OPCAT: How an international treaty regarding torture is relevant to the Australian mental health system.

The United Nations Subcommittee on the Prevention of Torture visits signatory nations to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). Its role is to monitor and support signatory nations in implementing and complying with the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). In October 2022, the United Nations Subcommittee on the Prevention of Torture visited Australia but was barred from visiting mental health wards in Queensland and all detention facilities in New South Wales leading to the termination of its visit. This breach of Australia's obligations under the OPCAT presents a significant setback for the rights of people with mental illness and other involuntarily detained populations. This piece sets out to demonstrate the relevance of OPCAT to the mental health system in Australia. Individuals who are detained for compulsory treatment in locked facilities such as acute psychiatric inpatient wards and forensic mental health facilities are deprived of their liberty, often out of public view. Thus, it highlights the ethical and professional obligations of all mental health professionals, especially psychiatrists, to safeguard the human rights of individuals being detained in mental health facilities as enshrined in Australia's international legal obligations under the OPCAT. Adhering to these obligations diminishes the risk of future human rights violations of people with mental illness.

"Rectal Feeding"-Unethical Medical Officer Participation at CIA Secret Interrogation Facilities.

This Viewpoint discusses recently released information regarding the practice of "rectal feeding" among detainees at Guantanamo Bay and Central Intelligence Agency (CIA) secret prisons.

In the immediate wake of Hoffman's independent review: Psychologist and general public perceptions.

In 2015, the American Psychological Association (APA) commissioned an independent review (IR) to examine APA's potential involvement with "enhanced interrogation" procedures following the 9/11 terrorist attacks. The IR concluded that certain APA officials acted together with the Department of Defense to "align APA and curry favor with" the Department of Defense to allow the involvement of psychologists in such enhanced interrogations (Hoffman et al., 2015, p. 9). Discussion following the IR's release underscored differences in the views of psychologists regarding the IR's conclusions. Despite extensive discussion, there is only anecdotal evidence regarding the views of psychologists on many of the questions investigated in the IR. This study examined the opinions of psychologists and the public shortly after the IR's release regarding the roles of psychologists in national security interrogations and other non-treatment-focused contexts. This survey of psychologists (N = 1,146) engaged in treatment-focused and non-treatment-focused activities, and of the general public (N = 522), sheds light on the broader perceptions of the IR's conclusions, and is relevant in considering future directions for the profession. Results suggest that the public is more accepting of psychologists' involvement in national security settings, including involvement in many of the activities highlighted as problematic in the IR, than are psychologists. The perceptions of treatment-focused and non-treatment-focused psychologists regarding the appropriate roles of psychologists in national security settings did not differ significantly. These empirical data should help inform the ongoing discussion in this area. None of the authors is associated with an unequivocal position on the IR or the issues addressed as part of it. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fanon's Police Inspector.

Frantz Fanon practiced psychiatry in a colonized Algeria during its struggle for independence. In his 1961 work The Wretched of the Earth, Fanon described cases from his treatment of Algerian nationalists and French colonists. I present one of Fanon's cases as an ethical inquiry into posttraumatic stress disorder (PTSD). A French police inspector, who is employed in torture, visits Fanon with symptoms of PTSD after escalating domestic violence. The patient asks Fanon "to help him torture … with a total peace of mind." Is it possible to treat the inspector in a meaningful way? More broadly, how might researchers and clinicians balance collective responsibilities to individual symptoms and social conditions? The answer depends on how trauma is framed: as disorder of meaning-making or circuit dysfunction, as individual illness or social rupture, as potentially gendered and racialized. These framings can reveal different views on the allocation of responsibility for the causation, expression and management of PTSD. I do not propose that it is inherently immoral to modify traumatic memories; nor do I question the efficacy of individual interventions. Rather, I ask whether PTSD has a social meaning that transcends individual comfort in decision making about erasure. What do individual interventions accomplish in the absence of concurrent political and social transformations? I argue that a holistic understanding of PTSD entails a set of social obligations: to address at its root political, gendered, and racialized violence, to repudiate occupations centered on exploitative manipulation of individuals and cultures, and to social change that prioritizes these commitments.

