During phases the covert weapon employs conspicuous techniques intended to create and maintain learned helplessness in victims. Here is a Paper published by Physicians for Human Rights that states that learned helplessness was a foundational goal of the US “enhanced interrogations“ of suspected enemies following 9/11, as they believed it was the key to successful coercive control. It was hypothosised that an enemy forced into a learned helplessness state would loose all resistance, become passive and completely complient to interrogators.
Given the capabilities of the modern remote forced silent speech interface interrogation no longer poses a problem as desired information can just be harvested by asking the relivent questions and monitoring the internal dialogue for the answers. Once a victim is trapped on the interface I believe they are exploring ways to control behavior and cognition without or in spite of conscious resistance. They are looking to identify or create ways of controlling people remotely using the forced interface; by combining old techniques like “brain washing,” “thought reform” and “learned helplessness” with the amazing capabilities of modem technology I think they believe they have a chance.
Nuremberg Betrayed Human Experimentation and the CIA Torture Program
Contents
3 Executive Summary
6 Methodology
7 Introduction
22 CIA Torture
Experiments
30 Research on the Health
Effects of Torture
44 Applications of CIA
Research on Detainees
51 Conclusion
55 Recommendations
56 Appendix A: Legal and
Ethical Standards for
Human Subjects
Protection
60 Appendix B: Select New
Evidence since PHR’s
2010 Analysis
61 Appendix C: Select
Timeline of Relevant
Events
65 Endnotes
Acknowledgments
This report was written by Sarah Dougherty, JD, MPH,
senior anti-torture fellow at Physicians for Human Rights
(PHR) and Scott Allen, MD, FACP, medical advisor at PHR.
The report benefitted from review by PHR staff, including
Carolyn Greco, JD, senior U.S. policy associate; Vincent
Iacopino, MD, PhD, senior medical advisor; Donna
McKay, executive director; Marianne Møllmann, LLM,
MSc, director of research and investigations; Susannah
Sirkin, director of international policy and partnerships;
and Homer Venters, MD, director of programs. PHR
advisors and former employees contributed invaluable
expertise and guidance on this report, including Widney
Brown, JD; Nathaniel Raymond; and Stephen Soldz, PhD.
PHR intern Robert Erikson provided research assistance.
The report also benefitted from external review by
Deborah D. Ascheim, MD, member of PHR’s board of
directors.
The report was reviewed, edited, and prepared for
publication by Claudia Rader, MS, content and marketing
manager.
Support for this report was provided by the Open Society
Foundations.
Executive Summary
After the 9/11 terror attacks, as part of its counterterrorism efforts, the Bush
administration authorized the systematic torture and ill-treatment of detainees in U.S.
custody. In order to do so, it created a legal and policy framework to permit abusive
interrogation and detention practices and undid long-standing, internationally-agreed
protections for prisoners of war. The goal of the Central Intelligence Agency (CIA)
“enhanced interrogation” program was to break detainees psychologically, using harsh
techniques designed to inflict severe pain and suffering. The program rested on the
flawed claim that torture could be useful in overcoming a person’s resistance to
interrogation and in facilitating the collection of intelligence. Physicians for Human
Rights (PHR) has previously documented that, as part of the CIA torture program, U.S.
health professionals systematically collected data involving torture and conducted
analysis to make this information generalizable to other aspects of the program. These
activities amounted to human subjects research, a term used interchangeably with
human experimentation. Analysis of new information indicates that the CIA torture
program was itself a regime of applied research on detainees and implicitly
conceptualized as such by the CIA. This constitutes one of the gravest breaches of
medical ethics by U.S. health professionals since the Nuremberg Code was developed to
protect individuals from nonconsensual human experimentation following Nazi
medical atrocities during World War II.
At the heart of the CIA’s research was an unproven theory that exposing detainees to
uncontrollable stress and trauma would disrupt normal mechanisms of resistance and
create “learned helplessness” and dependence.1 That, in turn, would induce total
compliance in detainees, enabling interrogators to secure their cooperation and elicit
accurate intelligence from them. The techniques proposed for this process were derived
from the U.S. military’s Survival, Evasion, Resistance, and Escape (SERE) training
program to teach service personnel how to resist abusive treatment if captured. These
tactics were themselves a distillation of coercion methods used by Cold War communist
regimes to produce false confessions. While the underlying phenomenon of
helplessness and dependency had been studied by U.S. researchers trying to understand
the apparent “brainwashing” effect of such techniques, the new theory that torture
would produce learned helplessness – and that this would ultimately produce
intelligence – had never been researched or demonstrated to be “effective.” At the time
the CIA program began, the existing evidence suggested that coercive approaches to
Analysis of new information indicates that the CIA
torture program was itself a regime of applied research on detainees.
interrogation did not work and were counterproductive.2 Nevertheless, psychologists
contracted by the CIA promoted this theory, improvised and applied various torture
techniques, and reported outcomes in line with their contention that these techniques
facilitated detainee compliance and cooperation with interrogation.
This research was driven by implicit hypotheses of “efficacy” and “safety.” The CIA
sought to demonstrate that the tactics “worked” for interrogation and would not injure
the subjects beyond a certain threshold of harm, as delineated in secret “torture memos”
issued by the Department of Justice Office of Legal Counsel (OLC). The August 2002 OLC
memos authorized the use of “enhanced interrogation” techniques, to be applied in an
isolated and sequential manner, and redefined “pain and suffering” such that the effects
had to be much more severe and/or lasting than previously permitted in order for the
techniques to be regarded as torture. This created a permissive, rather than prohibitive,
approach to torture. Relatedly, the memos also directed medical personnel to conduct
systematic monitoring of interrogations in order to calibrate pain and mitigate harm.
