What You May Not Know About That Famous Manual

By William Fisher

While applauding President Barack Obama’s recent executive orders banning torture and other harsh interrogation practices, medical authorities are calling attention to a little-reported section of the Army’s Field Manual on Interrogation that they say still allows the use of tactics that can constitute torture or cruel, inhuman or degrading treatment under U.S. and international law.

The suspect section of the Manual is known as Annex M, which allows the use of sleep deprivation, sensory deprivation, and isolation, termed “separation” in the Manual. Obama’s executive orders directed all government agencies, including the Central Intelligence Agency (CIA), to follow the Manual for interrogations.

But Physicians for Human Rights (PHR), a Nobel laureate not-for-profit organization, is calling on the task force appointed by the president to review U.S. interrogation and transfer policies to revoke the Appendix and consult with human rights organizations as part of the review process.

John Bradshaw, Director of PHR’s office in Washington, DC, told IPS, “The technique of separation allowed by Appendix M sounds innocuous, but in reality it allows the use of sleep deprivation, sensory deprivation and isolation.”

“Particularly when used in combination, these techniques amount to psychological torture. The Obama Administration must close this loophole in the Army Field Manual by eliminating Appendix M, which leaves the door open to torture,” he said.

Legal experts agree. Marjorie Cohn, President of the National Lawyers Guild, told IPS, “President Obama’s announcement that the United States will not engage in torture is commendable. But cruel, inhuman and degrading treatment or punishment also violate U.S. law, as specified by three treaties we have ratified. The new administration should not use the Army Field Manual as the gold standard for interrogations since Appendix M sanctions techniques, including isolation and prolonged sleep deprivation, that amount to cruel, inhuman or degrading treatment.”

PHR also called on President Obama and Congress to “immediately authorize a non-partisan commission to investigate the authorization, legal justification, and implementation of the Bush Administration’s regime of psychological and physical torture.” It added that “any accountability mechanism must include a subgroup tasked with investigating the participation of health professionals in detainee abuse.”

PHR also urged the Obama Administration to end the use of Behavioral Science Consultants (BSCs) in interrogations. “The continued use of BSCs violates medical ethics and subverts the traditions of the healing professions. Any procedures currently in place involving health professionals in interrogations which violate medical ethics should be prohibited,” said PHR’S Chief Executive Officer, Frank Donaghue.

“The past administration’s weaponization of the health professions to inflict harm on detainees constitutes a war crime unto itself,” said Donaghue. He added, “Despite all that has been disclosed so far about abuses committed by health professionals, many questions remain, chief among which is whether there will be any accountability for gross violations of medical ethics and the law.”

"The desire to turn the page on the past seven years of detainee abuse and torture by U.S. forces is understandable," Donaghue said. But he noted that "President Obama, Congress and the health professions will not have fulfilled their obligation to the Constitution and medical ethics if we settle only for reform without accountability."

Other health professionals are taking similar positions. One of the most outspoken, psychologist Dr. Jeffrey Kaye, points out that the AFM’s Appendix M “continues to allow use of isolation (called ‘separation’) on so-called ‘unlawful enemy combatants’.”

He told IPS, “After the Abu Ghraib scandal exploded, the U.S. government wanted to hide or forbid all types of treatment that became notorious due to press exposure, including the revelations around waterboarding. They pared down their torture program to the model laid down by the CIA's Kubark manual of the early 1960s. They twisted the meaning of the Geneva Conventions at their will, in order to implement this program of coercive interrogation, using the Army Field Manual and Appendix M as their primary device.”

He added, “This program relies on the production of psychological regression by using a combination of solitary confinement, fatigue, sleep deprivation, sensory deprivation, and feelings of fear to produce dependency upon the interrogator. These techniques, allowed by the Army Field Manual, and implemented with the assistance of doctors and behavioral health specialists, like psychologists, are totally antithetical to existing law, and amount to torture and/or cruel, inhumane treatment of prisoners.”

Kaye contends that, “In many senses, isolation is the essence of U.S. detainee abuse. All else follows. Isolation can cause serious mental deterioration in many individuals.”

He adds that “This deterioration can occur within days, well under the 30 day initial period allowed by Appendix M. This 30 days can be followed by additional periods, if the proper approval is obtained.”

While ostensibly banning it, the AFM also allows sensory deprivation, he says. “As a last resort, when physical separation of detainees is not feasible, goggles or blindfolds and earmuffs may be utilized as a field expedient method to generate a perception of separation.“

In the Bush Administration’s only admission that it inflicted torture on a prisoner, a senior Pentagon official recently disclosed to the Washington Post that a combination of permissible techniques used on a Guantanamo detainee, plus the intensity and duration of these techniques, seriously endangered the health of a prisoner and constituted torture. She declined to refer him to Guantanamo Military Commission authorities for trial.

During the Bush Administration, a number of leading medical organizations called on the president to end the participation of health care professionals in detainee interrogations. The American Medical Association (AMA) adopted a resolution opposing “participation by physicians in the torture or inhuman treatment or punishment of individuals in relation to detention and imprisonment.”

Similar positions have been adopted by other organizations, including the American Psychiatric Association, the American Psychological Association, and the American Nurses Association.

However, there is ample evidence that some military medical personnel have participated in torture and abuse of detainees. Reports indicate, for example, that so-called Behavioral Science Consultation Teams -- known as "biscuit" teams – included medical personnel who were aware of prisoner abuse but failed to report or properly document it; that interrogators were given access to detainees’ confidential medical records; that health professionals participated directly in the development and implementation of abusive interrogation plans; and that doctors, other medical personnel, and “biscuit” teams of psychiatrists and psychologists may have facilitated abuse by giving interrogators information about detainees’ mental health and vulnerabilities.

The International Committee of the Red Cross described what it observed at the U.S. military detention center at Guantanamo Bay, Cuba, in June 2004 as a “flagrant violation of medical ethics.”