Doctors Without Scruples

High-ranking al Qaeda official Abu Zubaydah had apparently, at one point in his 12-year imprisonment by the United States, refused to drink fluids — or at least “partially” refused — according to the Senate report on CIA torture. That refusal, however limited it may have been, led to a tube containing a nutrient enema being inserted into his rectum. Zubaydah was hung with his head lower than his torso and gravity forced the flow of whatever was in the tube into his colon. At least one doctor was present to observe the situation.

Other detainees suffered similar humiliations, which have now been widely reported and often in lurid detail. Detainee Majid Khan, for instance, was given his ground-up lunch of hummus, pasta with sauce, and nuts and raisins as an enema. Though a medical justification was cited in both cases, doctors I spoke with said there is absolutely no indication that would justify what was done to either man. Since the Senate document was released, many other doctors have also expressed horror at the invocation of “medicine” in torture techniques — and at their fellow doctors’ involvement in these methods. In a statement released Friday, the American Medical Association called this involvement “a violation of core ethical values.”

According to Physicians for Human Rights (PHR), which has a new report out Tuesday on doctors’ roles in the U.S. torture program, “rectal feeding,” as it is called, was done to Zubaydah, Khan and other detainees as a form of sexual assault and punishment.

More broadly, the medical professionals involved in the program made a conscious decision, PHR says, to actively participate in torture: “designing, directing, and profiting from the torture program; intentionally inflicting harm on detainees; enabling U.S. Department of Justice lawyers to create a fiction of ‘safe, legal and effective’ interrogation practices; engaging in potential human subjects research to provide legal cover for torture; monitoring torture and calibrating the level of pain; evaluating and treating detainees for the purposes of torture; conditioning medical care on cooperation with interrogators; and failing to document physical and/or psychological evidence of torture.”

“The main thing is to see that this operation was in the hands of medical professionals from beginning to end,” says psychologist Steven Reisner, one of the authors of the report.

PHR says medical professionals committed “at least eight violations of ethics and law.” After designing acts of torture for maximum psychological hurt, people working in the program forced men to stand shackled on broken feet for extended periods. They condoned depriving prisoners of sleep for up to 180 hours at a stretch while held in “stress positions,” which might involve arms being shackled above heads until numb.* (Zubaydah at one point lost his left eye in custody, though details as to exactly how are elusive.) Doctors stood by and assessed detainees’ mental and physical stress as interrogators worked, according to Dr. Vince Iacopino, a senior medical advisor to PHR and one of the authors of the new report. “It’s like those Abu Ghraib pictures you see,” he says. “People who are taking delight in finding new and novel ways of inflicting pain to achieve their goals.”

The torture report revealed that the U.S. government paid a team of psychologists an extraordinary amount — $81 million — to devise ways to leverage “enhanced interrogation techniques” to extract information from detainees. Two of these psychologists have been identified: James Mitchell and Bruce Jessen. But, as PHR details, an unknown number of psychiatrists, psychologists, and other medical professionals participated as well — “to a degree previously unknown,” and with apparent gusto — at every level of the torture program.

The crimes carried out, according to the report, “may reach the level of war crimes and crimes against humanity.”

So how does a doctor, who has taken an oath to “do no harm,” direct interrogators to do exactly that? To make the leap from caregiver to torturer, according to the health care experts, medical professional first dehumanized the torture subjects (just as genocidaires called Tutsis “cockroaches” in Rwanda, making them easy targets of rape and mutilation). It was a process abetted by the relationship between doctors and interrogators, which allowed each group to convince the other that torture was the right thing to do.

“We do things to maintain our morality in our minds,” says Iacopino. “It’s a question of humanity as much as it is of our profession.”

The CIA program had been legally sanctioned through some intensive legal gymnastics; those who designed and carried it out had been made immune to prosecution. And in the post-9/11 era, terrorists — both alleged and proven — had been cast as the epitome of evil, moral monsters undeserving of sympathy. The interrogators “believe these guys are bad,” says Dr. Stephen Xenakis, a psychiatrist and former Army brigadier general who has spent months investigating conditions at Guantanamo Bay. “I’ve heard it from them.”

The problem with thinking of the subject of torture as something other than a full human being is that it situates the interrogators and others associated with the program in a place of moral abandon. Dr. Frank Ochberg, a psychiatrist who worked with the FBI in the 1970s on hostage situations and later founded the Dart Center for Journalism and Trauma, asks, “Did the torturer enter into something in which he set his ethics aside?”

Ethics, however, may have played less of a role than the allure of authority, Ochberg adds.

“We have a kind of unfortunate natural propensity for being attached to powerful people and then doing what they tell us to do,” he says. He points to the 1960s experiments carried out by Stanley Milgram at Yale University. Milgram began his study just three months after the Eichmann trial began in Jerusalem in 1961; he wanted to figure out whether people would simply follow orders to commit torture, as so many Nazis claimed to have done. Test subjects, goaded by an “experimenter,” asked students questions and shocked them with electricity each time they got an answer wrong. The voltage increased with each incorrect answer; sometimes a subject administered shocks beyond the point at which a student, who was on the other side of a wall, had fallen silent, indicating possible death or unconsciousness. (In reality, the students were actors and no actual shocks were administered; the situation was feigned to give the subjects the impression that they were inflicting harm.)

