Oath Betrayed: America’s Torture Doctors

"Where were the doctors and nurses at Abu Ghraib?"This was the question that prompted Steven Miles to begin probing into medical complicity in prisoner abuse in the "War on Terror". His resulting book, "Oath Betrayed: America's Torture Doctors", is yet another in a series of profoundly important books documenting the abuse, neglect and outright torture of prisoners in U.S. custody from our base in Guantanamo Bay to prisons in Iraq and Afghanistan to secret "black site" prisons throughout the globe. This time the focus is specifically on the role of doctors, nurses, medics and mental health professionals in abetting this abuse through silence as well as the ways in which medical staff have actively participated in the abuse.Dr. Miles weaves excerpts of various documents, such as the Geneva Conventions, other treaties, and official statements from various medical professional organizations in with evidence from government records and other verifiable sources to demonstrate how the U.S., in its planning, execution and policies regarding the "War on Terror" has violated many medical ethical restrictions against participating in, being present at, or condoning in any way torture, abuse, or degrading treatment of prisoners.He details, from documented evidence, many ways in which medical personnel have participated in and sanctioned torture and abuse. Physicians and medics have examined prisoners before, during and after interrogation - including so-called "harsh" interrogation - to certify their fitness for interrogation. Physicians, psychologists and other mental health professionals have reviewed medical and other records to recommend prisoner-specific methods of interrogation, such as using specific phobias or injuries to pressure prisoners to comply. Medical personnel have withheld needed and requested treatment as part of the interrogation procedure and, conversely, have forced medically unnecessary or unwanted treatment in other cases, such as force-feeding of hunger striking prisoners and forced medication for compliance. Medical professionals have altered, falsified and "lost" records, including even death certificates, to cover abusive and neglectful treatment. And medical personnel have remained silent in the face of abuse and neglect, failing to prevent or report abuse, and in some cases actively denying or even supporting it.Dr. Miles presents example after example of actual documented cases of prisoner abuse such that there can be no doubt that such abuse does occur. More importantly, where available in unclassified documents, he names names of the guilty parties who perpetrated or allowed such abuse. On the other hand, he also names names of those who did try to prevent or report such abuse. Those men and women are tragically unsung heroes.Dr. Miles is clearly a competent, dedicated and caring physician as well as a diligent medical ethicist. What he is not, however, is a professional writer. This book could have done with a ghost writer.Dr. Miles believes in the "tell them what you're going to tell them; tell them; tell them what you told them" model of writing. Also, it appears that the chapters were written independently, without thorough cross-checking to avoid repeated information. These two factors lead to a frequent sense of déjà vu as one encounters basically the same information repeated several times over.The book is also a rather choppy read. Dr. Miles' sentences don't always flow smoothly into a coherent argument; rather we tend to lurch from point to point, with the connection between points not always entirely clear. In an early segment on torture and "American" culture, Miles veers into a discussion of a Turkish film and other foreign cultural productions which most Americans have probably never heard of and will likely never see.This is not a long book - 169 pages plus an introduction to the second edition, two appendices*, endnotes (source references for material in the book) and an index. The font is fairly large and there are several pages with plenty of blank space. It seems the limited space could have been better spent with less repetition and more filling out of arguments and provision of examples. As it was, I was left feeling like there was so much more to say. It's not until the final chapter - a mere ten pages - that Dr. Miles begins to launch into an exploration of the meaning and implications of medical complicity with abuse and torture by American personnel and what it means for us as a country. This chapter alone could have been several times longer.Dr. Miles refers frequently to the work of Robert Jay Lifton, a physician who has written works on medical complicity with abuse and torture in Nazi Germany and during the Vietnam War. I would recommend simply reading Lifton's work. Other than proof that abuse and torture are indeed happening in the War on Terror - important in itself, but heavily documented elsewhere - Dr. Miles doesn't add much to Dr. Lifton's work in this area.*One of the appendices is, in my opinion, the most important part of the whole book. It documents the role of psychologists in "Behavior Scientist Consultation Teams" in GITMO, Iraq and Afghanistan. It shows how psychologists and other mental health professionals were utilized in reviewing prisoner's files in order to make recommendations for interrogations techniques to exploit prisoners' weaknesses and, supposedly, to force their cooperation. It also demonstrates how psychologists oversaw prisoner interrogations, supposedly to keep them from becoming abusive, yet they were the ones recommending psychological techniques - isolation, sleep deprivation, exploitation of phobias, etc. - which were so hard on the prisoners' mental health to begin with. And perhaps most important, it documents the American Psychological Association's support of this sort of role for psychologists. This section alone perhaps makes the book worthwhile.**Update 10/10/10** In my haste to get this review posted before running to catch my train, I neglected to give Dr. Miles kudos for recognizing something that many other torture book authors fail to recognize. Not only is torture not a problem of "a few bad apples", it is also not just a problem of the Bush administration. Torture is a societal problem. Torture and abuse don't happen in a vacuum and they can't happen without the consent of the people - whether express or implied - of the society committing the torture. Each of us needs to recognize our own role in refusing to acknowledge the reality of what is happening and our failure to speak out. The role of medical complicity plays a vital role in that process, because it sanctions and sanitizes abusive procedures, which gives an acceptable veneer to torture. This is another reason I wish the final chapter would have been longer, as this is a crucial point to explore in depth.