This role posed a conflict from the outset. Medical ethics absolutely prohibit the
involvement of health professionals in torture and ill-treatment, including even being
present when abuse is used or threatened. In addition, it is a violation of ethics to
mitigate harm in the context of facilitating the intentional infliction of physical or
mental pain and suffering. Torture cannot be made “safe,” nor was the Bush
administration interested in making it “safe.” Instead, it was interested in not exceeding
certain limits of injury.
Health professionals in the CIA Office of Medical Services (OMS) were ordered to ensure
interrogators did not exceed these limits – thus ostensibly maintaining the “safety” of
the subjects – with little idea in actual practice of how to do so. The extant literature was
restricted to SERE studies, which involved limited application of milder forms of the
methods for the purposes of increasing, rather than destroying, resilience. The SERE
subjects were volunteers from the U.S. military who were able to stop the infliction of
the torture techniques at any time. In addition, precautions were taken to prevent the
risk of harm, which was well-documented in the SERE literature.
By contrast, the people subjected to the CIA’s “enhanced interrogation” were
indefinitely detained, did not provide consent, and were unable to stop the infliction of
physical or mental pain. In light of the vast gap between the SERE and CIA models and
populations, medical officers worked to monitor, collect, analyze, and disseminate data
on the effects of the torture tactics in real world applications to detainees. These
observations were used to formulate clinical protocols to modify the techniques and
guide medical monitors in future interrogations – conducting, in effect, a “safety trial.”
This research was part of an effort to contend that the torture tactics did not exceed the
elevated physical and mental pain thresholds established by OLC lawyers. At the same
time, the CIA’s research was driven by a need to create a legal defense for U.S. personnel
involved in the “enhanced interrogation” program, in the event of future torture
charges. OLC lawyers claimed that reviewing evidence gained in the course of interrogations
could establish that interrogators lacked the intent to inflict lasting
harm, and thus commit torture. The resulting findings were used to justify commission
of the crime and to protect perpetrators from legal liability.
The CIA’s “enhanced interrogation” program was based on a tenuous theory proffered
by contract psychologists with a financial vested interest. The subsequent deployment
of this crude program required constant invention, assessment, and modification in the
field – based on actual applications of torture techniques on non-consenting
interrogation subjects – to refine the approach and demonstrate the promised “safety”
and “efficacy.” In any other context, such an approach would be considered merely
improvisational. However, when the individuals improvising are scientists and the
subjects are humans, such improvisation is something more. When human subjects
undergo an intervention or interventions (particularly harmful interventions) and their
response is methodically measured and analyzed, and the results of the analysis are
disseminated – even internally within a program – the activity meets the U.S.
government’s definition of human subjects research.
The definition of research does not require that the methodology used be sound or that
investigators intend or are even aware that their investigation constitutes research.
Indeed, it appears the CIA’s research to establish learned helplessness as a theoretical
construct, and parallel efforts to try to prove that torture did not have lasting health
effects, all lacked a legitimate research purpose, design, and methodology. The premise
of “efficacy” conflicted with the extant literature on effective interrogation, which
showed that coercive measures were counterproductive and undermined intelligence
collection. Similarly, the premise of “safety” conflicted with the U.S. government’s own
SERE research, which showed a significant risk of harm even in the controlled
environment of training. Here, the CIA’s activities not only met the essential criteria for
human subjects research, they were explicitly conceptualized as such: a systematic
investigation – including data collection and analysis – to create generalizable
information in support of “enhanced interrogation” and detention.
The CIA’s research evolved to fit the legal needs of the Bush administration in response
to internal and external pressures on the torture program. In particular, interrogators
were using multiple torture techniques in combination, with a far greater severity,
duration, and repetition than initially described to OLC lawyers. This was inflicting far
greater physical and mental injury to detainees, contradicting representations that the
techniques were safe. Health professionals faced increasing pressure to generate data to
justify and indemnify torture practices that were already in use, but that exceeded the
scope of authorization or were not yet approved. Accordingly, OMS medical guidelines
were created to reflect and incorporate the latest findings of CIA medical officers. In
response to requests by Bush administration officials to provide scientific and clinical
assurances of “safety” and legality, these findings were reinforced with additional data
to develop new legal memos. Over time, the severe physical and psychological harm of the
torture techniques, as well as an absence of proof of their effectiveness for interrogation purposes, undermined the
flawed theories of “safety” and “efficacy.” The torture program was eventually reined in
and ultimately ended – but not before great damage had been done to the human beings
at its center.
The available evidence documents, at a minimum, deployment by the CIA of coercive
techniques for interrogation that were unproven both in terms of “efficacy” and “safety.”
There was, at the very least, an ad hoc effort to assess these newly deployed techniques
on detainees in the field – at secret “black site” prisons. The documents newly in the
public domain, which form the basis of this report, detail activities by the CIA that meet
the definition of human subjects research. Without a more complete record, it is
difficult to say how formal or extensive this research was. What is clear is that this type
of research on prisoners or detainees is the very reason the Nuremberg Code protocols
were developed. In the course of facilitating the crime of torture, U.S. health
professionals committed a second and related crime: human subjects research and
experimentation on detainees being tortured, in violation of medical ethics and U.S.
and international law.
There must be accountability for both the crime of torture and the second and related
crime of human experimentation. There is also a pressing need for additional
information to come to light, with transparency as a critical first step toward
accountability for and prevention of grave human rights violations. Drawing on the
lessons of Nuremberg, we must never again permit the exigencies of national security –
or any other reason – to be used as justification for unlawful and unethical research on
human beings. In this uncertain political climate, it is even more crucial to shine a light
on this disturbing chapter and act now to prevent such crimes from being repeated.
