The Breaking of Bodies and Minds: Torture, Psychiatric Abuse and the Health Professions. By Eric Stover and Elena O. Nightingale, MD, editors; W.H. Freeman, $21.95 hardcover, $11.95 paperback.
The Achille Lauro. The airports in Rome and Vienna. Beirut. Recent events have focused our attention on acts of terrorism affecting Americans. Speculation that terrorist acts may occur on U.S. soil sends shivers down our spines.
All this is new and horrifying for Americans to contemplate. And to focus our attention is precisely the point. The public nature of such attacks is critical to terrorists who seek worldwide attention.
There are other acts of brutality, however, that take place in private and secret. Torture, according to a 1984 study by Amnesty International, is sanctioned officially or unofficially by two thirds of the countries of the world. It victimizes hundreds of thousands of people each year. Torture has become so institutionalized, according to Robert White, former U.S. ambassador to Paraguay, that "perfectly normal people get up and go to their jobs and their work is torture."
"The Breaking of Bodies and Minds" is about a particularly loathsome aspect of torture: How repressive regimes have enlisted the aid of health professionals in perpetuating systems of torture. These people are not the stereotypical mad doctors bent on sadistic ends, the editors note. Their involvement -- sometimes willingly and sometimes under threats to themselves and their families -- includes falsifying medical certificates and autopsy reports of persons tortured or killed; keeping torture victims alive so the abuse can continue; designing new methods of torture; training lay torturers in medical techniques such as amputation; or acting as torturers themselves.
Sometimes, as is well-documented in the Soviet Union, the medical system itself is used to diagnose the mentally well as suffering from serious psychiatric disorders requiring institutionalization. Once in confinement, the authors say, doctors subject these dissidents to psychological and physical abuse through inappropriate drug therapy. "It was frightening to think the difference between us was not genetic," one victim of torture recounts. "They were still human beings."
This book of readings grew out of the editors' work with the American Association for the Advancement of Science's Committee on Scientific Freedom and Responsibility. The essays written by physicians, psychiatrists, journalists, political scientists and human rights workers cover such topics as the philosophy and justifications used for torture, particularly in Latin American and the Soviet Union. Useful appendices document existing codes against torture, names and addresses of organizations concerned with torture and psychiatric abuse, and an extensive, well-organized bibliography.
The writing is restrained. Statistics are reported no differently than the Centers for Disease Control might do for measles. We learn that all torture victims suffer the degradation of denial of personal hygiene, privacy and verbal abuse; 85 to 98 per- Doctors' involvement is sometimes willing, sometimes under threat. cent are beaten; two thirds undergo electric shocks either directly or with electrodes attached to fingers, toes, head or genitals; half (men and women) are sexually molested; almost a third suffer near asphyxiation from submersion in blood, feces and vomit. Of those released and available for study, 20 percent are left with skeletal fractures, 34 percent suffer continuing episodes of night panic, 55 percent suffer headaches, 88 percent have continuing anxiety and 10 percent attempt suicide.
The long-term effects of torture point to a "torture syndrome" clinically similar to post-traumatic stress disorder. The authors raise many unanswered questions: Are the psychological symptoms associated with torture caused or aggravated by the stresses of being a refugee? How should the diagnosis of post-traumatic stress disorder be modified to distinguish torture-induced stress from other forms of abuse such as rape or assault? Who will fund this work? And how can victims of torture be persuaded to seek help when in so many cases they have suffered at the hands of members of the "healing professions"?
Reporting such grim statistics is not an exercise in sensationalism. Public awareness of the magnitude of the problem is the first step to preventing it. The "shame of exposure" has been a critical determinant in keeping repressive regimes accountable. Torture thrives out of the public eye -- people disappearing from their homes or jobs never to be heard from again until, perhaps, piles of skeletons are uncovered years later, as recently occurred in Argentina.
Examples are documented in the book in which persistent public interference -- through letters, press coverage and messages sneaked out of prison -- has saved lives, brought freedom to some victims and, in a few remarkable cases, justice. Amnesty International has used these methods for years, as have other human rights organizations.
The book is ultimately an appeal to action for international pressure to be applied to the perpetrators. The authors call for a centralized network to collect data so that torture can be documented and responded to quickly.
This process already exists in the field of medical epidemiology. A number of the writers suggest that this model could be adopted by a network against torture. Making torture as easily documented as a flu epidemic is not to make light of this ultimate abomination of the human spirit. It is the best chance for preventing the future breaking of bodies and minds.
"Silence condones," write the editors. "Once awareness exists, it is both unethical and unthinkable to remain silent." That is why this book was written. That is why we should read it.