There is a clear parallel here to what happened in CIA interrogation rooms. “The experimenter in the Milgram study played the same role as the psychologist or psychiatrist in a torture setting,” says Lawrence Swaim, author of Trauma Bond: An Inquiry into the Nature of Evil. (Milgram also told subjects in the experiment that he had the approval of Yale’s president — just like the CIA could say it had the thumbs up from the Bush administration.) Milgram wrote an elaborate script the experimenter had to use at all times, Swaim explains. “It was perfectly designed to draw the subject in compliance, and make him or her complicit in the evil act of torturing a man to death in the next room.” In the CIA torture program, psychologists carefully designed the “enhanced interrogation methods” used, allowing interrogators to feel in compliance with a permitted situation.

This also created a unique, twisted bond between doctors and torturers. “It could have been that in the beginning these psychologists are smitten with those who are above them in the power structure,” Ochberg says. “But then they become the professors who say, ‘It’s OK to do this.’ They become like Milgram getting people to torture students at Yale.”

He continues: “The psychologist can enter the world of the military or the police and in so doing, sacrifice his ‘caregiver’ ethic in the service of an interrogator ethic. And then, the military interrogator can further diminish his own standards, influenced by a ‘healer’ who has abandoned his healing role.”

Sheer opportunism also played an important role in medical professionals’ decision to participate in the torture program. Mitchell and Jessen (identified by the pseudonyms Grayson Swigert and Hammond Dunbar in the Senate torture report) were paid $1,800 a day. They were among the psychologists who, after 9/11, “reverse-engineered” the Survival, Evasion, Resistance, and Escape (SERE) techniques developed by the Air Force at the end of the Korean War to help soldiers withstand extreme torture. Reisner argues that the men positioned themselves as the world’s foremost experts in resistance — making themselves look like the only ones qualified to be designing the torture program. “I believe that Mitchell expanded its [the SERE program’s] mystique to make it seem that only psychologists expert in resistance would be able to handle these operatives,” Reisner says. Once they were seen as essential to the program, the pair reaped huge amounts of money and status.

Other medical professionals may have rationalized their involvement as being legitimate to their profession, says Xenakis, the former Army brigadier general. “Looking at how you interrogate people and apply learned helplessness are researched by psychologists.”

In a similar vein, some doctors seem to have reconfigured in their minds what it means to “do no harm.” In 2009, a former SERE psychologist named Bryce Lefever told NPR that “the idea that [psychologists] would be involved in producing some pain just seems at first blush to be something that would be wrong.” But, he went on to say, “the ethical consideration is always to do the most good for the most people.”

Lefever even went so far as to argue that torture isn’t necessarily bad for the victims. Jean Maria Arrigo, a specialist in the ethics of intelligence gathering, published notes she took at a June 2005 American Psychological Association Presidential Taskforce on Psychological Ethics and National Security meeting. In them, she writes that Lefever said the “pain and stress are not so bad,” and that prisoners at the Hanoi Hilton, the infamous Vietnamese prison where many U.S. service members were tortured, “reported gains” — meaning their torture came with a silver lining of positive personal growth.

“I think the media ought to give us a big ol’ thank you for our efforts on behalf of America,” Lefever told NPR.

Doctors complicit in torture may have been trying to prove their machismo, too. Xenakis says that in the military, psychiatrists and psychologists especially are always fighting the perception of being “soft.” Numerous sources I spoke with mentioned some version of the argument that these supposed caregivers were seduced into demonstrating toughness — that they were man enough to do what was deemed necessary in the moment, and for their country.

In a 2011 documentary called “Doctors of the Dark Side,” a Navy captain who was part of SERE at Guantánamo put it bluntly: “My patient is the U.S. government, not the detainees.”

But as Xenakis wrote in a 2005 Washington Post op-ed, “Unlike soldiers, doctors have a duty to patients as well as country. That is what separates U.S. military physicians from the German doctors who aided the Nazis in concentration camps.”

Perhaps underneath all the possible justifications and rationalizations, there is a fundamental aspect of human nature that allowed these medical professionals to override their most basic ethics. Swaim looks to Kurt Vonnegut’s book Mother Night, in which a character is a double agent, for guidance; Vonnegut writes, “Generally speaking, espionage offers each spy an opportunity to go crazy in a way he finds irresistible.”

Ochberg notes, however, that regardless of instincts and the many reasons proffered to explain away terrible deeds, “we have to have within us some constraint. Even the rules of war do not allow war crimes.”

When people who are meant to provide care say it’s acceptable to do harm, Ochberg continues, “the torturer is relieved of responsibility.”

*Clarification (Dec. 16, 2014): An earlier version of this article stated that detainees were deprived of sleep for up to 180 hours per week. They were deprived of sleep for periods of up to 180 hours at a time. (Return to reading.)