Methodology
This Physicians for Human Rights (PHR) report is based on analysis of public source
materials documenting the Central Intelligence Agency (CIA) rendition, detention, and
interrogation program. This includes review of thousands of pages of declassified U.S.
government records, reports, and other materials from the CIA, Department of Defense,
Department of Justice, and other U.S. agencies. Many of these materials were publicly
released, or released in substantially less redacted form, following the 2014 publication
of the summary of the U.S. Senate Select Committee on Intelligence report on CIA
torture, as well as in response to Freedom of Information Act requests by human rights,
civil liberties, and media organizations. In addition, this report draws on more than 15
years of PHR’s research, investigation, and reporting in connection with the U.S. torture
program and the role of U.S. health professionals in detainee mistreatment and harm.
PHR analyzed the factual record, reviewed the state of knowledge about the physical and
psychological effects of so-called “enhanced interrogation” techniques at the time the
CIA program began, and conducted research on the ethical and legal protections for the
human subjects of research, including especially vulnerable populations such as
prisoners. In addition, this analysis references evidence cited in PHR’s 2010 publication,
“Experiments in Torture,”3 the first report to show human subjects research and
experimentation in the CIA program, as well as additional data that has come to light.
This report is limited to publicly available sources. Given the scope, complexity, and
secrecy of the CIA program, this analysis does not claim to provide a complete picture of
the public record, nor a definitive analysis of the CIA’s illegal and unethical research on
prisoners. To date, no evidence has been made public of a formalized research protocol,
plan, or ethics review. In addition, actual data from psychological evaluations, medical
monitoring, and other observations is not publicly available. Nevertheless, a research
regime can be inferred from CIA contracts discussing “applied research,” CIA medical
guidelines reflecting generalizable knowledge drawn from prior interrogation of
detainees, references to data collection, analysis, and dissemination in government
records, and documented activities of CIA personnel corresponding with human
subjects research and experimentation.
The analysis is made more difficult by the continued classification of the CIA program,
including the concealment of the names and titles of the health professionals who were
involved. Many relevant documents remain classified, and most of the declassified
documents that are available are heavily redacted,4 including nearly all information
regarding Office of Medical Services personnel. In addition, the U.S. government
continues to make incomplete, conflicting, and inaccurate representations regarding
the program.5
I. Introduction
After the 9/11 terror attacks, the Bush administration authorized the torture and ill-
treatment of detainees in U.S. custody as part of its counterterrorism efforts. In order to
do so, it created a legal and policy framework to permit abusive interrogation and
detention practices and undid long-standing, internationally-agreed protections for
prisoners of war (POWs). The goal of this so-called “enhanced interrogation” program
was to exploit detainees for intelligence collection purposes. The Bush administration
authorized the capture, rendition, and indefinite secret detention of individuals
considered to have links with terrorist organizations. It additionally authorized a range
of interrogation tactics long recognized by the United States as illegal, such as
waterboarding, isolation, sleep deprivation, sensory deprivation, forced nudity, extreme
temperature manipulation, and stress positions. Over time, these practices, as well as
their legal and operational justifications, spread from the Central Intelligence Agency
(CIA) “black sites” – secret overseas prisons – to military detention and interrogation
facilities.
In the wake of the 9/11 attacks, the CIA faced pressure to obtain better intelligence from
human sources derived from more aggressive interrogation strategies.6 Psychological
expertise in human manipulation and exploitation was seen as especially critical to
these efforts.7 The Bush administration sought to “take the gloves off,”8 yet experienced
professionals within the intelligence community did not support the use of coercion or
torture.9 The CIA turned to psychologists James Mitchell and Bruce Jessen to design and
develop its interrogation operations.10 In December 2001, the CIA contracted with them
to review the Manchester Manual – a training manual of the terrorist organization al-
Qaeda discovered in Manchester, England – which ostensibly contained strategies for
resisting interrogation by countries compliant with the Geneva Conventions’
protections for POWs.11 Mitchell and Jessen drafted a white paper assessing that al-
Qaeda operatives were highly trained to resist hostile questioning.12 They proposed
providing a range of psychological consultation services, reflected in dozens of contracts
for “applied research,” development, and operational support. Individually, they each
received in excess of $1 million, in addition to $81 million paid to their consulting
company, Mitchell Jessen and Associates, between 2005 and 2009.13
In addition to Mitchell and Jessen, who ultimately designed, implemented, and oversaw
a vast regime of psychological torture and ill-treatment, a wide range of health
professionals were complicit in the program. Psychologists, physicians, physician
assistants, nurses, and medics participated in torture, monitored and collected data
ostensibly to manage harm, maintained abusive detention conditions and treatment,
and provided basic care to an institutionalized population.14 They were involved in the
following activities: withholding food, medical care, and personal hygiene; medically
clearing detainees for torture; medically treating detainees to return to abusive
treatment; sharing medical information with interrogators; advising on the application
Nuremberg Betrayed Physicians for Human Rights phr.org
f techniques; directly committing acts of torture and ill-treatment; studying and
experimenting with the effects of torture; failing to stop and report abuse; and
concealing evidence of mistreatment.
Physicians for Human Rights (PHR) has previously documented evidence that the CIA
engaged in activities constituting nonconsensual human subjects research and
experimentation on detainees being tortured.15 New evidence indicates that the CIA
“enhanced interrogation” program itself was a regime of human subjects research and
that the agency conceptualized it as such. This creates the most complete picture of this
illegal and unethical enterprise to date. In 2016, Mitchell co-published a book describing
his participation in waterboarding and other forms of torture and told interviewers he
had no regrets.16 Yet due to continued secrecy surrounding the program, the identities
of many other individuals involved, including health professionals, remain unknown.
