Psyche, Science, and Society

Ray Bennett, retired military interrogator, speaks against torture

At a recent Human Rights First confence of interrogators speaking against torture, blogger Thomas Nephew spoke with retired military interrogator Ray Bennet. He recounted that discussion in his post: “I want my white hat back” - military interrogators against torture. I’ve met Ray Bennett and was very impressed with his integrity and passion to oppose torture. Like Maj. Frakt, whose legal argument I posted earlier today, Bennett is one of those military folk who take the idea of honor quite seriously.

Later Nephew conducted an email “interview” with Ray. Here it is. Because the comments to that post are interesting, I include them as well.

Interview with an interrogator

On Tuesday, Human Rights First held an event in downtown Washington D.C. honoring the efforts of professional military, CIA, and FBI interrogators to restore decency and respect for human rights to U.S. detainee interrogation policy. Human Rights First and these interrogators are advocating a policy of “rapport-based” interrogations — no torture and no cruel, inhumane or degrading treatment by anyone acting on behalf of the United States of America.

I had a conversation at that event with one man who is now retired from the military after extensive service as an interrogator. I wrote about our conversation here: “I want my white hat back” — military interrogators against torture.

Today I corresponded again with “Ray” — a pseudonym — about his positions on following orders to waterboard or otherwise torment a detainee, about what he thought his colleagues believe, about Abu Ghraib, and about what the future may hold.

1. If you had been ordered to waterboard someone or engage in other cruel/inhumane/degrading detainee mistreatment (e.g.., hypothermia, long time standing), what would you have done?

Refused the order. That would probably have resulted in my getting fired or re-assigned, but so be it. In addition, I would have documented the incident, and reported it to the Army’s (assuming that’s the environment I would have been working in) Criminal Investigation Division, or otherwise appropriate authorities.

2. [Excuse my ignorance here]: … what if the order was not “up to snuff” — not written, not verbally direct with witnesses, or whatever constitutes “an order that should be obeyed”?

Same answer. Refuse the order, immediately document the incident, and follow up with a report to the appropriate investigative authorities.

3. Do you believe that such orders/wishes should not be obeyed by military personnel?

This is where it gets murky. Personally, of course, I feel that they should not be obeyed. The difficulty for my collegues, especially in the military, is that we are sworn to follow “the lawful orders of the officers appointed above us”. So what’s lawful? All of us were trained in the Law of Land Warfare and the Geneva Conventions, which these “enhanced interrogation techniques” are clearly a violation of.. But Private Snuffy is confused: “didn’t the United States Attorney General, the top law enforcement official in the land, muddy the waters by saying that it was legal? And didn’t the president say that these folks don’t fall under the Geneva Conventions? So what about those rules they taught me?” We are doing our troops a great disservice by blurring the “lawful” line. So to answer your question again: me personally, I would hope that an order to carry out these techniques would be disobeyed. But I can’t really hold it against someone who carried it out, thinking that it was legal, and felt compelled to carry out a lawful order.

4. Do you feel your answers to the above three questions would be a majority opinion in the group of interrogators you were with over the past few days?

Question 1: Not just majority opinion, but unanimous.
Question 2: Same
Question 3: Certainly majority, if not unanimous. One of the retired generals in the group explicitly made the point that he did not want the authority to order these techniques carried out, for the reason listed above: it would make it a lawful order, and the soldiers serving under him would have no recourse but to carry out a lawful order, or face prosecution under the Uniform Code of Military Justice for failing to do so.

5. Do you believe that such orders/wishes should not be obeyed by any govt. personnel? (i.e., CIA or FBI — the latter seem to have drawn the line themselves, but that could change someday)

Same answer as number 3. I do not believe the order should be carried out, but it is asking a lot of these personnel to put their livelihoods and careers on the line, and we can condemn them with hindsight if we like, but the better solution is to not ask them to do it in the first place.

6. Do you feel there’s the possibility of professional opinion changing as new interrogators become accustomed to the new regime of loosened restrictions (at least within the CIA)?

I’m assuming you mean professional opinion changing for the worse. And yes, I can absolutely see that happening. Let’s say this policy stays in force. Those that would refuse the order would eventually be weeded out of the system, leaving only those that would use these techniques, and they in turn would be the only mentors to the next generations of interrogators. Those that abhor the techniques would be on the outside looking in. Basically, our group is in that same position. We are no longer in the military, or CIA, or FBI. We are on the barricades, but outside the fort, not inside. We are trying to influence the policymakers to not put those inside the fort into the position of having to compromise their core values. And we are arguing from a position of professional strength: sure, we also oppose these techniques on moral grounds, and in the belief that they dilute our nation’s image abroad (creating a breeding environment for more terrorists), etc., but mainly we are saying that from the standpoint of professional interrogators, we DO NOT NEED these techniques. We can get the job done without them.

I know that it’s important to follow orders in the military, but that’s not drilled in to me the way it is (and for 99.99% of cases, should be) for a soldier. On the other hand, I know at least one ex-military blogger who said, at the time Abu Ghraib broke, that the people involved should simply not have followed those orders (or carried out those wishes) based on code of conduct.

