The realization that physicians are part of a killing machine provokes a special horror

  

In his memorable account of the Plague, Albert Camus described how Dr. Rieux was determined to complete his chronicle, “so that he should bear witness in favor of the victim, so that some memorial of the injustice and outrage done to them might endure. He knew that the tale he had to tell could not be one of final victory. It could only be the record of what had had to be done, and what assuredly would have to be done again in the never-ending fight against terror and its relentless onslaughts.” I can think of no better reason for telling the story in these pages.

While political terrorism has been capturing widespread attention for some time, almost nothing has been made public of how doctors today use their knowledge and skills in its support. Yet they regularly medically examine political prisoners before questioning to assess the degree of torture to be used. They attend interrogations to treat the direct physical effect of the torture they have approved so that investigation can continue. They recommend how much further torture can then be applied. Physicians employed in state-sponsored terrorism also falsify autopsy reports and provide fake medical certificates for persons those doctors know were tortured to death. A common description is “cardiac failure” or ‘pneumonia’ on those certificates.

Physicians who are members of terrorist organizations provide, or themselves use, drugs to fotce hostages into video recordings— confessions, exhortations, and genuinely pathetic pleas that have become a regular feature of TV newscasts. These stage-managed appearances are aimed at exerting worldwide psychological pressure designed to achieve the aims of the kidnappers.

All such routine malpractices violate medical ethics as defined by one of three oaths sworn by every physician before he or she starts to practice: to do no harm, provide assistance to all in need, and only treat with the consent of the patient.

Yet every day these pledges are flagrantly abused by doctors whose actions conform to the generally accepted definition of torture produced by the United Nations, Amnesty International, and other human rights organizations: the deliberate infliction of pain by one person on another in an effort to break the will of the victim.

In 1988 this gross and pervasive violation was occurring in over ninety countries; a quarter of the world’s population were living in areas where abuses have long become habitual, particularly in the Soviet Union, Latin America, Asia, Africa, and the Middle East.

The nonmedical perpetrators of physical and mental violence, such as prison guards and interrogators, are steadily being joined by doctors prepared to put aside all professional ethics to advise upon or perform torture. Psychiatry, in particular, is highly vulnerable to being used by the state to maintain power and control the thoughts and actions of its citizens. George Orwell’s 1984 and Aldous Huxley’s Brave New World continue to exist within all those countries where a person’s intentions and actions are interpreted by the state in a manner designed to destroy legiti- mate political dissent. In a high proportion of those instances psychiatrists provide the clinical label—and the veneer of legitimacy—that allows the state to incarcerate opponents. Doctors, therefore, are increasingly used to discredit and silence all those who oppose official policies; the description of political dissent as “insanity’’ would have no credence without their active support.

In Russia, glasnost has done nothing to significantly reduce the number of dissidents languishing in closed institutions. There, as elsewhere, they continue to be tortured psychologically and physically by physicians trying to induce a change of political views. There are no firm figures for the number of doctors involved. Some human rights workers suggest the global number could run to many thousands. More likely it is in the hundreds, at least for those actively engaged in daily torture. It is manifestly impossible to arrive at any accurate figure for the number who discreetly play a supportive role in torture. But one, surely, is too many.

What is certain is that not since Hitler understood that doctors were an integral and indispensable part of his final solution have physicians become so involved in torture. Yet, dismissing them as simply mad doctors intent on satisfying their own sadistic whims is no more convincing than it was concerning Nazi clini- cians involved in the death camps program. Many such physicians appear normal, offering a reminder that certain behavior does elude our full understanding. Indeed, much of what is described in this book cannot be explained by a comforting resort to psychological explanations, where personality and motivation interlock perfectly. All that can be safely claimed is that, be- cause this account is authentic, there can be no simple explana- ' tion for the way these doctors behaved—and continue to behave.

In writing this book I had access to written testimony from prime sources, which can be assessed in the following descending order of importance: reports by human rights organizations of fully verified medically sponsored torture; properly attested affidavits by those who were subjected to medical torture; statements by defectors, either from a terrorist organization or from state-sponsored terrorism, about the use of physicians to design methods of abuse or who act as torturers themselves; and authentic documents, gathered by security forces, which offer proof of cruel, inhuman, or degrading treatment administered directly by doctors or at the behest of those security forces.

That evidence was supported by interviews. Thirty-five years of researching other subjects has convinced me that the only way to fully understand an issue is to talk to those directly involved. For this book I traveled extensively in North America, Europe, the Middle East, and beyond to Asia and, finally, Latin America, during which I had to ponder many versions of truth and untruth.

