[Paleopsych] SW: Physicians and Military Interrogators

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Science Policy: Physicians and Military Interrogators

    The following points are made by M.G. Bloche and J.H. Marks (New Engl.
    J. Med. 2005 353:6):
    1) Mounting evidence from many sources, including Pentagon documents,
    indicates that military interrogators at Guantanamo Bay have used
    aggressive counter-resistance measures in systematic fashion to
    pressure detainees to cooperate. These measures have reportedly
    included sleep deprivation, prolonged isolation, painful body
    positions, feigned suffocation, and beatings. Other stress-inducing
    tactics have allegedly included sexual provocation and displays of
    contempt for Islamic symbols.[1] The International Committee of the
    Red Cross (ICRC) and others charge that such tactics constitute cruel
    and inhuman treatment, even torture.
    2) To what extent did interrogators draw on detainees' health
    information in designing and pursuing such approaches? The Pentagon
    has persistently denied this practice. After the ICRC charged last
    year that interrogators tapped clinical data to craft interrogation
    strategies, Defense Department officials issued a statement denying
    "the allegation that detainee medical files were used to harm
    detainees."[2] This spring, an inquiry led by Vice Admiral Albert T.
    Church, the inspector general of the U.S. Navy, concluded: "While
    access to medical information was carefully controlled at GTMO
    [Guantanamo Bay], we found in Afghanistan and Iraq that interrogators
    sometimes had easy access to such information."[3] The implication is
    that interrogators had no such access at Guantanamo and that medical
    confidentiality was shielded, albeit with exceptions. Other Pentagon
    officials have reinforced this message. In a memo made public last
    month, announcing "Principles . . . for the Protection and Treatment
    of Detainees," William Winkenwerder, the Assistant Secretary of
    Defense for Health Affairs, said that limits on detainees' medical
    privacy are "analogous to legal standards applicable to U.S.
    3) However, the inquiry of the authors has determined that this claim
    is sharply at odds with orders given to military medical personnel --
    and with actual practice at Guantanamo. Health information has been
    routinely available to behavioral science consultants and others who
    are responsible for crafting and carrying out interrogation
    strategies. Through early 2003 (and possibly later), interrogators
    themselves had access to medical records. And since late 2002,
    psychiatrists and psychologists have been part of a strategy that
    employs extreme stress, combined with behavior-shaping rewards, to
    extract actionable intelligence from resistant captives.
    4) A previously unreported U.S. Southern Command (SouthCom) policy
    statement, in effect since August 6, 2002, instructs health care
    providers that communications from "enemy persons under U.S. control"
    at Guantanamo "are not confidential and are not subject to the
    assertion of privileges" by detainees. The statement, from SouthCom's
    chief of staff, also instructs medical personnel to "convey any
    information concerning . . . the accomplishment of a military or
    national security mission . . . obtained from detainees in the course
    of treatment to non-medical military or other United States personnel
    who have an apparent need to know the information. Such information,"
    it adds, "shall be communicated to other United States personnel with
    an apparent need to know, whether the exchange of information with the
    non-medical person is initiated by the provider or by the non-medical
    person." The only limit this policy imposes on caregivers' role in
    intelligence gathering is that they cannot act as interrogators.[4,5]
    1. Break them down: systematic use of psychological torture by U.S.
    forces. Cambridge, Mass.: Physicians for Human Rights, 2005
    2. Lewis NA. Red Cross finds detainees abuse at Guantanamo. New York
    Times. November 30, 2004:A1
    3. Church report: unclassified executive summary. (Accessed June 16,
    2005, at http://www.defenselink.mil/news/Mar2005/d20050310exe.pdf.)
    4. Huck RA. U.S. Southern Command confidentiality policy for
    interactions between health care providers and enemy persons under
    U.S. control, detained in conjunction with Operation Enduring Freedom.
    August 6, 2002 (memorandum). (Accessed June 16, 2005, at
    5. Department of the Army. Field manual 34-52: intelligence
    interrogation. 1992. (Accessed June 21, 2005, at
    New Engl. J. Med. http://www.nejm.org
    Related Material:
    The following points are made by S.T. Fiske et al (Science 2004
    1) Initial reactions to the events at Abu Ghraib prison in Iraq were
    shock and disgust. How could Americans be doing this to anyone, even
    to Iraqi prisoners of war? Some observers immediately blamed "the few
    bad apples" presumably responsible for the abuse. However, many social
    psychologists knew that it was not that simple. Society holds
    individuals responsible for their actions, as the military
    court-martial recognizes, but social psychology suggests we should
    also hold responsible peers and superiors who control the social
    2) Social psychological evidence emphasizes the power of social
    context; in other words, the power of the interpersonal situation.
    Social psychology has accumulated a century of knowledge about how
    people influence each other for good or ill [1]. Meta-analysis, the
    quantitative summary of findings across a variety of studies, reveals
    the size and consistency of such empirical results. Recent
    meta-analyses document reliable experimental evidence of social
    context effects across 25,000 studies of 8 million participants [2].
    Abu Ghraib resulted in part from ordinary social processes, not just
    extraordinary individual evil. Meta-analyses suggests that the right
    (or wrong) social context can make almost anyone aggress, oppress,
    conform, and obey.
    3) Virtually anyone can be aggressive if sufficiently provoked,
    stressed, disgruntled, or hot [3-5]. The situation of the 800th
    Military Police Brigade guarding Abu Ghraib prisoners fit all the
    social conditions known to cause aggression. The soldiers were