[I]t’s important to keep facts straight and in reasonable proportion. Abu Ghraib, for example. The abuses and resulting pictures were not an interrogation tactic, but a guard force night shift run amok. Don’t get me wrong: this was without question a horrific abuse of detainees in U.S. custody, and must be addessed and those responsible held to account. All I’m saying is that it’s a different discussion. Yes, there were comments from interrogators to “make sure he has a bad night” etc, maybe even with a nudge/wink, and those interrogators share the resulting fiasco, because they were not clear in their instructions. But I don’t think what resulted was really what the interrogators had in mind. Nevertheless, it is this nudge/wink and between the lines communication that were part of the permissive environment that ended as it did. Most of the orders leading to the abuses were not in writing, if any of them were. The only exception I can think of would be the use of “military working dogs”. That was a technique promoted by a general (who was not an intelligence officer, let alone an interrogator). Unfortunately, by virtue of his rank and position, he held authority over detainee treatment and interrogation procedures. As for the ex-military blogger you mentioned, I only say that we all see clearly in hindsight. The answer, again, lies in not putting these soldiers and other intelligence professionals into this netherworld of blurred lines and questionable legal definitions, for soldiers are conditioned to follow lawful orders. They are not lawyers, and we can not expect them to be. They must have clearly defined delineations, which were provided under the Laws of Land Warfare and the Geneva Conventions, and don’t need the waters muddied by policymakers and their lawyers, who in the end don’t know anything about interrogation beyond what they’ve seen on television.

Add comment June 22nd, 2008

A drugged army is a more reliable army

Meanwhile, te soldiers who are in Iraq and Afghanistan are taking psychoactive drugs, primarily antidepressants and sleeping medications, in order to cope:

Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn’t consistently asked about prescription-drug use, which makes it difficult to track. Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use. But if the Army numbers reflect those of other services — the Army has by far the most troops deployed to the war zones — about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.

The extensive use of psychotropics may enable the military to keep more troops in the field longer, at the cost of more mental disorders long-term:

“No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day,” says Combat Stress Injury, a 2006 medical book edited by Charles Figley and William Nash that details how troops can be helped by such drugs. “Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries” and “help restore personnel to full functioning capacity.”

Which means that any drug that keeps a soldier deployed and fighting also saves money on training and deploying replacements. But there is a downside: the number of soldiers requiring long-term mental-health services soars with repeated deployments and lengthy combat tours. If troops do not get sufficient time away from combat — both while in theater and during the “dwell time” at home before they go back to war — it’s possible that antidepressants and sleeping aids will be used to stretch an already taut force even tighter. “This is what happens when you try to fight a long war with an army that wasn’t designed for a long war,” says Lawrence Korb, Pentagon personnel chief during the Reagan Administration.

Not everyone is fooled:

Military families wonder about the change, according to Joyce Raezer of the private National Military Family Association. “Boy, it’s really nice to have these drugs,” she recalls a military doctor saying, “so we can keep people deployed.” And professionals have their doubts. “Are we trying to bandage up what is essentially an insufficient fighting force?” asks Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress Studies.

Add comment June 8th, 2008

Self-mutilation as a life preservative: ‘Anything Not to Go Back’

Those of us old enough to remember Vietnam recall the creativity of men avoiding the draft. Today we see similar signs of a war gone badly wrong, as Newsweek reports:

‘Anything Not to Go Back’

By Tony Dokoupil

As an internist at New York’s Mount Sinai Hospital, Dr. Stephanie Santos is used to finding odd things in people’s stomachs. So last spring when a young man, identifying himself as an Iraq-bound soldier, said he had accidentally swallowed a pen at the bus station, she believed him. That is, until she found a second pen. It read 1-800-GREYHOUND. Last summer, according to published reports, a 20-year-old Bronx soldier paid a hit man $500 to shoot him in the knee on the day he was scheduled to return to Iraq. The year before that, a 24-year-old specialist from Washington state escaped a second tour of duty, according to his sister, by strapping on a backpack full of tools and leaping off the roof of his house, injuring his spine.

Such cases of self-harm are a “rising trend” that military doctors are watching closely, says Col. Kathy Platoni, an Army Reserve psychologist who has worked with veterans of Iraq and Afghanistan. “There are some soldiers who will do almost anything not to go back,” she says. Col. Elspeth Ritchie, the Army’s top psychologist, agrees that we could see an uptick in intentional injuries as more U.S. soldiers serve long, repeated combat tours, “but we just don’t have good, hard data on it.” Intentional- injury cases are hard to identify, and even harder to prosecute. Fewer than 21 soldiers have been punitively discharged for self-harm since 2003, according to the military. What’s worrying, however, is that American troops committed suicide at the highest rate on record in 2007—and the factors behind self-injury are similar: combat stress and strained relationships. “It’s often the families that don’t want soldiers to return to war,” says Ritchie.

Soldiers have long used self-harm as a rip cord to avoid war. During World War I, The American Journal of Psychiatry reported “epidemics of self-inflicted injuries,” hospital wards filled with men shot in a single finger or toe, as well as cases of pulled-out teeth, punctured eardrums and slashed Achilles’ heels. Few doubt that the Korean and Vietnam wars were any different. But the current war—fought with an overtaxed volunteer Army—may be the worst. “We’re definitely concerned,” says Ritchie. “We hope they’ll talk to us rather than self-harm.”

