Would You Ever Participate in Torture?

First there was an accusation by Mental Health Disability Rights International. They claimed to document "torture" against children and adults living with disabilities at a Massachusetts residential school. This "torture" consisted of electric shocks to the body and long-term restraints.

The second had to do with two military psychologists facing complaints to their licensing boards over their roles at Guantanamo. They are accused by another psychologist of indirectly participating in the abuse and "torture" of military detainees in violation of their professional standards to do no harm. There are presumably more mental health professionals, including at least one psychiatrist, who were involved in the creation and operation of the Behavioral Science Consultation Team in question. This team seemed to use reversal of therapeutic principles by undermining a sense of trust, perception, and safety.

Both of these concerns have received intermittent attention in recent years. However, at least in my circles, the "torture" in the military has drawn virtually all the recent attention, while the "torture" in residential facilities is largely ignored.

Although there may always be some disagreement on what defines "torture," all the mental health disciplines have come out with statements regarding participation in torture, whether that is military or civilian interrogation. Among them:

The American Psychiatric Association
It put out a position statement in May, 2006, "Psychiatric Participation in Interrogations of Detainees," which states, "The American Psychiatric Association reiterates its position that psychiatrists should not participate in, or otherwise assist or facilitate, the commission of torture of any person." As stated, this is actually not a new position, and it was not accepted without some controversy.

The American Psychological Association
Though apparently in some flux in recent years, and officially becoming closer to the position of the American Psychiatric Association, it still seems acceptable for psychologists to have a role in torture that can be justified as protecting the detainees.

The American Medical Association
On the one hand, the AMA takes the position of prohibiting physicians from participation in the interrogation of detainees. On the other hand, it also recognizes the contingency of "balancing obligations to individuals with obligations to protect third parties and the public." 

The International Federation of Social Workers
Their guidelines state that "social workers should not allow their skills to be used for inhumane purposes, such as torture or terrorism."

All the positions are close, but there are some important variations. Of course, all of us have a role–and obligation–to treat anybody who has been psychologically harmed by such interrogation techniques. It also leaves us with responsibility to try to find more humane ways of interrogation that would provide information that would increase the safety of others. Can we also help with preventing the desire to use such torture techniques? It seems like the reverberations of PTSD in the military, in the detainees, and in adolescents in residential facilities, may lead to further aggression in the re-enactment of trauma; more simply put, trauma may beget trauma.

All of this leaves me a bit–or maybe more than a bit–uneasy. How can a simple position statement do justice to the complexity of these situations? Why all the attention to military torture, as very few of us work in such settings, while the more common residential facilities for adolescents are ignored? What about jails and prisons, where mental health professionals commonly work, and where reports of inmate abuse are common?

A bit of necessary disclosure. I served in the military from 1975-77 on a base that specialized in housing the military police. Going against orders was risky to one's professional well-being, even if you felt that patients or soldiers were at risk. In more recent times, I specialized in the treatment of refugees, who often suffered from PTSD. The worse story I heard, which still elicits intrusive recall in myself, was hearing how a Serbian grandfather witnessed the torture and subsequent death of his grandson. I was a new grandfather at the time. Currently, I also work part-time in a medium security prison, where security is clearly the priority over healthcare; fortunately, in this prison I know of no inmate abuse or torture.

Research indicates that it can be quite difficult even for physicians to resist authority that would hurt others. Lifton examined Nazi doctors, who in a kind of what he termed psychological "doubling," could separate their support of Nazi policies in their work, while in other aspects of their lives, seemed kind and caring. Then there are Milgram's classic experiments on how normal individuals in an experiment ended up delivering fake electric shocks to others when authority told them it was all right to do so. This was repeated in Zimbardo's experiments with students at Stanford; this research had to be terminated early as many students seemed to relish using their authority to hurt others.

We also have a real-life historical example of how a psychiatrist can use his professional knowledge to lead to the killing and torture of others. That is the Serbian psychiatrist Radovan Karadzic, who used his professional knowledge of paranoia to commit extensive war crimes against Bosnians. I heard his name mentioned more than once among my refugee patients, which was not exactly an aide to their trusting me as a psychiatrist.

It is easy to claim the presumed high ethical ground when one is not involved in the real life situation at hand. It is also easy to project and proclaim strong positions in order to cover our own inadequacies and anxiety. So I try to imagine a scenario [please see accompanying video] where I am put in the position of being asked–or ordered–to help out at an interrogation and I think (however erroneously) that my knowledge might help prevent the harm or death of a loved one, colleagues, or many soldiers or citizens. Should I always follow the position statement of the American Psychiatric Association, or justify an exception? What would you do under such circumstances?

[Editor's note: To help you imagine such a scenario, we've attached a video from YouTube in which a reporter volunteers to be waterboarded .]