Ethical considerations on the complicity of psychologists and scientists in torture.

INTRODUCTION: The long-standing debate on medical complicity in torture has overlooked the complicity of cognitive scientists-psychologists, psychiatrists and neuroscientists-in the practice of torture as a distinct phenomenon. In this paper, we identify the risk of the re-emergence of torture as a practice in the USA, and the complicity of cognitive scientists in these practices. METHODS: We review arguments for physician complicity in torture. We argue that these defences fail to defend the complicity of cognitive scientists. We address objections to our account, and then provide recommendations for professional associations in resisting complicity in torture. RESULTS: Arguments for cognitive scientist complicity in torture fail when those actions stem from the same reasons as physician complicity. Cognitive scientist involvement in the torture programme has, from the outset, been focused on the outcomes of interrogation rather than supportive care. Any possibility of a therapeutic relationship between cognitive therapists and detainees is fatally undermined by therapists' complicity with torture. CONCLUSION: Professional associations ought to strengthen their commitment to refraining from engaging in any aspect of torture. They should also move to protect whistle-blowers against torture programmes who are members of their association. If the political institutions that are supposed to prevent the practice of torture are not strengthened, cognitive scientists should take collective action to compel intelligence agencies to refrain from torture.

Torturing science Science, interrogational torture, and public policy.

Contrary to the claims of the Central Intelligence Agency (CIA) that its torture program was scientific, the program was not based on biology or any other science. Instead, the George W. Bush administration veneered the program's justification with a patina of pseudoscience, ignoring the actual biology of torturing human brains. We reconstruct the Bush administration's decision-making process to establish that the policy decision to use torture took place in the immediate aftermath of the 9/11 attacks without any investigation into its efficacy. We then present the pseudoscientific model of torture sold to the CIA, show why this ad hoc model amounted to pseudoscience, and then catalog what the actual science of torturing human brains-available in 2001-reveals about the practice. We conclude with a discussion of how a process incorporating countervailing evidence might prevent a policy going forward that is contrary to law, ethics, and evidence.

The captive brain: torture and the neuroscience of humane interrogation.

Despite it being abhorrent and illegal, torture is sometimes employed for information gathering. However, the extreme stressors employed during torture force the brain away from the relatively narrow, adaptive range of function it operates within. Torture degrades signal-to-noise ratios of information yield and increases false positive discovery rates. As a discovery methodology, torture fails basic tests of veridical, reliable and replicable information discovery. Torture fails during interrogation because it is an assault on our core integrated, social, psychological and neural functioning. There is a need for a profound cultural shift regarding torture, recognizing that torture impairs, rather than facilitates, investigations and truth-finding. Rising to this challenge will increase operational effectiveness, eliminate prisoner abuse and torment, and aid veridical and actionable information gathering. Policy regarding prisoner and detainee interrogation need to be refocused as a behavioural and brain sciences problem, and not simply treated as a legal, ethical or philosophical problem. Getting the science, ethics and practice in line is a challenge, but it can and should be done.

From Nuremberg to Guantanamo Bay: Uses of Physicians in the War on Terror.

Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

Revenge versus rapport: Interrogation, terrorism, and torture.