Definition of Research and Experimentation
The system of protections for human subjects of research is enshrined in U.S. federal
policy in the form of the Common Rule and Code of Federal Regulations Title 45 part 46.
The latter contains a detailed definition of what constitutes human subjects research:
“Research means a systematic investigation, including research
development, testing, and evaluation, designed to develop or contribute to
generalizable knowledge. Activities that meet this definition constitute
research for purposes of this policy, whether or not they are conducted or
supported under a program that is considered research for other
purposes. For example, some demonstration and service programs may include
research activities. […]
Human subject means a living individual about whom an investigator
(whether professional or student) conducting research obtains
1 Data through intervention or interaction with the individual, or
2 Identifiable private information.
Intervention includes both physical procedures by which data are gathered
(for example, venipuncture) and manipulations of the subject or the
subject's environment that are performed for research purposes. Interaction
includes communication or interpersonal contact between investigator
and subject.
”17 [emphasis added]
To be considered a “systematic investigation,” the concept of a research project must
meet the following criteria: it attempts to answer research questions; it is
methodologically driven (that is, collects data or information in an organized and
consistent way; the data or information (whether quantitative or qualitative) is analyzed
in some way; and conclusions are drawn from the results.
“Generalizable knowledge” must include one or more of the following concepts: the
knowledge contributes to a theoretical framework of an established body of knowledge;
the primary beneficiaries of the research are other researchers, scholars, and
practitioners in the field of study; publication, presentation, or other distribution of the
results is intended to inform the field of study; the results are expected to be generalized
to a larger population beyond the site of data collection; and the results are intended to
be replicated in other settings.18
Accordingly, the key elements of human subjects research are:
1 Systematic investigation (data collection) about an interaction or intervention with a
living individual,
2 Designed to develop or contribute to generalizable knowledge.
Legitimate human subjects research can include studying the effectiveness of specific
medical treatments or procedures on patients, collecting data to better understand a
sociological problem, or assessing the susceptibility of certain demographic groups to
disease, among other applications. The term “human experimentation” is often used
interchangeably with “human subjects research,” as in this analysis, and involves the
systematic variation and study of a new or unproven practice. Research can be
considered experimental when it is based on untested ideas or involves methods or
devices that lack an established or accepted scientific basis, procedure, or clinical
standards. As a result, it entails inherent uncertainty about benefits, risks, and
effectiveness of the intervention.19 Note, however, that these definitions do not require
that an activity was contemplated or conceived of as research by the investigators in
order to constitute research, nor do they require a particular study design, the testing of
hypotheses, the use of control groups, or even a legitimate scientific purpose.
In addition, the evaluation of “service” programs – that is, formal or ad hoc efforts to
promptly improve a process rather than contribute to generalizable knowledge – can
constitute research if it meets the criteria detailed above. However, guidance exists to
help differentiate quality improvement processes that would not be subject to rigorous
human subject protections from research subject to ethics review by an Institutional
Review Board (IRB). While both processes involve the systematic collection of data,
several features preclude designation as quality improvement, including activities that
pose risk to human subjects or activities that are in fact designed to determine the
“safety” and “efficacy” of an intervention. The quality improvement designation
generally applies only when monitoring the application of low-risk interventions that
have already been well-established in the field as a solid, evidence-based practice –
which does not apply in the context of torture.
Nuremberg Betrayed Physicians for Human Rights.
Research Hypothesis for CIA Torture
CIA contract psychologists Mitchell and Jessen proposed using coercive techniques and
abusive conditions of confinement to break detainees down psychologically.20 They
claimed that torture could be useful in overcoming an individual’s resistance to
interrogation and in creating conditions that were conducive to intelligence collection.
The psychologists hypothesized that exposing detainees to uncontrollable stress and
trauma would disrupt normal mechanisms of resistance and create the condition of
“learned helplessness.”21 That, in turn, would induce total compliance and cooperation
with interrogation, causing detainees to voluntarily provide accurate intelligence. The
interrogator’s goal was to “establish absolute control,” “induce dependence to meet
needs,” “elicit compliance,” and “shap[e] cooperation.”22
Mitchell and Jessen formulated their research hypothesis in part from the U.S. military’s
Survival, Evasion, Resistance, and Escape (SERE) counter-resistance training program,
which taught select U.S. service personnel strategies to resist exploitation if captured by
countries that did not adhere to the Geneva Conventions.23 The purpose of the training
was to build resistance to the extreme stresses of capture, interrogation, and detention
by exposing students to simulated scenarios in a controlled and constructive manner.
The physical and mental pressures used in the SERE curriculum carried a serious risk of
psychological and physical harm.24 In particular, SERE manuals in 2002 warned that
instructors needed to take steps to prevent learned helplessness from the tactics,
particularly waterboarding:
“Maximum effort will be made to ensure that students do not develop a sense of
'learned helplessness’ during the pre-academic laboratory…. The goal is not to
push the student beyond his means to resist or to learn (to prevent ‘Learned
Helplessness’).”25
Mitchell and Jessen proposed doing the reverse – using torture to produce “fear and
panic”26 and, ultimately, learned helplessness27 – and adapting this process for use on
detainees. Consistent with this implicit hypothesis, their research centered on whether
the psychological and physical pressures employed in SERE training could be used to
disrupt detainees’ resistance and produce compliance,28 and when the threshold of
learned helplessness had been reached.29
On December 15-16, 2001, Mitchell, already under contract with the CIA, met with a
select group of intelligence personnel and academics in the home of Martin Seligman,
the psychologist who first identified the learned helplessness phenomenon based on
electroshock experiments on dogs. The purpose of this meeting was to discuss
counterterrorism strategies based on the “psychology of capitulation” as applied to…..
continued https://www.sciencedirect.com/science/article/pii/S0732118X26000516
https://phr.org/our-work/resources/...-experimentation-and-the-cia-torture-program/
Given the capabilities of the modern remote forced silent speech interface interrogation no longer poses a problem as desired information can just be harvested by asking the relivent questions and monitoring the internal dialogue for the answers. Once a victim is trapped on the interface I believe they are exploring ways to control behavior and cognition without or in spite of conscious resistance. They are looking to identify or create ways of controlling people remotely using the forced interface; by combining old techniques like “brain washing,” “thought reform” and “learned helplessness” with the amazing capabilities of modem technology I think they believe they have a chance.
