I have a piece up at Newsweek covering a major 542-page report, published for the first time yesterday by the New York Times, which shows that top psychologists and senior officials at the American Psychological Association collaborated with the Bush administration’s interrogation programs. Read more here.
In a detailed analysis of the Senate’s torture report, Physicians for Human Rights – a US-based rights group – found that CIA medical personnel might have committed war crimes by monitoring and approving the use of torture, and by conducting research on prisoners.
Some outlets had already noted the prominence of health professionals in the Senate’s summary, but PHR‘s new report, authored by a host of experienced medical professionals, offers the most thorough treatment of this subject so far. Based on its analysis of the summary, PHR finds that “health professionals played not only a central, but an essential role in the CIA torture program – to an extent not previously understood…Without the participation of health professionals, this illegal program might have been prevented.” Although the torture started with psychologists, it involved three medical professions: psychologists, physicians (including psychiatrists), and physician assistants. PHR enumerates eight categories of abuse by health professionals “that violate their ethical and legal obligations.”
For instance, the summary shows that medical professionals designed, directed and profited from the torture program. SERE psychologists James Mitchell and Bruce Jessen (referred to in the text by the pseudonyms Swigert and Dunbar) devised a list of “enhanced interrogation techniques” for CIA in the summer of 2002. These techniques were based on Dr Martin Seligman’s theory of “learned helplessness” and adopted from various tactics inflicted on trainees at the US military’s SERE (Survival, Evasion, Resistance and Escape) school, where Mitchell and Jessen had both worked.
The summary provides the fullest description yet of “the scope of Mitchell’s and Jessen’s involvement in the torture program,” according to PHR. They performed psychological assessments of prisoners prior to their torture, drew up brutal interrogation plans and then administered the techniques themselves. And they did not do this for free, either: the summary shows that Mitchell and Jessen profited handsomely from the torture program, eventually launching their own company (Mitchell, Jessen & Associates) and bagging $81 million of a mammoth $180 million contract from CIA. By 2007, the torture program was overwhelmingly outsourced to contractors (many of them from Mitchell, Jessen & Associates, according to the summary). Some CIA personnel protested about conflicts of interest, noting how Mitchell and Jessen would evaluate the effectiveness of techniques they themselves administered and stood to profit from, cashing in to the tune of $1800 per day (four times the pay of other interrogators). A racket, in other words.
In his new book, Pay Any Price, published just before the Senate released its executive summary, reporter James Risen drew on the example of Mitchell and Jessen to show how greed and ambition drove US counter-terrorism policies in the wake of 9/11. However, Risen makes clear that the psychologists were not lone rangers, but part of a much broader constellation of doctors and behavioral scientists working for the US government. In a recent article, Jeff Kaye shows that Mitchell and Jessen were closely involved with the intelligence community before they concocted “enhanced interrogation techniques”. In early 2002 they appeared with other carefully-selected scientists and intelligence professionals at a conference sponsored by the FBI and American Psychological Association (now under investigation thanks to revelations of CIA collusion published in Risen’s new book). Far from being an outsider, plucked randomly out of a hat, Mitchell was already part of the counter-terrorism fold before the Agency sent him to Thailand for Abu Zubaydah’s interrogation. Some have placed excessive blame on the contractors, implying they hijacked a panicky, innocent CIA and conned its officials into adopting torture.
Back to the summary, PHR explains that doctors inflicted harm on captives, most clearly in their use of “rectal feeding” and “rectal rehydration” (I wrote a detailed post about this recently). They also helped give legal cover for the torture program: Office of Legal Counsel lawyers had argued, in an August, 2002 memo, that “enhanced interrogation techniques” would be safe and lawful provided doctors were present to safeguard the prisoners’ health. The doctors therefore monitored torture sessions to make sure CIA’s abuses stayed within the broad legal limits laid down by the Justice Department, limits which – according to PHR – were meaningless and permitted torture and cruelty. By assessing prisoners before and during interrogation, and deeming them to be mentally and physically fit, the doctors were effectively approving their torture. The analysis gives various examples from the Senate’s summary to support this point, including the case of two CIA detainees who broke their feet during an escape attempt. The medics initially recommended they not be placed in stress positions but, two weeks later, a physician assistant, with the approval of other OMS doctors, determined that the prisoners’ wounds were “sufficiently healed to allow being placed in the standing sleep deprivation process.” The summary also shows that doctors were present throughout the waterboarding of Khalid Sheikh Mohammed and Abu Zubaydah, recommending the former be waterboarded with saline solution to forestall the possibility of water intoxication, and suggesting the latter be transferred to a liquid diet as he was vomiting copiously in response to the waterboarding. Former CIA Director Michael Hayden insisted that Abu Zubaydah had been switched to Ensure because he was recovering from abdominal surgery. “If this were the case,” PHR states, “it raises the question of why an individual recovering from abdominal surgery would be subjected to waterboarding, to the point of vomiting and losing consciousness.”
