June 15, 2006

Ask Amnesty: The Impact of Psychological Torture Techniques Against Detainees at Guantanamo Bay

The apparent suicide of three Guantanamo Bay detainees this past Saturday highlights the tragic results of arbitrary and indefinite detention. A human rights travesty, Amnesty International called for the closure of Guantanamo over a year ago, and the European Union, United Nations and several U.S. allies have echoed that call.

Join Scott Allen, M.D. of Physicians for Human Rights from 1:00 – 2:00 p.m. EDT on Thursday, June 15 to discuss the use and health impact of psychological torture techniques against detainees at Guantanamo Bay, Abu Ghraib and other U.S. detention facilities.

Featured Guest: Scott Allen, M.D.

From our featured guest: "I look forward to speaking to you on June 15."

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Question Submitted by John:

What makes you think in the long run our own troops will not be subjected to similar torture? What will our outrage be when we have our own go through such treatment?

Scott Allen, M.D. answers:

Before answering this first question, allow me to thank Amnesty International for inviting me to participate in this timely forum. I also wish to thank the participants. The questions are rolling in fast, and I will not be able to answer them all. I will try to preferentially focus on questions most directly related to the topic of the impact of psychological torture techniques against detainees.

Also, for additional reading on the subject, I highly recommend reading the Physcian for Human Rights report entitled "Break Them Down" avaialable at: http://www.phrusa.org/research/torture/report_breakthemdown.html. Many of my answers are supplemented by information contained within this excellent report.

Finally, to the question: One of the more compelling justifications for the preservation of basic human rights of detainees invloves the platform from whcih we will be able to assert the basic human rights of our own troops who fall into enemy hands. This was the logic behind the development of the Geneva Conventions and other prisoner or war protections. I would add that in addition to this argument, there are moral and ethical reasons as well. How we treat prisoners and detainees says much about us as a civilized society.
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Question Submitted by David:

Dear Dr. Allen, Apparently, the United States would like to assert that it is not unlawful intentionally and deliberately to cause a person to believe that her or his life is coming to an immediate end, though I imagine that most authorities would say that such a practice would contravene the U.N. anti-torture convention. Could you say a few words about psychologists who would lend or have lended their professional expertise to a project designed to induce such a state of mind, and what avenues of recourse are available to a person who has survived such techniques?

Scott Allen, M.D. answers:

Threats of bodily harm or death – even if the threat is never carried out – constitutes torture. Threats of death in particular create a sense of compete unpredictability and induce chronic fear and helplessness. Survivors often relive these near-death experiences through nightmares, flashbacks and intrusive memories. Psychologists and other health professionals who may have been complicit in the development of such strategies or the execution of such strategies would clearly be in violation of medical ethics.

From a clinical perspective, survivors would benefit from appropriate professional care, and centers such as the Bellevue NYU Program for Survivors of Torture or Minnesota-based Center for Victims of Torture have expertise in dealing with torture survivors.

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Question Submitted by Jean-Pierre:

Dear Dr. Allen, I would like to ask a question relating to the psychological effects of detention. What do you consider to be the psychological effects of prolonged detention of for exmaple asylum seekers in detentionc maps in european states? I know that this is not directly linked to the topic but would appreciate your comments on this. even if maybe not during this discussion/

Scott Allen, M.D. answers:

Prolonged detention can have adverse health effects on detainees, particularly when there is no apparent end in sight. This is a major concern for detainees at Guantanamo who have been held without access to the courts or their families for years and who have no reason to believe their detention will end soon. The recent suicides are sentinel indicators of increasing desperation and despair likely being experienced b y detainees of Guantanamo.

Related to this issue is the use of prolonged isolation. Guantanamo was designed around a model used in the domestic correctional system called "super-max," which uses prolonged isolation. Solitary confinement results in sensory deprivation, the adverse consequences of solitary have been know back to the U.S. Civil War era. Effects include depression, anxiety, difficulty with concentration and memory, hypersensitivity to external stimuli, hallucinations and perceptual distortions.
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Question Submitted by Jonathan Neiss:

Have there been pyschological protocols established for what techniques do and do not constitute torture? Have there been attempts to make it illegal to use psychological techniques against prisoners, or even the population at large? Should it not be illegal for these techniques to even be taught?

