Psyche, Science, and Society

Colbert on investigating torture

Stephen Colbert on the dangers on investigating torture:

Now read Glenn Greenwald’s take on this piece.

July 23rd, 2009

Welch: The American Psychological Association and Torture: The Day the Tide Turned

Bryant Welch, the former director of the American Psychological Association’s Practice directorate, has published another article on the background behind the APA’s policies on psychologists participating in sometimes abusive national security interrogations.  In this article he tells of the task force who’s conclusions threatened the national security state, leading to its suppression by APA leadership through parliamentary chicanery:

The American Psychological Association and Torture: The Day the Tide Turned

by Bryant Welch

In my blog last month, I described the complicity of psychologists and the American Psychological Association (APA) with torture under the Bush Administration’s War on Terror. I also described APA’s transition from an organization highly sensitive to human rights to one that supported the Bush Administration’s torture interrogation program. I pointed both to excessive and unchecked connections with the military and to a longstanding management style that left the APA governance ill -prepared to stand up to the military and intelligence pressures even on an issue as evil as torture.

There was a critical turning point to this story that has not received the attention it deserves. It illustrates “what could have been” had the APA preserved psychologists’ historically humanitarian values. It also underscores why the current battle for the heart and soul of American psychology is something that should concern all Americans.

The governance of the APA at first responded to the War on Terror when a group of respected psychologists concerned with human rights proposed a task force to study the psychological cost to America of the Bush Administration’s War on Terror. At the time there was a desperate need for a psychological explanation of the practical importance of human rights. Many Americans in their state of fear felt America could no longer afford to support what to many Americans were simply vague principles embodied in human rights and in our own Bill of Rights. The proposed task force, chaired by Dr. Paul Kimmel, was to study the psychological ill-effects on Americans of living in the perpetual state of war that President George Bush and Vice-President Dick Cheney were prescribing as their post 9/11 strategy.

The task force findings provide a tragic illustration of what the American Psychological Association’s contribution to post 9-11 efforts could have been had its leadership at the time remained consistent to the historical values of the APA and psychologists everywhere.

We found that this stressful environment often leads authorities to overestimate the threat and consequence of terrorist activities and to make poor decisions in trying to prevent these activities. The “war on terror” has affected the emotions, beliefs, and behaviors of the American public in ways typical of situations characterized by uncertainty, extreme stress, and fear.

(Collateral Damage, Kimmel and Stout (Eds.) Praeger, 2006, p.xvi)In short, psychology, through its national organization, was positioned to provide a scientific rationale documenting the practical cost of subverting our democratic values and terrorizing our citizenry. The task force made clear it was not just a vague set of liberal values at stake; it was America’s ability to function rationally in its hour of peril. America’s need for such a voice at that time is now painfully obvious.

When I worked at the APA from the mid-1980′s to the mid-1990′s, I was frequently stunned by the extent to which the press was eager for any word from APA on just about any subject. Had APA issued a document like the one the task force prepared, there is no question it would have received widespread play in the mass media. Naturally, for an Administration trying to sell a war on terror, the Bush/Cheney regime would not have relished such a document. Neither would the military or intelligence apparatus that supported its efforts.

The proposed APA task force received broad support when it was introduced in February of 2003 to the APA Council of Representatives, the legislative assembly of the APA that has ultimate control of the Association under its by-laws. The Council vote authorizing the task force to proceed passed 127 to 0, with two abstentions. The two abstentions in the Council vote, task force members believe, were military psychologists. The report was to be completed and submitted to the Council for the final approval at the upcoming Council meeting.

It was not to be. How APA turned psychology away from these humanitarian values is a study in organizational failure and professional disaster for psychology and the APA.

At the Council meeting when the task force report was to be submitted for Council approval, Dr. Kimmel and another task force member were called out of the room, during the luncheon recess. Waiting for them were APA President-elect Dr. Ronald Levant, APA public affairs director Rhea Farberman, APA Public interest director Dr. Henry Tomes, and task force member New York psychologist Dr. Nina Thomas. (Personal Communication, Kimmel to Welch, July 10, 2009.)

The group explained to Dr. Kimmel that he would be ill advised to submit the task force report to Council at that meeting because, as currently worded, APA could “only receive the report” but not “do anything” with it. The task force objectives could be better achieved, he was advised by Levant and the group, by delaying the presentation of the report so this problem could be addressed. (Personal Communication, Kimmel to Welch, July 10, 2009.) While in actuality any such problem that might have existed could have been corrected on the Council floor with little difficulty, Dr. Kimmel and fellow task force members, unfamiliar with APA procedures, reluctantly agreed.

This was hardly a friendly suggestion, as the task force was to find out. When the report reached the APA Board of Directors for the Board’s vote on whether to endorse the report prior to sending it back to Council, to the surprise of the task force members, the Board voted unanimously to reject the task force report in its entirety. Prior to that Board meeting the Board of Directors liaisons to the task force had given the task force members no indication the report was even controversial on the Board.