This trend poses complex ethical issues for psychologists and other mental health professionals. What is the ethical way to “help” these soldiers: fix them up and send them back to their units; help them escape; or to treat their desire to avoid another horrifying tour as a mental illness? And who is the treater primarily responsible to? The patient or the army? Unfortunately, I see few signs of our professions grappling with these thorny issues.

Add comment June 8th, 2008

Support our troops. Bring them home.

For Memorial Day. Don’t let more soldiers die in vain. And take care of them when they’re home.
Bruce Springsteen - Bring Them Home - San Francisco 2006:

Add comment May 25th, 2008

Pressure to increase body count produces civilian deaths

Mark Benjamin and Christopher Weaver of Salon writes of how the military’s pressure of snipers to increase their body count led to the murder of civilians.

The snipers were told they could shoot if someone had “hostile intent”:

The snipers felt they were being pressured to interpret “hostile intent” loosely to justify kills. During testimony, sniper Spc. Joshua Michaud said that Lt. Col. Balcavage and Command Sgt. Maj. Knight “constantly pushed for ‘If you feel threatened, you know, obviously eliminate the threat.’ But they kind of said it in a manner in which a lot of us took it like, ‘Hey, you need to go out there and you guys gotta start getting kills.’”

Additionally, the rules explicitly allowed the killing of civilians:

At worst, the rules explicitly allowed the killing of unarmed Iraqis under certain circumstances, a particularly dicey concept given an enemy that does not wear a uniform and hides among civilians. Specifically, the snipers were allowed to shoot unarmed people running away from explosions or firefights. The chain of command was particularly frustrated by insurgents fleeing after attacks from roadside bombs, called improvised explosive devices. The notes from Army agents who later investigated the shootings said the battalion leaders, Balcavage and Knight, worried that the snipers had “let a lot of guys go after IED explosions.” The snipers called these fleeing, sometimes unarmed Iraqis “squirters.” Of course, it’s not unusual for innocent people to run from explosions.

One soldier involved in a killing got a 10-year sentence. As usual, the officers who created the conditions leading to the brutality were never even investigated:

Top battalion leaders, who had to sign off on the charges, have faced no serious questions about whether their demand for more bodies, their vague rules of engagement or the confusion sown by the secret program might have contributed to the events of spring 2007.

One of the soldiers involved explained succinctly the connection between the type of war and th brutality:

“If you have never been outside the wire, you really have no basis [to judge],” said Hand. “You’ve never been in a life-or-death situation where you have had to count on the guy to your left and right … You see stuff out there that no one back here is going to see.”

The answer is to end the war. Scapegoating a few soldiers will only increase the final death toll by helping to focus attention away from the brutality of occupation and onto the supposed depravity of a few, the perennial “bad apples” that seem to grow  whenever rotten trees are not recognized ad pruned.

Add comment May 9th, 2008

Jason Isbell/Drive-By Truckers: Dress Blues

[H/t CounterPunch.]

Add comment February 27th, 2008

Fort Hood soldiers protest the war

Those of us who lived through and participated in the 1960’s and early ’70’s antiwar movement know that one of the most important aspects of those movements was the growth of the antiwar movement among active duty GIs. Most demonstrations were led by active duty soldiers, every base had its antiwar coffee house and newspaper. “Fuck the Army!” was all over the place. And discipline fell to the point where the brass knew that it was get out or get out of the way.

A friend stationed in Nam aroung 1971 described being assigned to pick up litter on the base. As he’s walking around, he smokd and three down a cigarette butt. His ergeant yelled “Pick that up!” As he tells it, he just looked at the Srage and said “F***You!” the Sergeant glowered back in rage, but kept his mouth shut, knowing that to say anything, much less discipline the soldier for insubordination, was to risk danger. an army in that shape cannot be kept in an unpopular war indefinitely.

While nowhere to that degree, there are indications that a movement of active duty soldiers is growing. A TV station in Austin Texas reports on the growth of Iraq Veterans Against the War on the base. As it quotes soldiers on base:

“The honest truth is that if the American people knew what was going on over there everyday, they would be raising their voices too. They would be saying, ‘Hey, bring those guys home,” Sgt. Selena Coppa said.

Coppa blames lawmakers in Washington for filtering the facts on the war in Iraq. She said there’s no real end in sight.

“There is a cost to this war. This war is being paid in American blood, in my soldier’s blood. And that is not okay,” Coppa said.

“We lost really good friends, really good leaders who died in Iraq. From my perspective, it didn’t make any sense, we didn’t ccomplish anything, and I talked to a lot of other soldiers who feel the same way,” Fort Hood soldier Casey Porter said.

Ronn Cantu is between Iraq deployments. He feel a need to use the opportunity to speak out:

“I honestly thought I might not live through my second tour, so I
thought, you know if I’m going to die anyway, I need to say the
things I need to say,” Cantu said.

