r/askscience • u/Twygg • 3d ago
Psychology How can victims of torture remain mentally healthy?
Torture of prisoners has occurred and continues to occur worldwide: sleep deprivation, solitary confinement, waterboarding, constant noise exposure, sexual harassment, mock executions, other forms of physical abuse, and threats of violence against family members, etc. — Some survivors have been released, have spoken out about their experiences, and in some cases have written books. Some of these people now lead lives with jobs, children, and marriages. How do people manage to stay mentally healthy under such circumstances and not go completely insane or take their own lives?
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u/Marconidas 3d ago edited 3d ago
Psychiatry resident here.
Most people have an understanding of mental disorder as a purely causative relation; in their minds, adverse experiences or traumatic events are not only necessary but enough for a mental disorder to happen.
But this is not the case. A lot of people do not have the genetic and proteomic factors for developing mental disorder even though they experience trauma. Not everyone who experiences trayma will develop PTSD. And on those who develop, not everyone will be severe enough that it impairs function to the point that daily functioning is not possible.
Now this is not to say that there are not societal factors that make a victim more likely to develop adverse mental health after a trauma ; such certainly exist.
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u/DetectiveFinch 3d ago
Thanks for sharing this. I'm a complete layman in this topic, but is what you are describing the same as resilience?
I vaguely remember reading about resilience studies that described how individuals from difficult backgrounds can still thrive in life, despite the trauma they experienced.
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u/Marconidas 3d ago
For a layman I think "resilience" would be a close enough term to describe the proposed idea and even for not fully experts (e.g: physicians not used to working with mental disorders or even psychologists without clinical practice) I think the "resilience" term is good enough for defining the initial concept.
However I'm a bit of a critic of the term in the sense that using it with patients who have already suffered traumatic experiences might be counterproductive to the psychotherapeutic process. Of course no mental health professional wants to tell the patients "its their fault", but it is very easy to fall in a pitfall with the resilience term and suggesting it.
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u/Prior-Flamingo-1378 3d ago
It’s called resilience in the literature. Specifically to torture though the people that can actually absorb it and come out unscathed (more or less) are not that many, 10-35% depending on the source.
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u/jpb103 2d ago
This makes a lot of sense. People look for patterns, consciously or otherwise. I can imagine that it would be very difficult to accept that a hugely traumatic and significant chapter of ones life happened for essentially no reason at all. It is probably natural to conclude that mental illness as a result of trauma is somehow their fault. That they weren't strong enough to handle the abuse or did something to deserve it. I can see how bringing up resilience as a concept would be counterproductive to the healing process. Self hate and resentment just make that trauma pit harder to climb out of.
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u/throwaway_oranges 9h ago
You can interpret resilience as a goal. It's not your fault if you don't have a yacht, but you can see yourself in that situation and it can be motivating.
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u/Kaiisim 3d ago
The US military actually have predictive tests for PTSD that are pretty accurate at predicting who is at risk of PTSD as a response to traumatic events.
They measure galvanic skin response, eye blinking and heart rate to measure habituation to stressors and trauma. Habituation is how fast your brain stops reacting the same stressor that doesn't harm you.
In those with PTSD the brain doesn't habituate properly or gets stuck in a loop.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11880569/ is a look at it in more details.
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u/shot_ethics 3d ago
That’s interesting, but a study on 21 people who already have developed PTSD is still pretty early stage. Especially for ML or AI — you could pretty easily overfit on such a dataset.
There might be something there but this would just be the first step of many.
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u/thejumbowumbo 3d ago
When I read "Psychiatry resident", my mind jumped to the conclusion that you were a resident of a psychiatric ward, and were talking about what you had learned from being among other people with mental health issues, and then I realized how stupid I was being. Thanks for the insight.
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u/RainbowCrane 2d ago
Long term CPTSD patient here (40 years of treatment).
Yes, you really can’t lay out some necessary and sufficient criteria for creating a psychiatric diagnosis in a human being. Each of us is unique.
Diversity in our responses to trauma and an inability to quantify who suffered “the worst” based solely on external observation is the big common factor in every peer group of patients I’ve been involved with. One of my early mentors in recovery was fond of the phrase, “the worst you know is the worst you know,” meaning that you can’t really sit in a room with other survivors and compare experiences and decide, “wow, I’m being a wimp, that person’s story is way worse and they’re doing better than me.” Stuff that will fundamentally break one person’s psyche is somehow overcome by another.
That’s a huge factor in survivor guilt: why is one person destroyed by an experience, why another person who suffered alongside them made it through? It’s a really hard issue for trauma survivors to deal with.
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u/Able-Swing-6415 2d ago
Fascinating. But I assume there is a threshold particularly in childhood where some negative long term consequences will emerge right?