Nuremberg Betrayed Human Experimentation and the CIA Torture Program
Contents
3 Executive Summary
6 Methodology
7 Introduction
22 CIA Torture
Experiments
30 Research on the Health
Effects of Torture
44 Applications of CIA
Research on Detainees
51 Conclusion
55 Recommendations
56 Appendix A: Legal and
Ethical Standards for
Human Subjects
Protection
60 Appendix B: Select New
Evidence since PHR’s
2010 Analysis
61 Appendix C: Select
Timeline of Relevant
Events
65 Endnotes
Acknowledgments
This report was written by Sarah Dougherty, JD, MPH,
senior anti-torture fellow at Physicians for Human Rights
(PHR) and Scott Allen, MD, FACP, medical advisor at PHR.
The report benefitted from review by PHR staff, including
Carolyn Greco, JD, senior U.S. policy associate; Vincent
Iacopino, MD, PhD, senior medical advisor; Donna
McKay, executive director; Marianne Møllmann, LLM,
MSc, director of research and investigations; Susannah
Sirkin, director of international policy and partnerships;
and Homer Venters, MD, director of programs. PHR
advisors and former employees contributed invaluable
expertise and guidance on this report, including Widney
Brown, JD; Nathaniel Raymond; and Stephen Soldz, PhD.
PHR intern Robert Erikson provided research assistance.
The report also benefitted from external review by
Deborah D. Ascheim, MD, member of PHR’s board of
directors.
The report was reviewed, edited, and prepared for
publication by Claudia Rader, MS, content and marketing
manager.
Support for this report was provided by the Open Society
Foundations.
Executive Summary
After the 9/11 terror attacks, as part of its counterterrorism efforts, the Bush
administration authorized the systematic torture and ill-treatment of detainees in U.S.
custody. In order to do so, it created a legal and policy framework to permit abusive
interrogation and detention practices and undid long-standing, internationally-agreed
protections for prisoners of war. The goal of the Central Intelligence Agency (CIA)
“enhanced interrogation” program was to break detainees psychologically, using harsh
techniques designed to inflict severe pain and suffering. The program rested on the
flawed claim that torture could be useful in overcoming a person’s resistance to
interrogation and in facilitating the collection of intelligence. Physicians for Human
Rights (PHR) has previously documented that, as part of the CIA torture program, U.S.
health professionals systematically collected data involving torture and conducted
analysis to make this information generalizable to other aspects of the program. These
activities amounted to human subjects research, a term used interchangeably with
human experimentation. Analysis of new information indicates that the CIA torture
program was itself a regime of applied research on detainees and implicitly
conceptualized as such by the CIA. This constitutes one of the gravest breaches of
medical ethics by U.S. health professionals since the Nuremberg Code was developed to
protect individuals from nonconsensual human experimentation following Nazi
medical atrocities during World War II.
At the heart of the CIA’s research was an unproven theory that exposing detainees to
uncontrollable stress and trauma would disrupt normal mechanisms of resistance and
create “learned helplessness” and dependence.1 That, in turn, would induce total
compliance in detainees, enabling interrogators to secure their cooperation and elicit
accurate intelligence from them. The techniques proposed for this process were derived
from the U.S. military’s Survival, Evasion, Resistance, and Escape (SERE) training
program to teach service personnel how to resist abusive treatment if captured. These
tactics were themselves a distillation of coercion methods used by Cold War communist
regimes to produce false confessions. While the underlying phenomenon of
helplessness and dependency had been studied by U.S. researchers trying to understand
the apparent “brainwashing” effect of such techniques, the new theory that torture
would produce learned helplessness – and that this would ultimately produce
intelligence – had never been researched or demonstrated to be “effective.” At the time
the CIA program began, the existing evidence suggested that coercive approaches to
Analysis of new information indicates that the CIA
torture program was itself a regime of applied research on detainees.
interrogation did not work and were counterproductive.2 Nevertheless, psychologists
contracted by the CIA promoted this theory, improvised and applied various torture
techniques, and reported outcomes in line with their contention that these techniques
facilitated detainee compliance and cooperation with interrogation.
This research was driven by implicit hypotheses of “efficacy” and “safety.” The CIA
sought to demonstrate that the tactics “worked” for interrogation and would not injure
the subjects beyond a certain threshold of harm, as delineated in secret “torture memos”
issued by the Department of Justice Office of Legal Counsel (OLC). The August 2002 OLC
memos authorized the use of “enhanced interrogation” techniques, to be applied in an
isolated and sequential manner, and redefined “pain and suffering” such that the effects
had to be much more severe and/or lasting than previously permitted in order for the
techniques to be regarded as torture. This created a permissive, rather than prohibitive,
approach to torture. Relatedly, the memos also directed medical personnel to conduct
systematic monitoring of interrogations in order to calibrate pain and mitigate harm.
