* In this prestudy article, related parts of the references are shown in quotes as in the original text of open resources. Two important main texts are provided seperately. Interested readers can thus find the opportunity to read this reports themselves. The authors’ own views as well as the points that are more closely related to this article are marked in bold”




Although there has been a long debate over concept of trauma, its’ subjective and objective components, criteria and classification of Posttraumatic Stress Disorder, there is a consensus that a trauma can effect mental health and torture and sexual assault is a kind of trauma. When we look at the association between psychiatric disorders and torture, most of the Data come from the studies that was conducted in refugees that come from conflict areas.

In two Denmark studies representing asylum seekers primarily from Afghanistan, Iraq, Iran, Syria, and Chechnya (from 33 different countries) it was shown that psychiatric symptoms were very common in this group. “…….the health of traumatised asylum seekers, both physically and mentally, is affected upon arrival to Denmark, and time in asylum centres leads to further deterioration in health. Of the asylum seekers, 45 percent had been exposed to torture–approximately one-third within the year of arrival to Denmark. Unsystematic blows, personal threats or threats to family, degrading treatment, isolation, and witnessing torture of others were the main torture methods reported. The majority of the asylum seekers had witnessed armed conflict, persecution, and imprisonment. The study showed that physical symptoms were approximately twice as frequent and psychological symptoms were approximately two to three times as frequent among torture survivors as among non-tortured asylum seekers. However, even the health of non-tortured asylum seekers was affected. 1. “Physical and psychological symptoms were 2-3 times as frequent among  survivors as among non-tortured asylum seekers. Among the torture survivors, 63% fulfilled the criteria of post-traumatic stress disorder, 58% had objective psychological findings, and 42% had torture-related scars.” 2


Before a conclusion is made, it is very important to consider cultural differences, patients’ values and language barriers. “Continuity and integration of mental health care is achieved by bridging discrete elements…..Also important will be actions that build resilience intrinsically over time, such as the asylum seeker’s values, sustained supportive interpersonal relationships and therapeutic care plans3. ” Asylum seekers can present with a wide range of psychological problems caused by traumatic experiences in the country they have fled. They may also experience adjustment problems in the host country. For better recovery, addressing the biological, psychological and social needs of the individual is important. 4


Here we wanted to discuss the effects of widespread application practice of strip search in the light of scientific data, cultural differences and whether it can be included in the concept of psychological torture. Our research has shown us that there is a lack of studies examining the topic in general population. The specific cultural meaning of strip search is an important point.




The discussion over trauma ist generally about Posttraumatic stress disorder. “Posttraumatic stress disorder (PTSD) has attracted controversy since its introduction as a psychiatric disorder in the third edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The criteria for posttraumatic stress disorder PTSD have changed considerably with the newest edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Changes to the diagnostic criteria from the DSM-IV to DSM-5 include: the relocation of PTSD from the anxiety disorders category to a new diagnostic category named “Trauma and Stressor-related Disorders”, the elimination of the subjective component to the definition of trauma, the explication and tightening of the definitions of trauma and exposure to it, the increase and rearrangement of the symptoms criteria, and changes in additional criteria and specifiers. In the DSM-5, PTSD was placed in a new diagnostic category named “Trauma and Stressor-related Disorders” indicating a common focus of the disorders in it as relating to adverse events. This diagnostic category is distinctive among psychiatric disorders in the requirement of exposure to a stressful event as a precondition. PTSD begins with criterion A, which requires exposure to a traumatic event. Criterion A is not only the most fundamental part of the nosology of PTSD, but also its most controversial aspect. Some trauma experts criticized criterion A in the DSM-IV as too inclusive  and warned that this change had the potential to promote “conceptual bracket creep” or “criterion creep”. Some authors questioned the value of criterion A altogether, even suggesting that it should be abolished. Criterion A was retained in the DSM-5, but it was modified to restrict its inclusiveness. Not all stressful events involve trauma. The DSM-5 definition of trauma requires “actual or threatened death, serious injury, or sexual violence”. Stressful events not involving an immediate threat to life or physical injury such as psychosocial stressors (e.g., divorce or job loss) are not considered trauma in this definition.” 5


It is not true to restrict the effects and psychiatric sequeles of trauma and torture with PTSD, these  can be expanded to a variety of psychiatric disorders, from psychosis and depression to alcohol dependence and personality changes. “Growing awareness of the high prevalence of traumatic experiences in the population leads to a contextual shift in therapists regarding their understanding of the short and long term effects of traumatization in their patients. Exclusive focus on the traumatic history, however, biases the diagnostic process and could lead to wrong conclusions about a causal relationship between traumatic experiences and the psychopathology observed in the patient.” 6


On the other hand, trauma cannot be considered only as a medical issue. “Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war,  torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds.” 7



Torture and its relationship with healthcare have been examined in many studies. “torture has become a key theme in healthcare and a rising number of publications, especially over the last years, confirm its relevance also in regard to mental health. Torture survivors appear to be a frequent but also underdetected group in clinical and general populations. Sequelae include posttraumatic stress disorder, chronic pain, depressive disorders, and more, but so far insufficiently explored and partly culture-based, reactive symptoms. Symptoms are frequently chronic and can be hard to treat even in cost-intensive treatment settings. Torture prevention and interdisciplinary rehabilitation of survivors must receive more attention, and healthcare professionals have an obligation to take a substantial role in this effort.” 8


Many studies emphasize the psychological side of torture as well as its physical sequels. “Torture, which violates human rights, is still being practiced worldwide despite of all the bound rules and regulations. Although “beating” is the commonest method applied, other physical, psychological and sexual methods are often being practiced. 1975 Tokyo declaration defines torture and the doctor’s role in managing torture. Injury identification and accurate dating are major challenges faced by medical professionals in dealing with cases of torture. Inadequacy of the history and late presentation are another major issues that often interfere with proper medico-legal management” 9