Scott Allen, M.D. answers:

What does and does not constitute torture is defined in a body of law and ethics, and in general, techniques that have great potential to cause distress, harm or injury to a detainee are not permissible. Legal issues are more complex and depend on setting (detainees of U.S. domestic facilities have constitutional protections, whereas detainees at Guantanamo remain in a sort of legal void). The teaching of techniques that constitute torture or cruel, inhuman or degrading treatment would be unethical.
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Question Submitted by Russ:

PTSD is a condition that occurs when a person is subjected to an unusual incidentover a period of time. With prolonged abuse and interrogative methods designed to break down a person's psyche...what psychological issues will they eventually have to deal with and will these be different than PTSD? What will be the long term health effects that will need to be managed? In your opinion how log does physical and mental recovery take? How or where does one start with the healing process and what type of therapy works best with individuals who have been abused on a long term basis?

Scott Allen, M.D. answers:

Post-Traumatic Stress Disorder (PTSD) is an important clinical concept in the discussion of the mental health effects of victims of torture. PTSD is common among survivors of torture, and typically involves repeated re-experiencing of the traumatic event, emotional numbing and detachment and hypervigilance and chronic arousal. In severe cases, these symptoms can lead to personality changes that can interfere with daily function and the maintenance of social and intimate relationships. Persistance of symptoms and recovery can vary widely from case to case, but often may take years and even decades.

Some experts have argued that the PTSD syndrome of torture survivors should warrant its own specific syndrome, ie “torture syndrome."

Recovery from PTSD and related disorders can take years and even decades, even with good professional help, and relapses are not uncommon. Still, therpay can be very effective, and survivors are encouraged to seek professional help, and if possible, take advantage of centers with expertise in the treatment of survivors of torture such as the Minnesota based CVT and the Bellvue program referred to above.

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Question Submitted by Tom:

How else can we humanely find out about Al Queda particuliars?

Scott Allen, M.D. answers:

This question assumes that without torture, we could not uncover intelligence information. The idea that torture yields reliable information is highly questionable as vicitms will often say whatever it is they think their interrogators want to hear to stop the torture. Torture has led to false and misledading testimony with devastating consequences (including a much cited but later recanted account of links between Al Queda and Iraq). This "utilitarian" justification for torture rests on a faulty foundation.
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Question Submitted by Mary:

What will come of the information gained by Dr. Allen? Does this discussion have any real impact on this situation? Will the results of Dr. Allen's work be presented to any of the policy makers in the Bush Admin?

Scott Allen, M.D. answers:

Physicians for Human Rights, the group I am associated with, along with Amnesty International and other human rights advocacy groups do indeed document and compile reports about torture, including the report “Break Them Down.” http://www.phrusa.org/research/torture/report_breakthemdown.html
These reports and others are presented to members of congress, medical associations, members of the administration and the defense department and military and do appear to be having an impact on the discussion. While it is easy to get discouraged, advocacy efforts, reports and the campaigns against torture have resulted in some reigning in of the abuses. Obviously, we still have a long way to go. I hope you and others resist the feelings of helplessness. Your advocacy can and does make a difference.

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Question Submitted by Loral Orow:

First: Is it not torture to be threatened with terrorist attacks by these same indidividuals we are now working so hard to protect? Are the people they threaten any less prone to these psychological affects? Is our sympathy to be placed with those who reach across the world to harm others rather than to those who are harmed while doing nothing to deserve it? Are we now supposed to give the red carpet treatment to people who are trying to murder us? Are our own country's prisons serving its citizens any less effectively than they are to citizens in other nations, or is it the same thing only different people? Why not stop the soft glove treatment and cry-babying over murderers, and spend the time and energy on helping people who are trying to stop the terror?

Scott Allen, M.D. answers:

Obviously traumas and human rights abuses have been visited upon Americans, and Americans are no less prone to the adverse psychological effects. In the human rights community, we advocate for the basic human rights of ALL humans, regardless of nationality, religion, beliefs or crimes.

As someone who has provided health care in U.S. prisons for over seven years, I can reassure you that the preservation of basic human rights does not necessarily result in a comfortable existence for prisoners. The "red carpet" anology is a red herring.
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Question Submitted by Corinne:

It occurs to me that the fact that we are having to discuss this issue of torture in and of itself is a blight on our country. We were supposedly founded on the principles of freedom, justice, and rights for all individuals. Wouldn't we be just as culpable as our "enemies" if we resorted to the same type measures that we are supposed to be "freeing" them from in their own land?