I spoke to more than a hundred persons either directly employed or working indirectly for intelligence agencies. They ranged from desk men to field agents, from academics to physicians employed in prisons and interrogation centers. I conducted multiple interviews with over fifty of these people; some seventeen prime sources were each questioned a dozen or more times.
Their patience is something at which I still marvel—that and their willingness to talk. The only guarantee they asked for, and received, was that their anonymity would be protected.

To those who do not toil in the fields of investigative journalism, this is sometimes the moment when hands are thrown up and the question is put: “If they won’t be named, how can we believe them?” The only sensible answer is this: Men and women who work in intelligence generally will not discuss security matters without an absolute guarantee of not being identified.

However, that does not mean their words are any more, or less, believable; it simply requires that a reporter does not lower his guard.

In addition I followed the rules laid down by two of the great editors of this century, whom I had the good fortune to work for:

Arthur Christiansen of the Daily Express, London, and Ed Thompson of the Reader’s Digest. Both were absolutely firm on such matters as wherever possible using two sources for an important fact, and that when writing someone was said to have “felt,” “sensed,” “thought,” “understood,” or “believed,” such reactions must genuinely reflect the essence of a particular portion of an interview with that person. Both editors were insistent on the need to reproduce as accurately as possible the attitudes and personality of an interviewee, even when he or she was not directly quoted. 

Bob Woodward of the Washington Post has rightly reminded all of us of the need to try and distinguish between what should genuinely be kept secret for the sake of national security and what officialdom tries to hide under the guise of security, when what is really at stake is the uncovering of inept decision-making and unethical behavior. In his own book, Veil: The Secret Wars of the CIA 1981-1987, Woodward quoted the guide-lines of another veteran of our business, Ken Auletta. He has synthesized the complex business of prime and secondary sources, on-and off-the-record conversations, and recreating an event or happening with the use of memoranda, documents, letters, diaries, and notes-to-file. Auletta wrote that ‘‘no reporter can with 100 percent accuracy re-create events that occurred some time before. Memories play tricks on participants, the more so when the outcome has become clearer. A reporter tries to guard against inaccuracies by checking with a variety of sources. But it is useful for a reader—and an author—to be humbled by this journalistic limitation.”

Auletta’s reminder was certainly constantly in my mind during the interviews for this book. And just as Veil is among the first to illuminate the world of modern intelligence, so mine is an early entry into describing the field of medical torture. Like Woodward’s stated attitude to his work, I freely recognize that the story in these pages cannot be the final word; instead, I see it as an encouragement for others to pursue the trail, to turn what is essentially today’s reportage into the substantiality of tomorrow’s history. Sometimes, such as that day in May 1987 in Beirut, as on previous occasions, I had no alternative but to simply be my own prime source—to enter the story and describe what I saw. I’m not enthusiastic about such intrusions; after all, it is the story and not the teller who matters. But at those times there really seemed no other way.

When Veil was published in the autumn of 1987 it was attacked largely on the grounds that the one-time director of the Central Intelligence Agency, William Joseph Casey, would never have given the interviews Woodward claimed, let alone be so forthcoming—or if he had, it had simply been to use Woodward to shape Casey’s place in history and spread disinformation. It’s the old story of trusting a source. Personally, I have no problem in believing that Woodward spoke, as he wrote, close to fifty times with Casey and that the director was as frank as Veil suggests.

I met Casey on two occasions in Washington in March 1986. My path to him had been cleared by senior U.S. diplomats and members of the CIA in the Middle East whom I had gotten to know through the hostage situation in Beirut. They said the only person who could begin to answer some of my questions was Casey.

The first occasion we met was in the International Club in Washington, D.C., on Friday, March 21; the second time was at the same venue four days later. On both occasions Casey wore the same dark blue suit, clearly custom-made because of his size. He seemed considerably bulkier than in his television appearances—and older, too. He looked physically unwell, his skin gray and taut around the eyes and jaw.

He wasted no time on small talk, getting down to business at once. I gave him a brief account of what I had learned in the Middle East about the hostages. He listened carefully and said some of it had to be “just goddamn speculation.” Then he proceeded to substantially reduce that element by explaining in some detail why the CIA believed the hostages were being held under appalling conditions, including being ill-treated by a doctor. He suggested further ways I could “look into that aspect.” He was courteous and helpful, to a certain point—that point being that he told me he was “working with another writer,” and consequently could only be of limited assistance. That writer, of course, was Bob Woodward.