The reduction of torture can be achieved by increasing awareness and related studies on this issue. Many studies have clearly demonstrated that psychiatric symptoms are common after torture. “There is little available data on torture survivors from studies designed and conducted by health professionals in low income countries. This study is a collaboration between five centres from Gaza, Egypt, Mexico, Honduras and South Africa who provide health, social and legal services to torture survivors, advocate for the prevention of torture and are part of the network of the International Rehabilitation Council for torture Victims (IRCT). …. A high level of traumatic events was experienced. 64% had suffered head injury whilst tortured and 24% had ongoing torture injury problems. There was high prevalence of symptoms of anxiety, depression, post traumatic stress as well as medically unexplained somatic symptoms10

Mental effects of the torture are more prominent when all community is under a collective pressure and effects not only the torture victims, also the non-tortured individiuals.  “The mass expulsion and exile of Bhutanese de facto refugees to displaced camps in Nepal represents one of the world’s most neglected humanitarian crises. …..All studies report a dramatically high incidence of mental illness including depression, anxiety and post-traumatic stress disorder. Both tortured and non-tortured participants reported elevated rates of mental illness. Our review indicates that the prevalence of serious mental health disorders within this population is elevated. The reported incidence of  torture is a possible contributor to the illnesses.” 11.


Strip search

The research for strip search comes mainly from the studies from North Ireland. These studies give a general approach about the effects of strip search in women. But most of the studies were limited to women in prison. “… women’s powerlessness and vulnerability, particularly those enduring mental ill-health. It contextualises their experiences within continua of violence and ‘unsafety’. .. three decades on from publication the first critical analyses of women’s imprisonment, the conditions of gendered marginalisation, medicalisation and punishment remain. ..stark relief in the punitive regimes imposed on those most vulnerable through mental ill-health” 12 There is also a study on the sexual perception of strip search in the same community. “..women political prisoners in Northern Ireland as a violent technology of control aimed at breaking the political identity of prisoners. Focusing on a controversial case of a mass strip search carried out in 1992, the article examines the phantasmatic investements pervading this seemingly rational technology of control. .. strip searches constitute a gendered form of political domination driven by… ” 13

A better understanding of psychiatric effects, what the victims feel because of strip search can be better seen with words of victims: “All women prisoners in Northern Ireland were strip-searched every time they enter of leave their prison compound, like when they are going to meet a visitor, or taken to court on remand, or visiting the infirmary. You have to stand in a closed-off cubicle, take off all your clothes and them out to two screws. I knew one woman prisoner, and she was having a miscarriage. She was hemorrhaging and on her way to the hospital, and they stopped her and strip-searched her while she was bleeding (Shannon, 118). “We were brought down to this area all alone and put into a wee cubicle. Then someone would say “strip naked!” If you refused, you would be thrown down on the floor and forcibly stripped. And you are so vulnerable. You have to stand there with all your clothes off, and they stand there looking at you, passing remarks like “you’re too fat” or “you’re too thin” and then they search you and slowly walk all around you. What happened over the next ten hours can only be described as sexual, physical, and psychological torture. Gangs of screws [guards] dressed in riot gear and armed with batons and shields entered the wings. A gang of screws entered a cell and set upon the defenseless women inside, in each case up to sixteen screws. The POW’s were seized and dragged to the floor; their faces pushed to the floor so that they couldn’t see their assailants and their mouths were covered to stifle their screams. Once inside, the screws began to remove the women’s clothes until [they] were entirely naked. Every other woman in the gaol could hear the attack as it took place, so in actual fact each woman spent the entire day listening to comrades being sexually abused before and after their turn came” (Congressional Briefing Paper).

All of these women suffered severe cuts and bruising. The women were charged with “breaches of prison rule,” which resulted in the loss of privileges. Disciplinary action taken against the women for resisting the brutal assault included forty-two days loss of remission, twenty-eight days loss of afternoon yard, and three days solitary confinement (Ibid.).

The House of Commons anwers questions regarding the use of strip-searching in Britain: “Full searching is a necessary measure to maintain prison security. A full search is a visual search only and at no time is the prisoner entirely undressed. Prison staff do not hav the power to conduct any body-cavity search although they may require prisoners to open their mouths. All prisoners (male and female) are routinely full searched when leaving or returning to the prison to inhibit the passage of items such as explosives, weapons, drugs, and other contraband into and out of the prison in order to reduce the risk of escape and for the general safety of prisoners, staff, and visitors” (House of Commons). There are now no IRA women in prisons, but there is evidence that strip searching is still going on in prisons in Britain and New Zealand, and African-American women have been targeted at airports in the United States. ” 14

There are also other reports on the effect of this practice on women. “.. how strip-searching was used against women in a gender-specific way. In so doing, it will draw attention to the disjunction between official policy relating to strip-searching and the way it was used and conducted in practice, and to the way the issue of security was used by the prison authorities to legitimise the practice of strip-searching. The chapter will challenge the official discourse around the use of strip-searching by examining how the women experienced and responded to this particular type of gendered punishment, and how it was used to control and discipline the bodies of political prisoners15

“…specific experiences of women in prison, focusing on previous (and continuing) physical and mental abuse, the consequent health care requirements of women prisoners, the policy response and the availability of suitable health care in prisons across the EU. … There are probably many more women prisoners with a history of domestic abuse than is officially recognised. …” 16


Cultural meaning

One of the most important issues that will make the situation even more complicated when examining a subject with so many components is the inclusion of cultural, sociological and historical concepts. The subjective aspect of trauma and the concept of psychological torture cannot be separated from these factors. Cultural and individual variations in emotion, perception, values and judgements are all important for the meaning and impact of  torture and trauma.

