Overwhelming evidence has emerged that during the so-called 'war on terror' following the attacks on 9/11, doctors and psychologists were instrumental in advising on 'enhanced interrogation techniques' that are known to have included torture. How did mental health professionals become willing to participate in torture of suspected terrorists? In an article in the British Medical Journal, Derrick Silove, professor of psychiatry, and social scientist Susan Rees explored whether there is any scientific foundation for mental health professionals to claim special expertise in judging the so-called 'torture threshold' or in predicting the long term psychiatric outcomes of interrogation practices.
After several years of dissent, associations of psychologists and psychiatrists in the United States and elsewhere seem to have reached a consensus that mental health professionals have no role in the interrogation process. However, the debate continues. A recent editorial in the journal Nature for instance, offers support for the views of people who argue that since risks of abuse (during interrogation) are always present, having a mental health professional present should serve as protection for detainees. In response to these lines of thought, Silove and Rees argue that there are scientific and clinical reasons to question whether mental health professionals can claim the knowledge or the technical ability to judge the 'torture threshold'.
They state that there is no objective metric for reliably measuring the subjective reaction to extreme experiences that cause pain or psychological trauma. Doctors who assess a patient after an acute traumatic event rely primarily on what the patient tells them to judge his or her level of pain or psychological suffering. "The accuracy of that communication depends on a setting of safety, trust, and confidentiality in which the doctor is perceived as acting from a stance of beneficence", the authors write. Since the opposite conditions operate in detention facilities, how can professionals make accurate assessments of the level of pain or mental trauma being experienced by the detainee? Detainees may overreport pain and distress, to avoid further torture. They may also underreport symptoms, either as the result of shock or willful action - such as a stoical response to suffering. Does that mean that for resilient detainees, the assessing mental health professional should recommend increasing the level of duress and thereby raise the threshold for torture?
"We do not yet have the scientific knowledge to predict with any precision what the psychological outcome will be for an individual, particularly at the time of trauma exposure. The state of shock or dissociation shown is an inexact guide, partly because it is difficult to assess. Also, some people show only a moderate symptom response in the immediate aftermath of interrogation but develop frank traumatic stress symptoms later—the delayed onset group." Over several decades, health professionals have played important roles in showing the mental health impact of torture and in establishing rehabilitation services for survivors. Thus, the authors conclude, "it seems ironic if this accrued expertise has encouraged others (politicians, policymakers, the military, and legal advisers) to exploit the role of mental health professionals in an effort to blur the distinction between interrogation and torture. The risk is that the presence of mental health professionals in the interrogation room will do little more than provide a moral shield that confers the aura of respectability on practices that may involve torture."
Interrogating the role of mental health professionals in assessing torture, Derrick Silove & Susan Rees, in: British Medical Journal, 2010, 340:c124, published 28 January 2010