As I explained in my prior column, the APA Council had become increasingly ineffectual over the course of the previous CEO’s administration and was heavily controlled by upper echelon staff operating through the APA Board of Directors. With such strong opposition from the Board, passage of the task force report by the Council of Representatives was unlikely. Nonetheless, given the strong support they had received previously from the Council and other governance entities, the task force members decided to submit the report to the Council of Representatives for a vote at the winter 2004 meeting, hoping to override the Board’s recommendation.

Dr. Ronald Levant, as APA president, was the presiding officer at the Council meeting when the report was ultimately submitted to the Council floor for deliberation. Task force members report that throughout the day on which the matter was scheduled to come to a vote, Levant announced several changes in the order of the agenda, ostensibly to accommodate other groups. The effect of these delays was to postpone the vote on the task force report until the last few minutes of the meeting. After minimal discussion, in which the task force members were unable to make their planned presentation, Levant called the matter to a voice vote. According to task force members, Levant proclaimed that the report had been defeated “unanimously” although task force members insist votes of support were quite audible. (Personal Communication, Kimmel to Welch, July 10, 2009.)

With that action, the APA rejected the effort by psychological experts in the field to call attention to the psychological cost to America of being turned into a fear-plagued nation under siege. The report was referred to another APA Board and never surfaced again, despite efforts by the task force members to revive it. (Dr. Kimmel and several members of his task force did find an independent publisher for their report, now entitled Collateral Damage: The Psychological Consequences of America’s War on Terrorism. Edited by Paul R. Kimmel and Chris E. Stout. Praeger, 2006. http://www.amazon.com/Collateral-Damage-Psychological-Consequences).

From that point forward, it was quite clear that a small number of upper echelon members of the APA Board and APA staff working in conjunction with military psychologists and their colleagues were highly committed to psychologist’s continued participation in “enhanced interrogation techniques.”

When the American Psychiatric Association and other health care organizations passed measures deeming it unethical for their members to participate in the Bush detention center activities, the American Psychological Association, instead, appointed a task force to study the matter and make recommendations to Council on the appropriate positions for the APA to take with respect to national security interrogations and related matters. The task force was known as The Task Force for Psychological Ethics in National Security (PENS). After the fact, many APA members were surprised to learn that of the ten members appointed to the task force six were employed by the military and/or the national security apparatus.

As I have indicated, many, and probably even most, of the people in the APA Governance are not evil people who support the Bush/Cheney interrogation policies. The APA organizational structure was cleverly debilitated through psychological and structural changes over a fifteen year period largely for in-house political reasons. When the military took a strong interest in APA, these people were simply over their heads and succumbed to the rationalizations and pseudo-logic they were handed by people whom they wanted to believe knew more than they did or with whom they wished to gain favor.

Arguments which to most observers lacked all credibility prevailed in the APA Council deliberations. For example, it would be “disrespectful” to military psychologists for any Council member to imply a military psychologist would do anything untoward in the detention centers. Other council members were naïve (or in some cases grandiose) enough to believe that psychologists’ participation in the interrogations could serve as a protective buffer against torture. People who were critical of the APA positions were dismissed as mean-spirited, biased, and insincere. Thus, the substance of their arguments was ignored.

Many of the governance members, however, could probably have been led in just about any direction. The fact that it was torture in this case probably proves that point. What is remarkable from an organizational perspective is just how small a number of people operating in such a system could manipulate the APA for evil purposes.

I have been trained in two professions, the law and psychology. Each sheds light on the causes and consequences of torture. Torture is visible only indirectly in the law. Our Bill of Rights and the modern concept of human rights stand like gravestone monuments to man’s historical capacity for inhumanity to man through torture. They also symbolize a cluster of fragile barriers established against torture by those who have seen its horrors in the past.

It’s in psychology, however, especially in psychotherapy, the true horror of torture becomes much more visible to the naked eye. When I am doing psychotherapy with a patient I am not advising or “counseling” the patient as many think. Nor am I trying to construct arid intellectual rationales about the patient’s past. Instead, I am doing my best to sit inside the inner-most experience the patient is having at that moment. If I can successfully give myself over to that experience, I can walk about in very sensitive and personal regions of a person’s mind. What I see there is extremely tender and fragile.

Often, I can see where feelings of love, anger, shame or fear, for whatever reason, are being held at bay and stifling patients’ capacity to experience their own existence and their deepest and most personal feelings. Even words like “soul” do not do justice to the sensitive nature of this terrain. It is in this area where life defines itself by virtue of its capacity to feel.

If I can gently help patients look at those walled off experiences and slowly assimilate these split off parts of their mind, over time, remarkable things begin to happen. Patients become happier and healthier, they are better parents, they are more understanding spouses, and they are more productive workers. Their lives are more robust and richer.

If, on the other hand, a therapist approaches these sensitive realms with heavy handedness, it can be devastating to the patients. Some may never recover from the stultifying, even petrifying effect it can have.

When one sees this sensitivity of the human spirit on a daily basis, as a psychotherapist does, the thought of one human being torturing another is literally nauseating, whether one focuses on the tortured victim or the grotesque and twisted dead soul of the torturer. When a psychologist sees the tools of his trade twisted by colleagues to inflict pain, it is an experience that defies description.

