Adaptation after torture: Some thoughts on the long‐term effects of surviving a repressive regime

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Abstract
The long‐term problems of refugee survivors of organized violence are considered. A case example is described in order to illustrate the complexity of factors that contribute to the psychological well‐being and social adaptation of such a survivor. The limitations of the classic diagnostic approaches are discussed. It is suggested that measures of social function can be more helpful than a description of symptoms, and should be included in the concept of PTSD, in order to increase the usefulness of this diagnosis in relation to severe and chronic trauma. The Doctor's Role in Wartime, by William G. Porter, Carolinas Medical Center, Charlotte, USA. Annals of Internal Medicine 1991; 114: 987–88. The ethics of medical personnel engaging in armed combat are discussed, based on the death of an American surgeon piloting an F‐15E against Iraq during the Gulf War. The Geneva Conventions give special protection to military medical personnel and specifically forbit them from engaging in or being parties to acts of war. However, physicians must serve in the military if ordered, unless they claim conscientious objection. This apparent contradiction of international by national law may be ameliorated in practice since medical personnel are virtually never given combat assignments unless these are actively sought by the individual. The ethical issues raised when physicians join the ranks of combatants merit wider discussion.

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