Watch the story:

IVAW Fort Hood posts a banner — “IVAW is pro-soldier, but antiwar.”:

IVAW can be reached at ivaw.org

Add comment February 22nd, 2008

US Iraq Rules of Engagement leaked; Raises question about Rumsfeld authorizing war crimes

Wikileaks has obtained the long kept secret Rules of Engagement (ROE) for U.S. troops in Iraq. This document sets out the rules guiding authorized U.S. troop actions in that occupation. While the Wikileaks document dates from 2005, as these ROEs generally change slowly the rules for today are likely similar, though we can’t be sure, of course, to what extent more recent ROE’s differ.

Among several interesting nuggets in the ROE, it provides indications that U.S. attacks likely to result in civilian deaths required authorization at the top of the Pentagon, by the SECDEF (Secretary of Defense). Thus, the ROE states repeatedly; “If the target is in a HIGH CD [collateral damage] area, SECDEF approval is required.” And what is the definition of a High Collateral Damage area? The ROE contains a set of explicit definitions of its terms. There we find High Collateral Damage Targets defined as:

“Those targets that, if struck, have a ten percent probability of causing collateral damage through blast debris and fragmentation and are estimated to result in significant collateral effects on noncombatant persons and structures, including: (A) Non-combatant casualties estimated at 30 or greater; (B) Significant effects on Category I No Strike protected sites in accordance with Ref D; (C) In the case of dual-use facilities, effects that significantly impact the non-combatant population, including significant effects on the environment/facilities/infrastructure not related to an adversary’s war making ability; or (D) Targets in close proximity to known human shields.”

Thus, all attacks, except those in self-defense or active pursuit, with a reasonable possibility of harming 30 or more civilians needed approval from Defense Secretary Rumsfeld. Presumably such approval would need to be in writing. The ROE thus suggest that there may exist an extensive documentary record of requests, and possibly Rumsfeld’s approval or rejection, for attacks with the potential for resulting in significant civilian casualties. Congress should demand access to these documents to determine the extent to which attacks resulting in civilian casualties were authorized, potentially providing insight into who was responsible for possible war crimes committed in the course of the occupation.

While much of the rest of the ROE appears rather unsurprising, there are a couple of other interesting aspects to the document. One is that the main “hostile forces,” from the U.S. perspective are the Baath remnants, such as the Special Republican Guard and the Baath Party Militia. There is no mention of Iraqi al-Qaida or its predecessors. These predecessors, led by al-Zarqawi, had identified with and pledged allegiance to al-Qaida as early as October, 2004, yet they receive no mention in the ROE. The ROE rather refers to Baath forces that “have transitioned from overt conventional resistance to insurgent methods of resistance.”

While the Sunni al-Qaida predecessors do not make the list of hostile forces, the Shia-based Mahdi Army of Muqtada al-Sadr does make the list of “Declared Hostile Forces,” However, as of the ROE’s writing, this status was “suspended and such individuals will not be engaged except in self-defense.”

Another interesting feature of the ROE is a complete ignoring of the language barriers separating U.S. troops from the Iraqi populace. Thus, in a section on graduated force, the first stage is “shout verbal warnings to halt.” There is not even a mention of the fact that most Iraqis cannot understand warnings shouted in English. In general, the ROE is notable for lacking any recognition that, in an “insurgency,” there are at best blurry boundaries between combatants and noncombatants. Thus, there is no emphasis of the need to take extraordinary measures to protect the civilian population. Rather, it provides a rationale for virtually any attacks:

“US Forces may always use force, up to and including deadly force, to neutralize and/or detain individuals who commit hostile acts or exhibit hostile intent against US Forces or Coalition Forces.”

As we have seen repeatedly, from the numerous roadblock killings of civilians to the Haditha massacre, this ROE authorization to use force can be used to provide cover for virtually any civilian killings. The ROE suggests that preventing such deaths was low on the priority list of those officials writing the rules of engagement for the occupation. Even so, a military study found that less than half of US occupation soldiers would report a unit member for violating an ROE. Thus, even the limited protections provided civilians in the ROE were often not present on the ground.

Add comment February 4th, 2008

Blast trauma may act at a distance

The new Science contains an important article on current thinking on traumatic brain injury (TBI) from bomb blasts:

Shell Shock Revisited: Solving the Puzzle of Blast Trauma

Even at a distance, explosions may cause lasting damage to the brain. Such findings could have big implications for arming and compensating troops

by Yudhijit Bhattacharjee

Working at the Military Hospital in Belgrade during the brutal Balkan war of the 1990s, neurologist Ibolja Cernak encountered a medical enigma. She saw soldier after soldier with memory deficits, dizziness, speech problems, and difficulties with decision-making–but no obvious injury. Cernak recalls one 19-year-old who went to a grocery store and began to weep after he couldn’t remember how to get back home. When his mother brought him to the hospital a few days later, Cernak learned what later emerged as a common element in all these cases: The soldier had survived an explosion on the battlefield.

The strange thing was that most of these patients had not suffered a direct injury to the head. And yet, in computed tomography and magnetic resonance imaging scans, Cernak saw signs of internal damage. In some cases, the brain’s ventricles–channels that carry cerebrospinal fluid– had become enlarged; and in some, there was evidence of minor bleeding.

But when Cernak dug into the medical literature for an explanation, she came up empty. According to the available research, shock waves from an explosion injure mainly air-filled organs such as the lung and the bowel, not the brain.