Psychology has wonderful things to offer, but, like most disciplines, and like most nations, it can be used for good or evil. Ultimately, it comes down to the quality and character of the individuals who are making the decisions and providing leadership. The American Psychological Association’s fall to the dark side is all the more tragic when one recognizes the lost potential of the APA’s Task Force on the Psychological Effects of Efforts to Prevent Terrorism. It is that potential, however that makes psychology worth fighting for.

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Bryant L. Welch, J.D., Ph.D. is a clinical psychologist and attorney. He is the author of State of Confusion: Political Manipulation and the Assault on the American Mind (St. Martin’s Press, 2008.)

1 comment July 21st, 2009

Horton: The APA’s Nuremberg Defense

Harper’s Scott Horton has written a brief introduction to the American Psychological Association’s controversy over ethics standard 1.02: embodying the Nuremberg Defense [I will have an article on this issue within the next few days]:

The APA’s Nuremberg Defense

By Scott Horton

As I noted in a recent post, the disclosures surrounding the waterboarding of Abu Zubaida give further proof that beginning in 2002, healthcare professionals, specifically psychologists, played an essential role at every stage in the development and application of torture techniques. The failure of professional organizations, and specifically the American Psychological Association, to acknowledge this and take appropriate countermeasures is disturbing. The mounting evidence of involvement of psychologists in the torture program should lead both to ethics enforcement measures and a review of existing ethical standards. But just the opposite has happened. Professional oversight bodies have engaged in consistent evasion, and now the APA is focused on the relaxation of its ethics standards to provide defenses for psychologists who joined in the Bush Administration’s torture program.

As the Bush Administration introduced its torture program in 2002, the APA modified Section 1.02 of its ethics rules, to state that in the event of conflict between ethics standards and law as interpreted by government organs like the Department of Defense or CIA, psychologists are free to disregard the requirements of applicable ethics guidelines and “may adhere to the requirements of the law, regulations, or other governing legal authority.” This provision was curiously passed just as psychologists undertook their key role in the torture program. And it dovetails perfectly with a scheme introduced by Defense Secretary Rumsfeld to undercut the ethics standards of lawyers, doctors, and other healthcare professionals by binding them strictly to the laws and regulations as definitively interpreted by him as Secretary of Defense (DOD Policy Directive 3115.09). It is a full-throated repudiation of the rule fashioned at Nuremberg under which individuals involved in the torture or abuse of prisoners are not entitled to rely on a defense of superior orders. The APA was saying that Donald Rumsfeld and Dick Cheney were free to suspend the organization’s ethics rules whenever they chose to do so.

Stephen Behnke, the APA’s Director of Ethics, claims that this provision is “written largely in response to conflicts regarding confidentiality, arising most often when courts issue subpoenas for psychologists’ records.” In fact, the provision’s direct relationship to the Defense Department’s efforts to vitiate professional ethics rules, shown in Directive 3115.09, could not be clearer. The modification reflected an effort by APA leaders to give psychologists who were preparing to participate in the torture program an ethical “out.” Since the Bush Administration held “legal opinions” issued by the likes of John Yoo, Jay Bybee, and Stephen G. Bradbury, under the reasoning of this amended ethics provision psychologists were entitled to rely upon those opinions—notwithstanding any restrictions contained in their professional ethics code. The rationale that Behnke claims as cover could easily be handled in a provision authorizing psychologists to comply with legal process concerning the turnover of records—a garden-variety provision already found in commercial agreements.

Kenneth S. Pope and Thomas G. Gutheil expose the APA leadership’s latest torture scam in an article in the current issue of the International Journal of Law and Psychiatry.

July 20th, 2009

Music: Song of a U.S. Army Interrogator

John Crigler sings his original composition, Song of a U.S. Army Interrogator, about our mutual friend, veteran Army interrogator Ray Bennett. It beautifully captures Ray’s passion, moral conflicts, and self-deprecating humor.

The song is dedicated to Ray and to Abu Ghraib whistleblower Sam Provance (another wonderful human being):

July 20th, 2009

CIA slammed for lying by judge

In a  case dragging on from 1994, the judge has ruled that the CIA lied about state secrets. He has reported one CIA attorney for disciplinary action and is cosidering actions against several other attorneys and CIA officials, including former CIA Director George tenet. The judge also criticized current Direcetor Leon Panetta for his conflicting statements:

Lamberth criticized Panetta for claiming at one point that the CIA’s methods for conducting electronic surveillance are state secrets, even though the type of transmitter that Horn claims was used on his coffee table is unclassified and on display at Washington’s Spy Museum.

July 20th, 2009

David Shuster and Scott Horton dissect John Yoo

David Shuster and Scott Horton dissect John Yoo’s disingenuous defense in the Wall street Journal of his legal advice on warantless wiretapping and attack o the IG’s report:

July 17th, 2009

NYT: Investigate Bush-era crimes

The New York Times, in an editorial, calls for a full investigation of Bush-era lawbreaking:

Illegal, and Pointless

We’ve known for years that the Bush administration ignored and broke the law repeatedly in the name of national security. It is now clear that many of those programs could have been conducted just as easily within the law — perhaps more effectively and certainly with far less damage to the justice system and to Americans’ faith in their government.