“…torture is an assault on the physical and mental health of an individual, impacting the lives of survivors and their families. The survivor’s interpersonal relationships, social life, and vocational functioning may be affected, and spiritual and other existential questions may intrude. Cultural and historical context will shape the meaning of torture experiences and the aftermath. To effectively treat torture survivors, providers must understand and address these factors.. Trauma’s five-domain model covering the Trauma Story, Bio-medical, Psychological, Social, and Spiritual domains… ” 17

“..the multiple meanings of culture in the contemporary world and their relevance for understanding mental health and illness. …..Multiple methods are needed to address the many different components or dimensions of cultural identity and experience that constitute local worlds, ways of life or systems of knowledge. … Emerging issues in cultural psychiatric research include: cultural variations in illness experience and expression; the situated nature of cognition and emotion; cultural configurations of self and personhood; concepts of mental disorder and mental health literacy; and the prospect of ecosocial models of health and culturally based interventions ” 18

“…. the significance of cultural variations in emotion for the meaning and impact of torture, focusing on the dynamics of shame, humiliation, and powerlessness. Forms of physical and psychological pain and suffering share some common neurobiological pathways and regulatory systems that are influenced by social and cultural factors. All forms of torture follow an affective logic rooted both in human biology and in local social and cultural meanings of experience. Understanding the impact of specific forms of torture on individuals requires knowledge of their learning histories, and of the personal and cultural meanings of specific kinds of violence. Exploring cultural meanings requires attention to over-arching discourse, embodied practices, and everyday engagements with an ecosocial environment” 19

Also, the processes of coping and healing with trauma cannot be separated from cultural factors. “Coping is not only an individual property but also a structural feature. Five main coping strategies were identified: (a) creating cultural and religious meaning; (b) individualism to collectivism; (c) normalization and habituation; (d) belonging, acceptance, expectation and readiness; and (e) social support. Participants also reported culture-specific expressions for indicating psychological distress. Implications for cultural informed clinical work are then discussed.” 9.

Cultural differences may be significant, even between groups with similar religious characteristics living in nearby areas. “Amongst Muslim majority countries,  torture is reported most in Afghanistan and Iran. In addition, despite the significant impact of sexual violence on individuals and public health, the issue has been poorly researched amongst victims of  torture. Special attention was given to the discussion of gender and sexual violence in those studies. Seven papers were identified and examined in this review. ..there is a high prevalence of sexual torture in Iranian and Kurdish refugees, the issue merits greater attention in this population. Studies are most limited amongst the Afghan population. Moreover, there is a great need for further culture-and gender- specific health research in  torture survivors from Muslim backgrounds.” 20



In this section, it will be useful to present a summary of the report of UN special raporteur 21, in which a good and comprehensive review of the concept of psychological torture has been made. Although this report examines the concept under human rights law, it also gives a comprehensive approach also in terms of psychology and psychiatry. Full text of this report is added to website together with this document. 

” … Mandate holders have long recognized “psychological” or “mental” torture as an analytical concept distinct from physical torture, have addressed specific methods or contexts of psychological torture, and have pointed to specific challenges arising in connection with the investigation and redress of this type of abuse, as well as to the inextricable link between psychological torture and coercive interrogation.

  1. Although these initiatives have been generally well received by States, national practice still tends to deny, neglect, misinterpret or trivialize psychological torture as what could be euphemistically described as “ torture light”, whereas “real torture” is still predominantly understood to require the infliction of physical pain or suffering (so-called “materialist bias”).
  2. “Psychological torture” is not a technical term in international law, but has been used in various disciplines, including legal, medical, psychological, ethical, philosophical, historical and sociological, for different purposes and with varying interpretations.
  3. According to article 1 of the Convention against torture, the substantive concept of “ torture” comprises, most notably, the intentional and purposeful infliction of severe pain or suffering “whether physical or mental”. It is this explicit juxtaposition of “mental” and “physical” pain or suffering which is generally referred to as the legal basis for the concept of psychological torture.
  4. … “psychological torture” should be interpreted to include all methods, techniques and circumstances which are intended or designed to purposefully inflict severe mental pain or suffering without using the conduit or effect of severe physical pain or suffering.
  5. …. the psychological dimension of torture can be divided into at least three parallel and equally important strands, which relate to the psychological methods (i.e., techniques), psychological effects (i.e., sequelae) and psychological rationale (i.e., target) of torture.
  6. First, the distinction between psychological and physical methods of torture should not obscure the fact that, as a matter of law, “torture” is a unified concept. All methods of torture are subject to the same prohibition and give rise to the same legal obligations, regardless of whether the inflicted pain or suffering is of a “physical” or “mental” character, or a combination thereof.
  7. In reality, both physical and psychological methods of torture each have both physical and psychological effects. Thus, the infliction of physical pain or suffering almost invariably also causes mental suffering, including severe trauma, anxiety, depression and other forms of mental and emotional harm. Likewise, the infliction of mental pain or suffering also affects bodily functions and, depending on intensity and duration, can cause irreparable physical harm or even death, including through nervous collapse or cardiovascular failure.
  8. A third, distinct aspect of the psychological dimension of torture is its inherently psychological rationale (i.e., target). From a functional perspective, any form of torture deliberately instrumentalizes severe pain and suffering as a vehicle for achieving a particular purpose. … always aimed at affecting the minds and emotions of victims or targeted third persons. Many methods of physical torture deliberately create and exploit debilitating inner conflicts, for example by instructing captives to remain in physically painful stress positions under the threat of rape in case of disobedience. …. in front of guards and inmates, again under threat of rape in case of disobedience. Thus, the distinction between “physical” and “psychological” torture does not imply any difference in functional rationale but, rather, refers to the methodological avenue through which that rationale is being pursued by the  torturer.

