicts	p. 121
Impact	p. 122
Recommendations for Future Research	p. 127
References	p. 128
Former Prisoners of War: Highlights of Empirical Research	p. 133
Worldwide POW Research	p. 133
Course and Complications	p. 136
Biological Correlates of Captivity Survivors' Impairments	p. 137
The Captor-Captive Relationship and Coping	p. 137
Recent Attention to U.S. POWs	p. 138
References	p. 140
Holocaust Trauma and Sequelae	p. 143
Impact of Trauma	p. 144
Individual Differences	p. 147
Coping With Life Stresses Subsequent to the Trauma of the Holocaust	p. 149
Protective Factors Facilitating Healing	p. 150
Contextualizing the Holocaust Experience	p. 152
Conclusion	p. 153
References	p. 154
Survivors of War Trauma, Mass Violence, and Civilian Terror	p. 159
Introduction	p. 160
Methodology	p. 161
Trends in Trauma Assessment	p. 163
Trauma as a Risk Factor	p. 164
Comorbidity and Other Outcomes	p. 167
Influences on Psychopathology	p. 168
Research Recommendations and Conclusions	p. 169
References	p. 171
Torture and the Impact of Social Violence
Rape and Sexual Assault	p. 177
Focus of Section	p. 178
Scope of Exposure	p. 179
Impact	p. 180
Posttraumatic Stress Disorder	p. 180
Other Psychological Outcomes	p. 181
Neurobiological Findings	p. 181
Cognitive Outcomes	p. 182
Physical Health	p. 182
Economic Impact	p. 184
Social Functioning	p. 184
Risk and Protective Factors	p. 185
Research Recommendations	p. 186
References	p. 187
Homicide and Physical Assault	p. 195
Scope of Exposure	p. 196
Impact	p. 198
Risk Factors	p. 203
References	p. 206
Children, Adolescents, and Families Exposed to Torture and Related Trauma	p. 211
Introduction	p. 211
Range and Prevalence of Trauma Exposure in Children and Adolescents	p. 212
Nature and Course of Psychological, Physical, Social, and Developmental Consequences	p. 214
Factors That Influence Vulnerability, Adjustment, and Recovery	p. 217
Assessment and Intervention	p. 218
Conclusion	p. 221
References	p. 221
Domestic Violence in Families Exposed to Torture and Related Violence and Trauma	p. 227
Does Exposure to Torture Detention; War-Zone, Political, and Ethnic Violence; and Refugee Resettlement Increase the Likelihood or Severity of Domestic Violence?	p. 231
Are the Characteristics of Domestic Violence Different in Families That Have Experienced Severe Trauma?	p. 235
Should Approaches to Treatment and Prevention of Domestic Violence Be Different for Families That Have Experienced Trauma?	p. 239
References	p. 242
Clinical Issues for Survivors of Torture
Assessment, Diagnosis, and Intervention	p. 249
Assessment	p. 251
Diagnoses	p. 253
Intervention Issues	p. 255
Specific Intervention Strategies	p. 259
Community Approaches	p. 265
Research Recommendations	p. 269
References	p. 270
Measurement Issues	p. 277
Basic Principles of Measurement	p. 278
Measurement Procedures	p. 283
Measurement Instruments	p. 285
Summary of Measurement Issues	p. 287
References	p. 288
Mental Health Services Research: Implications for Survivors of Torture	p. 291
Structure and Organization of the Health Care System	p. 292
Process of Care	p. 298
Intended Outcomes of Care	p. 301
Access to Care	p. 302
Conclusion	p. 305
References	p. 305
Professional Caregiver and Observer Issues	p. 309
Therapist Reactions	p. 310
Other Caregiver Responses	p. 312
Ethical Issues in Torture and Trauma Treatment	p. 313
References	p. 314
Torture and Human Rights Violations: Public Policy and the Law	p. 317
Definitions	p. 317
The Law and Treatment and Services for Trauma Survivors	p. 318
An Overview of International Human Rights Law Concerning Survivors of Torture	p. 319
Addressing War Crimes and Other Massive Human Rights Violations	p. 320
The Crime Victims' Rights Laws and Their Implementation	p. 321
Reparations, Restitution, and Compensation	p. 326
Restorative Justice	p. 327
Implications and Policy Recommendations	p. 328
References	p. 329
Discussion
Future Directions	p. 335
Summary of Selected Research Findings	p. 336
Conclusion	p. 341
Index	p. 343
Contributors: Biographical Information	p. 369
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The Mental Health Consequences of Torture

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