Doctors who work with these victims often rely not on scientific studies but on their own personal observations to assess the long-term impacts of a particular experience.
Harvard psychiatrist Stuart Grassian, who studies prisoners put into solitary confinement, believes from his own personal experience that "people [put into solitary confinement] become loners." Years after being removed from solitary confinement, "they tend to become irritable, hypervigilant, jumpy, fearful and chronically tense." But when asked to testify in a class-action suit against a "supermax" prison that used solitary confinement, he found few scientific studies to support these beliefs.
Research that tried to isolate the impact of solitary confinement on American soldiers kept in Korean P.O.W. camps, for example, was largely inconclusive. Its analysis was complicated by the fact that people put in solitary confinement are usually mistreated in other ways as well.
New research that tries to untangle the horrors suffered by torture survivors recently was presented at the 11th European Conference on Traumatic Stress in Oslo, Norway. Metin Basoglu, a psychiatrist at King's College London, described the statistical techniques he used to single out the mental impacts of "cruel, inhuman, and degrading treatments" that range from threats and isolation to electric shocks and beatings on the feet.
His previous work suggested that the distinction between the harshness of "physical" torture and the mildness of "psychological" torture is a false one. When torture victims from the former Yugoslavia rated the distress caused by different forms of abuse on a scale from zero to four, those techniques that did not involve physical pain were just as distressing, or even slightly more so, than those that directly inflicted pain. "The threat or anticipation of pain may be worse than the pain itself," said Basoglu.
Bosaglu's latest and largest study looked for links between a person's perception of the severity of an experience and the likelihood of later developing PTSD, the most common disorder associated with torture.
By studying hundreds of political dissidents from Turkey and military prisoners of war of the former Yugoslavia -- all of whom were tortured -- Basoglu discovered that deceptively banal mistreatments that may not cause long-term psychological problems when used individually can lead to mental disorders when grouped together or inflicted sequentially.
Consider a situation in which a prisoner is slapped across the face while wearing a hood with his hands tied behind his back. Alone, none of these abuses -- slapping, hooding, or hand-tying -- can predict whether that person will develop a long-term mental disorder. But when the techniques are grouped together, said Basoglu, their effects multiply and raise the likelihood of developing PTSD. The psychological trauma of being slapped in the face is made much worse by a blindfold and handcuffs, which prevent victims from anticipating and shielding themselves against the blow.
"We find strong correlations between clusters of events and mental health outcomes," said Basoglu.
Other combinations that predicted PTSD included putting people in stressful, helpless positions to maximize the impacts of verbal threats and stripping their clothes off to enhance the humiliation of being sprayed with cold water.