Having tried to read every article and book that addresses the controversy over physicians and psychologists participating in the planning or implementation of detainee interrogations, I believe this second edition is one of the essential works and in my opinion the best.It deserves the strong reviews from Robert Jay Lifton, Seymour Hersh, Adam Liptak, Los Angeles Times Book Review, Time, and so many others.For those who do not know Steven Miles' background, he is Professor of Medicine & Bioethics at the University of Minnesota Medical School in Minneapolis. He is also an Affiliate Faculty for the Center for Holocaust and Genocide Studies and for the Law School's Concentration in Health Law and Bioethics. He served as medical director for the American Refugee Committee for 25 years which included service as chief medical officer for 45,000 refugees on the Thai-Cambodian border and projects in Sudan, Croatia, Bosnia-Herzogovina, Indonesia, and the Thai-Burmese border. He is on the Board of the Center for Victims of Torture.Professor Miles received the Distinguished Services Award from the the American Society of Bioethics and -- especially appropriate for this area -- the National Council of Teachers of English' George Orwell Award for Distinguished Contribution to Honesty and Clarity in Public Language.This background and the exceptional care and even-handedness with which he reports and documents his discoveries have enabled Dr. Miles to produce a monumental work of scholarship that is exceptionally down-to-earth and readable.Ken Pope, Ph.D., ABPPDiplomate in Clinical Psychology

Words failed me when I completed reading Steven Miles' Oath Betrayed. They come no more easily now as I write this review. My dread in putting into words what and how the material in his book has made me feel as a health care professional is compounded by yet another "sucker punch." The latest blow came with the recent release of the four secret memos in response to litigation by the ACLU that were used by the Bush administration to justify torture. But silence of any kind, whether born of fear, intimidation, coercion, apathy, or revulsion is simply unacceptable. Malfeasance and evil deeds thrive on silence and when our words disappear, they must be found and employed.Dr. Miles speaks of the silence and complicity of physicians and nurses. As a health care professional of 42 years, it pains me to have the knowledge of both brought to my attention and bubble up from those dark places where I like to keep things like horrors hidden. I am a health care professionals. By virtue of my commitment to the social good and special knowledge that I possess as a result of my education, I have a relationship with society that is unique. As part of my social contract I am expected to be trustworthy, competent and to do no harm. In return society affords me and all health professionals a special status. We are honored as caregivers and trusted to alleviate suffering and save lives. To be a health care professional is a privilege.Other reviewers have most eloquently described and reviewed this book's first edition on medical complicity in the torture and deaths, and their cover-ups in the Afghanistan and Iran during the Bush years. They have spoken of its content and unfailing scholarship, as well as of Dr. Miles' passion. I am unsure how my own review will add to those voices except to say that I agree with all of them. The book is exquisitely written, and constitutes one of those "keepers" for one's bookshelves.Perhaps my contribution can be that of celebrating those who did and who do breach the silences. It is easy to be horrified and express outrage from the comforts of our homes. It is easy to engage in moral obviation. It is far more difficult to speak up when faced with the withdrawal of one's professional and personal esteem and approbation. That requires the courage, not only to overcome fear and aversion to do what is morally right, but to face the anger and hateful slurs of those who would attribute disloyalty or lack of patriotism for our actions when we speak.So yes, this book is about the most odious aspects of humanity and the cowardly silence of many. But it also stands as a celebration of those few in this book who had the courage to fight the silence and expose it. The book, even by virtue of having been researched and written by this brave man gives the rest of us hope.