The concept of Torturing Environments is a new one that shows promise in the assessment of problematic conditions in which the combination or accumulation of coercive methods might amount to torture (7), as the Special Rapporteur against Torture has recently acknowledged (19). The Torturing Environment Scale (TES) is the first tool to assess the construct systematically. The present study is the first to apply the TES to a representative sample of torture survivors and assess its psychometric characteristics. According to the "known group" methods (21), the TES showed differences by critical variables in the analysis of the experience of SOTs and exhibited agreement in the expected direction as suggested by previous studies, qualitative reports, and field workers and human rights groups from the Basque Country (8, 13, 15, 22–26). Moreover, our data suggest that the TES has good construct validity as measured by its good discriminative power. In addition, our results are highly consistent with previously published data from the same sample that explored torture methods and long-term sequelae applying the Istanbul Protocol checklist of torture methods (12, 23, 29).
Our results support our initial hypothesis of a different profile of torture by gender. Accordingly, the TES was able to discriminate gender profiles in torturing environments in the Basque country, as described in previous studies in this context (12), and in line with data from other contexts like Balkans (27), French-Algerian War (28) and South Africa (29), among others. We also found differences in the torturing profile between the different security forces involved in the detentions. The Civil Guard used more manipulation of environment, fear, pain, and attacks to identity as compared to National Police and local Basque police (Ertzaintza). These results are in accordance with previously published qualitative research conducted on similar samples, where Civil Guard was described as using more violent methods such as electrodes and bathtub torture whereas survivors more often described National Police and Ertzaintza as conducting interrogations with blows and very long waits but without harsh physical assaults (7). Finally, our third hypothesis regarding the evolution of torture environments over time was only partially supported. Although the use of psychological methods of torture, aimed to attack the sense of identity and self, has increased through the years, physical pain as a fundamental approach has remained throughout the decades. In qualitative studies, survivors from the Basque country reported that torture evolved with time to more psychological methods and that torture was mostly physical during the 1980s (13). However, this does not appear to be confirmed by our data, most likely due to the small number of participants in our study who were tortured during the 1980s. We cannot discard also recall problems. We have not found directly comparable studies from other countries, although a sample of torture survivors from the Yugoslavian civil war reported gender differences in torture methods and sequelae that coincide with our results (27). Taken all together, there is substantial evidence that there is a tendency over time and especially in the later years to target psychological processes in an attempt to leave no marks and have shorter detention periods. However, interrogators do not renounce physical coercion. Further studies will have to explore if this was specific to the Basque context or if it is part of a more global tendency.
The TES showed different degrees of internal consistency across its eight Conceptual Blocks. Values of categorical omega were acceptable for Sexual Integrity, Identity and Coercive Interrogation but very low for Fear and Need to belong. Different factors may have influenced these low values. Some factors are related to the structure of the scale, as suggested by low intercorrelations among individual items or a small number of items in some blocks. A potential workaround would be to increase the number of items in the blocks with lower omega values (30). Also, the sample might be too homogeneous in terms of the experience of detention and interrogation (31). For instance, the conceptual block Need to belong includes only four items, with most participants scoring positive as all detainees were submitted to incommunicado detention. The homogeneity of the sample is, at the same time, the principal strength and one of the limitations of the study. Additional studies are needed in other more heterogeneous samples. The information arising from the analyses within this group is especially useful while conceptualising the Basque Country conflict. More exploratory studies conducted in other contexts and conditions will add essential knowledge regarding the generalizability of the results and the usefulness of the scale. However, the TES has confirmed what was suggested by previous qualitative studies based on the Istanbul Protocol, the standard of reference in the assessment of torture allegations, which suggests the robustness of the scale (29). Finally, there is also the concern that some subjects, especially those detained during the 1980s, and those detained by Ertzaintza, were underrepresented.
We consider this study to have several strengths. First, it shows results from an extensive sample of torture survivors assessed using the Istanbul Protocol and the TES. The reliability of these expert forensic assessments has been appraised elsewhere (29). The magnitude of the sample and the careful process of applying the TES with a high inter-rater k coefficient suggests that it can be used in research without intensive training. The scale is offered free to the scientific community to use through a website of the Project (www.psychosocial.info).
The TES is not a substitute for a clinical or an ethnographic interview. Instead, it helps to organise the information using a teleological approach. By teleological, we mean that the focus of the TES is not on listing methods, but the target of each method in terms of a human mind-body system. Hence, it opens new avenues for quantitative research on contemporary torturing environments and its correlation with clinical variables. The TES is by no means a measure of the suffering of persons and should not be used with that purpose. It also offers potential for monitoring visits to institutions and in the framework of public health studies.
Limitations.
There are some limitations of the study. (a) The sample is very homogeneous, and this might influence the validation of those subscales with lower scores. (b) It includes torture survivors from 40 years. In some instances, time might distort the perception of trauma (c) People tortured in the 80s and people tortured by Ertzaintzz might be underrepresented in the sample.