Dr. Allen Keller
Director, Bellevue/NYU Program for Survivors of Torture
Dr. Allen Keller is a long-time expert in the evaluation and treatment of the victims of torture. He is the director of the New York University School of Medicine Center for Health and Human Rights, and, in 1995, co-founded the Bellevue/NYU Program for Survivors of Torture. A member of the advisory council for Physicians for Human Rights, Dr. Keller was a chief reviewer of the 2007 PHR/Human Rights First report, "Leave No Marks: 'Enhanced' Interrogation Techniques and the Risk of Criminality." He is also co-author of the manual used by many health professionals, "Examining Asylum Seekers."
Dr. Allen Keller on...
Interview: November 15, 2007
We recently interviewed some former prisoners and their experiences varied. A couple were picked up in Pakistan. One was a rendition. One of them was in the Dark Prison in Afghanistan. One of them was in another prison in Afghanistan. What I was struck by is that in every one of the interviews, they were describing what I would call horrifying details in such a matter-of-fact way.
When I first started working with torture survivors, I thought clearly that anybody who'd been so brutalized, either you wouldn't be able to talk about what happened or would become so emotionally overwhelmed in the context. But frankly there's a lot of variability for some individuals. First of all, there needs to be a presumption that any time somebody is recounting what are horrific experiences, there is an element of re-traumatization that occurs where the individual re-experiences what happened, and those memories can be terrifying.
And so individuals may respond to that in different ways. Some may become exceptionally emotional, tearful, you know, and even begin to relive the experiences while they're talking about it. For others as a way of coping with the horror of what happened, it's not uncommon that they'll describe it in a rather detached manner, as if it almost had been happening to someone else, that this is a natural coping mechanism of emotionally distancing themselves from the horror of what did happen. But in the many torture survivors that I've interviewed, you know, I've seen it both ways, those who become overwhelmed by what happened to them -- I've often been struck that for many individuals as difficult as it is to recount the horror of what happened to them, it can be as, if not more difficult, to talk about what they witnessed others that they knew or loved subjected to.
I asked every one of them what -- which was worse in their -- in their experiences, the physical abuse or the psychological abuse. And every one of them answered, "the psychological abuse."
It's often difficult to tease out the physical and the psychological abuse because it's quite common that they're happening simultaneously. But for many individuals, the psychological forms of abuse including even the anticipation, the waiting, the uncertainty and the terror, as well as being subjected to forms of humiliation where they may not be physically injured or for example, if someone is subjected to a mock execution. If a gun is held to someone's head and the trigger is pulled in a mock execution, there may be no physical marks, but the nightmares, the terrors can go on for months and likely for years, if not a lifetime, after what the individual has suffered.
All these people were held multiple years and each of them said that for at least the first two years that they were prisoners they were every day, if not every hour, afraid that they were going to be killed.
Right. That fear of being killed, of course, naturally is one of the most terrifying things that one can experience and can result in profound anxiety. And then in years to come anything that might remind the individual of that terror, of that fear, can result in just an overflow of terrifying memories and nightmares.
You have testified recently and talked about the, as you say, the benign-sounding "enhanced interrogation techniques." As I understand it, you think they're anything but benign?
As a doctor who's dedicated his career to caring for individuals who've experienced torture and other human rights abuses and evaluating such individuals, I've been terribly concerned about the language, the erroneously innocuous, or seemingly innocuous, language that is used to describe abusive, horrific methods, many of which clearly are torture. Specifically I'm referring to the terms such as "enhanced interrogation techniques," which has this innocuous sound to it. But there's really nothing innocuous or benign about these methods referred to as "enhanced interrogation techniques." They are harmful. As a doctor who's cared for individuals who've been subjected to these methods, I can tell you that they result in very real physical, psychological and social harm and suffering, and should be seen for what they are, which is torture.
Not "torture lite", as some people say.
There again, terms such as "enhanced interrogation methods" or "torture lite" give a misleading sanitizing of these abusive methods, just as with the term "waterboarding," which also has this kind of innocuous sound to it. These are brutal, cruel, inhuman methods that we should not in any way be looking to condone, to sanitize, or to rationalize.
Waterboarding has been the subject of a recent political and therefore somewhat more public debate. What was your reaction to that debate?