But Casey did provide me with confirmation of a number of key matters relating to medical torture, speaking candidly after he had been satisfied that anything he said would not be attributed to him. His death on May 6, 1987, freed me of that agreement and I can simply say that this book owes a debt to Casey—even though I am certain he would not have wanted many of the revelations about the CIA’s own behavior to emerge; it was very clear from our discussions that the director had a fierce protective feeling about not only the agency he then headed but the one he had inherited. I learned of his death back in the Middle East while pursuing one of the leads he had given. His passing came at the very time Congress had begun its public hearings on the Iran-Contra fiasco, whose ramifications arose directly out of the hostage-taking that forms a theme of this book.

The director, like my other interviewees from the intelligence world, would not be taped and would not allow notes to be taken at the time; those had to be written up immediately afterwards as background, that catchall phrase that means information provided could be fully used but not directly attributed.

Surprisingly, it worked; cross checks invariably showed my sources were not only in a position to know, but what they were saying was the truth. I am not one who subscribes to the idea that intelligence services spend their time and money running a continuous international conspiracy to deceive journalists and authors. All, undoubtedly, do spread disinformation some of the time among the gullible and unaware. But all the time? No.

Yet, that said, I should also add that sometimes attempts were made to dismiss medical torture as no more than harsh but essential treatment of dangerous suspects—and that, indeed, the very presence of a doctor should be seen as that of a physician ready to intervene, rather like a boxing referee, when a victim’s life is in danger.

Such arguments take no account of the long-term effects on the emotional stability of those who endure any form of violation of their basic human rights. Accounts by victims of torture are filled with trauma: recurrent nightmares and phobias, in- creased anxiety, and often impotency. Some of those symptoms are a direct result of medical abuse, itself not always easy to pinpoint, let alone assess, because its practitioners are often greatly skilled in its application.

Again, it was claimed that some of the doctors who were engaged in physical ill-treatment or psychological mind control were forced into such behavior because of threats to their own careers, and possibly their lives and those of their families. The most effective rebuttal to this suggestion is that the great majority of doctors—whether in totalitarian states or living amid terrorist enclaves—refuse to participate in such practices. Indeed, they are often prepared to risk their jobs, lives, and the safety of loved ones to avoid taking part in the violations of human rights that have become so systematic and efficient as to create a growth industry whose tools include drugs, electro-shocks, mouth gags, garrots, blindfolds, and branding irons, with methods ranging from sexual abuse to sham executions.

Nor is the defense of self-preservation new. It was advanced by some of the twenty-one German physicians charged with medical crimes at Nuremberg. Disclosures during their trials led to the Hippocratic Oath having an addendum: “I will not permit consideration of race, religion, nationality, party politics, or social standing to intervene between my duty and my patient.” Forty years after that edict was framed, medical cooperation forms an integral part of torture in many countries; the demands of state-sponsored terrorism, or the organizations that deal in terrorism, require no less.

What remains for me the most disturbing aspect of my investigation is that even as I write, and later when it is read, there are physicians who continue to participate in torture. Their behavior poses a continuous threat to all those of us who still possess that most precious of all gifts: the right of the human spirit to choose. In working on this book I have had to come to terms with my own emotions—disbelief, bewilderment, disgust, and anger and, more than once in the early stages, a feeling that the subject was simply too evil to cope with. Nothing I had researched before could have prepared me for the dark reality of doctors who set out to deliberately destroy minds and bodies they were trained to heal. The realization that physicians are part of a killing machine provokes a special horror. Throughout the interviews I worked through much of my personal conflict— whether to stop or go on—knowing that at every turn there would be further personally unsettling revelations. I survived by constantly reminding myself of a professional obligation to be balanced about doctors whose actions in the end raise a fundamental question: How did they become the way they were and are?

For the most part they did not give the impression, outside their work, of being totally evil; certainly they rarely filled the popular imagery of demonic figures. Equally, it must be said it is demonic that they are not demonic. And, without doubt, there is a deeply disturbing psychological truth that what they do does not require personalities anywhere close to sadistic: their behavior confirms that what can be properly called ordinary people, nurtured and tutored to find places within the oldest caring profession, can perform acts of authentic wickedness. To reveal their capacity to do so, I felt, like Dr. Rieux, a powerful need to complete a chronicle that has its beginning, though not its roots, in the predawn, neither light nor darkness, the hour the Moslem faithful say when night properly ends and another day starts in Beirut—4:30 A.M. on my watch on a morning in May 1987. (...)

from the book Journey Into Madness The True Story of Secret CIA Mind Control and Medical Abuse by Gordon Thomas