With a small band of collaborators in Belgrade, China, and Sweden, Cernak undertook animal studies that eventually confirmed that blast waves can cause neuronal damage. The work drew little attention until 2 years ago when hundreds of U.S. and British soldiers began returning from Iraq with symptoms similar to those of Cernak’s patients. As roadside explosions became more common, military doctors suspected that these symptoms were the likely result of mild traumatic brain injury (TBI) sustained in blasts. Seeing her observations borne out was as if “a myth had become reality,” says Cernak, who is now a researcher at the Applied Physics Laboratory at Johns Hopkins University in Baltimore, Maryland.

How blasts affect the brain has since become an urgent question in military medicine. Last summer, the U.S. Congress gave $150 million to the Department of Defense (DOD) for the first year of research on TBI– both severe injuries that damage the skull and milder ones suspected of causing neurological deficits. The Defense Advanced Research Projects Agency (DARPA) has already launched a $9 million research program aimed specifically at understanding trauma caused by shock waves, heat, and electromagnetic radiation emanating from blasts. Another $14 million a year is going to the Defense and Veterans Brain Injury Center (DVBIC), a DOD-funded agency headquartered in Washington, D.C., for research and outreach on TBI.

This flurry of interest has focused a spotlight on Cernak’s research. There is growing consensus that blasts can produce subtle injuries in the brain as suggested by Cernak several years ago. In fact, the Department of Veterans Affairs (VA) proposed a new rule this month acknowledging blast-related TBI as a special neurological condition whose symptoms may have gone undetected in the past. The proposed rule, published in the Federal Register on 3 January, would allow for greater disability compensation to victims than is granted currently.

But many researchers are skeptical of Cernak’s ideas about how these injuries might occur. Cernak postulates that blast waves ripple through the victim’s torso up into the brain through the major blood vessels, leading to neurological effects that can be slow to appear. Although she has evidence from animal experiments to back up that hypothesis, she admits that more research is needed. If the mechanism is confirmed by future studies, Cernak says, it would mean that helmets do not protect the brain against blast injury.

Besides raising questions about the protection of troops currently in combat, Cernak’s suggestion that simply being exposed to an explosion might lead to long-lasting brain damage has opened a Pandora’s box, particularly for veterans. It implies that some could be suffering from neurological deficits that went undiagnosed or were mistakenly attributed to posttraumatic stress disorder (PTSD). Indeed, since the government began putting out information about blast-related TBI, veterans have been trickling in to seek treatment for mental problems that some have lived with for decades. “It may well be that blast injuries follow the pattern of Agent Orange and Gulf War syndrome,” says former VA psychiatrist David Trudeau, referring to ill-defined health problems that have lingered for years after battle.

Hidden trauma

If Cernak had been a doctor during World War I, she says, she might well have recognized mild TBI among the thousands of soldiers who suffered from what was simply called “shell shock.” But during World War I, many doctors and military commanders viewed shell shock as a transient psychological phenomenon that affected soldiers who, in their opinion, were mentally weak.

Cernak discovered something very different: that soldiers’ mental problems seemed to be driven by enduring physical changes in the brain. To test her hypothesis, she conducted a study of 1300 patients who had suffered penetrating wounds to the lower body but not the head. More than half had suffered injuries in a blast; the rest had been wounded by projectiles. Many of the blast victims complained of symptoms such as insomnia, vertigo, and memory deficits, and more than 36% in this group showed irregular patterns of electrical activity in the brain–as measured by electroencephalograms taken within 3 days of the injury– compared to only 12% in the other group. A year later, 30% of blast- injured patients still showed abnormal brain activity compared to 4% of the rest. Cernak says the findings, published in the Journal of Trauma in 1999, suggested that the mental problems of blast victims had a biological basis.

Her study wasn’t the first to make that point. A year earlier, VA researchers had found that among veterans with PTSD, individuals with a history of blast exposure were much more likely than others to have abnormal brain activity as well as cognitive and behavioral problems.

“Our evidence pointed to the possibility that blast injury was a long- lasting injury in combat veterans,” says Trudeau, who retired in 2000. He says he was disappointed by the lack of follow-up to the study, published in the August 1998 Journal of Neuropsychiatry. “The reception we got was pretty lukewarm,” he says.

For decades, Army researchers had been studying the effects of blast waves but with a different focus. They concentrated on how to protect the lungs and bowel because the pressure from an explosion is most likely to shear at the interface of these tissues, where densities differ. DOD was so confident that advanced body armor was protecting troops against lung and bowel injuries that it closed down this research program in 2003. “We thought, why spend more money on this when we’ve fixed the problem?” says Geoffrey Ling, a neurologist and a program manager at DARPA.

Then the bad news arrived. As blast survivors from Iraq were air-lifted to hospitals, U.S. Army doctors, including Ling, who was deployed in Iraq in late 2004, began to see patients whose brains had swelled markedly within hours of being close to a blast. Some had clear head injuries but many did not. Even in cases involving visible wounds, the extent of swelling was often much greater than expected, leading neurosurgeons to wonder whether blast waves had played a role in addition to penetrating shrapnel. Ling says the patterns of vascular enlargement seen across a range of patients showed a continuum of brain injury, suggesting that there could be milder versions that were less obvious.

