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Book Reviews   |    
The Mental Health Consequences of Torture
Reviewed by Janet Eddy Ordway, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.7.1049
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edited by Ellen Gerrity, Terrence M. Keane, and Farris Tuma; New York, Kluwer Academic/Plenum Publishers, 2001, 375 pages, $49.50

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The Mental Health Consequences of Torture is a valuable and long overdue book. Two of its editors—Ellen Gerrity and Farris Tuma—are with the National Institute of Mental Health (NIMH), and the other—Terence M. Keane—is with Boston University School of Medicine. The research on which this book is based was initiated after an NIMH-sponsored conference held in 1997, which included a panel of international experts and torture survivors. The conference led to a working group and ultimately to the writing of The Mental Health Consequences of Torture.

Torture, the most serious abuse of human rights, occurs in 120 of the world's 204 countries, causing psychological, physical, and economic problems for the affected individuals as well as their families and communities. The authors of this book believe that "torture" as defined by the World Medical Association and the United Nations, focusing only on the individual, is too narrow. They therefore define it more broadly as "an act of terrorism aimed at instilling a paralyzing fear not only in individuals but also in the family, the community, and society."

Sister Dianna Ortiz of the Guatemalan Human Rights Commission wrote one of the book's most moving chapters. Her chapter includes direct quotations from torture survivors, who provided permission to use their words anonymously. Because this is the leading chapter, it sets the tone for the contributions by the other 25 authors, who describe particular aspects of torture and terrorism. Included in the chapters is a discussion of mental health changes among torture survivors, the neurobiological models of posttraumatic stress disorder, and economic burdens. The book also includes discussions of assessment, mental status, interventions, public policy and law, and restorative justice. The end of each chapter lists the author's recommendations for change and an extensive bibliography.

Although there is much discussion about torture and terrorism that occur in other countries, The Mental Health Consequences of Torture includes a large section on the impact of rape, sexual and physical assault, homicide, and domestic violence, all of which we see here in the United States.

This book is a must for anyone who is involved with the treatment of violence and its consequences. Clinicians, researchers, policy makers both at home and abroad, those in the legal profession, and the victims themselves, if they are so inclined, will find this book well worth reading.

Dr. Ordway is affiliated with the Maine Department of Behavioral and Development Services, Region III, and Eastern Maine Medical Center in Bangor.

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