That is the inescapable conclusion from a devastating report by the inspectors general of the intelligence and law-enforcement community on President George W. Bush’s warrantless wiretapping program. The report shows that the longstanding requirement that the government obtain a warrant was not hindering efforts to gather intelligence on terrorists after the 9/11 attacks. In fact, the argument that the law was an impediment was concocted by White House and Justice Department lawyers after Mr. Bush authorized spying on Americans’ international communications.

We know less, so far, about the Bush administration’s plan to send covert paramilitary teams to assassinate Al Qaeda leaders. But what is overwhelmingly clear is that there was no legal or rational justification for Vice President Dick Cheney’s order to conceal the program from Congress. The plan was never put into effect, apparently because it was unworkable. But it’s hard to imagine Congress balking at killing terrorists.

So why break the law, again and again? Two things seem disturbingly clear. First, President Bush and his top aides panicked after the Sept. 11 attacks. And second, Mr. Cheney and his ideologues, who had long chafed at any legal constraints on executive power, preyed on that panic to advance their agenda.

According to the inspectors general, the legal memo justifying warrantless wiretapping was written by John Yoo, then the deputy head of the Justice Department’s Office of Legal Counsel and author of other memos that twisted the law to justify torture.

In this case, the report said, he misrepresented both the law and the details of the wiretapping operation to make it seem as if the 1978 Foreign Intelligence Surveillance Act was outdated and that Mr. Bush could ignore it. And, according to the report, Mr. Yoo bypassed his bosses at the Justice Department and delivered his reports directly to, you guessed it, Mr. Cheney’s office.

For four years, until The Times revealed the warrantless wiretapping, Mr. Bush reauthorized the eavesdropping every 45 days based on memos from the intelligence community and Justice Department. The report said that when the “scary memos,” as they came to be called, were not sufficiently scary, lawyers under the direction of Alberto Gonzales, White House counsel and later attorney general, revised them or ordered up additional “threat information.” Each ended with a White House-written paragraph asserting that communications were intercepted from terrorists who “possessed the capability and intention” to attack this country.

After Mr. Yoo and his boss, Jay Bybee, left the Justice Department, their replacements concluded that the wiretapping program was illegal. The White House did eventually change parts of the program and then demanded that Congress legalize it, but only after the White House tried to force the Justice Department to ignore its own conclusions and after Robert Mueller, the director of the F.B.I., threatened to resign.

Mr. Cheney has tried to head off a reckoning by claiming that the warrantless wiretapping saved thousands of lives. The report said the C.I.A. could point to little direct benefit. The F.B.I. said most of the leads it produced were false. Others never led to an arrest.

This is not an isolated case. Once the Bush team got into the habit of breaking the law, it became their operating procedure that any means are justified: ordering the nation’s intelligence agents to torture prisoners; sending innocents to be tortured in foreign countries; creating secret prisons where detainees were held illegally without charge.

Americans still don’t have the full story. Even now, most of what the inspectors general found remains classified, including other wiretapping that Mr. Bush authorized. Mr. Yoo’s original memo is also classified.

President Obama has refused to open a full investigation of the many laws that were evaded, twisted or broken — pointlessly and destructively — under Mr. Bush. Mr. Obama should change his mind. A full accounting is the only way to ensure these abuses never happen again.

July 17th, 2009

Isikoff: Questions for AG Holder

Michael Isikoff of Newsweek formulates some interesting questions for attorney General Holder:

Questions for the Attorney General

By Michael Isikoff

Attorney General Eric Holder, you’ve made quite a splash this week with the news that you’re “leaning” toward appointing a prosecutor to investigate brutal interrogations that took place during the Bush administration. But this disclosure has raised as many questions as it answers. Here are a few I would suggest you address in the next few weeks when, we are told, you are expected to make your announcement.

1. You have told one associate that some of what you read in internal government reports about interrogation abuses “turned my stomach.” What was it you’ve read that caused such a reaction? And why have Justice Department lawyers recently filed motions (on behalf of the CIA) declining to release, or delaying the release, of these same reports? Doesn’t the public deserve to know the full story about such abuses sooner rather than later?

2. You reportedly spent two days late last month closely studying one of those documents—the CIA inspector-general report completed in May 2004—and its findings “shocked and saddened” you. But this report has been in the possession of the Justice Department for more than five years. Why do you think your predecessors didn’t have the same reaction to that report as you did? And given the fact that you were sworn in Feb. 3, and your obvious interest in this subject, why did it take you four and a half months to read the report?

3. Your aides have said this is only about investigating operatives and contractors who went beyond the “four corners” of Justice Department legal memos on interrogations. In addition, they have told us your planned probe will not investigate senior Bush administration officials—at the Justice Department, the CIA, and the White House—who gave the green light to the “enhanced” interrogation techniques that were authorized in the memos. If that is the case, don’t you risk a repeat of Abu Ghraib, in which only low-level soldiers were court-martialed and their superiors walked free, with no penalties at all?

4. In a speech in Washington last March, you said the following: “Waterboarding is torture. My Justice Department will not justify it, will not rationalize it, and will not condone it.” Do you still stand by that statement? And if so, please explain how you square those words with your decision to exclude the individuals who designed, approved, and ordered waterboarding from the scope of your investigation?