Applying the constitutive elements

  1. Severe pain or suffering
  2. International anti-torture mechanisms have left no doubt that the definition of torture does not necessarily require the infliction of physical pain or suffering but may also encompass mental pain or suffering. It is worth underlining, however, that the devastating effects of psychological torture are frequently underestimated.
  3. More controversial than this basic dichotomy between physical and mental is the interpretation of the required level of “severity” of the pain inflicted.
  4. Whether the required threshold of severity is reached in a particular case may depend on a wide range of factors that are endogenous and exogenous to the individual, such as age, gender, health and vulnerability, but also duration of exposure and accumulation with other physical or mental stressors and conditions, personal motivation and resilience and contextual circumstances. All these elements must be holistically evaluated on a case-by-case basis and in the light of the specific purpose pursued by the treatment or punishment in question. For instance, the threat of overnight detention combined with verbal abuse may be sufficiently severe to coerce or intimidate a child, whereas the same act may have little or no effect on an adult, and even less on a hardened offender.
  5. Several treaty provisions even suggest that the concept of torture includes conduct which, at least potentially, does not involve any subjectively experienced pain or suffering at all. … the use of “procedures calculated to disrupt profoundly the senses or the personality” could amount to torture even in the absence of subjectively experienced pain or suffering.
  6. Intentionality
  7. … the infliction of severe mental pain or suffering may result from the cumulative effect of multiple circumstances, acts or omissions on the part of several participants, such as in the case of mobbing, persecution and other forms of concerted or collective abuse, the required intentionality would have to be regarded as present for each State or individual knowingly and purposefully contributing to the prohibited outcome, whether through perpetration, attempt, complicity or participation.
  8. Purposefulness
  9. In order to amount to psychological torture, severe mental pain or suffering must be inflicted not only intentionally, but also “for purposes such as obtaining from the victim or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person”, or “for any reason based on discrimination of any kind
  10. Powerlessness

39… the victim of torture is a detainee or a person ‘at least under the factual power or control of the person inflicting the pain or suffering’, and where the perpetrator uses this unequal and powerful situation to achieve a certain effect, such as the extraction of information, intimidation, or punishment”.

  1. In practice, “powerlessness” arises whenever someone has come under the direct physical or equivalent control of the perpetrator and has effectively lost the capacity to resist or escape the infliction of pain or suffering (. This is typically the case in situations of physical custody, such as arrest and detention, institutionalization, hospitalization or internment, or any other form of deprivation of liberty.
  2. “Lawful sanctions” exception
  3. The definition of torture in the Convention explicitly excludes “pain or suffering arising only from, inherent in or incidental to lawful sanctions”.

29 Most notably, the “lawful sanctions” clause can be accurately understood only in conjunction with the 1975 Declaration on the Protection of All Persons from Being Subjected to torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, from which it is directly derived, and which excludes only those lawful sanctions from the definition of torture that are “consistent with the Standard Minimum Rules for the Treatment of Prisoners” (art. 1). For example, therefore, even if permitted by domestic law, none of the following methods of inflicting mental pain or suffering can be regarded as “lawful sanctions”: prolonged or indefinite solitary confinement; placement in a dark or constantly lit cell; collective punishment; and prohibition of family contacts.

  1. Importantly, in order to be “lawful”, sanctions cannot be open-ended, indefinite or grossly excessive to their purpose, but must be clearly defined, circumscribed and proportionate.
  2. Predominant methods of psychological Torture
  3. In practice, specific methods of torture are rarely applied in isolation, but almost always in combination with other methods, techniques and circumstances, forming what has aptly been described as a “torturing environment”…
  4. Security (inducing fear, phobia and anxiety)
  5. Perhaps the most rudimentary method of psychological torture is the deliberate and purposeful infliction of fear. ..
  6. In practice, fear can be induced through a virtually limitless variety of techniques; some of the most common include the following: Direct or indirect threats of inflicting, repeating, or escalating acts of torture, mutilation, sexual violence or other abuse, including against relatives, friends or other inmates; Withholding or misrepresenting information about the fate of the victims or their loved ones, mock executions, witnessing the real or purported killing or torture of others; Provoking personal or cultural phobia ..
  7. The extreme psychological distress and enormous inner conflicts triggered by fear are often underestimated.
  8. Self-determination (domination and subjugation)
  9. A psychological method applied in virtually all situations of torture is to purposefully deprive victims of their control over as many aspects of their lives as possible, to demonstrate complete dominance over them, and to instil a profound sense of helplessness, hopelessness and total dependency on the torturer. In practice, this is achieved through a wide range of techniques including, most notably: Arbitrarily providing, withholding or withdrawing access to information, reading material, …
  10. All these techniques have in common that they disrupt the victim’s sense of control, autonomy and self-determination and, with time, consolidate in total despair and complete physical, mental and emotional dependency on the torturer (“learned helplessness”).
  11. Dignity and identity (humiliation, breach of privacy and sexual integrity)
  12. Closely related to the suppression of personal control, autonomy and self-determination, but even more transgressive, is the proactive targeting of victims’ sense of self-worth and identity through the systematic and deliberate violation of their privacy, dignity and sexual integrity. This may include, for example: Constant audiovisual surveillance, through cameras, microphones, one-way glass, caging and other relevant means, including during social, legal and medical visits and during sleep and personal hygiene, including urination and defecation; Systematic derogatory or feral treatment, ridicule, insults, verbal abuse, personal, ethnic, racial, sexual, religious or cultural humiliation; Public shaming, defamation, calumny, vilification or exposure of intimate details of the victim’s private and family life; Forced nudity or masturbation, often in front of officials of the opposite gender; Sexual harassment through insinuation, jokes, insults, allegations, threats or exposing genitalia; Breach of cultural or sexual taboos, including the involvement of relatives, friends or animals; Dissemination of photographs or audio/video recordings showing the victim being tortured or sexually abused, making a confession or otherwise in compromising situations.
  13. It must be stressed that the humiliating and degrading nature of abuse does not necessarily relegate it to the realm of “other cruel, inhuman or degrading treatment”, which is sometimes (incorrectly) regarded as a “lesser” wrong than torture. Systematic and prolonged violations of privacy, dignity and sexual integrity are known to instil severe mental suffering, including emotions of profound vulnerability, humiliation, shame and guilt, often exacerbated by anxiety about social exclusion, self-hatred and suicidal tendencies.
  14. Environmental orientation (sensory manipulation)
  15. Social and emotional rapport (isolation, exclusion, betrayal)
  16. A routine method of psychological torture is to attack the victim’s need for social and emotional rapport, through isolation, social exclusion, mobbing and betrayal. Persons deprived of meaningful social contact and subjected to emotional manipulation can quickly become deeply destabilized and debilitated.
  17. Communal trust (institutional arbitrariness and persecution)
  18. Torturous environments (accumulation of stressors)

68…. Thus, a finding of torture may depend not only on the specific characteristics of particular techniques or circumstances, but also on their cumulative and/or prolonged effect, sometimes in conjunction with external stress factors or individual vulnerabilities that are not under the control of the torturer and may not even be consciously instrumentalized by him. As aptly stated by the International Tribunal for the Former Yugoslavia, torture “may be committed in one single act or can result from a combination or accumulation of several acts, which, taken individually and out of context, may seem harmless … The period of time, the repetition and various forms of mistreatment and severity should be assessed as a whole”.

