Psyche, Science, and Society

Biko to Guantanamo: 30 years of medical involvement in torture

Valtin at Daily Kos writes of the letter in the Lancet protesting American medicine’s collaboration with the military torturers at Guantanamo. He points out that the AMA has a pattern of avoiding comment on abuses committed by America doctors in service to the Global War on Terrorism:

Looks like the AMA is giving the New York Times the same brush off it gave journalist Luke Mitchell of Harper’s a couple of months ago when he enquired about doctor participation in torture and abuse at CIA sites. As I noted then, the AMA sought to shift the blame for collaboration with torture over to the American Psychological Association, which has not requited itself well of late on this issue, as described multiply elsewhere (here and here, for instance).

Here is the Letter, signed by 266 doctors world-wide:

Biko to Guantanamo: 30 years of medical involvement in torture

David J Nicholl (a), Trefor Jenkins (b), Steven H Miles (c), William Hopkins (d), Adnan Siddiqui (e) and Frank Boulton (f), on behalf of 260 other signatories

This week marks the 30th anniversary of the death of anti-apartheid activist Steve Biko while being detained by South African security police. Initially, the Minister of Justice suggested Biko had died of a hunger strike; however, the inquest revealed that he had died of the consequences of head injuries sustained during police interrogation, and identified gross inadequacies in the medical treatment from the two doctors responsible for his care, including the falsification of records. The regulatory authorities failed to take firm action, and it was only grass-roots efforts by doctors that led, almost 8 years later, to Benjamin Tucker being found guilty of improper and disgraceful conduct and being struck off the medical register; Ivor Lang was found guilty of improper conduct and was given a caution and a reprimand.1

There are strong parallels between the Biko case and the ongoing role of US military doctors in Guantanamo Bay and the War on Terror. Last year,2 we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines. One of us (DJN) lodged formal complaints with the medical boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, John Edmondson, was a member.3 After 18 months, there had been no reply from the AMA, the Californian authorities stated that they “do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, and the authorities in Georgia stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”. Yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act”.

The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees4 and, to date, there has been no formal report on the three alleged suicides in Guantanamo that took place in June, 2006.

The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa, which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is damaging the reputation of US military medicine. No health-care worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping on detainees who have died as a result of failed interrogations.5 We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as Tucker who, in 1991, in expressing remorse and seeking reinstatement, said “I had gradually lost the fearless independence…and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner’s first responsibility is the wellbeing of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.”1

The attitude of the US medical establishment appears to be one of “See no evil, hear no evil, speak no evil”.

References

1. McLean GR, Jenkins T. The Steve Biko affair: a case study in Medical Ethics. Dev World Bioethics 2003; 3: 77-102.

2. Nicholl DJ, Atkinson HG, Kalk J, et alon behalf of 255 other doctors. Forcefeeding and restraint of Guantanamo Bay hunger strikers. Lancet 2006; 367: 811. Full Text | Full-Text PDF (39 KB) | CrossRef

3. Nicholl DJ. Guantanamo: a call for action. Good men need to do something. BMJ 2006; 332: 854-855.

4. Nicholl DJ and 119 other doctors, Doctors at Guantanamo. The Times Sept 18, 2006
http://www.timesonline.co.uk/tol/comment/debate/letters…
(accessed Aug 10, 2007)..

5. Miles SH. Oath betrayed: torture, medical complicity and the War on Terror. New York: Random House, 2006:.

Affiliations

a. Department of Neurology, City Hospital, Birmingham B18 7QH, UK
b. Division of Human Genetics, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
c. Center for Bioethics, University of Minnesota, Minneapolis, MN, USA
d. Medical Foundation for the Care of Victims of Torture, London, UK
e. CAGE Prisoners, London, UK
f. MEDACT, The Grayston Centre, London, UK

Of course we psychologists, dealing with the American Psychological Associationof psychologist’s roles as creaters, implementers and standardizers of torture understand all too well what it means for an establishment to adopt a “See no evil, hear no evil, speak no evil” attitude. The screams of tortured souls seldom penetrate self-protective establishments.

