Post-traumatic Stress Disorder

It's long been known that people subjected to abuse or torture often suffer long-term injuries to their mental health. Less often discussed is the injury to the person who commits the abuse. But it appears that the damage abuse inflicts cuts both ways.

There's not much research into the trauma inflicted on torturers, but what little there is suggests that torture has two victims.

One study that documented psychological damage to veterans who engaged in torture was the National Vietnam Veterans Readjustment Study. The NVVRS was set up by Congress in 1983 to research Post-traumatic Stress Disorder (PTSD) and other psychological problems that Vietnam veterans suffered as a result of the war.

The study found that increased exposure to combat was correlated with increased psychological trauma. Those findings are well-known. But a lesser-known part of the study also looked at "abusive violence" - including torture - and found that it, too, had a high correlation with PTSD.

"We can go into long philosophical discussion of torture, and is it effective or not, is it justifiable," said Dr. Richard Kulka, chief author of the study. "But the one thing I think that the research over all those years and different conflicts has shown is that for those who might be doing it as part of their duty … it can have very consequential effects … on their mental health."

According to Kulka, the NVVRS found that abusive violence had as strong a correlation with PTSD as combat violence, and perhaps stronger. Included in the definition of abusive violence was "torturing, wounding, or killing hostages or POWs [prisoners of war]."

Kulka says the research turned up another interesting fact.

"In general, most people are not going in there predisposed to do these things," he said.

That is, military personnel who commit abuses during war were not necessarily abusive people beforehand.

"There was speculation at the time that said, look, people who participate in abusive violence in Vietnam are probably people who were abused at home, they were abused as children, etc." said Kulka. "That wasn't a very strong relationship at all. In fact I think it was an insignificant relationship in our data."

"The social science on this…is unequivocal," added Darius Rejali. Rejali, a professor of political science at Reed College and author of Torture and Democracy. "It's the situation, not the disposition, that leads us to torture."

But not everyone who has mistreated prisoners is psychologically traumatized.

"What cases show repeatedly is whether or not you develop trauma related to violence is highly dependent on one factor alone, which is guilt," said Rejali. "That is to say, the extent to which you feel that you're guilty in the process."

David Foy, a professor of psychology at Pepperdine University and a research consultant for the Veterans Administration's National Center for PTSD, is researching the concept of moral or spiritual trauma among Iraq and Afghanistan veterans, which may include prisoner abuse and other acts of violence.

"We know that participating in events beyond what are normally expected…contributes to PTSD," said Foy. "We also know that doing things in wartime duties that challenge someone's sense of moral correctness, even if they're ordered" can lead to psychological trauma.

"[Committing acts of abuse] leaves them with an altered sense of correctness about themselves," Foy said. "That's what we would call a 'moral conflict' or more generally an inner conflict that may be connected to PTSD…So, there's the mental health consequence…but then there's the spiritual injury or moral injury."

Lara Battles is a psychologist who has treated a wide range of trauma cases, including one member of a unit involved in abusing Iraqi detainees. Battles says it can be hard for soldiers who've committed such acts to live with themselves. "Whether it was officially sanctioned by the Army I don't know," said Battles. "What I do know is that it was not sanctioned by their ethics when they entered the army. It was not sanctioned by their hearts."

"The reality is that often in war people are used for activities that are completely unsavory and unjustifiable, and after the war they're tossed aside," says Rejali.

Rejali says soldiers who've been traumatized by their own abusive actions need to get help quickly, because the longer they keep their secret, the more deeply entrenched the symptoms of PTSD can become.

But the stigma attached to detainee abuse and torture can make it harder for members of the military to seek treatment. Some veterans might also be reluctant to get help because they fear recriminations.

Bob Ireland, the program director for mental health policy at the Department of Defense, says the military will help any service member with a psychological problem, regardless of its source. But he acknowledged that there are disincentives to seeking help. For example, a Department of Defense regulation passed in 2006 compels military medical personnel to report prisoner abuse they hear about.

"The service member who is suffering with [abuse-related trauma] is confronted with that issue," said Ireland.

"So for the person who's suffering, if they're coming to the edge of suicide…they always have a choice to engage in what the real issues are or not. And the support for them is there… Which way would you err in that regard?"

Torture experts and clinicians often agree that publicly addressing the full costs of torture can help those veterans who were traumatized by the experience.

"The first step towards the dealing with these things is for the society to recognize the …conditions which they put these boys through," said Rejali. "And that takes a tremendous amount of political will - it requires us to acknowledge that we asked things of soldiers that went well beyond asking them to fight on behalf of their country and things we should not have asked them. That kind of public acknowledgement is absolutely critical."

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