  1. …. each person may react differently to a particular method of torture. In practice, therefore, torture techniques must always be evaluated by reference to the targeted victim’s individual vulnerabilities ..
  2. In such situations, rather than looking at each factor in isolation and asking which ones cross the “severity” threshold, it is more appropriate to speak of a “torturous environment”, that is …
  3. Cyber torture
  4. .. much more systematic, government-sponsored threats and harassment delivered through cyber-technologies not only entail a situation of effective powerlessness but may well inflict levels of anxiety, stress, shame and guilt amounting to “severe mental suffering”, as required for a finding of torture.
  5. Conclusions and recommendations
  6. Prevalence. Psychological torture occurs in a wide variety of contexts, including ordinary criminal investigations, police detention, “stop-and-search” operations, intelligence gathering, medical, psychiatric and social care, immigration, administrative and coercive detention, as well as in social contexts such as domestic violence, mobbing, cyberbullying and political or discriminatory persecution.
  7. General recommendations. Psychological torture constituting a subcategory to the generic concept of torture, the Special Rapporteur herewith reiterates the general recommendations of his mandate and emphasizes their full applicability, mutatis mutandis, to methods, techniques and circumstances amounting to “psychological torture”.
  8. Non-coercive investigation. Given the practical importance of continuing to clarify the fault lines between permissible non-coercive investigative techniques and prohibited coercive interrogation, the Special Rapporteur reaffirms the conclusions and recommendations in the thematic report submitted by his predecessor and invites States to actively support the ongoing process towards developing international guidelines on investigative interviewing and associated safeguards.
  9. Working definitions. For the purposes of human rights law, “psychological torture” should be interpreted to include all methods, techniques and circumstances which are intended or designed to purposefully inflict severe mental pain or suffering without using the conduit or effect of severe physical pain or suffering.
  10. Constitutive elements: In the context of psychological torture,

(a) “Mental suffering” refers primarily to subjectively experienced mental suffering but, in its absence, can also refer to objectively inflicted mental harm alone;

(b) “Severity” of mental pain or suffering depends on a wide range of factors that are endogenous and exogenous to the individual, all of which must be holistically evaluated on a case-by-case basis and in the light of the specific purpose pursued by the treatment or punishment in question;

(c) “Powerlessness” refers to the victim’s inability to escape or resist the infliction of mental pain or suffering, and can be achieved not only through physical custody but also, for example, through incapacitating medication, deprivation of legal capacity, serious and immediate threats and social contexts marked by coercive control, mobbing, cyberbullying and persecution;

(d) “Intentionality” is present where the perpetrator knew or should have known that, in the ordinary course of events, his or her acts or omissions would result in the infliction of severe mental pain or suffering, whether alone or in conjunction with other factors and circumstances;

(e) “Purposefulness” is present when mental pain or suffering is inflicted for purposes such as interrogation, punishment, intimidation and coercion of the victim or a third person, or with a discriminatory nexus, regardless of purportedly benevolent purposes such as “medical necessity”, “re-education”, “spiritual healing”, or “conversion therapy”;

(f) “Lawful sanctions” cannot include any sanctions or measures prohibited by relevant international instruments or national legislation, such as prolonged or indefinite solitary confinement, sensory manipulation, collective punishment, prohibition of family contacts, or detention for purposes of coercion, intimidation, or for reasons related to discrimination of any kind.

  1. Predominant methods. In contrast to physical torture, which uses the body and its physiological needs as a conduit for affecting the victim’s mind and emotions, psychological torture does so by directly targeting one or several basic psychological needs, such as:

(a) Security (inducing fear, phobia and anxiety);

(b) Self-determination (domination and submission);

(c) Dignity and identity (humiliation, breach of privacy and sexual integrity);

(d) Environmental orientation (sensory manipulation);

(e) Social and emotional rapport (isolation, exclusion and emotional manipulation);

(f) Communal trust (institutional arbitrariness and persecution).” 21



When we speak about psychological torture in a special condition it is very important to consider the cultural and social norms and the victims’ specific situation. We also need a systemic trauma perspective. The same point is a key part of the prevention, restoring the psychological well-being and treatment.


For this purpose, there are various studies that are specialized in various social communities or age groups around the world. ” Gaza Community Mental Health Programme (GCMHP) provides mental health services and psychosocial interventions that match local cultural and social norms. ” 22 These studies also emphasize that the findings should not be limited to PTSD and the importance of childrens’ traumatic factors. “… trauma and exile-related mental health in young refugees from the Middle East. A review of four empirical studies: … The reactions of the children were not necessarily post-traumatic stress disorder specific. Seventy-seven per cent suffered from anxiety, sleep disturbance and/or depressed mood at arrival. Traumatic experiences before arrival and stressful events in exile predicted internalizing behaviour, witnessing violence and frequent school changes in exile predicted externalizing behaviour. School participation, Danish friends, language proficiency and mother’s education predicted less long-term psychological problems. Traumatic experience before arrival is most important for the short-term reaction of the children while aspects of life in exile are important for the children’s ability to recover from early traumatization.” 23