With regards to the recent debate/discussion about waterboarding or whether this is a form of torture, I found myself amazed. Clearly, this is not subtle. This is a horrific method, which has as its intention to mimic drowning and to, in fact, re-enact drowning, one of the most frightening experiences imaginable. And so to somehow wonder or think, well, is this torture or isn't, doesn't jive with common sense, clearly doesn't follow with my clinical experience of having treated individuals who've been subjected to a variety of forms of mock drownings or asphyxiation. That waterboarding - where someone is strapped to a board - they may be leaned back at an angle and then water is poured over their face, where clearly they experience this terrifying feeling of drowning and are helpless to stop it, where they're literally gasping, inhaling, water can and does result in serious physical and psychological harm and should be seen for what it is: torture.
Are you concerned that the focus on waterboarding diminishes the focus on many of these other interrogation techniques?
I think it's important that there be no questions that waterboarding is clearly torture, but with that and with other methods, we need to use our common sense about what we should and should not be condoning, and that if we say, "Well, okay, we won't waterboard, but then we'll use these other methods," to me that's a real problem. If it looks like torture, if it smells like torture, it's probably torture, and we shouldn't be doing it. We shouldn't be doing methods that are abusive as well. But if we just say, "Okay, we're not going to waterboard, but yes we're going to go ahead and force individuals to stand for hours on end," or "Yes we're going to subject individuals to sleep deprivation for weeks or longer or subject individuals to extremes of cold or heat," this is very disconcerting as well.
These methods are abusive, also can result in physical and psychological harm. And I think it is important that we document that okay, these are clearly methods that we're not going to use, but we also need to rely on our common sense. We could come up with a 20-page list of abusive interrogation methods such as waterboarding and other methods. But if we just have that I'm sure, you know, human ingenuity, cruelly being what it's capable of, there'll be some horrific method that might have appeared on page 21 that we won't have thought of, and we shouldn't be doing that either. So we need to use our conscience, we need to use international guidelines; we need to use our common sense about methods that we must not condone or use.
I want to go through some of these methods, some of which you've mentioned and some others as well, that were described to me by former prisoners that were in US custody, and have you react to what the impact could be.
All of these enhanced interrogation methods that have been described including waterboarding, including sleep deprivation, including being forced to stand for prolonged periods, exposure to extremes of heat and cold, all of these methods and -- and others that have been documented to occur are clearly abusive and arguably also are clearly forms of torture, and we shouldn't be doing them.
What are the goals of those methods you've described?
First of all, when we look at the context in which these methods often were developed, a lot of these methods have been in use since the Middle Ages, were used by the KGB and others, and it was never really about eliciting accurate information. They were often used to get confessions, coerced confessions. So the individuals historically who have used these methods often didn't really care or weren't really interested in whether they were getting the truth. It was about humiliating these individuals. It was about getting false confessions. And it was also about sending a very chilling message to the community, that if you dare to speak out, that this is what will happen to you.
And I think that's a really important point, that when you look around the world, torture is documented to occur in more than 90 countries around the world. And most individuals being singled out for such abuse are not terrorist suspects. They are ordinary citizens that are individuals who are speaking out in favor of democracy or against persecution. And when they're abused, it's not about getting information from them; it's about sending a chilling message to the rest of society. If you dare to speak out, this is what will happen to you.
And so, while arguably it's dubious at best as to whether torture is effective at eliciting accurate information, what is clear is that it has profound and devastating health consequences. It undermines both the individual and the community's sense of truth and sense of safety. And that when we as a society in any way condone or practice torture or these abusive methods I believe we make the world a much more dangerous place -- for the Tibetan monk who is speaking out and maybe chanting along with the Dalai Lama, "Free Tibet," or the student advocate in Africa -- that we're making the world a much more dangerous place for all of these individuals. These methods arguably are not effective at eliciting accurate information. They can result in very harmful -- very real physical and psychological suffering, and they make the world a much more dangerous place.
At Kandahar one of them describes it as the "dehumanization process." That's the word he used, it was to terrify them and that it, in fact, worked. What is that about, "dehumanizing?"
First of all, it's important to appreciate that many of these abusive methods -- rarely do they occur in isolation. Rarely is an individual just being deprived of sleep or being exposed to loud noises or waterboarded or beaten. Often these things are happening simultaneously or in very close proximity to one another. So it's erroneous to think that well, we're just going to use this one method, and arguable even if we just did that that's too much. But that process of humiliation, of dehumanization, of making an individual feel terrified and helpless, is all part and parcel of the abuse and we shouldn't be doing that. Individuals become fearful, become utterly terrified. And I actually know in my experience in having interviewed torture survivors from all over the world, I often hear from them that they would say whatever they thought their interrogators wanted to hear to stop the torture, to stop the abuse.
You've mentioned sleep deprivation. One of the people whom I talked to was essentially sleep deprived for the better part of a month, a month that he refers to as the "month of torture." By the end of that, all he wanted to be able to do was to go to sleep.
