Psychiatrists and State-Sponsored Violence: Torture and the Death Penalty

BOULDER, Colorado -- The release last week of memoranda detailing the Bush administration's "enhanced interrogation program" has revealed another terribly troubling component of this already appalling practice - the role of psychiatrists in abetting the psychological torture of detainees in American custody.

Reports from the Red Cross had already detailed the participation of medical personnel in the CIA's torture program. Psychiatrists conducted evaluations of detainees, and they then disclosed their results to interrogators so that they could best exploit the subjects' psychological weaknesses, such as particular fears or paranoias that they had expressed to the doctor. Doctors also stood by while many of the harshest techniques were used, such as waterboarding, to ensure that the detainees didn't drown, and to revive them if they did. In his blog for Harper's Magazine, Scott Horton had this to say about these "torture doctors":

The conduct disclosed in the Red Cross report would plainly constitute cause not merely for prosecution, but also for revocation of medical licenses. The fact that Bush Administration lawyers wrote made-to-order memoranda saying that the perpetrators didn’t need to worry about prosecution has no bearing on this point–to the contrary it probably provides more evidence of conscious wrongdoing, especially after the memos were exposed and uniformly condemned by the legal community.

We have written on this blog recently about the use of psychiatry as a political weapon in the Soviet Union. We are not anti-psychiatry Scientologist fanatics - not by any stretch of the imagination. But the torture program has explicit ties to the Soviet Union. Many of the interrogation techniques were reverse-engineered from the Pentagon's S.E.R.E. (Survival, Evasion, Resistance, Escape) program, which trains military personnel to deal with torture at the hands of our enemies, should they be captured. But as Jane Meyer pointed out in the New Yorker in 2007, quoting retired Air Force colnel and interrogator Steve Kleinmann, "It was the K.G.B. model. But the K.G.B. used it to get people who had turned against the state to confess falsely. The K.G.B. wasn’t after intelligence." Despite the protestations of Dick Cheney, it is pretty clear that the program yielded little valuable intellegence, while also severely compromising America's moral standing. Perhaps we should not base our interrogation techniques on Darkness at Noon. As Horton points out in his interview on Democracy Now on April 17, we have already put ourselves in dubious company by torturing detainees; impressing medical professionals into the service of torture puts us in even nastier company.

This is not the only example of doctors using their expertise in the service of state-sponsored violence that clearly violates their Hippocratic oath. America's entire death penalty system places medical professionals in a very precarious position. Most states that have the death penalty require a doctor to be on the scene to oversee the administration of the lethal procedure (in the case of lethal injection) and to pronounce death, though no doctor will put the needle in themselves - that is left up to prison staff with varying levels of training. Most states also protect the identities of the personnel involved in the exection, though this still raises many ethical and legal issues. In Washington state, the state physician resigned earlier this year, saying his ethics prevented him from even indirect supervision of executions; then earlier this month, the state's entire execution staff resigned because they feared a pending lawsuit over their qualifications would jeopordize their anonymity.

Some doctors see serious ethical conflicts with the death penalty system, while others have embraced their participation in it. Even if they are not administering the lethal cocktail to execute a prisoner, doctors - especially mental health professionals - play a key role in moving defendants through the system from the courtroom to the death chamber. The Supreme Court has ruled (in Ford v. Wainwright) that it is unconstitutional to execute an insane person. Regardless of the prepoderance of medical evidence, some states are just hell-bent on executing their prisoners, and an entire cottage industry has developed of psychiatrists who will certify that pretty much everyone is fit to be executed.

The most notorious of these doctors was James Grigson, nicknamed "Dr. Death." Grigson testified as a prosecution expert in 150 capital trials, and in nearly all of them, he declared the defendant fit to be executed. He testified in many trials in Texas, where he almost uniformly stated that inmates met an aggravating factor in the state's death penalty statute - that they posed a threat of future dangerousness to the community should they be allowed to live. Grigson was stripped of his medial license by the American Psychiatric Association in 1995 for making such declarations without ever interviewing subjects, and he died in 2004.

Many doctors also find themselves in the position where they must treat a death row inmate to restore him to a state of mental health whereby he becomes fit to be executed. Some doctors have refused; others, like Mr. Grigson, never met an inmate they wouldn't help kill, and they are happy to do the state's dirty work for them, as was the case with an inmate named Claude Maturana in Arizona. After every last medical professional in the state refused to treat Mr. Maturana's schizophrenia, the state conducted a nationwide search, and they found a doctor who was willing to rubber-stamp the death warrant. Maturana escaped the death chamber - he died in 2002 during an operation while still in prison. But his case is just one of many like it.