When the effects of trauma are experienced again even after many years, it becomes an important factor in mental health problems. In this context, repeated exposure to the same practices is also a situation that should be discussed. Studies define a relationship between revictimization and childhood traumas. In this context, the long-term effects of the application on children may need to be re-evaluated years later. ” Revictimization affected 12% of women, and these women were substantially more likely to report current symptoms of anxiety, depression, and PTSD than women exposed to violence only in childhood or only as an adult. Revictimization is a methodologically distinct concept and is a potent risk factor for adult mental health problems. ” 24


On the other hand, it is beyond the scope of this article to discuss treatment and coping mechanisms for those exposed to such traumas. There are studies in the literature on this subject both indicating the importance of social, cultural and religious factors. “.. Proactive coping, reliance on self, and political or civic engagement significantly interacted with political violence to affect health in a counterintuitive direction; those with higher scores on these more internalized and individualistic coping strategies demonstrated worse health as political violence increased. Reliance on religious support, and, in particular, support from and participation in activities of religious institutions, emerged as a significant protective factor. ” 25


The importance of these factors are evident especially in migrant and refugee groups, but it is not limited to majority groups, the same cultural and sociodemographic factors always work when we are trying to assess a particular psychological torture case.  “.. clinicians must implement culturally appropriate methods of assessing and treating individuals from diverse backgrounds. Culture can exert a powerful and often misunderstood influence on psychological assessment, and the critical challenge is to account for both subjective experience of the client and the objective symptoms or behaviors present….” 26


Domestic factors play important role in documentation too, this was evident with the use of Istanbul Protocol. “… The emphasis on accurate and detailed documentation of examination findings of torture victims is currently necessary in Sri Lanka as the courts are relying heavily on medical reports for interrogation. …Therefore it was attempted in 2004, to introduce uniformity to existing documentation procedures by implementing Istanbul Protocol on island wide basis. However it was revealed that the adoption of the Istanbul Protocol could not be done as a whole in a short period due to variable degree of compliance from medical officers and further it need to be modified according to domestic requirements.27



We need a systemic trauma perspective and before a conclusion is made, it is very important to consider cultural differences. Culture can exert a powerful influence on psychological assessment. There are some common points with the current literature to interpret the ongoing debate in recent days in Turkey on the situation. On the other hand, there are significant differences in some points that have not been seen before. Cultural differences may be significant, even between groups with similar religious characteristics living in nearby areas.


The significant points about Turkey and the relationship of the situation with the psychological torture concept are :

  1. ” “Lawful sanctions” cannot include any sanctions or measures prohibited by relevant international instruments or national legislation, such as prolonged or indefinite solitary confinement, sensory manipulation, collective punishment, prohibition of family contacts, or detention for purposes of coercion, intimidation, or for reasons related to discrimination of any kind”. 21 In this context, Turkey’s debate is not limited to just women or prisoners. It is reported that this practice is routinely and repeatedly applied to both prisoners and visitors, including children and even the disabled. This can also be thought within “Powerlessness” (refers to the victim’s inability to escape or resist the infliction of mental pain or suffering, and can be achieved not only through physical custody but also, for example, through incapacitating medication, deprivation of legal capacity, serious and immediate threats and social contexts marked by coercive control, mobbing, cyberbullying and persecution 21 ).


Repeated exposure to the same practices is also a situation that should be discussed. Considering that there have been over 300,000 detentions and around 100,000 arrests under the state of emergency in the last 4 years, so that over one million people, including their families, have been affected. In addition, it is stated that the application is applied repeatedly in each visit process.

It is inevitable that especially family members and children will be negatively affected by this situation.  “Purposefulness” is present when mental pain or suffering is inflicted for purposes such as interrogation, punishment, intimidation and coercion of the victim or a third person, or with a discriminatory nexus, regardless of purportedly benevolent purposes such as “medical necessity”, “re-education”, “spiritual healing”, or “conversion therapy”


  1. Social and cultural concept:
  2. For the women and children this practice can be perceived as a particular type of gendered punishment, or as a control and discipline the bodies, or the practice can be perceived as a practice aimed at breaking the political identity.

When loved ones around a child have been persecuted, raped and tortured or the child has witnessed severe trauma or torture, he or she may develop dysfunctional beliefs such as that he or she is responsible for the bad events or that he or she has to bear the parent’s burdens. This type of belief can lead to long-term problems with guilt, loyalty conflicts, personal development and maturing into an independent adult.  (See İstanbul Protokol)


  1. Turkey largely has a Muslim population. Culturally, the perception of nudity is different compared to Western countries. Although there is no difference in perception of nudity in compulsory situations such as medical reasons, there has been a decades-long debate on the headscarf regarding public spaces. Concepts such as “not showing a single hair strand” are used constantly in politics, literature and the press.


  1. From the perspective of Turkish social identity and Turkish history, forcible removal of clothing is considered a serious sexual assault. Before the beginning of Turkey’s Independence War a similar compulsion turned into a war of independence in a city where tens of thousands died. This case is called “Sütçü İmam case”. The name “Maraş” of this city, with a population of over a million now, was being changed by the Parliament to “Kahramanmaraş” which has a meaning of “Hero Maraş”.


  1. Such practices affect all family members as well as the exposed ones. A child who is searched in this way may perceive this event as a situation imposed on him in order to see his father, while the father may have to choose not to visit his child to him, so that his child is not traumatized. Again, culturally, whether men are in prison women are outside or vice versa; this situation can be interpreted differently by both spouses. Culturally, it will not be surprising that such differences can have negative effects on long-term family relationships and sexual life. On the other hand the processes of coping and healing with trauma cannot be separated from cultural factors.


  1. “Mental suffering” refers primarily to subjectively experience. In the last four years, although there have been many allegations of torture resulting in death or disability, and although practices such as beating have become almost standard, no practice has received such a reaction. In this case, it actually points to the magnitude of the cultural meaning of the application.