Sleep deprivation can result in a lot of both physical and psychological symptoms. First of all, when an individual is deprived of sleep for extended periods, they may well become paranoid, profoundly anxious, delusional, arguably not a useful recipe for eliciting accurate information. And then they'll also develop physical complaints, somatic complaints, stomachaches, headaches, dizziness, nausea, and this sleep deprivation then can result in chronic disruptions in their sleep pattern. Sleep deprivation is done in a variety of ways: Individuals either frequently coming and waking them up or that they're exposed to bright and loud noises, which can also have health consequences. But again, sleep deprivation can result in severe physical and psychological suffering.
And with some of the things I've heard said about sleep deprivation, and for example, about being forced to stand for extended periods. And, gee, you know, are these really torture or - doesn't sound so bad - there is a profound difference between the individual who's pulling an all-nighter to complete a paper or the Presidential candidate who is being deprived of sleep voluntarily, but I'm sure with lots of amenities. There is a huge difference between individuals going with unlimited sleep by choice as opposed to an individual who, as part of their imprisonment and abuse, is kept up for weeks or months on end and not knowing when they'll be allowed to sleep again. And that sense of helplessness, that sense of fear, that total loss of control, that's part and parcel of the abuse.
Context with regards to these abusive methods clearly is important. There is a profound difference between an individual who's on his feet during the day as part of his work even if he's on his feet for hours on end and moving around as opposed to an individual who stands in one place even, you know, for several hours. If you stand in one place for several hours, first the blood begins to pool in your legs. This can result in painful swelling. Then you can get venostasis where clots begin to form in the blood that's pooling. And those clots can break off and go to the legs or even to the lungs and can result in potentially death. I've cared for many individuals who as a result of being subjected to standing for extended periods have suffered deep vein thromboses, clots in their legs, or even pulmonary emboli, where clots go to the lungs.
One of them described being hog-tied, where he was on the ground and his arms were behind his -- and legs -- sounds like hog-tied -- a hog being tied. Others described what was known as strappado, being held above their arms. Are those what are called stress positions?
Being restrained or forced to stand or being held in painful positions can result in long-term physical injuries far beyond the period that they're subjected to. It can result in torn ligaments. It can result in chronic muscle aches. It can result in broken bones in addition to the profound humiliation that, for example, being "hog-tied" can result in. But I've cared for many individuals who as a result of having been restrained, suspended or held in painful positions have chronic musculoskeletal pain and symptoms and physical findings years after their abuse.
One of the people I talked to was held for a time at the so-called "Dark Prison" in Afghanistan, yet another US-run facility where literally they were in a dark basement. And in addition to the darkness, it was freezing cold. And in addition to the darkness and the cold, cacophonous sounds were blasted at them 24 hours a day, not just music but the sounds of women screaming and airplanes taking off, and then Halloween sounds and cackling noises and that sort of thing.
For individuals who are held in dark cells, subjected to loud noises, subjected to cold, this speaks to the point that these abusive methods rarely happen just one at a time, that there's often many of these things happening at once. So, for example, an individual who's held in a dark cell experiences profound terror, a loss of a sense of time and place. And this can result in profound anxiety and fear, you know, the sense of not knowing what's going to happen. And this can be even worsened when other abusive things are happening at the same time, such as being subjected to loud or frightening noises intended to result in fear and terror where an individual has this fear response. It's not uncommon in such conditions where an individual is held in a dark cell or subjected to loud noises that they may also at the same time be exposed to extremes of heat or cold and that any one of these methods in and of themselves can cause physical and psychological harm. In combination, the impact can be even worse.
One of them described his experience in the Dark Prison as a "perpetual nightmare."
For individuals who are held in dark cells for extended periods -- this can be utterly terrifying. They have no sense of where they are and in fact it's intended, I believe, to strip them of their dignity, to strip them of a sense of time and place, and to instill in them this utter sense of fear that are they going to be taken out and killed, what's going to happen to them next?
When you combine that with exposure to loud frightening noises that makes it even worse. And in fact individuals exposed to loud noises repeatedly this can result in chronic hearing loss. This can result in other problems.
It's common for individuals subjected to torture and other abusive methods that months or years after the abuse has ended triggers in the environment that remind them of what they've suffered can result in terrifying things. So I've had patients who, as part of their abuse, were held in dark cold cells and years later were terrified of the nighttime, or sleeping with the lights off. Or if they were exposed to cold, it triggered this terrifying memory of when they were in that dark, cold prison cell.
