Social Science & Medicine 171 (2016) 1e8

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Social Science & Medicine

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Standardizing psycho-medical during the on Terror: Why it happened, how it happened, and why it didn't work

Myles Balfe

Dept. of Public Health, UCC, Cork, Ireland article info abstract

Article history: After 9/11/2001 the United States launched a global . As part of this War, terrorism suspects Received 20 April 2016 were detained by the U.S. military and by the C.I.A. It is now widely recognized that the United States Received in revised form tortured a number of these detainees in the context of its ‘enhanced ’ programme. This 8 November 2016 article examines how and why U.S. organizations developed standards that allowed healthcare pro- Accepted 9 November 2016 fessionals to become involved in torture; why the standards developed by U.S. security institutions failed Available online 10 November 2016 to control the actions of enhanced interrogation personnel on the ground; and what the role of standards were in stopping the enhanced interrogation initiative. The article concludes by discussing the general Keywords: United States lessons that the enhanced interrogation programme has for social science research on standards, namely Standard that individuals can experience ambivalence when caught between competing organizational and pro- Standardization fessional standards and that it might be inherently difficult to successfully enact certain protocols when Torture these relate to deviant or destructive acts. Enhanced interrogation © 2016 Elsevier Ltd. All rights reserved. Psychology Medicine War on Terror

