In this piece, Uthman Malik discusses how mental health practitioners have been used in the War on Terror from the psychologists behind the torture programmes rolled out by the CIA in Bagram, Abu Ghraib and other torture sites - to implications of the PREVENT programme here in the UK on the mental health arena. Malik provides practical examples of cultural practices being misinterpreted in an attempt to counter radicalisation instead of providing the patient care as required.
Introduction
On 1 July 2015 new legislation was introduced in the UK which stipulates that “A specified authority must, in the exercise of its functions, have due regard to the need to prevent people from being drawn into terrorism.” NHS Trusts and their staff are covered by the new legislation.
The UK government first set out the role of NHS staff in the prevention of terrorism in guidance issued in December 2011. The guidance spoke of providing “appropriate support” to those who are “in the process of being radicalised towards terrorism”. Interestingly, the foreword of that guidance, written by the Minister of State for Health, noted that, “Terrorist-related activity is not a subject normally associated with the health service”.
Since the guidance was issued, NHS organisations have set out policies for “PREVENT”, rolled out training for staff and begun to work closely with other bodies including the police. In general practice, NHS England has required clinical commissioning groups to instruct all practices to appoint a counter-terrorism lead. There was considerable disquiet about such measures, with leading British GP GPC chair Dr Laurence Buckman questioning whether the requirement was meant to be a joke. He said, “I think this a silly, totally pointless gimmick and I can see no inherent value in asking people who know nothing about something that is extremely serious to do this. It is so silly and ridiculous that I can’t believe NHS England are requiring this or making CCGs responsible for it.” Dr John Glasspool, a Southampton GP, also expressed his concerns about the expectations placed on doctors, stating, “I don’t see what role a GP should play in preventing radical Islam…we will lose the trust of our Muslim patients and it also raises the issue of patient confidentiality.”
Evidence-based practice?
The focus of “PREVENT” in mental health has persisted despite the dearth of evidence for the effectiveness of the strategy; indeed much of the published research literature has suggested that those who eventually engage in violent acts do not suffer from mental illness and there is little empirical evidence that militants are targeting the outpatient departments of psychiatric hospitals in order to garner recruits.
Interestingly, while some governments and politicians dismiss the role of foreign policy in driving terror, the issue has been explicitly cited as a key driver to militancy by a raft of official inquiries, intelligence reports and academic studies in recent years. Similarly, much of the psychiatric literature also cites political grievance, particularly related to foreign policy, as a powerful factor sustaining militant organisations.
With these developments, some in the world of mental health began to explore theories about “radicalisation” and present psychodynamic models that explained the actions of suicide bombers. Some psychiatrists claimed to have developed significant insight into the minds of extremists, even claiming to have developed psychological tools to expose those who are vulnerable to extremism. Professional bodies such as the UK Royal College of Psychiatrists and The British Psychological Society convened seminars to discuss the psychology of the “Islamist extremist preacher”.
The impact on patient care and the doctor-patient relationship
At a practical level, many of us working in the arena of mental health began to see the impact of “PREVENT” on the delivery of care. These are a handful of the cases that I have encountered in recent times:
A housing officer who had attended a short training session on “radicalisation” presented himself as an expert on counter-terrorism. The housing officer had spotted what he thought was a container of chemicals in the house of a mentally vulnerable man who appeared to have dry skin on his hands. The police quickly became involved only to establish that the man was in possession of sacred water from the well of Zam Zam in Makkah; any one familiar with the Islamic acts of pilgrimage to Makkah would know that overseas pilgrims often return with many such containers of water.
A floridly psychotic patient attended accident and emergency and drew a map that purported to show the location of the leader of ISIS. The mere name ISIS led many a health professional to panic and instead of ensuring the rapid delivery of mental health treatment as an immediate priority, some were diverted to consider whether this vulnerable, ill patient was a threat.
An Afghan national was detained under the Mental Health Act at an airport for acting “suspiciously” and being seemingly disorientated. In his possession were a vial of perfume (attar) and a wooden toothbrush (miswak). These were thought to be possibly dangerous substances. It transpired that he did not suffer from mental health problems and was no threat to anyone. He had simply missed his flight to Pakistan after getting separated from his brother; finding himself in a foreign country with no English led to his “suspicious” appearance and disorientation.
_ _
While a minority of psychiatrists have convinced themselves that their training and experience has equipped them to become authorities on counter-terrorism, most have felt that it is not within the realm of their expertise to identify signs of “radicalisation” and have questioned the likely negative effect of the Government measures on the relationship with Muslim patients and communities.
The President’s Psychologists who taught torture
Across the Atlantic, the potentially dire consequences of unfettered cooperation between health providers and security agencies has recently been uncovered. While almost everyone has now heard of waterboarding and the inhumane treatment to which detainees in US custody were systematically subjected to, few are aware of the role of psychologists in devising the torture programmes meted out at Abu Ghraib, Bagram and other US detention facilities.
