Subjective Meaning of Torture as a Predictor in Post-Torture Psychological Response

Paker, M. (2000). Subjective Meaning of Torture as a Predictor in Post-Torture Psychological Response. Dissertation Project. New York: New School for Social Research.

EXTENDED ABSTRACT

Introduction

Despite many efforts launched by international and national organizations, state-sponsored torture remains to be the most commonly used form of organized political violence and human rights violation worldwide. According to Amnesty International, in 1997, 117 countries used torture at varying degrees with the general aim of maintaining status quo. The widespread and intense use of torture in many countries imposes a serious public health problem and, with the fast flow of immigrants, the impact of this problem reaches beyond the boundaries of repressive regimes and conflict-ridden regions of the world.

Numerous studies in the last two decades have established that torture is a serious risk factor for developing subsequent mental health problems, including PTSD, depression, and anxiety. Although there is a more or less consensus with regard to the psychological aftereffects of torture, etiological factors and treatment approaches are still much debated. On the one hand, some researchers maintain the traditional dose-effect paradigm of the general psychotraumatology field and assert that the higher the severity of torture the higher the level of psychopathology. On the other hand, several other researchers have increasingly challenged this position with a more interactive paradigm taking into account event-related and subjective factors together. In the general psychotraumatology field, based on the findings regarding epidemiology (relatively low prevalence rates of psychopathology in non-clinical samples), vulnerability factors, and high comorbidity, Yehuda and McFarlane (1995) pointed out the possibility that the emergence of chronic PTSD following exposure to a traumatic event may represent the manifestation of an underlying diathesis rather than a normative adaptation to environmental challenge.

Somewhat parallel with this “paradigm shift”, in our previous reports, based on a comprehensive research project on the psychology of torture survivors in Turkey, we found that: 1) Torture had some long-term negative psychological effects independent of those related to uprooting, refugee status, and other traumatic events in a politically repressive environment. Yet, that effect was far less than would be expected from the dominant literature, given the very high severity level of trauma. The tortured-political survivors in this study seemed to have resilience against the effects of torture (Basoglu, Paker, et al., 1994). 2) Objective measures of severity of torture (types of torture and number of exposures) did not predict post-torture psychological problems whereas subjective severity ratings did (Basoglu & Paker, 1995). 3) The torture survivors differed from non-tortured political activists in having a more negative appraisal of the police and a more positive self-image. Torture had no effect on appraisals of others. The results also suggested that a strong belief system and lack of illusory beliefs about safety, trust, and justice might protect individuals against the traumatic effects of torture. (Basoglu, Paker, et al., 1996).

This dissertation project, after conceptually delineating two types of subjective meaning of trauma (SMT), that are private and contextual, aimed to explore the predictive role of contextual subjective meaning of torture (CSMT) in chronic post-torture psychological response. The two types of SMT were defined as follows: 1) Private SMT: The meaning here is derived from personality structure and, thus, is unique to the traumatized individual. 2) CSMT: The meaning here is derived from the social, political and cultural context in which the traumatic event occurs and is represented in the event-related schemas of the traumatized person. This type of meaning can be shared with others who experience the event in similar contexts, if they share similar event-related schemas. It is this second type of subjective meaning that is the basis of this dissertation project, and its background can be found in the schema-based literature on traumatic stress.

Study 1

The project consisted of two consecutive studies both of which were conducted in Turkey. Study I involved four groups: Tortured political activists (T/A, n=85), nontortured activists (n=55), nontortured nonactivists (n=55), and tortured nonactivists (T/NA, n=30). Various self- and assessor-rated instruments were used to assess the participants’ trauma history and psychopathology levels (PTSD, Anxiety, and Depression). It was hypothesized that: 1) Objective severity level of torture in T/A would be greater than that in T/NA; 2) Torture would increase the level of psychopathology in both T/A and T/NA; and 3) Paradoxically, psychopathology level in T/A would be less than that in T/NA. Results confirmed these three hypotheses.

Study 2

Study II, aiming to explore the role of CSMT in a more direct and in depth way, involved two groups: T/A (n=30) and T/NA (n=27). Besides the instruments used in Study I, an open-ended interview was also utilized to tap survivors’ worldviews and CSMT. Based on these interviews, two new scales were devised to measure these two constructs. It was hypothesized that: 1) T/A could make sense of their torture experiences more easily than T/NA, based on deeper and more comprehensive meaning structures; 2) Torture would lead to increased political commitment as measured by “worldview”; and 3) The less meaningful the torture experience, the higher the psychopathology. Results, overall, confirmed these three hypotheses.

Conclusion

Based on the overall results of the project, the following conclusions were drawn:

1) In repressive regimes like that of Turkey, human rights abuses such as state-sponsored torture targets first political dissidents; then their friends/relatives; then political or ethnic or religious groups; and finally, the society as a whole. The results of this study highlight the nature and extent of the torture experiences and point to the need for more effective action against torture.

2) Exposure to torture is a serious risk factor for subsequent psychopathology. However, especially chronic forms of torture-related psychopathology are exceptional rather than the norm. Furthermore, the current study results raise serious doubts about the normative nature of acute stress reactions. Thus, exposure to a traumatic event is a necessary, but certainly not a sufficient, condition for post-traumatic pathology. Normative paradigm in psychotraumatology should be replaced by an interactive paradigm, which takes into account contextual, subjective, personal, as well as objective (event-related) characteristics in understanding post-traumatic psychological response.

3) Political activism moderates the risk for post-torture psychopathology, and contextual subjective meaning of torture which is derived mainly from survivors’ torture-related worldviews has a predictive power over post-torture psychological response. Political activists have an interpretive framework which allows them more effectively to make sense of their torture experiences, and this cognitive mechanism appears to be a protective factor against psychopathology. Non-activist survivors’ level of political commitment tends to increase after torture, suggesting an effort to acquire a coping mechanism which was not available for them before torture.

4) Contextual subjective meaning of torture should be taken into account in the assessment and treatment of torture (and possibly all trauma) survivors. This result indicates that behavioral therapy or pharmacotherapy, which do not deal with “subjective meaning,” may, by themselves, not be sufficient in the treatment of trauma survivors. Therapies that operate through subjective meaning, such as cognitive, psychodynamic/psychoanalytic, and phenomenological approaches, might be used as a part of an integrative approach.

References

Basoglu, M., Paker, M., Paker, O., Ozmen, E., Marx, I., Incesu, C., Sahin, D., & Sarimurat, N. (1994). Psychological effects of torture: A comparison of tortured with non-tortured political activists in Turkey. American Journal of Psychiatry, 151, 76-81.

Basoglu, M. & Paker, M. (1995). Severity of trauma as predictor of long-term psychological status in survivors of torture. Journal of Anxiety Disorders, 9:4, 339-350.

Basoglu, M., Paker, M., Ozmen, E., Tasdemir, O., Sahin, D., Ceyhanli, A., Incesu, C., & Sarimurat, N. (1996). Cognitive effects of torture: A comparison of tortured and non-tortured political activists and controls. Journal of Abnormal Psychology, 105, 232-236.

Yehuda, R. & McFarlane, A.C. (1995). Conflict between current knowledge about post-traumatic stress disorder and its original conceptual basis. American Journal of Psychiatry, 151:12, 1705-1713.

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You can review the full presentation based on this dissertation study. The presentation was made at the International Trauma Congress in Istanbul on November 30, 2012.