This role posed a conflict from the outset. Medical ethics absolutely prohibit the
involvement of health professionals in torture and ill-treatment, including even being
present when abuse is used or threatened. In addition, it is a violation of ethics to
mitigate harm in the context of facilitating the intentional infliction of physical or
mental pain and suffering. Torture cannot be made “safe,” nor was the Bush
administration interested in making it “safe.” Instead, it was interested in not exceeding
certain limits of injury.
Health professionals in the CIA Office of Medical Services (OMS) were ordered to ensure
interrogators did not exceed these limits – thus ostensibly maintaining the “safety” of
the subjects – with little idea in actual practice of how to do so. The extant literature was
restricted to SERE studies, which involved limited application of milder forms of the
methods for the purposes of increasing, rather than destroying, resilience. The SERE
subjects were volunteers from the U.S. military who were able to stop the infliction of
the torture techniques at any time. In addition, precautions were taken to prevent the
risk of harm, which was well-documented in the SERE literature.
By contrast, the people subjected to the CIA’s “enhanced interrogation” were
indefinitely detained, did not provide consent, and were unable to stop the infliction of
physical or mental pain. In light of the vast gap between the SERE and CIA models and
populations, medical officers worked to monitor, collect, analyze, and disseminate data
on the effects of the torture tactics in real world applications to detainees. These
observations were used to formulate clinical protocols to modify the techniques and
guide medical monitors in future interrogations – conducting, in effect, a “safety trial.”
This research was part of an effort to contend that the torture tactics did not exceed the
elevated physical and mental pain thresholds established by OLC lawyers. At the same
time, the CIA’s research was driven by a need to create a legal defense for U.S. personnel
involved in the “enhanced interrogation” program, in the event of future torture
charges. OLC lawyers claimed that reviewing evidence gained in the course of interrogations
could establish that interrogators lacked the intent to inflict lasting
harm, and thus commit torture. The resulting findings were used to justify commission
of the crime and to protect perpetrators from legal liability.
The CIA’s “enhanced interrogation” program was based on a tenuous theory proffered
by contract psychologists with a financial vested interest. The subsequent deployment
of this crude program required constant invention, assessment, and modification in the
field – based on actual applications of torture techniques on non-consenting
interrogation subjects – to refine the approach and demonstrate the promised “safety”
and “efficacy.” In any other context, such an approach would be considered merely
improvisational. However, when the individuals improvising are scientists and the
subjects are humans, such improvisation is something more. When human subjects
undergo an intervention or interventions (particularly harmful interventions) and their
response is methodically measured and analyzed, and the results of the analysis are
disseminated – even internally within a program – the activity meets the U.S.
government’s definition of human subjects research.
The definition of research does not require that the methodology used be sound or that
investigators intend or are even aware that their investigation constitutes research.
Indeed, it appears the CIA’s research to establish learned helplessness as a theoretical
construct, and parallel efforts to try to prove that torture did not have lasting health
effects, all lacked a legitimate research purpose, design, and methodology. The premise
of “efficacy” conflicted with the extant literature on effective interrogation, which
showed that coercive measures were counterproductive and undermined intelligence
collection. Similarly, the premise of “safety” conflicted with the U.S. government’s own
SERE research, which showed a significant risk of harm even in the controlled
environment of training. Here, the CIA’s activities not only met the essential criteria for
human subjects research, they were explicitly conceptualized as such: a systematic
investigation – including data collection and analysis – to create generalizable
information in support of “enhanced interrogation” and detention.
The CIA’s research evolved to fit the legal needs of the Bush administration in response
to internal and external pressures on the torture program. In particular, interrogators
were using multiple torture techniques in combination, with a far greater severity,
duration, and repetition than initially described to OLC lawyers. This was inflicting far
greater physical and mental injury to detainees, contradicting representations that the
techniques were safe. Health professionals faced increasing pressure to generate data to
justify and indemnify torture practices that were already in use, but that exceeded the
scope of authorization or were not yet approved. Accordingly, OMS medical guidelines
were created to reflect and incorporate the latest findings of CIA medical officers. In
response to requests by Bush administration officials to provide scientific and clinical
assurances of “safety” and legality, these findings were reinforced with additional data
to develop new legal memos. Over time, the severe physical and psychological harm of the
torture techniques, as well as an absence of proof of their effectiveness for interrogation purposes, undermined the
flawed theories of “safety” and “efficacy.” The torture program was eventually reined in
and ultimately ended – but not before great damage had been done to the human beings
at its center.
The available evidence documents, at a minimum, deployment by the CIA of coercive
techniques for interrogation that were unproven both in terms of “efficacy” and “safety.”
There was, at the very least, an ad hoc effort to assess these newly deployed techniques
on detainees in the field – at secret “black site” prisons. The documents newly in the
public domain, which form the basis of this report, detail activities by the CIA that meet
the definition of human subjects research. Without a more complete record, it is
difficult to say how formal or extensive this research was. What is clear is that this type
of research on prisoners or detainees is the very reason the Nuremberg Code protocols
were developed. In the course of facilitating the crime of torture, U.S. health
professionals committed a second and related crime: human subjects research and
experimentation on detainees being tortured, in violation of medical ethics and U.S.
and international law.
There must be accountability for both the crime of torture and the second and related
crime of human experimentation. There is also a pressing need for additional
information to come to light, with transparency as a critical first step toward
accountability for and prevention of grave human rights violations. Drawing on the
lessons of Nuremberg, we must never again permit the exigencies of national security –
or any other reason – to be used as justification for unlawful and unethical research on
human beings. In this uncertain political climate, it is even more crucial to shine a light
on this disturbing chapter and act now to prevent such crimes from being repeated.