September 8th, 2007

Mind Hacks on psychologists and interrogations: Ethics, power and faustian pacts

The Mind Hacks blog discusses the American Psychological Association interrogations battle in the wider context of the increasing status of psychology vis a vis psychiatry and what this change implies for relations with governments:

Ethics, power and faustian pacts

Renowned psychologist Dr Mary Pipher has handed back her American Psychological Association presidential award in protest at the organisation’s refusal to ban participation in US military interrogations which some deem to be torture under the Geneva Convention.

However, the whole issue of psychologists participation in government interrogations shadows a significant, but little mentioned, change in the status of psychologists in the medical establishment.

Fifty years ago, clinical psychologists were little more than test technicians who provided information for psychiatrists to interpret.

During the last decade, clinical psychology training has become equally, if not more, arduous than medical training, and psychological interventions have been shown to be highly effective.

Consequently, psychologists are now being considered on a par with physicians in many organisations. For example, psychologist-led mental health and brain-injury teams are increasingly common.

This change in status is being increasingly reflected in the law. In the UK’s 2005 Capacity Act, psychologists are now able to sign assessments concerning someone’s mental competence to make a contested decision, something that was previously reserved for medical doctors.

The recently approved UK Mental Health Bill is likely to allow psychologists, rather than just psychiatrists, to take a lead in ‘sectioning’ people – i.e. detaining them if they’re deemed a risk to themselves or others owing to mental illness.

In the the US military, and in some US states, psychologists are now able to prescribe medication, previously the sole domain of physicians, and the APA is pushing for the extension of these rights.

Not all psychologists are of a same mind on these issues, and many see these changes as much as a ‘poison chalice’ as as benefit.

In many ways, psychologists and psychiatrists are a ‘good cop, bad cop’ double act in mental health. Psychiatrists can forcibly drug and detain people, while psychologists can tut and scowl with the patient and continue to work collaboratively to improve their mental state.

Of course, patients may be a lot less willing to work with psychologists if they’ve played a role in their detention or forcible medication.

Internal debates aside, the fact that the US Government is quite happy to rely on psychologists, rather than physicians, for their interrogation practices is testament to a general change in status.

Contentious issues concerning a potent mix of economics, ethics and power balance shifts are common for physicians, who are used to governments wanting to give or take responsibilities away from them to suit their political agenda or latest reform plan.

In contrast, these sorts of ethical dilemmas are relatively new for psychologists.

What makes this an interesting time, is that psychology is in a transition period where lots of legal changes are being made to solidify their responsibilities.

This makes the profession much more susceptible to influence by government, and it will be interesting to see how these issues play out, of which the debate over military interrogations is perhaps only an early skirmish.
Link to interview with Dr Mary Pipher.

September 8th, 2007

ACLU Executive Director Anthony Romero on psychologists and torture

ACLU Executive Director Anthony Romero was on Democracy Now! on Wednesday. Part of his interview was devoted to the issues of psychologists and US interrogations, including APA policy and the pre-Convention letter from the ACLU to the APA. Here is the relevant portion of the interview. [Note, if watch this interview, you can see footage from the Convention debate at the APA's Council of Representatives, including portions of the talk by Colonel Larry James supporting APA policy and a response by delegate Laurie Wagner.]:

AMY GOODMAN: Let me ask you about this big debate in the American Psychological Association. Democracy Now! went to San Francisco for the four-day convention, their annual convention, and broadcast from there. And in the midst of that, you wrote that letter to Sharon Brehm, the president of the APA.

ANTHONY ROMERO: Right.

AMY GOODMAN: Explain what your letter said.

ANTHONY ROMERO: Well, we wanted to be very clear. We want to exhort them to encourage their membership in the American Psychological Association to take a stand that would say that their members are not to participate in any of the interrogations that may use torture or abusive techniques, what are these advanced coercive techniques. And we wanted to be very clear on two fronts, frankly, Amy.

One was we were calling to the morality, that the healers shouldn’t be part of the tormenters, as we talk about at the end of the letter, that the American Psychological Association has always thought of itself as helping people grapple with difficulty, mental illness or mental issues or psychological problems, and that they should not be a part of the tormenting forces of government. And so, we wanted to appeal to their ethical side.

We also wanted to be clear that they have a legal liability. And frankly, as a legal organization and as an organization that takes very seriously the need to hold people accountable, that if there are individuals, psychologists, doctors, who are involved in such techniques, they face potential civil, criminal liability.

