Dr Anis Ahmed, clinical lead in psychiatry at Aston Medical School, has co-written an article looking at the mental health challenges for the victims of 'enforced disappearances'.
This is defined by the UN as "the arrest, detention, abduction, or any other form of deprivation of liberty by state agents, or those acting with state approval."
Together with his co-author, Professor Andrew Forrester, professor of forensic psychiatry at Cardiff University, Dr Ahmed says that the psychological trauma of victims and their families is under-researched. There is, therefore, no clear guidance for mental health professionals treating them. The authors say that there is a "dire need" to develop evidence-based treatments, and that addressing the "therapeutic void" is "not just a clinical necessity but a moral imperative."
Enforced disappearances are a globally significant human rights violation, affecting thousands of people across the globe. Historical examples include the 'Dirty War' in Argentina (1976–1983), where 30,000 people went missing, while in Syria now, tens of thousands of people are missing due to state repression and conflict.
Families of those who have disappeared live in a state of what is known as "ambiguous loss", with a prolonged state of uncertainty in which they are unable to grieve or move forward, often suffering chronic depression and anxiety and, in some cases, post-traumatic stress disorder (PTSD).
Traditional grief therapy assumes a confirmed death, and the social and cultural rituals that follow that, which allow for mourning and closure. However, in cases of enforced disappearance, these conditions are absent. Families are left in a painful limbo, trapped between hope and despair, with no closure. Conventional grief models fail to address the unique psychological suffering caused by prolonged uncertainty and ambiguous loss.
Victims who return also face unique challenges. As well as the psychological aftermath of prolonged captivity and torture, they struggle with trust, hypervigilance and shame. Reappearance can attract unwanted attention, suspicion and social stigma.
Dr Ahmed and Professor Forrester acknowledge the significant challenges in conducting research and developing the appropriate mental health guidelines. Fear acts as a powerful barrier, not only for victims, who may remain silent due to threats of reprisal or renewed targeting, but also for mental health professionals, who may hesitate to engage fully out of concern for their own safety. Even with assurances of medical confidentiality, many are only willing to speak openly after the fall of an oppressive regime, obstructing efforts to uncover the full extent of harm and delaying the development of effective, culturally appropriate treatments.
They say that the first step towards developing the necessary guidance is a study to map the prevalence and psychological impact across different regions. The second step should be developing and testing targeting treatments.
They write:
"Mental health professionals must advocate for policy changes that support victims' families, including legal recognition of their status, access to mental health services, and the right to seek justice without persecution. International psychiatric associations, human rights organisations, and trauma researchers need to collaborate to fill this critical gap."
Dr Ahmed said:
"Enforced disappearances remain a deeply neglected area in academic and clinical discourse, especially concerning mental health impacts. I'm currently working to establish an international, multidisciplinary research collaboration to address this gap – bringing together voices from psychiatry, anthropology, sociology, human rights, and legal studies. This is a complex issue that requires cross-sector engagement."
To read the full paper, 'Mental health challenges of enforced disappearances: A call for research and action', in Medicine, Science and the Law, visit https://doi.org/10.1177/00258024251349373 .