Prisoners who've been released have reported that this manipulation of temperatures of extreme hot, extreme cold was also relatively common in the treatment of the prisoners at Guantanamo.
So exposures to extremes of heat or cold can result in harmful physical and psychological consequences. So, first, exposure to heat for extended periods. This can result in dehydration, in confusion, in lethargy, in loss of consciousness. Individuals actually exposed too long to extremes of heat can result in hyperthermia, where the core body temperature can go up and this can be potentially fatal.
Similarly, exposure to extremes of cold can result in a number of harmful physical and psychological consequences. Hypothermia, as it's known, in addition to being quite uncomfortable, can result in a decrease in the body's core temperature, which can result in arrhythmias, irregular heartbeats or even potentially death. I've cared for individuals who were exposed to extremes of heat or exposed to extremes of cold who, months and years later when they're reminded of these things, have terrifying memories. So, the impact of exposures to heat and cold is both physical and psychological.
One of the people I talked to said that the most searing experience for him, given all that happened to him, was when he was kept in a prison in Afghanistan. He didn't know what had happened to his family after he was picked up, and he was led to believe that the woman screaming in the cell next to his was his wife. And that's the one thing he can't get past.
For many torture victims that I've evaluated and treated, almost worse or often worse than the abuse they experience themselves was what they believed happened to ones they cared about or colleagues. And this may be manifested by having heard the screams -- the terrifying screams of individuals they know or love being tortured or abused in the room next door. And so over and over, I've heard individuals recount to me that more frightening and more painful was the abuse that they themselves endured was knowing that someone they loved and cared about was being subjected to these abusive methods.
And with that, the sense of helplessness that they could do nothing to stop this. And that sense of helplessness also is profoundly traumatizing. What torture does is it undermines an individual's sense of trust, their sense of safety, their sense of control. It completely goes in the face of the core of what we believe is -- makes up our social fabric. And torture, as a result of this and because of the different methods used, results in devastating physical, psychological and social suffering. I'll often talk to individuals who've been subjected to torture and abusive methods, and I'll ask them, "How are you different now compared to before these things happened?" And often what I'll hear is that, "Well, you know, before I was very outgoing or I liked to be around people and now I find I'm irritated all the time. I don't trust other people. I just want to be by myself."
So torture really tramples the core social fabric, basically undermines our sense of trust and safety in devastating ways, both for the individual and the entire community. It's been said that when one individual in the community is tortured, the entire community is tortured, as well, through a ripple effect of fear, mistrust and terror. And these chilling effects go far beyond that individual who was subjected to torture or other abusive methods.
This same person who was led to believe that he was hearing the screams of his wife -- he had a child born while he was a prisoner. And he said that in his mind he distanced himself from that child whom he had never met. And since he has been released he has been unable to bridge that distance.
I've heard this over and over again from individuals that I've cared for that far more painful than their own abuse was what they heard or believed others were being subjected to, be it the screams of pain or fear for a loved one or colleague. And that individuals may try to distance themselves emotionally from this, but that's very difficult. And what happens is they may be haunted for months or years after this experience happened. Or if an individual has numbed themselves, you know, to try and distance themselves from these fears or terrors, what happens is that they have this blunting of their affect, this numbness.
And, in fact, many of these symptoms that I'm describing are classic symptoms of Post-Traumatic Stress Disorder. Post-Traumatic Stress Disorder is a severe form of anxiety where an individual re-experiences the terror that they had endured, either in the form of nightmares or recurrent intrusive memories. They experience hyper-vigilance or being easily startled, that they're always on guard, or that they experience an emotional numbing. Or unable or not wanting to remember the most terrifying components of what happened to them. Those symptoms, be it recurrent memories of what happened, or emotionally numbing or distancing oneself from these painful memories are classic hallmarks of what is a horrific psychological problem.
Every one of the people that I talked to were put in solitary confinement, total isolation, some for a year and a half, one for two years, some for slightly shorter than that. What is the impact of that isolation?
Prolonged isolation, solitary confinement -- again, it undermines the core social fabric. We're social beings. And so by being placed in solitary for extended periods, first, you're subjecting an individual to what's a terrifying experience, an experience filled with uncertainty, filled with terror of what's going to happen next. Are they perhaps going to be killed? And so, always that sense of feeling on edge and uncertain, which is, I believe, the intention of the individuals subjecting them to this.