Scott Allen, M.D. answers:

I agree that it appears we have carelessly giving up on many of the ethical and moral principles that we say we are fighting to preserve. To me, that seems to be a "weak" strategy in the war on terrorism.
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Question Submitted by Stephen Nickels:

Please explain how and why humiliation crosses the line into torture. I'm so tired of hearing about what was and is being done to P.O.W.s compared to college hazing. Thanks, Stephen

Scott Allen, M.D. answers:

The short answer to this question involves the context of the treatment. College hazing does not occur in the context of war, nor is it within a context that the victim has justification to fear for bodily harm or loss of life, nor is it within the context where the vicitm has no power to remove him or herself from the setting of ill treatment.

Having noted those differences, I have no hesitation in rejecting the practice of college hazing as well, and colleges and universities are increasingly in agreement.
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Question Submitted by George:

Another reason that torture is inflicted on prisoners is to dehumanize the subject and in doing so justify the atrocities being carried out against the group which the prisoner prepresents (e.g., Nazi death camps, Tuol Sleng Cambodia, etc). Do you see this rationale at work in Guantanamo, Abu Ghraib, etc.

Scott Allen, M.D. answers:

Thanks, George (for other participants, the question comes from George Chigas, a scholar on Cambodia and the Cambodian genocide). The practice of dehuminzing the victim is common to the practice of torture, and it is indeed often a part of the rationalization used by those who seek to justify the abuses. One need only listent to talk radio in the U.S. to hear this logic articulated.
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Question Submitted by Christine:

What are the effects of torture on the torturers?

Scott Allen, M.D. answers:

Torture is clearly dehuminizing and damaging to the victim, but it can be just as damaging to the mental well being of the torturer. In this context, torture is a "lose-lose" situation.
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Question Submitted by Julie:

As a health-care professional myself, and having seem much human misery, is there ANY benefit to ANY form of torure? I can understand the concept of interrogation, in gleaning pertinent information relating to a crime, but what specific crime have these unfortunate souls committed? And in what way does the US Government benefit from inflicting physical and psychological torture upon any individual...unless it is to satisfy some sadistic form of pleasure? Thank you for speaking out on this atrocity, Sincerely, Julie G. LPN

Scott Allen, M.D. answers:

As I have said earlier in this discussion, the utilitarian and practical justifications of the use of torture for ascertaining "actionable intelligence" are highly questionable.
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Question Submitted by Prof. Kamil Pinarci:

I am the founder of Turkish Union of Scientists at 1968. After two military juntas at 1971 and 1981 and many human rights violations, the human force for human rights nearly drained, the society depressed a new apathetic, consumer oriented youth emerged, their only wish is to go outside for education and desert the motherland which is fast becoming a large prison, full of jingoistic parties. I lost four close academician friends, and total around 21 professors and three investigative journalists. They are killed still no one knows who killed them. Some left the country and never returned. I myself imprisoned five times tortured and blacklisted for six years unable to work anyplace. One of the Turkish journalists M.A.Birand interviewed Paul Henze from US Embassy and CIA retired station chief of Turkey, he bragged “our boys did it”, they he tried to change it but it was on record and on video. When the US administration is loudly talking about “Democratization of Middle East”, Vice President Cheney visited Turkey before the invasion of Iraq. He went directly to the Chief of Staff of Turkish Army, to change his oppinion and Wolfowitz announced,”army top brass should lead the way for opening Northern front.” After bringing elite Kurdish Feudals and Southern fundamentalists Mullahs, who are against all democratic rights and women rights. They declared this is a democracy. My question is after decimating the basic principles of the constitutional democracy in the US (Spying on ten million people, listening their phones, agreement on torture and Geneva agreement on prisoners and etc.) and neglecting international agreements how they can fool 250 million people of the US and civilized! Western democracies. Because as an developing nation we are crushed by three juntas, but the west is free. Why there is a silence. Best regards.

Scott Allen, M.D. answers:

Thank you for this question. I am most impressed with the implicit challenge in your closing paragraph. Citizens of the free world really have no excuse for silence on issues such as torture. I have had the honor to meet and know many courageous human rights advocates who have spoken out at great risk to themselves and their families under oppressive circumstances. I'd like those participants who get discouraged by the appearance that their voice doesn't count to keep this perspective. In the U.S., we do still live in a participatory democracy, your voice still counts, and the risks of speaking out, while not zero, are minimal, expecially when compared to many other settings globally.
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Question Submitted by Chloe:

How much is actually known about what the prisoners are experiencing at Guantanamo Bay?