AMY GOODMAN: We invited a spokesperson from the American Psychological Association on the program, but they did not respond to our repeated requests. At the center of the firestorm is Dr. Stephen Behnke, who is Director of Ethics at the APA. At the end of the group’s annual conference, Dr. Behnke addressed a few hundred APA members gathered at a town hall meeting. The meeting was held after the APA’s policymaking council voted to approve a resolution that prohibited involvement in interrogations that use at least fourteen specified methods, including sleep deprivation, sexual humiliation and mock executions. Dr. Behnke got on the stage to defend the resolution.

DR. STEPHEN BEHNKE: The passage I’d like to read says that, “Be it resolved the American Psychological Association affirms that there are no exceptional circumstances whatsoever, whether induced by a state of war or threat of war, internal political instability or any other public emergency that may be invoked as a justification for torture or cruel, inhuman or degrading treatment or punishment, including the invocation of laws, regulations and orders.”But I also want to be very clear that if you look at the language of the resolution — and again, I hope that everyone reads it — what it says is that, that this unequivocal condemnation includes all techniques defined as — and then is says, “This unequivocal condemnation includes, but is by no means limited to,” so that there are specific techniques identified, but that is not a closed set — very explicitly not a closed set.

One final point about the resolution. Again, I just encourage people to read it. But the Ethics Committee has been directed by counsel. It says: “Be it resolved that the APA Ethics Committee shall proceed forthwith in writing its casebook and commentary that shall set forth guidelines for psychology that are consistent with international human rights instruments.” And then it actually specifies what those instruments are. The first is Common Article 3 of the Geneva Conventions.

AMY GOODMAN: That was Stephen Behnke. Stephen Behnke, ethics spokesperson for the American Psychological Association. Your response, ACLU Executive Director Anthony Romero?

ANTHONY ROMERO: Well, you know, I think one of the things that’s quite disconcerting about the debate — and I’d want to understand the study better, the resolution that he just read — is that part of what’s going on both within the government and it seems also within the American Psychological Association is this effort to redefine what is torture and to provide some wiggle room at the grey areas. To be very clear, there are certain techniques that were completely off the books before 9/11, that there were techniques that were not ever to be authorized. Rumsfeld and others within the military expanded the list of interrogation techniques, ultimately had to retract some of them because they had gone too far. And yet, you find an effort right now to redefine what does in fact constitute torture, what constitutes abuse, what is cruel and humiliating treatment. And I think part of what we’ve got to be very clear about and I think the American Psychological Association needs to grapple with is what is its role.

AMY GOODMAN: The American Medical Association, the American Psychiatric Association have said that their members cannot participate at all.

ANTHONY ROMERO: Categorically, yes, yes.

AMY GOODMAN: They rejected that possibility of a moratorium on psychologist involvement.

ANTHONY ROMERO: Correct.

AMY GOODMAN: And earlier in the day, before that town hall meeting, which was mainly just many angry psychologists from around the country decrying the decision of the APA policymaking council –

ANTHONY ROMERO: Right.

AMY GOODMAN: – but during the debate of the policymaking council, some of the top military brass was in attendance, perhaps none more so than Colonel Larry James. He was flown in from Cuba, from Guantanamo, where he served as the chief psychologist for the joint intelligence group at Guantanamo Bay. He was also the first psychologist at the Abu Ghraib prison in Iraq. An APA council representative himself, Colonel James addressed the council members on Sunday as they were preparing to vote on a proposed resolution that would have prohibited psychologists from participating in interrogations at Guantanamo and other US detention centers.

COL. LARRY JAMES: This is I my second tour at Gitmo, Cuba. I was also the first psychologist at Abu Ghraib. I’m going to repeat what I said earlier. If we remove psychologists from these facilities, people are going to die. If we remove psychologists from these facilities, people are going to get hurt.One other thing I want to add. We’ve got young twenty-seven-, twenty-eight-, twenty-nine-year-old psychologists on the battlefield right now. If you support this amendment, those young psychologists are going to feel as though we’ve abandoned them. And they need our support right now. Thank you very much.

AMY GOODMAN: Soon after Colonel Larry James spoke, he was confronted by an APA member in the audience. Laurie Wagner is a psychologist and a member of the APA’s Psychoanalysis Division. She took Colonel James to task.