Methodology
This Physicians for Human Rights (PHR) report is based on analysis of public source
materials documenting the Central Intelligence Agency (CIA) rendition, detention, and
interrogation program. This includes review of thousands of pages of declassified U.S.
government records, reports, and other materials from the CIA, Department of Defense,
Department of Justice, and other U.S. agencies. Many of these materials were publicly
released, or released in substantially less redacted form, following the 2014 publication
of the summary of the U.S. Senate Select Committee on Intelligence report on CIA
torture, as well as in response to Freedom of Information Act requests by human rights,
civil liberties, and media organizations. In addition, this report draws on more than 15
years of PHR’s research, investigation, and reporting in connection with the U.S. torture
program and the role of U.S. health professionals in detainee mistreatment and harm.
PHR analyzed the factual record, reviewed the state of knowledge about the physical and
psychological effects of so-called “enhanced interrogation” techniques at the time the
CIA program began, and conducted research on the ethical and legal protections for the
human subjects of research, including especially vulnerable populations such as
prisoners. In addition, this analysis references evidence cited in PHR’s 2010 publication,
“Experiments in Torture,”3 the first report to show human subjects research and
experimentation in the CIA program, as well as additional data that has come to light.
This report is limited to publicly available sources. Given the scope, complexity, and
secrecy of the CIA program, this analysis does not claim to provide a complete picture of
the public record, nor a definitive analysis of the CIA’s illegal and unethical research on
prisoners. To date, no evidence has been made public of a formalized research protocol,
plan, or ethics review. In addition, actual data from psychological evaluations, medical
monitoring, and other observations is not publicly available. Nevertheless, a research
regime can be inferred from CIA contracts discussing “applied research,” CIA medical
guidelines reflecting generalizable knowledge drawn from prior interrogation of
detainees, references to data collection, analysis, and dissemination in government
records, and documented activities of CIA personnel corresponding with human
subjects research and experimentation.
The analysis is made more difficult by the continued classification of the CIA program,
including the concealment of the names and titles of the health professionals who were
involved. Many relevant documents remain classified, and most of the declassified
documents that are available are heavily redacted,4 including nearly all information
regarding Office of Medical Services personnel. In addition, the U.S. government
continues to make incomplete, conflicting, and inaccurate representations regarding
the program.5
I. Introduction
After the 9/11 terror attacks, the Bush administration authorized the torture and ill-
treatment of detainees in U.S. custody as part of its counterterrorism efforts. In order to
do so, it created a legal and policy framework to permit abusive interrogation and
detention practices and undid long-standing, internationally-agreed protections for
prisoners of war (POWs). The goal of this so-called “enhanced interrogation” program
was to exploit detainees for intelligence collection purposes. The Bush administration
authorized the capture, rendition, and indefinite secret detention of individuals
considered to have links with terrorist organizations. It additionally authorized a range
of interrogation tactics long recognized by the United States as illegal, such as
waterboarding, isolation, sleep deprivation, sensory deprivation, forced nudity, extreme
temperature manipulation, and stress positions. Over time, these practices, as well as
their legal and operational justifications, spread from the Central Intelligence Agency
(CIA) “black sites” – secret overseas prisons – to military detention and interrogation
facilities.
In the wake of the 9/11 attacks, the CIA faced pressure to obtain better intelligence from
human sources derived from more aggressive interrogation strategies.6 Psychological
expertise in human manipulation and exploitation was seen as especially critical to
these efforts.7 The Bush administration sought to “take the gloves off,”8 yet experienced
professionals within the intelligence community did not support the use of coercion or
torture.9 The CIA turned to psychologists James Mitchell and Bruce Jessen to design and
develop its interrogation operations.10 In December 2001, the CIA contracted with them
to review the Manchester Manual – a training manual of the terrorist organization al-
Qaeda discovered in Manchester, England – which ostensibly contained strategies for
resisting interrogation by countries compliant with the Geneva Conventions’
protections for POWs.11 Mitchell and Jessen drafted a white paper assessing that al-
Qaeda operatives were highly trained to resist hostile questioning.12 They proposed
providing a range of psychological consultation services, reflected in dozens of contracts
for “applied research,” development, and operational support. Individually, they each
received in excess of $1 million, in addition to $81 million paid to their consulting
company, Mitchell Jessen and Associates, between 2005 and 2009.13
In addition to Mitchell and Jessen, who ultimately designed, implemented, and oversaw
a vast regime of psychological torture and ill-treatment, a wide range of health
professionals were complicit in the program. Psychologists, physicians, physician
assistants, nurses, and medics participated in torture, monitored and collected data
ostensibly to manage harm, maintained abusive detention conditions and treatment,
and provided basic care to an institutionalized population.14 They were involved in the
following activities: withholding food, medical care, and personal hygiene; medically
clearing detainees for torture; medically treating detainees to return to abusive
treatment; sharing medical information with interrogators; advising on the application
Nuremberg Betrayed Physicians for Human Rights phr.org
f techniques; directly committing acts of torture and ill-treatment; studying andexperimenting with the effects of torture; failing to stop and report abuse; and
concealing evidence of mistreatment.
Physicians for Human Rights (PHR) has previously documented evidence that the CIA
engaged in activities constituting nonconsensual human subjects research and
experimentation on detainees being tortured.15 New evidence indicates that the CIA
“enhanced interrogation” program itself was a regime of human subjects research and
that the agency conceptualized it as such. This creates the most complete picture of this
illegal and unethical enterprise to date. In 2016, Mitchell co-published a book describing
his participation in waterboarding and other forms of torture and told interviewers he
had no regrets.16 Yet due to continued secrecy surrounding the program, the identities
of many other individuals involved, including health professionals, remain unknown.
Definition of Research and Experimentation
The system of protections for human subjects of research is enshrined in U.S. federal
policy in the form of the Common Rule and Code of Federal Regulations Title 45 part 46.