5. As you may know, the CIA inspector general referred the most egregious cases of detainee abuse to the Justice Department years ago. These cases were investigated by a task force, consisting of career prosecutors, in the U.S. attorney’s office in Alexandria, Va. But in all but one case, the task force concluded that there were not criminal prosecutions to be made because of a lack of witnesses, forensic evidence, and other problems. Have you consulted with any of the prosecutors who worked on these cases to determine why they reached those conclusions? And why do you think a new investigation years later will reach a different conclusion?

6. If whoever you choose as the prosecutor ends up declining to bring indictments, won’t the net result be a Justice Department investigation that will forever be concealed from the public because of grand-jury secrecy? Or will you direct your prosecutor to prepare a public report—in much the same way independent counsels were previously required to do so by law—so the American people once and for all can know the truth about this subject?

July 16th, 2009

Mother Jones on health professionals’ complicity with US torture

Mother Jones has a major new article on health professionals’ complicity with the US military’s torture and detainee abuse. The article shows that none of our major professional associations acted honorably in the face of government-sanctioned torture and abuse.

While I have written extensively on the failures of the American Psychological Association, the American Medical Association, while possessed of better policies, failed to condemn US torture, or to investigate medical complicity with torture. Professional licensing boards across the country failed to act on, or even to investigate, ethics complaints filed against those accused of aiding abuse have been rejected without investigations.

From the perspective of the struggle about the role of psychologists in interrogations occurring in the American Psychological Association, the article has important information. It begins and ends with the story of Army medic Andrew Duffy, who served at Guantanamo in 2006. That is, he served two years after psychologist and former Guantanamo and Abu Ghraib Behavioral Science Consultation Team [BSCT] member Col. Larry James claims to have single-handedly “fixed hell” at both detention facilities. Yet Duffy tells tales of routine horrific abuse, even resulting in death. Granted, the abuse Duffy describes is not interrogation abuse, but, rather, the pervasive neglect that comes from dehumanizing those within one’s care.

THE MEMORY OF detainee No. 173379 still haunts Andrew Duffy. The 24-year-old prisoner showed up in March 2006 among a truckload of captures at Abu Ghraib, where Duffy was stationed as a medic. His job was to treat new arrivals in an overcrowded, sweltering tent suffused with the stench of human waste and vomit. There, Duffy, then 19, handled everything from common diseases like tuberculosis to festering gunshot wounds.

But the new prisoner stood out. He was belligerent, yelling gibberish and staggering like a drunk. Having witnessed this kind of behavior before with detainees in diabetic shock, Duffy checked the man’s blood-sugar level. From 70 to 140 milligrams per deciliter is normal; his read 431. The prisoner explained that Iraqi soldiers had held him for five days without his insulin. Duffy called the compound’s hospital to request an immediate transfer. It was denied. Duffy’s medical supervisor ordered him to just give the guy water.

He was used to this. The prison’s medical officers routinely rejected medics’ requests to hospitalize sick and wounded detainees; the general sentiment, Duffy says, was “screw these guys.” Once, he tried to re­vive an elderly prisoner whose heart had stopped. The ambulance’s defibrillator had the wrong pads, so Duffy attempted CPR and mouth-to-mouth. “Why did you make out with that hajji?” the hospital staffers taunted. “Why didn’t you just let him die?” For the next month, he heard it around the chow hall: “That fucking medic gave that hajji CPR!”…

BACK AT ABU GHRAIB, Andrew Duffy was in no position to disobey a direct order, so he did as he was told and gave water to his diabetic prisoner. By the next morning, detainee No. 173379 was even weaker and more confused. Duffy and his partner again called for a hospital transfer-their third try-and again the captain denied the request. This time, she told them to administer saline through a 14-gauge needle.

That’s a huge needle-more than two millimeters in diameter. A civilian doctor would only use it for extreme trauma situations, with an unconscious patient or with a local anesthetic to numb the pain. At Abu Ghraib, the large needles were used as punishment, or to discourage detainees from asking for care.

If Duffy’s account is verified by others who served at Abu Ghraib, it puts the lie to James’ claims of having transformed the facility to humane standards. As James’ account of the humane transformation of Guantanamo through his efforts in early 2003 are belied by virtually every other unbiased account of that facility in 2003, 2004, and after, James’ account of his alleged efforts to reform either facility are highly questionable at best. Either James was startlingly incompetent or he was engaged in some other activity than “fixing hell” during his time as a BSCT at these facilities. Unfortunately, the information we have on the BSCT program leans in the second direction.

First, Do Harm

By Justine Sharrock

THE MEMORY OF detainee No. 173379 still haunts Andrew Duffy. The 24-year-old prisoner showed up in March 2006 among a truckload of captures at Abu Ghraib, where Duffy was stationed as a medic. His job was to treat new arrivals in an overcrowded, sweltering tent suffused with the stench of human waste and vomit. There, Duffy, then 19, handled everything from common diseases like tuberculosis to festering gunshot wounds.

But the new prisoner stood out. He was belligerent, yelling gibberish and staggering like a drunk. Having witnessed this kind of behavior before with detainees in diabetic shock, Duffy checked the man’s blood-sugar level. From 70 to 140 milligrams per deciliter is normal; his read 431. The prisoner explained that Iraqi soldiers had held him for five days without his insulin. Duffy called the compound’s hospital to request an immediate transfer. It was denied. Duffy’s medical supervisor ordered him to just give the guy water.