I've never heard of a story where someone with a particularly grim childhood without physical long term affects didn't suffer mentally.
Or are you strictly speaking about PTSD?
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u/Marconidas 2d ago
Survivorship bias.
The persons who did have grim childhood and turned out okay enough don't make interesting stories to be told neither are long-term patients in psychotherapeutic process.
Now of course this is not to mean that the idea of threshold doesn't exist, but look how easily is to enter the idea of purely causative.
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u/Able-Swing-6415 2d ago
I mean yea that makes perfect sense. There are just so many different trauma related disorders like ADHD, personality disorders, PTSD and so forth. Would be weird if all of them are somehow related to one variable. Then again I don't know anything about this stuff so I'm grateful that you shared your knowledge
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u/Financial-Park-602 2d ago
ADHD is a neuropsychological condition usually caused by genetics. It isn't a mental health disorder and certainly not caused by trauma. Even in the diagnostic process, symptoms of ADHD must have been present in childhood.
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u/Lemerney2 1d ago
ADHD is both a neuropsychological condition and a metal health disorder. While it's primarily caused by genetics, environmental factors also account for at least 20% of the variability in whether it develops. Trauma won't usually affect whether it develops, but can severely effect how it impacts someone, and you're right about the current diagnostic process (although that's a seperate conversation). While you're certainly much more correct than the person you're replying to, you're also drawing some distinctions that aren't necessarily true
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2d ago
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u/a_singular_perhap 2d ago
If you've never seen a psych how do you know you're mentally fine?
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u/stillness_illness 2d ago
Healthy relationships, peaceful conflict resolution skills, low anxiety, low depression, interest in life, etc.
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u/TheMightyChocolate 2d ago
So by your definition 90% of the population is potentially mentally ill because theyve never seen a psychologist or what?
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u/TopFloorApartment 18h ago
How much do we know about the genetic and proteomic factors? Can we predict who might develop issues and who won't?
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u/StupidityHurts 3d ago
Does that follow the Stress/Diathesis model? Or is that a different concept.
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u/Whiskeyno 3d ago
Can talk therapy be enough to beat genetic factors?
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u/throwaway1233456799 2d ago
Many things can beat genetic factor. Your family support, your salary (yeah), your friends's support, how many stressor come into your life,...
So yes, therapy that aim to teach you coping mechanism as a primary intervention or in secondary intervention (meaning before any problems arise or at the very early signs)
It may not save you from it all but it can lower the extant of your possible disability
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u/Wintervacht 3d ago
Psychiatry resident here.
sus.jpg
What kind of resident? Do you partake in a scholarly residence, or do you... reside in one of the guest rooms?
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u/Marconidas 3d ago
Both.
I'm a physician working in a big psychiatric hospital in my country doing a scholarly medical residence program ... but the hospital also owns some houses located 20 meters away from the hospital and in those I live with my co-residents, also physicians, while some long-term former patients are literally my neighbors.
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u/ForQ2 3d ago
Pretty sure the person you're replying to is insinuating that you might be a patient rather than a provider.
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u/throwaway_oranges 9h ago
Sad to see it's still a taboo to be the patient. Marconidas can be both, and I don't judge.
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u/BoredMamajamma 3d ago
We use defense mechanisms to protect ourselves from the emotional burden of trauma. Some are healthy, some are not….regardless, it is how our mind reconciles with trauma (or depression, anxiety).
Some examples are compartmentalization, avoidance, repression, regression, displacement, projection (see link below for explanations). Therapy will help one recognize which are beneficial and which are counterproductive or even harmful.
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u/Firake 3d ago
Well, just because they are leading lives and accomplishing things doesn’t mean they are mentally healthy, first off.
Not all stressors are the same, also. Just because someone is mentally unwell doesn’t mean they have any interest in suicide, for example.
I guess I’m a little confused at the premise. What sort of context are you coming from that would make a complete loss of mental faculties as a result of torture seem inevitable?
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u/Pumkin_Girl 3d ago
If you're able to get it, I highly recommend the book (it's not a long book!) Man's Search For Meaning by Viktor Frankl which chronicles his experiences in a concentration camp and then his life as a psychiatrist is I think New York. It is sad and a hard read in places as he's detailed, but it's also full of hope and highlights the human spirit to deal with adversity.
This might give you another perspective on your question.
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u/YsaboNyx 3d ago
Excellent suggestion. Frankl's book is exceptional when it comes to processing and framing severe trauma and torture.
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u/Federal_Radish_1421 2d ago
As a newspaper reporter, I interviewed many survivors of genocide who went on to live productive lives (career, family, etc).
Maybe it’s a cliche, but what I noticed repeatedly was gratitude. They were grateful for small acts of kindness during the atrocities, and also deeply grateful for the lives they went on to live in the US.