In December 2014 the release of the US Senate Select Intelligence Committee’s “torture report” led Vanity Fair to conclude that, “The C.I.A. tortured detainees in ways more brutal, sustained, and gruesome than was previously known, and two medical professionals were integral to its efforts.” The two medical professionals were CIA psychologists James Mitchell and Bruce Jensen. These were the health professionals who oversaw the work of breaking down detainees; waterboarding, locking some in coffin shaped boxes, blasting them with music and locking them in freezing rooms. Vanity Fair’s Katherine Eban concluded that, “The psychologists were actually designing the torture, overseeing its implementation, assessing its effectiveness, and getting paid handsomely for it. Mitchell and Jessen’s consulting business was ultimately awarded $180 million in contracts by the C.I.A.”
If this was not bad enough, earlier this year a report revealed that the American Psychological Association (APA) clandestinely worked with the Bush administration in order to“coordinate APA ethics policy with the needs of the CIA’s “enhanced” interrogation program”. Quite rightly, the American Medical Association and the American Psychiatric Association determined that it would violate their members’ oaths to patients to participate in the interrogations.
Conclusion
While there is no suggestion that health professionals in the UK have been involved with security agencies to such an extent, all who work in health should remember that they are health professionals, not sleuths, and that their principal obligation is to “do no harm”.
Uthman Malik is a consultant psychiatrist with extensive experience of treating victims of rights abuses and torture.
<em>In this piece, Uthman Malik discusses how mental health practitioners have been used in the War on Terror from the psychologists behind the torture programmes rolled out by the CIA in Bagram, Abu Ghraib and other torture sites - to implications of the PREVENT programme here in the UK on the mental health arena. Malik provides practical examples of cultural practices being misinterpreted in an attempt to counter radicalisation instead of providing the patient care as required.</em>
<h3>Introduction</h3>
<div>On 1 July 2015 new legislation was introduced in the UK which stipulates that “<em>A specified authority must, in the exercise of its functions, have due regard to the need to prevent people from being drawn into terrorism</em>.” NHS Trusts and their staff are covered by the new legislation.</div>
<div></div>
<div>The UK government first set out the role of NHS staff in the prevention of terrorism in <strong><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215251/dh_131934.pdf">guidance</a> </strong>issued in December 2011. The guidance spoke of providing “<em>appropriate support</em>” to those who are “<em>in the process of being radicalised towards terrorism</em>”. Interestingly, the foreword of that guidance, written by the Minister of State for Health, noted that, “<em>Terrorist-related activity is not a subject normally associated with the health service</em>”.</div>
<div></div>
<div>
<hr />
<h5 style="text-align: left;"><a href="https://cage.ngo/?p=4850"><strong>Read: Challenging the Counter-terrorism and Security Bill</strong></a></h5>
<hr />
<p>Since the guidance was issued, NHS organisations have set out policies for “<strong><a href="https://cage.ngo/?p=3215">PREVENT</a></strong>”, rolled out training for staff and begun to work closely with other bodies including the police. In general practice, NHS England has required clinical commissioning groups to instruct all practices to appoint a counter-terrorism lead. There was considerable disquiet about such measures, with leading British GP GPC chair Dr Laurence Buckman questioning whether the requirement was meant to be a joke. He said, “<em>I think this a silly, totally pointless gimmick and I can see no inherent value in asking people who know nothing about something that is extremely serious to do this. It is so silly and ridiculous that I can’t believe NHS England are requiring this or making CCGs responsible for it</em>.” Dr John Glasspool, a Southampton GP, also expressed his concerns about the expectations placed on doctors, stating, “<em>I don’t see what role a GP should play in preventing radical Islam…we will lose the trust of our Muslim patients and it also raises the issue of patient confidentiality</em>.”</p>
</div>
<h3>Evidence-based practice?</h3>
<div>The focus of “PREVENT” in mental health has persisted despite the dearth of evidence for the effectiveness of the strategy; indeed much of the published <strong><a href="http://euc.sagepub.com/content/5/1/99.short">research literature</a> </strong>has suggested that those who eventually engage in violent acts do not suffer from mental illness and there is little empirical evidence that militants are targeting the outpatient departments of psychiatric hospitals in order to garner recruits.</div>
<p>Interestingly, while some governments and politicians dismiss the role of foreign policy in driving terror, the issue has been explicitly cited as a key driver to militancy by a raft of official inquiries, intelligence reports and academic studies in recent years. Similarly, much of the psychiatric literature also cites <strong><a href="http://www.academia.edu/3209016/The_Primacy_of_Grievance_as_a_Structural_Cause_of_Oppositional_Political_Terrorism_Comparing_Al_Fatah_FARC_and_PIRA">political grievance</a></strong>, particularly related to foreign policy, as a powerful factor sustaining militant organisations.</p>