He was used to this. The prison’s medical officers routinely rejected medics’ requests to hospitalize sick and wounded detainees; the general sentiment, Duffy says, was “screw these guys.” Once, he tried to re­vive an elderly prisoner whose heart had stopped. The ambulance’s defibrillator had the wrong pads, so Duffy attempted CPR and mouth-to-mouth. “Why did you make out with that hajji?” the hospital staffers taunted. “Why didn’t you just let him die?” For the next month, he heard it around the chow hall: “That fucking medic gave that hajji CPR!”

Beyond patching up detainees, Duffy and his comrades with the 134th Medical Company of the Iowa National Guard were ordered to soften them up for interrogation. One day, Duffy and an MP restrained and hog-tied a resisting detainee-cuffing his wrists to his crossed ankles behind his back-so that Duffy could check his vital signs. Guards later boasted that they’d left the man that way for 12 hours.

Throughout Duffy’s year at Abu Ghraib-long after the infamous photos were published and the Pentagon vowed that detainees were no longer abused-men were still being strapped into restraint chairs and left in the blazing sun for hours or locked in cells too small to lie down in for 24 hours at a time. The medics regularly found prisoners dehydrated, wrists bloody from overtight handcuffs, ankles swollen from forced standing, joints dislocated from stress positions. They knew to keep their written evaluations vague, never mentioning cause of injury as a standard medical report would. When they shuttled broken detainees to and from the prison’s interrogation rooms, the orders were explicit: Transport only. No medical care. No paper trail. Flouting the Geneva Conventions, Duffy’s platoon sergeant even ordered the medics to strip their uniforms and ambulances of the Red Cross emblems that denoted them as noncombatants. Should anyone from the Red Cross show up to see the prison, the soldiers were told, send them away and tell them nothing.

FOR MORE THAN five decades, starting with the prosecution of Nazi doctors during the Nuremberg trials-seven were sentenced to death-the Pentagon made a point of ordering its physicians to abide by international norms. The World Medical Association, which counts the American Medical Association (AMA) as a member, had issued clear directives: Doctors could not assist in torture or cruelty of any kind, and were duty bound to report abuses they witnessed. The United Nations later clarified that the rules apply to all medical personnel-from surgeon to nurse to psychologist to lowly medic. Even now, the Army’s Military Medical Ethics textbook echoes the Geneva Conventions, noting that a doctor-warrior’s priority is always “physician first.” “They don’t give up their licenses and their medical ethics when they join the military,” explains George Annas, a professor of law and public health at Boston University.

But even as the nation debates disbarment for the Bush administration lawyers who green-lighted torture, the medical profession has dealt reluctantly, if at all, with its own involvement. “The indifference is shocking,” says retired Army Brig. General Stephen N. Xenakis, a rare outspoken critic among military doctors. “Some civilian doctors are appalled, but many say, ‘It doesn’t affect my life; I’m not involved.’”
Doctors were complicit in the torture strategy from the start. In December 2002, Defense Secretary Donald Rumsfeld issued a directive allowing interrogators to withhold care in nonemergency situations-men with injuries including gunshot wounds were denied treatment as a way to make them talk. (The directive was soon revoked, but the practice continued.)

Four months later, Rumsfeld ordered that doctors had to certify prisoners “medically and operationally” suitable for torture and be present for the sessions. At Abu Ghraib, interrogations had to be preapproved by a physician and a psychiatrist. “They have the final say as to what is implemented,” Colonel Thomas M. Pappas told military investigators.

The CIA received similar advice in 2002 and 2005 from the Justice Department, whose torture memos recommended that physicians and psychologists be present for the interrogation of “high value al Qaeda detainees.” These doctors, the lawyers argued, would see to it that interrogators didn’t torture detainees by intentionally inflicting “serious or permanent harm.”

But it was in June 2005 that the Pentagon delivered its biggest ethical bombshell, a memo that allowed doctors to participate in torture and share medical records with interrogators so long as the detainee in question wasn’t officially their patient. The directive’s author, physician and top Pentagon health official William Winkenwerder Jr., received a prestigious award from the AMA that year for outstanding contributions “to the betterment of the public health.”

Field medics like Duffy, who were still being trained to do no harm according to the military’s old ethical standards, faced a rude awakening on the ground. “You have all these codes you follow as a health care worker, but then it’s, ‘Now we’re in Iraq, forget those,’” Duffy told me.

Plenty of doctors in uniform felt similarly but, like Duffy, did as they were told. A 2007 Red Cross report indicates that CIA medical personnel presided over hundreds of waterboardings, including those of Abu Zubaydah and Khalid Sheikh Mohammed. One Al Qaeda associate, an amputee named Walid bin Attash, told the Red Cross that health workers periodically measured the swelling in his remaining leg as he was shackled in a stress position at a CIA black site. Gitmo military doctors twice sent alleged 9/11 planner Mohammed al-Qahtani to the hospital after his heart rate fell to dangerously low levels, only to send him back to the torture chamber when he improved.