Some death penalty statutes are also designed to maximize the number of people who can be executed by parsing the difference between "insane" and "mentally ill." Such is the case with Andre Thomas (pictured), who sits on death row in Texas. Thomas was convicted of murdering his wife and two children and cutting out their hearts; since he has been in prison, he has gouged out both of his eyes and eaten them. But the Texas Court of Criminal Appeals (we have written about them before) ruled that Thomas is "clearly 'crazy,' but he is also 'sane' under Texas law."

We may not place political dissidents in mental institutions, but the shocking revelations about the use of psychiatric medicine to torture, maim, and even kill prisoners in US custody are not unique to the US' torture program. Nor are they only found in shadowy, extra-legal government programs. In many states this practice is actually part of the black-letter law, and it is carried out in courtrooms and prisons across the country. Everything about these memoranda is blood-curdling, and the people responsible for authorizing, legitimizing and employing these techniques should be brought to justice, but it is not unique to find people willing to set aside their personal and professional ethics to aid state-sponsored violence.

Psychiatry In Russia: A View From 1955

BOULDER, Colorado -- In 1955, American filmmaker Albert Maysles traveled to the Soviet Union to document their practice of psychiatry. He produced a short film about his trip, Psychiatry in Russia, which was aired on American television the following year:

Psychiatry in Russia - Albert Maysles.
Uploaded by zohilof

The most striking difference that Maysles notes between Russian and Western psychiatric practice is the former's reliance on Pavlovian theory, which does not emphasize psychoanalysis and talking therapy as much as the Freudian psychology predominantly in use in the United States at the time. Obviously, much in the film should be taken with a grain of salt - while most Soviet mental health professionals were undoubtedly conscientious and caring, their statistics on the low incidence of mental illness and the success of treatment are highly exaggerated. That said, American psychiatry at the time was in large measure barbaric, inhumane, and damaging to many patients. Lobotomies were still in wide use in the US in 1955, while the Soviet Union had banned the practice five years previous.

Maysles' film misses another important aspect of Soviet psychiatry, though his amateur foray could hardly be expected to capture one of the most oppressive practices of the Soviet state - committing political dissidents to mental institutions. The practice became widespread towards the end of Stalin's rule in 1953, and subsequent regimes, especially that of Brezhnev, used the practice to muzzle and incarcerate hundreds, if not thousands, of political opponents. The favorite stock diagnosis was "sluggishly-progressing schizophrenia," which had no symptoms other than the inability to function peaceably and obediently in Soviet society. Fighting for "truth and justice" was considered a sign of extreme paranoia, and even the failure to believe in Marxist ideology was labeled a form of psychosis.

Unfortunately, the practice is not unheard of in contemporary Russia. In 2007, journalist and opposition activist Larisa Arap wrote an article about sexual abuse and other vile mistreatment of children at a mental health facility in the Murmansk Region. After the story was published, Arap was detained by police while visiting another hospital for a personal appointment. Hospital staff then drugged her and committed her against her will to a mental facility. Medical staff moved her to another hospital in the city of Murmansk and refused to give any information to her family about her condition or even her whereabouts. Finally, she was released after being held for 46 days, during which time she was repeatedly beaten, drugged, and force fed after she went on a five-day hunger strike to protest her detention. She was only discharged on the condition that she agree to continued out-patient psychiatric care, and Russian courts have repeatedly upheld her detention as legal.

In February of this year, the Russian Constitutional Court ruled that it was illegal to involuntarily commit patients without a court order, which could only be issued with a recommendation from a court-appointed expert. Like so many decisions by the Russian courts, it is unlikely that this one will be fully and forcefully implemented by the government. Because this incident was not an isolated one, nor was it the work of a few corrupt and deranged individuals. So little of the Soviet state has been dismantled in Russia, and the security services employ many of the same coercive practices that they did in communist times. Add to a police force wholly untrained in the ways of democratic law enforcement (the emphasis there should be on the law) a political leadership born of that very same coercive apparatus, and you get a society in which medicine, which is meant to heal people, is used as a political weapon.

Maysles is still alive and well, and he is currently working on a documentary about the affair of Menahem Mendel Bailis, entitled Scapegoat on Trial. Bailis was a Russian Jew who was accused of murdering a 13-year-old boy to use his blood to make matzoh in 1913, and it was the last of the so-called "blood libel" trials against Jews in Europe.