All statements made by government officials in the face of these allegations are “there is no such practice”, not that the application is a legal requirement or a necessity. Again, this attitude actually means the implicit acceptance of the cultural unacceptability of the practice. “Intentionality” is present where the perpetrator knew or should have known that, in the ordinary course of events, his or her acts or omissions would result in the infliction of severe mental pain or suffering, whether alone or in conjunction with other factors and circumstances . 21



As a result there is a need to develop structured, cultural and community-specific approaches by repeating such studies for different groups. In conclusion, Severity” of mental pain or suffering depends on a wide range of factors that are endogenous and exogenous to the individual, all of which must be holistically evaluated on a case-by-case basis” 21 , so as a next step there is an important need to develop approaches and treatment algorithms compatible with protective factors, coping methods that have been shown to work good before, and studies that are addressing social and cultural factors in this direction.

Additional Part: Documentation of  torture and Istanbul protokol

“Documentation of torture is a multidisciplinary, multistage scientific procedure evolved over the past decades through the experience of various strata in medical and related fields. It plays a key role in effective corroboration of facts, providing redress to victims and also has a long term regulatory impact on prevention of torture in a society. The UN endorsed Istanbul protocol serves as the model for effective documentation of torture in the present context and there were many attempts in the recent years to create a systematic and uniform approach among professional bodies to document torture by adopting it to the local medico-legal and legal systems in some less resourced countries.” 28.

“The Istanbul Protocol (IP) is one of the great success stories of the global anti-torture movement, setting out universal guidelines for the production of rigorous, objective and reliable evidence about allegations of torture and ill-treatment. The IP is explicitly designed to outline ‘minimum standards for States’. However, it is all too often left to civil society organizations to investigate allegations of  torture and ill-treatment. In this context, important questions remain as to how and where the IP can be used best by such organizations. These questions are particularly acute in situations where human rights groups may have limited institutional capacity. This paper explores the practical challenges faced by civil society in using the IP in Low-Income Countries. It is based on qualitative research in three case studies: Nepal, Kenya and Bangladesh. This research involved over 80 interviews with human rights practitioners. The conclusions of the paper are that the Istanbul Protocol provides a useful framework for documentation, but more comprehensive forms of documentation will often be limited to a very small – albeit important – number of legal cases. In many cases, the creation of precise and standardized forms of evidence is not necessarily the most effective form of documentation for redress or accountability. In the absence of legal systems willing and able to respond effectively to allegations of torture and ill-treatment, there are severe limitations on the practical effectiveness of detailed and technical forms of documentation.” 29.

Full text of Istanbul Protokol is added to website together with this document. 