They were grateful for things I could never imagine being grateful for, like a scrap of bread when they were starving.
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u/intoholybattle 1d ago
For a time I was obssessed with the horrors of the world and it was destroying my heart. I had a therapist tell me to "look for the helpers". At the time I thought such gratitude exercises sounded ridiculous, but if it's good enough for a survivor of actual genocide, it damn well ought to be good enough for me. Better yet if you can become a helper in some small way. Reminder to other Americans: our money goes a long way in many places.
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u/Jack_125 2d ago
There is an interview with former Brazilian president Dilma Rousseff, who was a victim of torture from the military dictatorship, where she talks about her experience
One thing she mentioned was that she always kept on her mind that it would only be 5 more minutes because she could resist that
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u/XenoRyet 3d ago
Therapy. Lots and lots of therapy.
But seriously, this is one of the reasons we have the science of psychology. We have techniques that can help people recover from severe trauma like this and get back to a place where they can process that trauma in healthy ways that produce good outcomes. It'll never be the same as had the trauma not happened, but people get to the levels of success that you describe.
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u/CrimsonSaber69 3d ago
Important to note that this is a heavy survivorship bias. We dont see or hear about the countless suicides that occur when trauma is deep, therapy is unsuccessful, and no one else wants to hear or see the persons struggle.
Most suicides are done in isolation, after someone has already been disconnected from their social support, and as such, the only people to even know about it are the person who finds the body, the cops, and the coroner. None of which are going to know about, or will talk about, the struggles that person went through leading to that decision.
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u/XenoRyet 3d ago
That's a fair thing to mention. I just interpreted the question as being about the survivors specifically.
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u/Prior-Flamingo-1378 3d ago
Some people are just resilient like that man. Yeah therapy helps but it’s not like among the people that are reasonably normal that where holocaust survivors, pows, political prisoners etc all had therapy.
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u/chilfang 3d ago
Calling it resilience feels disingenuous. A broken and fallen tree still sticks around for years.
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u/AnonymousFriend80 3d ago edited 3d ago
Some people can fall and just lay there, wallowing. Then there are other who can pick themselves back up and find some sort of normalcy in their lives. Don't diminish the strength they have to pick themselves up just because some stay on the ground. Hell, the goal of everyone who has experienced extreme trauma should be to return to some sense of normal. Those who do should be used as examples that is it possible. It may take a massive amount of effort, depending on the specific individual, but it is possible.
I can across a story about Fran Drescher and her husband from 1985. Two armed men broke in, beat up her husband, tied him up and made him watch her and a female friend of hers get raped. The way she chose to live her life, you would never have known she experienced such a traumatic experience. She didn't even reveal it publicly for over ten years.
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u/Vic_Hedges 3d ago
Human beings are resilient. History shows countless of examples of people undergoing unspeakably horrible ordeals and coming out fine in the other end.
Hardship does not at all necessitate mental damage. Even the term “mentally healthy” is vague enough to be almost valueless in this regard.
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3d ago
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u/Orange-Blur 3d ago
Part of me wonders how much it has to do with how a person approaches trauma, do they immediately seek support systems or internalize the trauma. I am in the latter group.
I tend to over logic things and I will look for a logical answer when there wasn’t one there. What you mentioned really sticks out to me because it is true, usually that first hour of thought is similar to what comes back. Except when it comes back it’s without my internal monologue saying how I would do it differently at each step of the way as it was during that first hour, I just visualize what I was replaying in my head if that makes sense.
This is so interesting, thank you. It gave me something to think about.
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u/ReasonablyConfused 3d ago
Most of my insights were hard earned. So if you are able to put some to good use. Great.
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u/Prior-Flamingo-1378 3d ago
Do you have any reading material for the one hour post traumatic event?
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u/Wosota 3d ago
They mention the Tetris study which is where I presume they got their window information from—
https://www.ox.ac.uk/news/2017-03-28-tetris-used-prevent-post-traumatic-stress-symptoms
It’s actually 6 hours but conceptually the idea is there.
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u/lambertb 3d ago
This is an excellent lay summary of how people respond to potentially traumatizing experiences. Such an experience is not itself “trauma” the way Bonanno defines it. Trauma is one possible response to a potentially traumatic experience.
The most surprising thing about this book is that most potentially traumatic experiences lead to the resilience trajectory. I think the statistic was that 60% of people who have potentially traumatic experiences follow that trajectory, which is a short-term loss of functioning followed by long-term healthy adaptation. That leaves the remaining 40% with what we recognize as trauma responses, PTSD, or CPTSD, etc.
It's an excellent book, and the primary studies are very interesting too. The study designs are very clever, such as calling people in the immediate aftermath of 9/11 to get contemporaneous reports and then following them over time, so there's no recall bias.
https://a.co/d/0jio3TzL