As PHR writes, doctors should never participate in torture and to do so constitutes a gross violation of domestic and international law, along with their ethical obligation to “do no harm” . Dr Atul Gawande of Harvard Medical School responded to the revelations of medical complicity in torture with a series of fierce tweets, such as:
3/The torture could not proceed w/o medical supervision. The medical profession was deeply embedded in this inhumanity.
— Atul Gawande (@Atul_Gawande) December 10, 2014
Even more alarming is PHR‘s contention that CIA doctors were conducting human subjects experimentation. They collected data from the interrogations and analyzed it with a view to improving the safety of the techniques; they shared this information with the Justice Department who then incorporated it into their memos legitimizing the torture. Although the doctors were, in theory, working to protect the prisoners, they were, in effect, facilitating their abuse by helping Bush lawyers justify waterboarding and other brutal practices. PHR extracts various sections in the summary where medical personnel express concern about playing this role. For example, two officers were asked to perform an independent review of the program, and responded: “… that it would not be possible to assess the effectiveness of the CIA’s enhanced interrogation techniques without violating “Federal Policy for the Protection of Human Subjects” regarding human
experimentation.” (p. 13) As Dr Steven Reisner said during a recent discussion at Al Jazeera’s The Stream, “In their zeal to protect the government against charges of torture, they actually committed an equally heinous crime, which was human subjects research.” Such research is prohibited by domestic statute and also by the Nuremberg Code (created in response to the Nazi medical experiments at Auschwitz and elsewhere). PHR writes, “If further investigation establishes that human subjects research without consent was performed systematically on detainees then such activities are violations of the Nuremberg Code and could constitute a crime against humanity.”
These assertions are not new. PHR had already raised concerns in 2010 that doctors were conducting research on prisoners and a bipartisan report found last year that doctors working for the military and CIA were complicit in torture. Moreover Mitchell’s and Jessen’s importance as architects of “enhanced interrogation” had emerged gradually in the last several years, thanks to reporting by Jane Mayer (in her book The Dark Side, for example) and Katherine Eban at Vanity Fair (see here and here). But new evidence gleaned from the Senate’s summary provides compelling proof that doctors played an indispensable role in the torture program and violated numerous laws and ethical codes in the process. In fact, as human-rights researcher Nathaniel Raymond said on Al Jazeera, “Health professionals, in their engagement in this program, actually violated more laws and ethics than the other personnel involved”. That being so, PHR calls on President Obama to establish a blue-ribbon federal commission, with full subpoena powers, to investigate the role of medical professionals in CIA torture and, if appropriate, recommend those culpable for prosecution (last week PHR had still not received a response from the administration). Given Obama’s refusal, throughout his presidency, to hold Bush-era torturers accountable for their crimes, such an inquiry is unlikely to get off the ground, effectively meaning that the egregious legal and ethical violations documented by PHR will go unpunished. This not only has grave implications for the rule of law in America, but also increases the likelihood that such atrocities will repeat themselves.
Democracy Now hosted a long discussion today about the role of health professionals in the CIA torture program. The show featured Nathaniel Raymond – one of the co-authors of PHR‘s analysis – who described the involvement of doctors in torture after 9/11. Raymond also talked about the ongoing (and aforementioned) investigation into the American Psychological Association which, he says, was “potentially engaged in racketeering related to its relationship with CIA and White House officials”.