This review begins with the historical context of harsh interrogation methods that have been used repeatedly since the Second World War. This is despite the legal, ethical and moral sanctions against them and the lack of evidence for their efficacy. Revenge-motivated interrogations (Carlsmith & Sood, 2009) regularly occur in high conflict, high uncertainty situations and where there is dehumanization of the enemy. These methods are diametrically opposed to the humanization process required for adopting rapport-based methods-for which there is an increasing corpus of studies evidencing their efficacy. We review this emerging field of study and show how rapport-based methods rely on building alliances and involve a specific set of interpersonal skills on the part of the interrogator. We conclude with 2 key propositions: (a) for psychologists to firmly maintain the Hippocratic Oath of "first do no harm," irrespective of perceived threat and uncertainty, and (b) for wider recognition of the empirical evidence that rapport-based approaches work and revenge tactics do not. Proposition (a) is directly in line with fundamental ethical principles of practice for anyone in a caring profession. Proposition (b) is based on the requirement for psychology to protect and promote human welfare and to base conclusions on objective evidence. (PsycINFO Database Record

The compulsory psychiatric regime in Hong Kong: Constitutional and ethical perspectives.

This article examines the compulsory psychiatric regime in Hong Kong. Under section 36 of the Mental Health Ordinance, which authorises long-term detention of psychiatric patients, a District Judge is required to countersign the form filled out by the registered medical practitioners in order for the detention to be valid. Case law, however, has shown that the role of the District Judge is merely administrative. This article suggests that, as it currently stands, the compulsory psychiatric regime in Hong Kong is unconstitutional because it fails the proportionality test. In light of this conclusion, the author proposes two solutions to deal with the issue, by common law or by legislative reform. The former would see an exercise of discretion by the courts read into section 36, while the latter would involve piecemeal reform of the relevant provisions to give the courts an explicit discretion to consider substantive issues when reviewing compulsory detention applications. The author argues that these solutions would introduce effective judicial supervision into the compulsory psychiatric regime and safeguard against abuse of process.

Complicity and torture.

One of the great merits of On Complicity and Compromise is that it wades into specific swamps where ordinary theorists fear to slog. It is persuasive that in general it can be right sometimes to be complicit in wrongdoing by others through causally contributing to the wrongdoing, but not sharing its purpose, if by being involved one can reasonably expect to lessen the extent of the wrong that would otherwise be suffered by the victims. I focus on whether the book's general thesis is applicable to torture, which depends on what torture and the torture situation are in fact like. I focus on the case to which the chapter several times refers: the innovative CIA paradigm of torture. First, to the extent that the paradigm, which is predominantly mental, or psychological, torture succeeds in its goal of producing regression to a compliant state, the physician would be unable to rely on the torture victim's expressions of preferences or interests as authentically his own. Second, since disorientation plays such a large role in the CIA's style of torture (adopted at Guantanamo by the military), the authorities would refuse to allow a stable relationship to be built up with any one doctor by any victim, making comprehension of the victim's preferences difficult. Third, even if the doctor could somehow judge what the victim's genuine interests were, the control of the situation is much too totalistic to allow the physician any action independent of what the torture regime requires.

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

After 9/11/2001 the United States launched a global War on Terror. As part of this War, terrorism suspects were detained by the U.S. military and by the C.I.A. It is now widely recognized that the United States tortured a number of these detainees in the context of its 'enhanced interrogation' programme. This article examines how and why U.S. organizations developed standards that allowed healthcare professionals to become involved in torture; why the standards developed by U.S. security institutions failed 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 lessons that the enhanced interrogation programme has for social science research on standards, namely that individuals can experience ambivalence when caught between competing organizational and professional standards and that it might be inherently difficult to successfully enact certain protocols when these relate to deviant or destructive acts.

Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal.

The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA's behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA's institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to "advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives" (APA, 2016).

Why Did U.S. Healthcare Professionals Become Involved in Torture During the War on Terror?

This article examines why U.S. healthcare professionals became involved in "enhanced interrogation," or torture, during the War on Terror. A number of factors are identified including a desire on the part of these professionals to defend their country and fellow citizens from future attack; having their activities approved and authorized by legitimate command structures; financial incentives; and wanting to prevent serious harm from occurring to prisoners/detainees. The factors outlined here suggest that psychosocial factors can influence health professionals' ethical decision-making.

Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe.

Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.