    certainly provoked and stressed: at war, in constant danger, taunted
    and harassed by some of the very citizens they were sent to save, and
    their comrades were dying daily and unpredictably. Their morale
    suffered, they were untrained for the job, their command climate was
    lax, their return home was a year overdue, their identity as
    disciplined soldiers was gone, and their own amenities were scant.
    Heat and discomfort also doubtless contributed.
    4) The fact that the prisoners were part of a group encountered as
    enemies would only exaggerate the tendency to feel spontaneous
    prejudice against outgroups. In this context, oppression and
    discrimination are synonymous. One of the most basic principles of
    social psychology is that people prefer their own group and attribute
    bad behavior to outgroups. Prejudice especially festers if people see
    the outgroup as threatening cherished values. This would have
    certainly applied to the guards viewing their prisoners at Abu Ghraib,
    but it also applies in more "normal" situations. A recent sample of US
    citizens on average viewed Muslims and Arabs as not sharing their
    interests and stereotyped them as not especially sincere, honest,
    friendly, or warm.
    5) Even more potent predictors of discrimination are the emotional
    prejudices ("hot" affective feelings such as disgust or contempt) that
    operate in parallel with cognitive processes. Such emotional reactions
    appear rapidly, even in neuroimaging of brain activations to
    outgroups. But even they can be affected by social context.
    Categorization of people as interchangeable members of an outgroup
    promotes an amygdala response characteristic of vigilance and alarm
    and an insula response characteristic of disgust or arousal, depending
    on social context; these effects dissipate when the same people are
    encountered as unique individuals.
    References (abridged):
    1. S. T. Fiske, Social Beings (Wiley, New York, 2004)
    2. F. D. Richard, C. F. Bond, J. J. Stokes-Zoota, Rev. Gen. Psychol.
    7, 331 (2003)
    3. B. A. Bettencourt, N. Miller, Psychol. Bull. 119, 422 (1996)
    4. M. Carlson, N. Miller, Sociol. Soc. Res. 72, 155 (1988)
    5. M. Carlson, A. Marcus-Newhall, N. Miller, Pers. Soc. Psychol. Bull.
    15, 377 (1989)
    Science http://www.sciencemag.org
    Related Material:
    The following points are made by Richard F. Mollica (New Engl. J. Med.
    2004 351:5):
    1) The shocking, unfiltered images from the Abu Ghraib prison in Iraq
    have focused the world's attention on the plight of torture survivors.
    Physicians in the US are confronted as never before with the need to
    identify and treat the physical and psychological sequelae of extreme
    violence and torture. Yet this is not a new role for medical
    practitioners. More than 45 countries are currently suffering from the
    destruction caused by mass violence.(1) The 20th century has been
    called the "refugee century", with tens of millions of people
    violently displaced from their homes. Millions of these people have
    resettled in the US, and refugees, asylum seekers, and illegal
    immigrants now commonly enter our health care institutions.(2)
    2) Despite routine exposure to the suffering of victims of human
    brutality, health care professionals tend to shy away from confronting
    this reality. The author states that he and his colleagues have cared
    for more than 10,000 torture survivors, and in their experience,
    whether in Bosnia and Herzegovina, Cambodia, East Timor, or the US,
    clinicians avoid addressing torture-related symptoms of illness
    because they are afraid of opening a Pandora's box: they believe they
    will not have the tools or the time to help torture survivors once
    they have elicited their history.
    3) Unfortunately, survivors and clinicians may conspire to create a
    relationship founded on the avoidance of all discussion of trauma. In
    one instance, a middle-aged Cambodian woman had had an excellent
    relationship with her American doctor for nine years, but he had no
    idea that she had been tortured. He had had only partial success in
    controlling her type 2 diabetes. After attending a training session on
    treating the effects of terrorism after the events of September 11,
    2001, the doctor asked the patient for the first time whether she had
    undergone extreme violence or torture. She revealed that two of her
    children had died of starvation in Cambodia, her husband had been
    taken away violently and disappeared, and she had been sexually
    violated under the Khmer Rouge. More recently, in the US, her
    remaining daughter had been nearly fatally stabbed by a gang that
    burglarized her home. Since September 11, the patient had taken to
    barricading herself in her house, leaving only to see her doctor. When
    the doctor became aware of the patient's traumatic history, he used a
    screening tool to explore the effects of her traumas, diagnosing major
    depression. Over time, he was able to treat the depression with
    medication and counseling, eventually bringing the diabetes under
    control as well.
    4) The author concludes: Torture and its human and social effects are
    now in the global public eye. Medical professionals must relinquish
    their fears and take the lead in healing the wounds inflicted by the
    most extreme acts of human aggression. Commitment to a process that
    begins with a simple but courageous act -- asking the right question
    -- bespeaks the belief that medicine is a potent antidote to the
    practices of torturers.(3-5)
    1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report
    on violence and health. Geneva: World Health Organization, 2002.
    2. Bramsen I, van der Ploeg HM. Use of medical and mental health care
    by World War II survivors in the Netherlands. J Trauma Stress
    3. Goldfeld AE, Mollica RF, Pesavento BH, Faraone SV. The physical and
    psychological sequelae of torture: symptomatology and diagnosis. JAMA
    1988;259:2725-2729. [Erratum, JAMA 1988;260:478
    4. Mollica RF. Waging a new kind of war: invisible wounds. Sci Am
    5. Cassano P, Fava M. Depression and public health: an overview. J
    Psychosom Res 2002;53:849-857
    New Engl. J. Med. http://www.nejm.org

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