ISTSS' Official Statement on Torture in the Modern World
In response to member concern brought to the ISTSS board's attention by the society ombudsperson, and because torture is a pressing national and international issue that has direct implications for ISTSS's central mission to reduce traumatic stressors and their immediate and long-term consequences, the society has released the following statement, drafted by Stuart Turner, MD, with input from the ISTSS Executive Committee and approved by the board of directors.
Nonetheless, although responses are more complex than this, PTSD is also strongly predicted by experience of torture, even in low-income settings where there has also been violent civil conflict (de Jong et al., 2001) such as Algeria, Ethiopia, Cambodia and Gaza. This is an important study as it also helps to confirm that PTSD is not restricted to Western communities and cultures. It highlights the need for culturally appropriate and sustainable services in many parts of the world--a topic on which an ISTSS task force has produced some international training guidelines (Weine et al., 2002).
We have taken a leading role in our work and writings in opposing torture and advocating rehabilitation services. For example, past presidents Yael Danieli (2002), Bonnie Green, Matt Friedman and John Fairbank (2003), Terry Keane (2001 & 2003), and John Wilson (2004) have all produced important books dealing with this subject. The Society has a long and honorable history of collaboration with the United Nations and other agencies dealing with human rights.
Special Roles of Health and Social Care Professionals
The United Nations has set out these ethical principles in a number
of documents, for example stating that "health personnel ... charged
with the medical care of prisoners and detainees have a duty to provide
them with protection of their physical and mental health and treatment
of disease of the same quality and standard as is afforded to those who
are not imprisoned or detained" (
Recently, ISTSS has circulated a consultation document in which we have set out some key principles--for example that our members should adhere to relevant professional codes of ethics and to pertinent international, national and local laws governing their activities. In cases where local laws might mandate or encourage unethical behavior that could potentially harm, we as clinicians should seek consultation, try to resolve the situation within the confines of law, try to change the law, and ultimately strive to choose a course of action that maximizes the welfare of the people. We should strive to ensure that any working environment for which we are responsible is consistent with, and encourages, ethical behavior.
de Jong, J.T.V.M., Komproe, J.H., Van Ommeren, M., El Masri, M., Araya, M., Khaled, N., Van De Put, W.A.C.M., and Somasundaram, D.J. (2001), Lifetime Events and Posttraumatic Stress Disorder in Four Postconflict Settings. Journal of the American Medical Association, 286, 555â€“562.
Eitinger, L. (1964), Concentration Camp Survivors in Norway and Israel. Allen & Unwin: London.
Gerrity, E., Keane, T.M., & Tuma, F. (2001), The Mental Health Consequences of Torture. Kluwer Academic/Plenum Publishers: New York.
Green, B.L., Friedman, M.J., de Jong, J.T.V.M., Solomon, S.D., Keane, T.M., Fairbank, J.A., Donelan, B. and Frey-Wouters, E. (eds) (2003), Trauma Interventions in War and Peace; Prevention, Practice and Policy. Kluwer Academic/Plenum Publishers: New York.
Schnurr, P.P., Kaloupek, D.G., Turner, S.W., Bloom, S., and Kaltman, S. (2004), Another Grand Challenge: Mental Health (Letter). Science 303, 168-169.
Turner, S.W. (2004,) Emotional Reactions to Torture and Organised State Violence. PTSD Research Quarterly. The National Center for PTSD.
Weine, S.M., Danieli, Y., Silove, D.M., Van Ommeren, M., Fairbank, J., and Saul, J. (2002), Guidelines for International Training in Mental Health and Psychosocial Interventions for Trauma-Exposed Populations in Clinical and Community Settings. Psychiatry, 65, 156â€“164.
Wilson, J. and Drozdek, B. (2004), Broken Spirits: the Treatment of Traumatised Asylum Seekers, Refugees, War and Torture Victims. Brunner-Routledge: New York.