Of the many gruesome details revealed in the Senate’s summary of its 6000-page report on the CIA’s post-9/11 torture program, perhaps the worst is the Agency’s use of “rectal rehydration” and “rectal feeding” on at least five detainees. In case, like me, you had never heard of these methods before, they denote, respectively, the insertion of water and food into an individual’s anus by tube or enema. The summary shows that Khalid Sheikh Mohammed was rectally hydrated, that Abu Zubaydah was given Ensure (a liquid nutrient) via his backside, that Majid Khan was fed with Ensure, and that once his plate of hummus, pasta with sauce and pine nuts was pureed and “rectally infused” (Khan later tried to self-harm, chewing into his own elbow).
The report states that these procedures were used “without medical necessity” in an attempt to control and coerce the detainees. Rehydration is described, in the summary, “as helping to ‘clear a person’s head’ and effective in getting KSM to talk.” (page 83), and is discussed as a means of “behavior control” (footnote 584 on page 100 gives voluminous evidence).
You would think that even Michael Hayden, who has appeared numerous times in public to rebut the torture allegations, would not stoop so low as to defend these practices. But in an interview with CNN’s Jake Tapper last Thursday, he did just that. Tapper naively assumed that the rectal rehydration was an “unauthorized” form of abuse carried out by rogue CIA sadists deviating from Agency guidelines. But Hayden cut in, “No, stop, that was a medical procedure…The people responsible there for the health of these detainees saw that they were becoming dehydrated.” Tapper then replied incredulously, “Pureeing hummus and pine nuts?” “Jake, I’m not a doctor and neither are you,” Hayden said, “but what I am told is this is one of the ways that the body is rehydrated. These were medical procedures.”Tapper still wasn’t convinced: “Are you really defending rectal rehydration?”
It is unclear who “told” Hayden these were medical procedures, but a number of highly-qualified doctors have challenged his comments. In interviews with the International Business Times both Dr Steven Miles and Dr. J Wesley Boyd of Harvard Medical disputed the necessity of rectal feeding and hydration. Boyd said it was “totally false” that rectal hydration was a legitimate medical procedure. “We hydrate people normally by handing them water, handing them a glass or bottle of water and you drink it. If you’re unconscious and unable to drink fluid, in those instances we would place an IV in your arm and run fluids into you that way. That is a legitimate medical procedure. … Rectal feeding is full-on 100 percent torture, period. It’s about humiliation, it’s about degradation and exerting control and obviously about inflicting pain.”
This view was echoed in a factsheet compiled by the US-based rights group Physicians for Human Rights. The document states that, “Rectal hydration is almost never practiced in medicine because oral and intravenous routes of fluid administration are more effective.” While the large colon has the “capacity to absorb fluids”, it has a “very limited capacity to absorb nutrients. Pureed food and nutritional supplements, such as Ensure, should never be administered rectally.” Rectal hydration is only used in very rare circumstances, with wounded soldiers or terminally ill patients, when oral or intravenous access is not possible.
Professor Thomas Burke of Harvard Medical School is quoted as saying, “For all practical purposes, it’s never used. No one in the United States is hydrating anybody through their rectum. Nobody is feeding anybody through their rectum.” Burke told the Washington Post that he polled several of his colleagues and found that none of them had ever used these methods. In its June 2013 rebuttal to the Senate’s summary the CIA insisted the rectal feeding and hydration were applied partly because they were “safer” than using IV needles with uncooperative prisoners, and more efficient than conducting oral procedures. But, according to Burke, “Every day in the United States, health workers encounter uncooperative, belligerent or mentally disturbed patients who need hydration or sustenance. “And [in] none of them do we put a tube in their bottom,” he said.”
Dr Steven Field, of NYU’s School of Medicine, adds, “In over 30 years of gastroenterology practice I never used rectal hydration. Also, rectal feeding simply doesn’t make physiologic sense. The colon cannot absorb even pureed food.”
As the factsheet shows, it is clear from the Senate’s summary that these methods were used without medical necessity, to coerce and humiliate the prisoners. It concludes by stating unequivocally that “Insertion of any object into the rectum of an individual without their consent constitutes a form of
Dr Allen Keller, Director of the NYU/Bellevue Program for Survivors of Torture, said, “This was done not solely for therapeutic reasons but as another form of abuse or humiliation”. Keller added, “Given the circumstances, this is sodomy with the intention of humiliation under the guise of medical treatment.”
