Book Review

Torture and Its Consequences: Current Treatment Approaches

N Engl J Med 1993; 329:972September 23, 1993

Article

Torture and Its Consequences: Current Treatment Approaches
Edited by Metin Basoglu. 527 pp. New York, Cambridge University Press, 1992. $95. ISBN: 0-521-39299-3

In 1948 the General Assembly of the United Nations adopted the Universal Declaration of Human Rights. Article 5 of this declaration reads: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” Since then, many international declarations and conventions prohibiting torture and human-rights abuses have followed. Nevertheless, torture and human-rights abuses remain major problems worldwide. It has been speculated that 5 to 35 percent of the world's more than 15 million refugees have been tortured. Add to this the equal number of people displaced within their own countries, and the number becomes staggering. Not surprisingly, the physical and mental health of torture survivors is receiving increasing attention from the medical and psychiatric communities. Focus has shifted from documentation of physical injuries to advocacy, clinical care, and scientific research. Basoglu's Torture and Its Consequences contains contributions from around the world and serves as a compendium of the current theories and practices in the emerging field of torture treatment and refugee mental health.

This book is important not only for the vast ground it covers, but also because it raises to a new level the discourse on the fundamental issues of the prevention of torture and human-rights abuses, the validity of diagnostic constructs, and the rehabilitation of survivors of torture. In the outstanding first chapter, Richard Mollica identifies the task at hand; he proposes a philosophy for this new science based on collecting life histories of torture survivors, compiling phenomenologic descriptions of clinical and sociopolitical practices, studying unusual cases that challenge accepted norms, and generating hypotheses based on “radical theories.”

Although core symptoms of a trauma-related disorder probably do exist cross-culturally, torture-related illnesses are widely variable. As one can see when reading this book, clinicians and researchers often assume that severe trauma produces a single disorder that will respond to a predetermined treatment regimen. Acts of torture and their physical and psychological consequences are as diverse as the societies in which they are found. Cambodian women raped by the Khmer Rouge, Vietnamese men imprisoned for a decade in Communist reeducation camps, South African children detained under the apartheid system, and Latin American political prisoners present widely diverse stories of trauma; the unique cultural meaning of the torture has to be understood for each group. Historically, the conceptualization of torture and its sequelae has too often reflected the theoretical and ideological biases of the particular researchers and clinicians.

Basoglu juxtaposes chapters by authors who prescribe generic treatments for all survivors of trauma or torture with chapters devoted to torture in particular countries. In his own chapter on treatment, he points out that “no controlled evaluation of treatment outcome has been undertaken.” The examination of the phenomenology of the experience of torture in the context of the individual person's culture will carry the field of torture treatment and refugee mental health to a more sophisticated level. Dowdall's chapter, “Torture and the Helping Professions in South Africa,” is an excellent example of this important process. This juxtaposition exposes and highlights the need for phenomenologic descriptions in order to formulate creative preventive and rehabilitative models with measurable outcomes. The book would be of even greater value if Basoglu had included chapters by anthropologists, sociologists, epidemiologists, and others from related fields who could lend their expertise and their methods for this purpose.

Torture and Its Consequences is highly recommended reading for mental health clinicians, researchers, and human-rights advocates working in the fields of trauma, torture treatment, and refugees' mental health.

Kathleen Appleton, M.D.
Indochinese Psychiatry Clinic, Boston, MA 02135