That suspicion has grown stronger with hundreds of soldiers returning from the war zone complaining of a common cluster of cognitive and behavioral problems. Army doctors say they have encountered many patients who are unable to perform simple addition and subtraction, read more than one sentence at a stretch, or recall simple things like what they had for lunch. “The majority are individuals who lost consciousness or were dazed after a blast but did not sustain overt head injuries,” says Ronald Riechers, a neurologist at Walter Reed Army Medical Center in Washington, D.C. “Within a short time frame, they develop headaches and notice that their reaction time and concentration are not the same as before.” Based on these evaluations, DVBIC estimates that 10% to 20% of all soldiers on duty in Iraq and Afghanistan have suffered some type of TBI.

Ling says the TBI numbers prompted DOD to restart its research on blast injury, this time with a focus on the brain. DARPA is funding two main projects as part of the first basic science effort on the topic. One will study the mechanical and cellular effects of blast waves in an animal model. Another will look at the consequences of repeated exposures to low-intensity explosions among military breachers, whose job is to blast holes into buildings using shoulder-launched weapons. “Once you know for certain what in a blast is really hurting the brain and how, you can use that to develop therapies and prevention strategies,” says Ling.

A tsunami in the brain

Although it is becoming accepted that blast waves can cause TBI, Cernak’s theory about how the damage occurs is controversial, and it has implications for how best to protect troops. She hypothesizes that when blast waves strike the body, they transfer kinetic energy and cause pressure in the main blood vessels to oscillate rapidly. A pulse travels up through the neck into the brain, damaging axonal fibers and neurons in the hippocampus, brainstem, and other structures close to cerebral vessels. The shock can also injure cells farther out in the cortical regions.

That mechanism is entirely different from the more widely studied effects of acceleration or deceleration in a car crash. Researchers know that a crash impact can shake the brain so violently that axonal fibers are torn. Some say victims of explosions could be experiencing a similar whiplashing, in contrast to Cernak’s view–which would mean that helmets designed to dampen that effect could help. “I am very skeptical that kinetic energy could be transferred through the vascular system,” says J. Clay Goodman, a neuropathologist at Baylor College of Medicine in Houston, Texas. “It is much more reasonable to consider the blast effects directly on the cranial vault and the brain.”

Cernak says her findings show the vascular route to be more plausible. In experiments that exposed rats and rabbits to a simulated blast wave in a shock tube–a cylinder through which an air pulse is transmitted at high velocity–Cernak and her colleagues found that immobilizing the animal’s head with steel plates to prevent whiplash effects did not protect against hippocampal cell damage, as they reported in the Journal of Trauma in 2001. Cernak says the vascular-transmission theory could explain the unique combination of symptoms in blast-induced TBI, as well as why neurological symptoms are seen in soldiers wearing helmets. For example, memory deficits hint at damage to the hippocampus, whereas problems in orientation reflect injuries to the cerebellum. “What’s happening in blast injury is that these inner structures are being affected,” Cernak says, in contrast to TBIs in traffic accidents and contact sports, where the cortex bears most of the brunt.

Cernak presented unpublished results last month at the Blast Injury Conference in Tampa, Florida, showing that exposure to blast waves can trigger neurodegeneration in rat brains, fragmenting the walls of neurons in the hippocampus and other regions. Similar findings have been published by Annette Saljo, a researcher at the University of Goteborg in Sweden and a collaborator of Cernak’s. Saljo and her colleagues reported in the Journal of Neurotrauma in August 2000 that rats exposed to blasts showed a buildup of neurofilament proteins in the cortex and the hippocampus during the week following the injury. This suggests that the damage can worsen over time, like a “slow cooking under the surface,” says Cernak: “One could think of it as a horribly accelerated aging of the brain.”

If blast waves indeed cause injury by vascular transmission, new types of body armor may be needed. “We would need to develop materials that completely absorb or reflect the full range of blast-wave frequencies generated by an explosion,” says Cernak, adding that current body armor only shields against some of a blast’s kinetic energy.

Cernak has done pioneering work, says John Povlishock, a neuroanatomist at Virginia Commonwealth University in Richmond, adding that she may be right that a “rapid rise and fall in venous pressure” is what stamps the blast’s signature on the brain. But more studies are needed to validate her ideas and translate the animal results into humans: “This is a topic with great economic, military, and social implications,” he says, “and as of now, the literature is extremely limited.”

Needed: A gold standard

As blast casualties from Iraq have mounted, the U.S. military has stepped up efforts to detect TBI among troops. In July 2006, the Army Surgeon General asked all unit commanders in Iraq to request TBI screening for soldiers displaying “poor marksmanship, delayed reaction times, decreased ability to concentrate, and inappropriate behavior.”
Troops who have been in a blast are evaluated by field medics using a short questionnaire that asks, among other things, if the person lost consciousness and had trouble remembering things from just before the explosion. Depending on the severity of the symptoms, they are asked to take a day off or see a neuropsychologist.