Dr Howard Markel, of the University of Michigan, told PBS that rectal feeding and hydration are “almost never done”, as they are antiquated, inefficient methods dating back to the 18th and 19th centuries. ““It’s annoying and humiliating to have it done to you,” Markel wrote, adding, “If the fluids you are infusing into the rectum and colon are not the right balance of electrolytes, etc., your bowels could violently — and painfully — expel the contents all over you and the floor. Speaking as a physician, there is no place [for this] in medical treatment today. It’s a barbaric way to feed, let alone rehydrate anyone in the 21st Century [my emphasis].””
In a separate piece, Cornell Law Professor Michael Dorf writes that “there was no medical reason why the CIA chose rectal feeding and hydration for its prisoners”. He continues, “The CIA used rectal feeding and rectal hydration–rather than some less instrusive method of forced feeding or no forced feeding at all–specifically for the purpose of inflicting pain and humiliation on the prisoners. Put more starkly, in addition to threatening to rape the mothers of some of its prisoners, the CIA used rectal feeding and rectal hydration to anally rape prisoners.” According to international law (from the International Criminal Tribunal for the Former Yugoslavia and the International Criminal Tribunal for Rwanda) “systematic use of rape or other serious sexual violence is a war crime and/or a crime against humanity,” Dorf writes.
According to Hayden, the notion that rectal feeding and hydration were used to control or coerce detainees was based on “one half-ass, unwarranted comment in one email” in the Senate’s report. But the summary is amply documented: footnote 584, relating to the procedures, is so replete with evidence that it occupies most of page 100, for example. And, besides, the full report is about 6000 pages long and presumably contains more information. Senate Committee Chair Dianne Feinstein put out a statement on her website, “CIA’s Use of Rectal Hydration, Feeding Not Medical Procedures”, detailing the numerous instances from the report showing these methods were applied to control the detainees.
In short, Hayden is scraping the barrel. The procedures used by CIA were unnecessary, criminal and unethical: they constitute torture and sexual assault. As J Wesley Boyd told International Business Times, “”Medical personnel should only work toward the health and betterment of people.” He added later, “Whatever state boards of medicine these physicians are licensed through, they should certainly take action against them.””
Dick Cheney has weighed in on the rectal feeding and hydration controversy with predictable delicacy this afternoon during an interview with Chuck Todd on Meet the Press. Todd asked him if the insertion of pureed food into Majid Khan’s anus amounted to torture. Cheney said it was not one of the approved techniques and believes “it was done for medical reasons”. Todd shot back that the medical community disputed his view. Cheney then referred to the CIA’s rebuttal (debunked by the doctors in question). It’s not entirely clear, given the lack of concrete detail in Cheney’s remarks, that he has read a) the summary b) the CIA’s rebuttal or c) knows anything about the doctors’ criticisms of rectal feeding. Might is right.
While specific attention has been paid to the revolting, sadistic nature of rectal infusions, forced-feeding has not only been used by CIA, but was (and still is) applied by the military at Guantanamo Bay. While the stated purpose of military forced-feeding is to keep prisoners alive, it is likely that the extreme force and cruelty of the procedure – involving violent cell extractions, restraint chairs and repeated insertions of feeding tubes – is intended to break prisoners into ending their hunger strikes. Back in 2006 General Craddock admitted as much to the New York Times‘ Eric Schmitt and Tim Golden:
“On Tuesday, General Craddock said he had reviewed the use of the restraint chairs, as had senior officials at the Department of Defense, and they concluded that the practice was “not inhumane.” General Craddock left no doubt, however, that commanders had decided to try to make life less comfortable for the hunger strikers, and that the measures were seen as successful. “Pretty soon it wasn’t convenient, and they decided it wasn’t worth it,” he said of the hunger strikers. “A lot of the detainees said: ‘I don’t want to put up with this. This is too much of a hassle.’ ”
So, grisly though rectal hydration might be, it is not the only example of humiliating forced-feeding procedures used to coerce and control prisoners.