Aware of the breaches, Xenakis says, a few military physicians called for ethical reviews. But the Pentagon overruled them, and the protests ceased. “There was a blackout,” he explains. Fearing for their careers, “military doctors wouldn’t speak, even informally.” Before long, adds M. Gregg Bloche, a Georgetown University law professor who interviewed military physicians on condition of anonymity, the Defense Department was screening doctors and deploying only those on board with the program.

DURING THE 1980S, as a symbolic show of support for doctors working under oppressive regimes, the American Medical Association enacted guidelines that forbade their participation in torture. But even when it became clear that US doctors were violating these rules, the association (which represents a quarter of a million doctors and med students nationwide) took no steps toward censuring its wayward members. Instead, in 2004, it released a statement pointing to its existing guidelines. The AMA’s refusal to take a stronger stand, says Penn State bioethics professor Jonathan H. Marks, has been “a source of shame” for the profession.

What stood out for Steven H. Miles, a bioethicist at the University of Minnesota Medical School, was the association’s resounding silence in February 2006, after the UN Commission on Human Rights condemned American doctors for having “systematically” participated in detainee abuse. “In a serious medical community, that would be a call to arms,” Miles says. “But the AMA said nothing.”

It wasn’t until November 2006 that the association issued a statement clarifying that doctors cannot participate in interrogations of any kind. Xenakis, who helped shape the new policy, says most of the AMA’s military delegates resisted the move, arguing that “the mission of getting information was greater than the medical ethics they acknowledged we were overriding.” (The four military delegates contacted for this story declined to comment.)

The nation’s top medical association has all but ignored the sorts of serious ethical breaches that Duffy witnessed daily-the neglect, the filthy conditions, the incomplete medical reports. Some doctors even abused detainees under the guise of treatment. Brandon Neely, who served as a guard at Guantanamo back in 2002, twice watched a Navy physician perform violent exams on new arrivals. Without lubrication, he said, the doctor “just reached back and shoved his finger as hard as he could in the rectum.” His fellow MPs told him the other doctors were doing the same thing. They all heard the prisoners screaming.

On at least four occasions, doctors have petitioned AMA leaders to endorse an independent investigation of their colleagues’ role in the abuses-only to be voted down. “They said, ‘Look, we trust our military and we aren’t going to step on their toes,’” explains Matthew Wynia, director of the association’s Institute for Ethics.

None of the AMA’s top officials would be interviewed for this story. When pressed on why they were so reluctant to act, even after the complicity of doctors became apparent, spokeswoman Kate Cox insisted that the association has no specific knowledge of doctors being involved in abuse or torture and that it is not equipped to conduct the sort of investigation needed to “credibly confirm” such allegations. Besides, Cox said, the AMA has fulfilled its duty simply by setting ethical standards.
But the AMA’s critics worry that its half-measures have already-perhaps irreparably-damaged the moral standing of American doctors. “It has had a corrosive effect,” says Xenakis. Adds Miles, “We’re now in an extremely poor position to protest abuse in other countries. It will silence us as a medical community.”

MENTAL HEALTH practitioners were, if anything, even more deeply involved in the abuses. In November 2002, Gitmo commander Maj. General Geoffrey Miller put together a Behavioral Science Consultation Team, a group of psychiatrists and psychologists tasked with preparing prisoner profiles and advising interrogators on the use of environmental manipulation, sleep deprivation, exploitation of individual fears, and other coercive methods.

Among the practitioners was Guantanamo senior psychologist Major John Leso, who helped plan and implement the 50-day interrogation of Mohammed al-Qahtani. Detailed logs of the torture sessions indicate that the prisoner was sexually humiliated, isolated and deprived of sleep for extended periods, subjected to extreme cold, shackled in stress positions, tormented by military dogs, and leashed and made to perform like a dog.

Leso, who was in the interrogation room for part of Qahtani’s ordeal, advised-among other things-that the detainee could be disoriented by spinning him on a swivel chair so that he couldn’t fix his eyes on one spot. Along with the prison’s medical doctors, he regularly evaluated Qahtani for his ability to tolerate further abuse. During one session, the medical staff injected the prisoner with three and a half IV bags of saline-Qahtani’s questioner then wouldn’t let him urinate until he provided satisfactory answers. Despite evidence of Leso’s actions, the American Psychological Association has failed to act on an ethics complaint by a fellow APA member.

Rank-and-file psychologists are deeply divided on the subject of torture. In 2007, an association task force (six of its ten members had military ties) voted to condemn torture but still allow psychologists in the interrogation room, where, its members argued, they might discourage abuse and even save detainees’ lives. Incensed, thousands of psychologists petitioned for a vote on the question by the APA membership. In a roughly 60-40 tally, the association decided that psychologists have no place in the interrogation room. (For more on the APA and torture, see David Goodman’s “The Enablers”.) It was the right choice, says Robert Jay Lifton, a psychiatrist and former military medic who has written about the role of Nazi doctors during the Holocaust. Putting health professionals into an abusive setting, he argues, “can confer an aura of legitimacy and can even create an illusion of therapy and healing.”

Which is more or less what Duffy experienced. “If a medic was around, there was a sense of some control,” he told me. “The guards probably thought, ‘If I really cross the line, this guy would stop me.’”