Some veterans groups believe a more aggressive screening policy is needed, especially because the symptoms of blast injury might not show up until later and because subtle injuries might not show up in standard brain scans. The ideal option, some say, would be to use a biomarker:

“We’d like to be able to do a blood test to determine the injury,” says Colonel Robert Labutta, a neurologist at the health affairs office at DOD. But until the science of blast injury is established, officials say, it does not make sense to bring home every soldier who has been in the vicinity of an explosion.

The costs of treating TBI victims from Iraq and Afghanistan could be astronomical. At last count, nearly 25,000 soldiers had been diagnosed with TBI. One estimate of the financial burden, calculated by Harvard researchers, puts the number at $14 billion over the next 20 years. But officials seem determined not to miss any cases among troops coming
home: In April, VA mandated TBI screening for all Iraq and Afghanistan veterans who come to VA hospitals for any services, even if it’s a dental exam.

The spotlight on mild TBI has drawn the attention of older combat veterans who were exposed to blasts but were never treated for neurological symptoms. Many were diagnosed with PTSD; some of the symptoms–such as depression, irritability, and attention deficit– overlap with those of mild TBI. These cases, some reaching back to the Vietnam War, could have significant legal and financial implications, says Edward Kim, a psychiatrist with Bristol-Myers Squibb in Plainsboro, New Jersey, and author of a recent report from the American Neuropsychiatric Association on the mental health effects of TBI. “I question whether DOD and the VA really want to open this can of worms,”
he says. For example, a veteran with Alzheimer’s disease could make a claim pointing to research showing that TBI increases the risk of developing Alzheimer’s disease.

Cernak says she has been receiving e-mails and phone calls from veterans thanking her for her research and seeking more information. Last month, she got a call from a 47-year-old woman who had served in the first Gulf War. The woman had been a teacher before she went to the combat zone, where she was exposed to repeated blasts. After she returned home, she had to stop teaching because she could not remember any facts. The story reminded Cernak why she had begun studying this obscure field 2 decades ago. “Soldiers anywhere are one of the most vulnerable populations in the world,” she says. “It is a moral obligation to help them.”

2 comments January 25th, 2008

Liptak reviews Taxi to the Dark Side

Adam Liptak, in the New York Times, reviews Alex Gibney’s new documentary, Taxi to the Dark Side:

The Power of Authority: A Dark Tale

by Adam Liptak

FRANK GIBNEY was old and sick and a little more than a month away from dying. But he was filled with righteous anger, and he had some things to say. He told his son, the documentary filmmaker Alex Gibney, to unplug a noisy oxygen machine and to grab a video camera.

The older Mr. Gibney, a journalist and scholar who died in April, had served as a naval interrogator in World War II. In a moving statement that serves as a sort of coda to “Taxi to the Dark Side,” a new documentary about the Bush administration’s interrogation policies in the post-9/11 world, he said it had never occurred to him to use brutal techniques on the Japanese prisoners in his custody.

“We had the sense that we were on the side of the good guys,” Frank Gibney said, seething. “People would get decent treatment. And there was the rule of law.”

There would seem to be an enormous distance between the Bagram Air Base in Afghanistan, where the central events in “Taxi to the Dark Side” take place, and Enron’s headquarters in Houston, where the machinations of white-collar criminals brought down the giant energy company and became the backdrop for Mr. Gibney’s entertaining 2005 documentary, “Enron: The Smartest Guys in the Room.” But Mr. Gibney said the two projects have common themes.

“The subject of corruption unites my films,” he said. “‘Enron’ was about economic corruption, and ‘Taxi’ is about the corruption of the rule of law.”

In person Mr. Gibney, 54, is simultaneously casual and intense. He wears jeans, cool glasses and a goatee, and he juggles several projects at a time from an office overlooking the rail yards on the west side of Manhattan. On the wall is a poster for “The Trials of Henry Kissinger,” a 2002 documentary that he wrote. He is finishing up a documentary on the writer Hunter S. Thompson and is working on another about the lobbyist Jack Abramoff.

He said he has returned repeatedly to one concern: the power of authority to warp morality. At bottom, Mr. Gibney said, people do what they are told. “Everything in life,” he said, “goes back to the Milgram experiment.”

In the early 1960s Dr. Stanley Milgram, a psychologist at Yale, showed that many people were willing to deliver what they understood to be painful electric shocks to other human beings simply because they were told by a scientist that it was necessary.

At Enron as at Bagram, Mr. Gibney said, “a process had occurred, like Milgram, where they had crossed little personal lines, bit by bit.”

“Until,” he added, “they looked back and realized they were way over the line.”

Mr. Gibney persuaded a half-dozen guards and interrogators to appear in his documentary. They are candid, reflective, troubled and sometimes broken, and their testimony is the beating heart of the film.

Many of the traders at Enron were decent men too, Mr. Gibney said.

“One of the most interesting things for me was to discover that most of these guys, off the job, were really nice guys,” Mr. Gibney said. “I mean, pillars of their community. They gave to charity, set up orphanages. But on the job they were killers.”

“Taxi to the Dark Side” is an artful film, starting with cinematic vistas in Afghanistan and presenting soldiers in tight shots against dark backgrounds while former officials and journalists talk in grand settings filled with light.

