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Doctors must be healers, not interrogators

The Pentagon forces mental health professionals to betray the Hippocratic oath.

June 08, 2006|Robert Jay Lifton and Stephen N. Xenakis | ROBERT JAY LIFTON is a lecturer in psychiatry at Harvard Medical School. STEPHEN N. XENAKIS is a psychiatrist and retired brigadier general in the Army medical corps. Both are advisors to Physicians for Human Rights.

FOR SEVERAL YEARS, the Bush administration argued that it was ethically acceptable for psychiatrists and psychologists to participate in interrogations of terrorism detainees. As long as they acted "humanely" -- as defined by the Pentagon -- the administration suggested, there was no reason that mental health professionals shouldn't participate, both at the U.S. prison at Guantanamo Bay, Cuba, and elsewhere.

Much of the world disagreed. On May 19, for instance, the U.N. Committee Against Torture urged the administration to fully restore the absolute ban on psychological torture required by international treaty. Shortly afterward, the American Psychiatric Assn. officially prohibited psychiatrists from participating in the interrogation of prisoners and detainees.

But the administration refuses to back down. In fact, on Tuesday, the Pentagon adopted a new policy that, although putting some minimal limits on how mental health professionals may be used, still allows them -- delicately referred to as "behavioral science consultants" -- to assist interrogators. This is a full frontal assault on the most basic values of health professionals.

As psychiatrists who have been deeply engaged in military practice -- one of us with a long career in military medicine, the other having studied the behavior of physicians in war -- we are keenly aware of the dynamics and consequences of medical misbehavior in custodial settings, and of the dangers of allowing mental health professionals to become involved in interrogations.

Since 2001, health professionals, civilian as well as uniformed, have been put in the position of being active accomplices in the widespread abuse of detainees by U.S. interrogators. Significant evidence exists that the White House and the Pentagon have authorized brutal psychological techniques at Guantanamo, using the advice of special units of health professionals.

A report issued by the surgeon general of the Army in 2005 acknowledged that military psychiatrists and psychologists on behavioral science consulting teams, or BSCTs, have been involved in the design, approval and monitoring of interrogations.

Army interrogators have been instructed, the surgeon general reported, to consult regularly with the BSCTs regarding detainees' medical histories, focusing on vulnerabilities such as depression, delusional behaviors, manifestations of stress and "what are their buttons." Interrogators are to rely, the report continues, on BSCT personnel's knowledge of "when to push or not push harder in the pursuit of intelligence information."

These mental health professionals, in other words, have been asked to perform duties that conflict with their most fundamental role, which is to promote health and well-being. Their leaders have asked them to advise on what forms of stress can induce cooperation, how to calibrate it and, chillingly, to determine when it should stop and start.

Though these actions may be part of the interrogator's repertoire, they are not permissible for mental health professionals. Our obligation is always and unhesitatingly to act to preserve the health and well-being of the individual, even if the individual is a prisoner. Blurring these boundaries has a great ethical cost for physicians and for their future capacity to be healers.

The administration claims that its new guidelines are a step forward in removing health professionals from situations that would violate basic medical ethics. In fact, they will not.

What senior Defense Department officials, particularly William Winkenwerder Jr., assistant secretary of Defense for health affairs, need to do is to stop blurring the boundaries entirely. They must follow the recommendations of the U.N. Committee Against Torture and the American Psychiatric Assn. and end the use of psychological torture by U.S. personnel once and for all.

This administration must expressly prohibit all health professionals from participating in behavior that is anathema to the Hippocratic oath.

We have seen too many examples throughout history of ethical principles eroded by incremental actions that didn't quite seem consequential enough at the time but that led to human tragedy of great proportion. It is now time for health professionals, political leaders and ordinary citizens to speak out against torture and against medical participation in interrogations in order to avoid a similar legacy of shame.

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