<p>With these developments, some in the world of mental health began to explore theories about “radicalisation” and present psychodynamic models that explained the actions of suicide bombers. Some psychiatrists <strong><a href="http://www.amazon.co.uk/Human-Being-Bomb-Inside-Terrorist/dp/1840468629">claimed</a> </strong>to have developed significant insight into the minds of extremists, even claiming to have developed psychological tools to expose those who are vulnerable to extremism. Professional bodies such as the UK Royal College of Psychiatrists and The British Psychological Society convened seminars to discuss the psychology of the “Islamist extremist preacher”.</p>
<h3>The impact on patient care and the doctor-patient relationship</h3>
<p>At a practical level, many of us working in the arena of mental health began to see the impact of “PREVENT” on the delivery of care. These are a handful of the cases that I have encountered in recent times:</p>
<ul>
<li>A housing officer who had attended a short training session on “radicalisation” presented himself as an expert on counter-terrorism. The housing officer had spotted what he thought was a container of chemicals in the house of a mentally vulnerable man who appeared to have dry skin on his hands. The police quickly became involved only to establish that the man was in possession of sacred water from the well of Zam Zam in Makkah; any one familiar with the Islamic acts of pilgrimage to Makkah would know that overseas pilgrims often return with many such containers of water.</li>
</ul>
<ul>
<li>A floridly psychotic patient attended accident and emergency and drew a map that purported to show the location of the leader of ISIS. The mere name ISIS led many a health professional to panic and instead of ensuring the rapid delivery of mental health treatment as an immediate priority, some were diverted to consider whether this vulnerable, ill patient was a threat.</li>
</ul>
<ul>
<li>An Afghan national was detained under the Mental Health Act at an airport for acting “suspiciously” and being seemingly disorientated. In his possession were a vial of perfume (attar) and a wooden toothbrush (miswak). These were thought to be possibly dangerous substances. It transpired that he did not suffer from mental health problems and was no threat to anyone. He had simply missed his flight to Pakistan after getting separated from his brother; finding himself in a foreign country with no English led to his “suspicious” appearance and disorientation.</li>
</ul>
<div>
<hr />
<h5><strong><a href="https://cage.ngo/?p=5780">Read: Failing Our Communities: A case study approach to understanding PREVENT</a></strong></h5>
<hr />
<p>While a minority of psychiatrists have convinced themselves that their training and experience has equipped them to become authorities on counter-terrorism, most have felt that it is not within the realm of their expertise to identify signs of “radicalisation” and have questioned the likely negative effect of the Government measures on the relationship with Muslim patients and communities.</p>
<h3>The President’s Psychologists who taught torture</h3>
<p>Across the Atlantic, the potentially dire consequences of unfettered cooperation between health providers and security agencies has recently been uncovered. While almost everyone has now heard of waterboarding and the inhumane treatment to which detainees in US custody were systematically subjected to, few are aware of the role of psychologists in devising the torture programmes meted out at Abu Ghraib, Bagram and other US detention facilities.</p>
<p>In December 2014 the release of the US Senate Select Intelligence Committee’s “torture report” led Vanity Fair to <strong><a href="http://www.vanityfair.com/news/daily-news/2014/12/psychologists-cia-torture-report">conclude</a> </strong>that, “<em>The C.I.A. tortured detainees in ways more brutal, sustained, and gruesome than was previously known, and two medical professionals were integral to its efforts</em>.” The two medical professionals were CIA psychologists James Mitchell and Bruce Jensen.
These were the health professionals who oversaw the work of breaking down detainees; waterboarding, locking some in coffin shaped boxes, blasting them with music and locking them in freezing rooms. Vanity Fair’s Katherine Eban concluded that, “<em>The psychologists were actually designing the torture, overseeing its implementation, assessing its effectiveness, and getting paid handsomely for it. Mitchell and Jessen’s consulting business was ultimately awarded $180 million in contracts by the C.I.A</em>.”</p>
<h5><strong><a href="https://cage.ngo/?p=3065">Read: Revealed: Faces of CIA torture victims</a></strong></h5>
<hr />
<p>If this was not bad enough, earlier this year a report <strong><a href="https://s3.amazonaws.com/s3.documentcloud.org/documents/2069718/report.pdf">revealed</a></strong> that the American Psychological Association (APA) clandestinely worked with the Bush administration in order to“<em>coordinate APA ethics policy with the needs of the CIA’s “enhanced” interrogation program</em>”. Quite rightly, the American Medical Association and the American Psychiatric Association determined that it would violate their members’ oaths to patients to participate in the interrogations.</p>
<h3>Conclusion</h3>
<p>While there is no suggestion that health professionals in the UK have been involved with security agencies to such an extent, all who work in health should remember that they are health professionals, not sleuths, and that their principal obligation is to “do no harm”.</p>
<div></div>
<p><strong><em>Uthman Malik is a consultant psychiatrist with extensive experience of treating victims of rights abuses and torture.</em></strong></p>
