In a 1988 BMJ editorial,1 Marks and I reviewed the available knowledge on the mental health effects of torture and their treatment and presented a critical look at rehabilitation programmes for survivors. Eighteen years later, it is time to cast another look at the advances in our understanding of torture and its treatment and how this progress has translated into rehabilitation work with survivors. Such an update is timely: given the political developments of the last two decades, torture has become an ever more serious problem.

An important advance in the 1990s was the demonstration of an association between torture and post-traumatic stress disorder through controlled studies using standardised assessment instruments.2 Further work provided insight into the psychological mechanisms that played a part in torture-induced post-traumatic stress. In a controlled study survivors who felt that those they held responsible for the torture did not receive the punishment they deserved were more likely to have a sense of injustice, …