The latter contains a detailed definition of what constitutes human subjects research:
“Research means a systematic investigation, including research
development, testing, and evaluation, designed to develop or contribute to
generalizable knowledge. Activities that meet this definition constitute
research for purposes of this policy, whether or not they are conducted or
supported under a program that is considered research for other
purposes. For example, some demonstration and service programs may include
research activities. […]
Human subject means a living individual about whom an investigator
(whether professional or student) conducting research obtains
1 Data through intervention or interaction with the individual, or
2 Identifiable private information.
Intervention includes both physical procedures by which data are gathered
(for example, venipuncture) and manipulations of the subject or the
subject's environment that are performed for research purposes. Interaction
includes communication or interpersonal contact between investigator
and subject.
”17 [emphasis added]
To be considered a “systematic investigation,” the concept of a research project must
meet the following criteria: it attempts to answer research questions; it is
methodologically driven (that is, collects data or information in an organized and
consistent way; the data or information (whether quantitative or qualitative) is analyzed
in some way; and conclusions are drawn from the results.
“Generalizable knowledge” must include one or more of the following concepts: the
knowledge contributes to a theoretical framework of an established body of knowledge;
the primary beneficiaries of the research are other researchers, scholars, and
practitioners in the field of study; publication, presentation, or other distribution of the
results is intended to inform the field of study; the results are expected to be generalized
to a larger population beyond the site of data collection; and the results are intended to
be replicated in other settings.18
Accordingly, the key elements of human subjects research are:
1 Systematic investigation (data collection) about an interaction or intervention with a
living individual,
2 Designed to develop or contribute to generalizable knowledge.
Legitimate human subjects research can include studying the effectiveness of specific
medical treatments or procedures on patients, collecting data to better understand a
sociological problem, or assessing the susceptibility of certain demographic groups to
disease, among other applications. The term “human experimentation” is often used
interchangeably with “human subjects research,” as in this analysis, and involves the
systematic variation and study of a new or unproven practice. Research can be
considered experimental when it is based on untested ideas or involves methods or
devices that lack an established or accepted scientific basis, procedure, or clinical
standards. As a result, it entails inherent uncertainty about benefits, risks, and
effectiveness of the intervention.19 Note, however, that these definitions do not require
that an activity was contemplated or conceived of as research by the investigators in
order to constitute research, nor do they require a particular study design, the testing of
hypotheses, the use of control groups, or even a legitimate scientific purpose.
In addition, the evaluation of “service” programs – that is, formal or ad hoc efforts to
promptly improve a process rather than contribute to generalizable knowledge – can
constitute research if it meets the criteria detailed above. However, guidance exists to
help differentiate quality improvement processes that would not be subject to rigorous
human subject protections from research subject to ethics review by an Institutional
Review Board (IRB). While both processes involve the systematic collection of data,
several features preclude designation as quality improvement, including activities that
pose risk to human subjects or activities that are in fact designed to determine the
“safety” and “efficacy” of an intervention. The quality improvement designation
generally applies only when monitoring the application of low-risk interventions that
have already been well-established in the field as a solid, evidence-based practice –
which does not apply in the context of torture.
Nuremberg Betrayed Physicians for Human Rights.
Research Hypothesis for CIA Torture
CIA contract psychologists Mitchell and Jessen proposed using coercive techniques and
abusive conditions of confinement to break detainees down psychologically.20 They
claimed that torture could be useful in overcoming an individual’s resistance to
interrogation and in creating conditions that were conducive to intelligence collection.
The psychologists hypothesized that exposing detainees to uncontrollable stress and
trauma would disrupt normal mechanisms of resistance and create the condition of
“learned helplessness.”21 That, in turn, would induce total compliance and cooperation
with interrogation, causing detainees to voluntarily provide accurate intelligence. The
interrogator’s goal was to “establish absolute control,” “induce dependence to meet
needs,” “elicit compliance,” and “shap[e] cooperation.”22
Mitchell and Jessen formulated their research hypothesis in part from the U.S. military’s
Survival, Evasion, Resistance, and Escape (SERE) counter-resistance training program,
which taught select U.S. service personnel strategies to resist exploitation if captured by
countries that did not adhere to the Geneva Conventions.23 The purpose of the training
was to build resistance to the extreme stresses of capture, interrogation, and detention
by exposing students to simulated scenarios in a controlled and constructive manner.
The physical and mental pressures used in the SERE curriculum carried a serious risk of
psychological and physical harm.24 In particular, SERE manuals in 2002 warned that
instructors needed to take steps to prevent learned helplessness from the tactics,
particularly waterboarding:
“Maximum effort will be made to ensure that students do not develop a sense of
'learned helplessness’ during the pre-academic laboratory…. The goal is not to
push the student beyond his means to resist or to learn (to prevent ‘Learned
Helplessness’).”25
Mitchell and Jessen proposed doing the reverse – using torture to produce “fear and
panic”26 and, ultimately, learned helplessness27 – and adapting this process for use on
detainees. Consistent with this implicit hypothesis, their research centered on whether
the psychological and physical pressures employed in SERE training could be used to
disrupt detainees’ resistance and produce compliance,28 and when the threshold of
learned helplessness had been reached.29
On December 15-16, 2001, Mitchell, already under contract with the CIA, met with a
select group of intelligence personnel and academics in the home of Martin Seligman,
the psychologist who first identified the learned helplessness phenomenon based on
electroshock experiments on dogs. The purpose of this meeting was to discuss
counterterrorism strategies based on the “psychology of capitulation” as applied to…..
continued https://www.sciencedirect.com/science/article/pii/S0732118X26000516
https://phr.org/our-work/resources/...-experimentation-and-the-cia-torture-program/
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