6 the process can carry on over a very extended time period. For this reason, many workers feel that "ongoing traumatic stress disorder" would be a much more accurate expression of torture (Straker.1987). The problem of "labelling" is equally not trivial. Many workers feel that the reduction of torture sequelae to a psychiatric condition places a very unhealthy emphasis upon the victim, ignores the entire process behind torture, and can even ignore the likely probability of psychopathology in the perpetrators of torture. This criticism is only partially vitiated by the advantages of including torture in international classifications, and the recognition that torture is recognized as a cause of psychopathology. From a theoretical and epistemological perspective, the criticisms about the narrow definition of PTSD are rather more serious. The deliberate infliction of harm seems to place torture in the position of a distinct form of stressor, and the specific purpose behind torture makes it very different from random violence or catastrophe, whether natural or man-made. Furthermore, the violence is decidely purposive, with the aim of the systematic destruction of individual and community identity, and it is very hard to know how to include in a definition what is surely a notion of "evil", however unpalatable this notion might seem to a scientist. But in the final analysis, the claims for torture as distinct must rest on empirical as well as logical and moral grounds, and thus it needs to be demonstrated that a torture syndrome exists separate from PTSD. Little such evidence exists, nor has the issue received much empirical attention, but the clinical work does suggest that a torture syndrome is more than a logical or moral construct, although there are dissenters from this view (Turner & Gorst-Unsworth.1990). THE TORTURE SYNDROME: At the outset, we should note that there are different methods for approaching this problem (Turner.1993). One approach, which has already been extensively described, is to examine the range of pathologies already shown, and then to construct a syndrome. This is the preferred approach of psychiatry, and is the explicit method behind the construction of the DSM-III definitions. The second approach is to generate hypotheses based on an understanding of current theory, and to then test these on the problem at hand. This is generally the favoured approach of psychology, and is effectively a hypothetico-deductive empirical method. Both have their advantages and disadvantages, but it should be pointed out that the former is frequently argued to have greater validity because of the strong observational base behind the description. Actually, this is a spurious claim, since it is evident that the observations are very rarely unpolluted by theoretical bias (Faust & Miner.1986), and, certainly, within psychiatry there can be no claim that a symptom exists independent of the measuring device (Reeler.1993). If the second of the two approaches above is adopted, then it becomes possible to see the ways in which torture differs from PTSD. Turner has provided both interesting argument and clinical support for the view that torture has consequences not covered by the PTSD definition (Turner & Gorst-Unsworth.1990; Ramsay et al.1993). This theory argues that there are 4 themes common to torture survivors: incomplete emotional processing, depressive reactions, somatoform reactions, and the Existential Dilemma. The first covers many aspects included in the definition of PTSD, such as psychic numbing, re-experiencing of trauma, and avoidance, which can also be described as the attempts by survivors to split emotional and cognitive components of their being. It also reflects ways in which many survivors coped with the torture process, which frequently is described as having to learn to dissociate in order to survive (Somnier & Genefke.1986). The second theme is important, and relates to an important aspect of the definition of PTSD: that of its conceptualization as an anxiety disorder. As Turner points out, repressive violence usually leads to a wide range of losses, which are more frequent precipitants of depressive reactions than of anxiety (Turner.1993). Indeed, depressive symptoms are very frequently reported by torture survivors, and are not explicitly mentioned in the DSM-III definitions. Somatoform reactions are equally important. Most torture requires that the sufferer learn very complex associations between physiological and psychological events, and these may be adaptive during torture, but turn out to be maladaptive subsequently. Thus, it is apparent that the survivors may have a very wide range of idiosyncratic conditioned and formerly adaptive responses, and this needs to be included in the understanding of the response to torture. The point here is that the range of reactions may be exceedingly diverse, and it may be doubtful that even the reduction behind this taxonomic category, somatatoform reactions, will be an adequate description. The final criteria is perhaps the most important, because it rescues the four-dimensional model from a narrow and reductionist definition. The Existential Dilemma expands the theory away from mere consideration of conditioned responses, and reflects the ways in which the survivor's sense of Self and position in the world are affected. Alienation, shame, guilt, inability to trust, personal change, relationship difficulties, and sexual difficulties are all reported by torture survivors. There clearly must be difficulties in the operational definition of this dimension, but it does reflect some of the considerations that demarcate torture and repressive violence from other forms of trauma. The model may be preferable to both PTSD and the single entity theory of a Torture Syndrome, but it too has difficulties. To relegate the meaning of torture to an existential dilemma is not clearly an improvement, nor an answer to the criticisms raised by Basoglu, for