Scott Allen, M.D. answers:

Frustratingly little is known What little we know comes to us from the small number of former detainees now released and some information from attorneys for the detainees. This question draws attention to the fact that the operations at Guantanamo have little public oversite. While this lack of openness is justified in terms of security, the fact remains that detention systems with little publci accountability are prone to abuse, a fact noted by the Vera Institute in their recently released report on abuse in U.S. prisons (I don't have that link handy, but "google" Vera Institute and you should find that report.
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Question Submitted by Jessica:

As a psychology major, I have, of course, done some research on the Stanford Prison experiment. Does this effect on the guards seem to be having a greater effect on prisoners, especially considering how much headroom prison guards are given at the facility? Would more accountability in any way lessen the negative effects on prisoners?

Scott Allen, M.D. answers:

I commend all participants in this forum to read the original Stanford Prison Experiment (an excellent website is maintained by one of the original authors, again, do a web search on Stanford Prison Experiment). Basically, the landmark Stanford experiment illustrated and documented the rapidity with whcih basically decent and humane individuals engage in abuse of detainees when the absolute power of the guard is unchecked against the powerless of the detainee. While it is impractical to balance power between detainees and guards for obvious reasons, the role of strict protocols, regulations and oversite becomes more essential Protocols to protect detainees appear to be lacking at Guantanamo, and public oversite is virtually non-existent; a risky mix.
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Question Submitted by Liz:

The direction and oversight of any type of torture is in direct conflict with the Hippocratic Oath, and I think most people woul agree that it is morally wrong. What are the legal implications for physicians who participate in these activities? Are any US laws and regulations applicable at Guantanamo? Thank you, Liz Anderson

Scott Allen, M.D. answers:

Involvement by physicians in torture is ethically and morally wrong. This position is enshrined in the ethical guidelines of many organizations including the AMA, ACP, APA, WMA among others. For physicians who paricipate in torture within the domestic setting, there are legal implications in both state and federal law. As we see, however, Guantanamo remains in a legal void, and it is unlcear that there are legal actions that can be taken against physicians who may have been complicit in torture in that setting. Potentially, there are regulatory issues through state licensure boards that may be relevant, and membership in various professional societies could be threatened.
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Question Submitted by Harry:

Why doesn't the United Nations try to stop the US in unlawfully detaining people?

Scott Allen, M.D. answers:

The United Nations does not have absolute power over member countries. Do note that the UN has criticized U.S. practices in their recent report: http://www.ohchr.org/english/bodies/cat/docs/AdvanceVersions/CAT.C.USA.CO.2.pdf
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Question Submitted by Jeni Yamada:

In your opinion, what can we, individual citizens of the United States, do to help draw attention to and to stop these immoral acts on the part of the U.S. government? What can we do to get more media coverage of the individual stories of the detainees? How can you...and the rest of us ...let the public know what is going on. Perhaps, if we tell the story in human terms... at the personal level...we can effect change. We just feel so helpless, and writing letters feels so ineffective. Please advise.

Scott Allen, M.D. answers:

This is an excellent point. Many of us in advocacy can end up sounding like policy wonks... in the end, this comes down to stories about atrocities and torture visited upon individual people.

I agree that press and other public accounts of individual torture experiences are an important antidote to the process of "de-humanizing" of the victims.
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Question Submitted by Roy:

Do you know how many times and how many of the imprisoned have attempted suicide in the Guantanamo gulag? Thank you, Roy L. Absher

Scott Allen, M.D. answers:

As we all know, three detainees completed suicides this past week. We know less about the number of attempts. From the limited information available through the press, however, the number of suicide attempts at Guantanamo appears to be much higher than might be expected in a normal prison setting and may be an indicator of the distress, desperation and deterioration of the detainees there.
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Question Submitted by Patrick & Louise:

What is the treatment of our prisoners doing to the psyche of the concerned American people.Some of which believe our govrnment does not care what we think,feel,or bekieve

Scott Allen, M.D. answers:

I think the fact that our government has employed the use of torture is greatly distressing to many Americans. I should add that among the most distressed are many who serve in the military who are greatly troubled to see their long traditions of honor and decency trashed by a reckless civilian leadership. Be assured that many honroable men and women in uniform join those of us on the outside in condemning the use of torture, although military tradition results in their protests being lodged internally.

Finally, as this will be the last question that time allows, I again urge people not to become despondent and resigned. Advocacy on this issue IS having a direct impact on U.S. practice. Do speak out. Do write your congressmen and Senators, and regardless fo where you are from, support Senator McCain and his efforts to eliminate the use of torture. Finally, I refer you back to both our host, Amnesty International and my home institution, Physicians for Human Rights (www.phrusa.org) for more information on how you can become involved in the campaing against torture.

Thank you all for your interest. I am deeply sorry I could not respond to all of the many questions submitted. Thank you Amnesty International for drawing attention to this subject.

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