LAURIE WAGNER: I heard Colonel James say that if psychologists are not present in Guantanamo and other settings similar to it, that innocent lives will be lost, and I asked him what he meant by that, and he said, “The lives of detainees.” And I would submit that if psychologists have to be there in order to keep detainees from being killed, that those conditions are so horrendous that the only moral and ethical thing to do is to protest it by leaving it.

AMY GOODMAN: Anthony Romero?

ANTHONY ROMERO: We have to go back to a categorical rejection of the torture and abuse and the use of techniques that humiliate detainees. There is no need to argue about the niceties of these definitions. There is no need to talk about whether waterboarding is or is not torture, whether mock executions are or are not torture. We need to go back to a point, Amy, where we as a nation ascribe to some core values, that we do not allow people to be poorly treated in our custody.

And I think the questions about — if individuals are dying in Guantanamo, for the gentleman who spoke from the Guantanamo base, it’s because many of them are trying to commit suicide, because they have no hope, because we’ve eliminated the right of habeas corpus. They have no access to the judicial system, no access to their family members, where they’re kind of detained — I’ve been to Guantanamo, and I’ve been for the first round of military commission proceedings. It is not what the government describes it to be. No matter how good a face they try to put on the detention center at Guantanamo in the military commission proceedings, it is a travesty. It does not uphold to the best of American values.

And we have to go back to a point where we look at ourselves in the mirror as Americans and say, “Who are we as a people? What do we stand for?” We stand for some core values, the right to habeas corpus, the right to be treated well, the right to be treated humanely, to equal protection under the law, to right to due process. And that’s often what our government officials forget to remind themselves of in their jobs.

We might add that psychologists need to decide who we are as a profession. Are we a profession in which “psychologists strive to benefit those with whom they work and take care to do no harm” as Principle A of our Ethic Code states? Or are we a profession in which doing harm is fine as long as one can argue that the harm doesn’t cause “significant pain or suffering” or is done in such a manner “that a reasonable person would judge to cause lasting harm” as the APA Council voted almost unanimously, with no debate of this fundamental change in the nature of the profession. Psychology has now defined itself as the harming, but not too much, profession.

September 8th, 2007

Riverbend in exile

A new post on the Baghdad Burning web site reports that Riverbend and her family have joined the over a million Iraqi exiles in Syria. On leaving:

It was a tearful farewell as we left the house. One of my other aunts and an uncle came to say goodbye the morning of the trip. It was a solemn morning and I’d been preparing myself for the last two days not to cry. You won’t cry, I kept saying, because you’re coming back. You won’t cry because it’s just a little trip like the ones you used to take to Mosul or Basrah before the war. In spite of my assurances to myself of a safe and happy return, I spent several hours before leaving with a huge lump lodged firmly in my throat. My eyes burned and my nose ran in spite of me. I told myself it was an allergy.

On arriving:

As we crossed the border and saw the last of the Iraqi flags, the tears began again. The car was silent except for the prattling of the driver who was telling us stories of escapades he had while crossing the border. I sneaked a look at my mother sitting beside me and her tears were flowing as well. There was simply nothing to say as we left Iraq. I wanted to sob, but I didn’t want to seem like a baby. I didn’t want the driver to think I was ungrateful for the chance to leave what had become a hellish place over the last four and a half years.

The Syrian border was almost equally packed, but the environment was more relaxed. People were getting out of their cars and stretching. Some of them recognized each other and waved or shared woeful stories or comments through the windows of the cars. Most importantly, we were all equal. Sunnis and Shia, Arabs and Kurds… we were all equal in front of the Syrian border personnel.

We were all refugees- rich or poor. And refugees all look the same- there’s a unique expression you’ll find on their faces- relief, mixed with sorrow, tinged with apprehension. The faces almost all look the same.

The first minutes after passing the border were overwhelming. Overwhelming relief and overwhelming sadness… How is it that only a stretch of several kilometers and maybe twenty minutes, so firmly segregates life from death?

How is it that a border no one can see or touch stands between car bombs, militias, death squads and… peace, safety? It’s difficult to believe- even now. I sit here and write this and wonder why I can’t hear the explosions.

Riverbend will join those millions wondering if they will ever return home and, if they do return, who will be left alive.

September 8th, 2007