In May 2006, the American Psychiatric Association, which represents some 38,000 psychiatrists, reiterated its past position that its members should not directly assist in interrogations. But Steven Sharfstein, then the association’s president, also noted that psychiatrists “wouldn’t get in trouble” if they heeded military orders over the association’s advice-which, he added, should not be considered “an ethical rule.”

IT’S NOT THAT the medical community lacks the tools to police itself. Doctors can’t practice without a state license, and a grave breach of ethics can cost them that license. State licensing boards are legally obligated to investigate violations, yet no state medical board has ever disciplined a doctor for assisting in military torture.

One California complaint illustrates the boards’ reluctance to confront the military. Filed by New York-based attorney Scott Sullivan on behalf of four former detainees, the 2005 complaint targeted Captain John S. Edmondson, then Guantanamo’s lead physician. The men claimed that their medical records were shared with interrogators, who then withheld treatment for heart problems, worms, constipation, and injuries inflicted by the camp’s “internal reaction forces”-five-man teams dispatched to beat recalcitrant prisoners. When these attackers showed up, the detainees claimed, medical personnel would instruct them on details such as, “Hit him around the eye; don’t poke him in the eye.”
But the complaint never got a hearing: The Pentagon claimed jurisdiction in the case, and the medical board demurred. Citing insufficient subpoena power and resources, it turned the matter over to military investigators, who found no evidence of wrongdoing. “The board didn’t care how they got out of it,” says Sullivan. “They just didn’t want to be in the middle of a hot-button political issue.”

Mother Jones obtained three similar complaints filed by former APA member Trudy Bond against psychologists who allegedly participated in abuses. In addition to targeting Leso’s license in New York, she pursued his Gitmo colleague, senior psychologist Colonel Larry C. James, in Louisiana. In Alabama she filed a complaint against Diane M. Zierhoffer, a military psychologist who helped direct the interrogation of an Afghan teenager accused of throwing a grenade at a US military vehicle. Zierhoffer recommended a month of isolation, which can cause or exacerbate mental health problems; later, the teen tried to hang himself.

None of these complaints resulted in disciplinary action. Licensing boards, says bioethicist Marks, are “reluctant to call into question anything with broader implication beyond the individual physician, especially if it is impugning government officials or state policy.”

Absent action from the profession, some states have turned to political pressure. California’s Senate passed a symbolic joint resolution last year urging the state’s licensing boards to warn doctors that they could be prosecuted for participating in torture. (The American Psychiatric Association petitioned unsuccessfully to have psychiatrists exempted.) A bill under consideration in New York would bar any health care worker from participating in torture or “improper treatment,” as defined by international standards. But reform advocates say legislation is no substitute for sanctions by doctors themselves. “The practice of medicine,” says Boston University professor Annas, “is something the profession defines and the profession has to guard.”

BACK AT ABU GHRAIB, Andrew Duffy was in no position to disobey a direct order, so he did as he was told and gave water to his diabetic prisoner. By the next morning, detainee No. 173379 was even weaker and more confused. Duffy and his partner again called for a hospital transfer-their third try-and again the captain denied the request. This time, she told them to administer saline through a 14-gauge needle.

That’s a huge needle-more than two millimeters in diameter. A civilian doctor would only use it for extreme trauma situations, with an unconscious patient or with a local anesthetic to numb the pain. At Abu Ghraib, the large needles were used as punishment, or to discourage detainees from asking for care.

A day later, the Army’s criminal investigation unit summoned Duffy and his partner for questioning. No. 173379 was dead. Interpreting his symptoms as insubordination, MPs had pepper-sprayed the man and stuck him in a tiny cell in the scorching heat. Duffy says he filled out a five-page sworn statement, but his captain gave a conflicting account, and the case was dropped. Later, when it became clear that the dead man had been an associate of Abu Musab al-Zarqawi, the bloodthirsty commander of Al Qaeda in Iraq, soldiers came up to congratulate the medics.

Duffy did what he felt he could. Beyond his statement (which the investigators now claim they have no record of), he complained to his superiors about the shoddy medical supplies and the stripping of Red Cross emblems. More recently, he filed complaints about his platoon sergeant and captain with the Army Inspector General’s office, but nothing has come of it. In any case, much of the paper trail that might have implicated them is probably lost. When the military abandoned Abu Ghraib in September 2006, Duffy and his comrades were given one last order: Burn all of the compound’s medical records.

July 16th, 2009

Democracy Now! on Dasht-e-Leili massacre

Democracy Now! discusses the Dasht-e-Leili massacre with journalist James Risen and Physicians for Human Rights’ Susannah Sirkin. Somewhat surprisingly, Risen emphasizes several times that investigations should focus only upon Bush administration cover-up, ignoring the possible collusion of the hundreds of US troops reported to be present at the massacre by witnesses. It almost makes me wonder if Risen is concerned that others will succeed where he failed, in elucidating the role of US troops.

I think it’s still—it’s very unclear what US personnel knew at the time. And I think the investigation should focus rather on what happened afterwards in the Bush administration.

If “it’s very unclear what US personnel knew at the time,” why shouldn’t an official investigation find out? I don’t get it.

You can watch, listen, or read here.

July 15th, 2009