1. Introduction related documents, the enhanced interrogation programme could not have been created, let alone operationalized. After 9/11/2001 the United States launched a global War on Standards were also significant because they were responsible Terror. Suspects were captured by the U.S. military and by the C.I.A. for drawing health professionals into torture. Research on stan- and detained at various acknowledged and black sites across the dards suggests that, because of their ability to systematise technical world. It is now widely recognized that the United States tortured a information, scientific experts are often called upon when stan- number of detainees in its custody in the context of its ‘enhanced dards are being formulated (Jordan and Lynch, 1998). Health pro- interrogation’ programme (IMAP/OSF, 2013; SSIR, 2014). fessionals became involved in the enhanced interrogation This torture had a number of features. One was a strong reliance programme out of a perceived need to regulate interrogation on healthcare professionals, who supported, designed and carried practices and thereby protect detainees from harm. This shows that out enhanced interrogation. A second feature was the emphasis health professionals can become drawn into serious medical placed by the programme on clean (Rejali, 2007) violence. A third deviance through a mixture of moral and bureaucratic imperatives was the role played by standards, protocols and guidelines in the bound up in standards. torture programme. Finally, a third reason to consider the role played by standards in To date, no study has fully considered the role that standards the enhanced interrogation programme is because the programme played in enhanced interrogation. This is an important absence highlights that certain activities cannot be standardized. Although because standards were key to the entire initiative. They were the point that health professionals often find it difficult to stan- invoked throughout all its stages, from its development through to dardize their activities has been previously noted (Timmermans, its termination. One of the key documents that initially justified the 2005), it is worth emphasising it again in this context given that programme's violent tactics, for example, was called the “Standards the programme's authorization was based on a belief on the part of of Conduct for Interrogation 18 USC 2340-2340A” (Department of policy and operational architects that brutal interrogation tactics Justice, 2002). Without the standards developed in this and could be standardized. This article has two purposes. The first is to consider the overall role played by standards in the enhanced interrogation programme. E-mail address: [email protected]. The second is to consider the wider lessons that the case study of http://dx.doi.org/10.1016/j.socscimed.2016.11.014 0277-9536/© 2016 Elsevier Ltd. All rights reserved. 2 M. Balfe / Social Science & Medicine 171 (2016) 1e8 enhanced interrogation has for the more general field of the soci- upon rules and ways of acting (Bowker and Star, 1999; ology of standards. The first section of this article therefore con- Timmermans and Epstein, 2010). For instance when an individual siders recent sociological research on standards. This is followed by boards a plane one of the first things that they notice is that airline sections on the creation of enhanced interrogation standards, why personnel act the same way and engage in the same activities each health professionals became involved in standard creation, how time, such as cross-checking the door and preparing for departure. torture standards played out in practice, and the role played by For safety purposes their activities are fully controlled; there is little standards in stopping the programme. The discussion considers the variability from situation to situation. Medicine and its allied pro- wider lessons that the enhanced interrogation programme offers. fessions also develop standards to improve the effectiveness, quality and safety of care, and to decrease variations in care. 2. Methods Standards often fail in practice. A new standard enters a world that is populated by practices, people and other standards that This article is based on an analysis of data extracted from key might not be compatible with or controllable by the new standard. government (e.g. SSIR, 2014) and health professional reports (e.g. People may refuse to comply with or follow the standard (Star and IMAP/OSF, 2013), and government protocols that the enhanced Lampland, 2008); activist groups often resist standards, or seek to interrogation programme used (Department of Justice, 2002, 2005). alter standards to meet their particular aims (Whooley, 2010). The article also draws upon news media articles from sources of Whooley (2010) for instance notes that while psychiatrists theo- record (e.g. the New York Times, the New Yorker) that discuss the retically need to provide patients with a defined type of diagnosis standards used by the programme. Information from all these from DSM, in practice they often develop their own ‘deviant’ di- sources was extracted and thematically organised. agnoses that do not match those outlined in the guidelines. In This article has two limitations. One is the fact that it is mainly, general, a notable feature of modern medicine is how difficult it is though not exclusively, based on an assessment of secondary to get healthcare professionals to adopt and follow standards; sources. Even a central document such as the SSIR report is a 500 compliance rates may low (McDonald et al., 2005; Timmermans, page summary of a much longer (close to 6000 pages) report, 2005) for reasons such as lack of awareness, lack of familiarity which is itself a summary of a vast range of documentation. That and lack of agreement with the standard (Busch, 2010; Cabanna longer report has not been released. So while this article is et al., 1999) and a feeling that standardization is often linked comprehensive, much of its information is not based on primary directly to of care (Timmermans and Almeling, sources, which remain classified and/or redacted. At the time that 2009). this article was written (late 2016), for example, Physicians for The outcome is that very few standards work completely as Human Rights noted that the CIA had “redacted nearly all details expected (Timmermans and Almeling, 2009). Often rather than concerning the CIA's Office of Medical Services” (Physicians for standardizing practice, standards transform practice in unpredict- Human Rights, 2016). For the purposes of this article, however, able ways (Star, 1995; Timmermans and Almeling, 2009). To keep sufficient information is publicly available to provide an overview the standard working effectively, support armies of technicians of the role that standards played in the programme. may be needed (Busch, 2000). In medicine, standards may be The second limitation is that individuals who are critical of the further maintained through the development of evidence-based enhanced interrogation programme have written most of the sec- medicine and systematic reviews, and also through the use of ondary sources. This article has taken the position that these in- clinical guidelines (Timmermans, 2005). dividuals' reports not only provide information about the enhanced Standards have a complicated, mediating role between pro- interrogation programme, they are also examples of the ‘anti- fessions and bureaucracies. Traditionally, professions developed enhanced interrogation standard’ in action. their own standards, which allowed them to delimit their profes- sional territory within the context of countervailing relationships 3. Sociology of standards with other groups (Timmermans, 2005). This reflected the ability of professional groups to self-regulate and, largely, to determine their The past decade have seen significant research interest in own destinies. Increasingly, however, members of the professions standards, and the impacts that standards have for organizations are finding themselves working for powerful state or corporate and individuals. A standard, broadly speaking, is a convention or bureaucracies. These organizations may create their own standards requirement (Timmermans and Epstein, 2010), usually outlined in a which they can impose upon the profession, or ask it to follow formal document, that describes the uniform methods and pro- (Timmermans, 2005). The creation of standards in these situations, cesses that need to be undertaken if the standard is to be met. and how they are used and responded to, therefore reveals Standards fit somewhere between laws and norms in their ability to important information about the nature of the relationship be- direct action, and have, as such, been called ‘soft regulations’ tween the profession and the bureaucracy; and how the conflicts (Timmermans and Epstein, 2010). are resolved can say something important about the profession's Standards have a number of characteristics. Despite their ubiq- values and priorities. uity, standards tend to be infrastructures that escape notice (Star and Lampland, 2008). They are often developed by professional 4. Medical standards and torture groups and external (often national and international) bodies. The military is one institution that has always expressed a strong in- All healthcare professions produce ethical standards, man- terest in standards and standardization, and most industrialized ifested in guidelines, protocols and principles, that govern their nations see standardization as central to their national security members’ behaviour; regulation of ethical behaviour through codes (Busch, 2010). A standard model of training, for example, is is in fact one of the defining features of a profession. These stan- necessary to ensure that military personnel receive the same dards of conduct outline the behaviours that healthcare pro- training and can be relied upon to act in standard ways in high- fessionals should and should not engage in. pressure situations. Even terrorist groups develop detailed stan- For doctors, a foundational ethical standard or principle is ‘do no dards to control their activities (Star and Lampland, 2008). harm’; another is ‘do good’ (Miles, 2006). Torture and other forms Standards are often used to regulate practice, that is to create of cruel, inhuman and degrading treatment violate these principles uniformity across time and space through the creation of agreed- in a number of ways, and consequently the medical profession has Download English Version: https://daneshyari.com/en/article/5046833

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