  1. Tania Nicole Masmas, Eva Møller, Caecilie Buhmannr, Vibeke Bunch, Jean Hald Jensen, Trine Nørregård Hansen, Louise Møller Jørgensen, Claes Kjaer, Maiken Mannstaedt, Annemette Oxholm, Jutta Skau, Lotte Theilade, Lise Worm, Morten Ekstrøm. Asylum seekers in Denmark–a study of health status and grade of traumatization of newly arrived asylum seekers torture. 2008;18(2):77-86. PMID: 19289884
  2. Tania Nicole Masmas, Eva Møller, Caecilie Buhmann, Vibeke Bunch, Jean Hald Jensen, Trine Nørregård Hansen, Louise Møller Jørgensen, Claes Kjaer, Maiken Mannstaedt, Annemette Oxholm, Jutta Skau, Lotte Arlø Theilade, Lise Worm, Morten Ekstrøm[Health status and degree of traumatisation among newly arrived asylum seeker–secondary publication] Ugeskr Laeger . 2010 Jan 11;172(2):120-4. PMID: 20376916
  3. Nicholas G Procter. ‘They first killed his heart (then) he took his own life’. Part 2: Practice implications. Review Int J Nurs Pract. 2006 Feb;12(1):42-8. doi: 10.1111/j.1440-172X.2006.00548.x. PMID: 16403196 DOI: 10.1111/j.1440-172X.2006.00548.x
  4. Steve Maddern. Post-traumatic stress disorder in asylum seekers Review Nurs Stand. 2004 Jan 14-20;18(18):36-9. PMID: 14768231
  5. Anushka Pai,1,2,* Alina M. Suris,1,2 and Carol S. North2,3 Scott J. Hunter, Academic Editor. Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations Behav Sci (Basel). 2017 Mar; 7(1): 7. Published online 2017 Feb 13. doi: 10.3390/bs7010007. PMCID: PMC5371751. PMID: 28208816
  6. R J Rijnders, J E Hovens, H G Rooijmans. [Psychiatric disorders in refugees and asylum seekers: psychological trauma as a cause?] Case Reports Ned Tijdschr Geneeskd. 1998 Mar 21;142(12):617-20. PMID: 9623123
  7. Rachel E Goldsmith, Christina Gamache Martin, Carly Parnitzke Smith. Systemic trauma. J Trauma Dissociation. . 2014;15(2):117-32. doi: 10.1080/15299732.2014.871666. PMID: 24617751 DOI: 10.1080/15299732.2014.871666
  8. Thomas Wenzel. torture. Review Curr Opin Psychiatry. 2007 Sep;20(5):491-6. doi: 10.1097/YCO.0b013e3282c3a5c1. PMID: 17762594 DOI: 10.1097/YCO.0b013e3282c3a5c1
  9. Abdelhamid J Afana, Jacqus Tremblay, Jess Ghannam, Henrik Ronsbo, Guido Veronese. Coping with trauma and adversity among Palestinians in the Gaza Strip: A qualitative, culture-informed analysis. J Health Psychol. 2020 Oct;25(12):2031-2048. doi: 10.1177/1359105318785697. Epub 2018 Jul 5. PMID: 29974813 DOI: 10.1177/1359105318785697
  10. Helen McColl, Craig Higson-Smith, Sarah Gjerding, Mostafa H Omar, Basma Abdel Rahman, Mona Hamed, Aida S El Dawla, Miriam Fredericks, Nicole Paulsen, Gugu Shabalala, Carmen Low-Shang, Fernando Valadez Perez, Liliana S Colin, Aurora D Hernandez, Eliomara Lavaire, Arely Pa Zuñiga, Lucia Calidonio, Carmen L Martinez, Yasser Abu Jamei, Zeyad Awad. Rehabilitation of torture survivors in five countries: common themes and challenges. Int J Ment Health Syst. 2010 Jun 18;4:16. doi: 10.1186/1752-4458-4-16. PMID: 20565852 PMCID: PMC2904711 DOI: 10.1186/1752-4458-4-16
  11. Edward Mills, Sonal Singh, Brenda Roach, Stephanie Chong. Prevalence of mental disorders and torture among Bhutanese refugees in Nepal: a systemic review and its policy implications. International Rehabilitation Council for torture Victims. Med Confl Surviv. Jan-Mar 2008;24(1):5-15. doi: 10.1080/13623690701775171. PMID: 18456987 DOI: 10.1080/13623690701775171
  12. P Scraton, L Moore. ‘Hearing Voices’: Punishing women’s mental ill-health in Northern Ireland’s jails. Int J Prison Health. 2009;5(3):153-65. doi: 10.1080/17449200903115813. PMID: 25757421 DOI: 10.1080/17449200903115813
  13. B Aretxaga. The sexual games of the body politic: fantasy and state violence in Northern Ireland. PMID: 11270664 DOI: 10.1023/a:1005630716511
  15. The ‘Norms of Our Conflict’: The Use of Strip Searching as Gendered Punishment. January 2016 DOI: 10.1057/978-1-137-36330-5_9. In book: Ex-Combatants, Gender and Peace in Northern Ireland
  16. Morag Macdonald. Women prisoners, mental health, violence and abuse. Review Int J Law Psychiatry. May-Aug 2013;36(3-4):293-303. doi: 10.1016/j.ijlp.2013.04.014. Epub 2013 May 1. PMID: 23642339 DOI: 10.1016/j.ijlp.2013.04.014
  17. S Megan Berthold, Peter Polatin, Richard Mollica, Craig Higson-Smith, Frederick J Streets, Caitrin M Kelly, James Lavelle. The complex care of a torture survivor in the United States: The case of Joshua. torture. 2020;30(1):23-39. doi: 10.7146/ torture.v30i1.113063. PMID: 32657765 DOI: 10.7146/ torture.v30i1.113063
  18. Laurence J Kirmayer, Lauren Ban. Cultural psychiatry: research strategies and future directions. Adv Psychosom Med. 2013;33:97-114. doi: 10.1159/000348742. Epub 2013 Jun 25. PMID: 23816867 DOI: 10.1159/000348742
  19. L J Kirmayer, Lauren Ban, James Jaranson. Cultural logics of emotion: Implications for understanding torture and its sequelae. torture. 2017;27(3):84-100. PMID: 30047493
  20. Roghieh Dehghan. The health impact of (sexual) torture amongst Afghan, Iranian and Kurdish refugees: A literature review. torture. 2018;28(3):77-91. doi: 10.7146/ torture.v28i3.111194. PMID: 30649843 DOI: 10.7146/ torture.v28i3.111194
  21. Human Rights Council , Forty-third session, Report of the Special Rapporteur (24 February–20 March 2020), Agenda item 3 “Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development torture and other cruel, inhuman or degrading treatment or punishment”
  22. Marwan Diab, Yasser Abu Jamei, Ashraf Kagee, Guido Veronese. Integrating a public health and human rights approach into mental health services for Palestinians in the Gaza Strip. Lancet. 2018 Feb 21;391 Suppl 2:S27. doi: 10.1016/S0140-6736(18)30393-3. Epub 2018 Feb 21. PMID: 29553425 DOI: 10.1016/S0140-6736(18)30393-3
  23. E Montgomery. Trauma, exile and mental health in young refugees. Review Acta Psychiatr Scand Suppl. 2011;(440):1-46. doi: 10.1111/j.1600-0447.2011.01740.x. PMID: 21824118 DOI: 10.1111/j.1600-0447.2011.01740.x
  24. Rachel Kimerling, Jennifer Alvarez, Joanne Pavao, Amy Kaminski, Nikki Baumrind. Epidemiology and consequences of women’s revictimization. Womens Health Issues. Mar-Apr 2007;17(2):101-6. doi: 10.1016/j.whi.2006.12.002. PMID: 17403467 DOI: 10.1016/j.whi.2006.12.002
  25. Cindy A Sousa. Am J Orthopsychiatry. 2013 Oct;83(4):505-519. doi: 10.1111/ajop.12048. “Political violence, health, and coping among Palestinian women in the West Bank”. PMID: 24164522 PMCID: PMC4545659 DOI: 10.1111/ajop.12048
  26. Sumithra S Raghavan. Cultural Considerations in the Assessment of Survivors of torture. J Immigr Minor Health. 2019 Jun;21(3):586-595. doi: 10.1007/s10903-018-0787-5. PMID: 30006802 DOI: 10.1007/s10903-018-0787-5
  27. Clifford Perera. Review of initiatives adopted for effective documentation of torture in a developing country J Clin Forensic Med. Aug-Nov 2006;13(6-8):288-92. doi: 10.1016/j.jcfm.2006.06.001. PMID: 17055399 DOI: 10.1016/j.jcfm.2006.06.001
  28. Clifford Perera, Alice Verghese. Implementation of Istanbul Protocol for effective documentation of torture – review of Sri Lankan perspectives J Forensic Leg Med. 2011 Jan;18(1):1-5. doi: 10.1016/j.jflm.2010.09.010. Epub 2010 Oct 28. PMID: 21216370 DOI: 10.1016/j.jflm.2010.09.010
  29. Toby Kelly, Steffen Jensen, Morten Koch Andersen, Catrine Christiansen, Jeevan Raj Sharma. A comparative study of the use of the Istanbul Protocol amongst civil society organizations in low-income countries. PMID: 28102187


Our Website





Istanbul Protocol

Human Rights Council