Sometimes his filmmaking techniques stray from the journalistic straight-and-narrow. In an otherwise positive review of the Enron documentary, for instance, David Ansen of Newsweek objected to an impressionistic recreation of an executive’s suicide and whispering voices on the soundtrack, calling them “cheesy fictional techniques.”

Mr. Gibney said he is often asked why he does not give it to audiences straight.

His answer: “It’s because I didn’t want to give it to you straight. I wanted to have some fun.”

“Werner Herzog calls it the difference between an accountant’s truth and ecstatic truth,” Mr. Gibney continued. “It’s the idea that sometimes you can take a roundabout way to truth that’s more effective.”

In the new film he uses a re-creation to depict the interrogation of Mohamed al-Kahtani, a prisoner at Guantánamo Bay, Cuba.

“It took us a long time to get that sequence right, where we juxtaposed words, music, re-creations and then also testimony in some of the Senate hearings,” Mr. Gibney said. By mixing these, “you get some sense of the absurdity, of how the interrogators themselves were becoming unhinged,” he said. “By visualizing it you feel its power in a way you don’t if you just have someone describe it.”

Mr. Gibney became fascinated by film at Yale in the 1970s, haunting the film societies that showed classics for a dollar, and then attended film school at the University of California, Los Angeles. “My favorite filmmakers, generally speaking, are not documentary filmmakers,” he said. One is Luis Buñuel, and he keeps a framed letter from Mr. Buñuel on a wall of his office. “The way he shoots everything is so matter of fact,” Mr. Gibney said. “It’s kind of documentary. But he’s got such a wicked sense of humor. He’s always bringing something to the party, but in ways that you don’t really realize.”

Mr. Gibney worked for years on television series, including “The Fifties” and “The Blues,” bringing lessons from those sprawling projects to his feature films.

“You have to have characters that breathe inside a narrative,” he said, naming one lesson. “That’s what makes it work, and unless that happens none of the big ideas really matter.”

There has been no shortage of films about the wars in Afghanistan and Iraq and about the Bush administration’s approach to national security and civil liberties. The fictional ones — like “Lions for Lambs,” “Rendition,” “Redacted” and “In the Valley of Elah” — have landed at the box office with a thud. But there seems to be an appetite for accessible and sometimes argumentative documentaries about American power and values presented with nerve and verve, even from the earliest days of the war in Iraq, like “Gunner Palace.”

“Taxi to the Dark Side,” which opens in New York and Los Angeles on Jan. 18, is a sort of companion piece to “No End in Sight,” Charles Ferguson’s recent documentary about the occupation of Iraq. (Mr. Gibney was an executive producer.) The next month, Errol Morris’s documentary about the abuses at the Abu Ghraib prison in Iraq, “S.O.P.: Standard Operating Procedure,” will have its premiere at the Berlin International Film Festival.

The narrative thread of “Taxi to the Dark Side” recounts the story of an Afghan taxi driver known only as Dilawar, who was taken to Bagram and beaten to death. His family, interviewed in the film, described Dilawar as simple and shy, and he left behind a wife and a 2-year-old daughter.

His legs, a coroner’s report found, had been struck over and over again until they “had basically been pulpified.” “Even if he had survived,” an Army report found, “both legs would have had to be amputated.”

Mr. Dilawar’s story was first reported in The New York Times and was the subject of a series of investigative reports in the paper. Two reporters for The Times, Carlotta Gall and Tim Golden, appear in the documentary.

In 2005 a military jury convicted Willie V. Brand, who had been a guard at Bagram, of assault, maltreatment and maiming. But his only punishment was a reduction in rank. He received an honorable discharge.

Mr. Brand and the other guards and interrogators who appear in “Taxi to the Dark Side” make the case that they were untrained, unmoored from morality and only did what they thought their commanders wanted.

A week after the Sept. 11 attacks, for instance, Vice President Dick Cheney appeared on “Meet the Press” and sketched out his thinking.

“We also have to work, though, sort of the dark side, if you will,” he said, in a clip Mr. Gibney includes in his film. “We’ve got to spend time in the shadows of the intelligence world.”

Statements like those generated the abuses at Bagram and Abu Ghraib, Mr. Gibney maintains. “It’s the opposite of the bad apple theory,” he said. “The bad apple theory is that there are a few bad people who occasionally do bad things, and everything’s fine. Mostly they’re good kids who, like all of us, can over to the dark side if people like Dick Cheney say it’s O.K.”

David B. Rivkin, a lawyer in the administrations of President RonaldReagan and the first President Bush, said the abuses in Afghanistan and Iraq were exceptions and unfortunate byproducts of war. “It’s pretty clear that it’s not policy,” he said, “and it’s pretty clear that these things are prosecuted.”

Mr. Rivkin said the military’s performance by historical standards has been quite good in the recent conflicts. “In all the good wars,” he said, “we have had some pretty bad records.”

That is not how Frank Gibney saw it.

After the Second World War Frank Gibney would occasionally meet the men he had interrogated for dinner or drinks in Tokyo, and his son would sometimes tag along. The soldiers had a respectful rapport, a camaraderie.

“It’s hard to imagine that happening 10 years from now,” Alex Gibney said.

Add comment December 30th, 2007