But then this also can undermine their ability to make social connections in the future with other individuals. It's not uncommon that individuals will become terribly frightened, will become paranoid, may even begin to hallucinate. And again, not necessarily useful means for eliciting accurate information, but the psychological impact of such methods can be horrific. And in addition to the profound anxiety, this can also result in severe feelings of hopelessness, of helplessness, of depression, feelings of profound sadness which can last for months or years afterwards, where individuals may really wish that they were dead or, in fact, think they're going to die. For months or years after have suicidal thoughts or ideas, which are manifestations of this profound sense of hopelessness and sadness.
Torture can have devastating health consequences, physical, psychological and social. And all of these are interdependent and connected, so that, for example, if someone was beaten, they may suffer real physical injuries, but those physical injuries then months or years later when they have muscle aches or back aches that can trigger terrifying and frightening memories. And those terrifying and frightening memories can then result in profound and social phobias, fear and isolation. So these different dimensions of health, the physical, the psychological and social are all interconnected and can play on an individual months and years later.
And as a doctor who's cared for torture victims from all over the world, I've seen the physical scars from torture from being burned, from being beaten, I've seen the physical injuries, musculoskeletal pain, headaches, dizziness. But it's very common that far more damning and far longer lasting than the physical effects can be the psychological health consequences of this abuse, the haunting memories and nightmares, that sense of helplessness and hopelessness and depression, the paranoia and mistrust, those symptoms can go on for months if not years, if not potentially a lifetime after what an individual has endured.
We know that at least one prisoner at Guantanamo was touched with what he believed to be the menstrual blood of his female interrogator. There are other examples of sexual humiliation that even the lawyers cannot discuss with me because their clients have asked them not to make them public.
I've interviewed and evaluated many individuals who've been subjected to forms of sexual humiliations, which may not leave any physical marks, but for many individuals are some of the most horrific things that they have told me that they were subjected to. Being forced to stand naked for extended periods or being sexually humiliated, having their genitals fondled or having someone of the opposite sex seeing them naked or doing sexually abusive things to them. And this is particularly true for individuals from cultures where this is particularly a taboo. And so such methods, such humiliations, which are really degrading and shameful, can often be among the most haunting things that individuals may experience and can result in lasting shame. Shame so profound that years later, individuals may not feel comfortable talking about these methods.
It reminds me myself of the first time I saw those photos from Abu Ghraib. I was dumbfounded. How could this happen under our watch? And actually, I think there's several ways that this can happen. First, it's easier to do these abusive methods, to torture individuals, than we'd like to think. And that's because, one, we think of individuals as "the other," we dehumanize them. Or we somehow rationalize or condone what we're doing as somehow needed for national security. And then we emotionally distance ourselves.
And then it may well happen, as I believe was the case in Abu Ghraib, in an environment that not only didn't have protections against these things, but in fact, condoned them from occurring. So to me it's ridiculous to think that this was "the bad apple phenomena," just something happening on the night shift. It's clear that unless there are very clear and specific guidelines forbidding abusive methods, techniques being used, that this will happen, human nature being what it is. And we know this from a variety of experiments that have been conducted, and psychological experiments that have been conducted as well as the experience of what we've learned about has happened both in Abu Ghraib and in Guantanamo.
Sexual humiliations of being forced to be naked, or put in inhuman degrading positions can be among the most devastating traumatic events. What can be more helpless to an individual than being naked, totally exposed and publicly humiliated? This is profoundly degrading and can clearly result in long-term psychological harm.
If, as you've suggested and many others whom we have talked to have said, these tactics are not designed to elicit truthful information, then what is the purpose?
I think there's an erroneous belief that somehow these methods are useful or effective at eliciting accurate information. And I think just the opposite is true. Over and over, I've heard from patients that I've cared for, individuals who've been tortured, that they would say whatever they thought the torturers wanted them to say. So it's dubious at best as to whether these methods are effective.
Now, while it's dubious that these methods are effective, to me what is clear is that when we as a society in any way condone or sanction torture, first, I believe we cheapen who we are as a society, as a community. And we also make the world a much more dangerous place. Torture is always invoked in the name of "national security," whether it's the Chinese authorities torturing the Tibetan monk, who dared to chant, "Long live the Dalai Lama, free Tibet," or African despots who are abusing student advocates speaking out in favor of democracy.
And so when we, as a country and as a society condone torture, we make the world a much more dangerous place.
Look, I was rounding the bend at the Lincoln Tunnel when the first plane hit the World Trade Center. And then I rushed over to Bellevue Hospital to do, you know, what I and others could to help individuals in the towers.
So I understand where this fear comes from, but torture is clearly not the answer. I think there has, though, been this sense that well, one, clearly you know, we have to torture because we live in dangerous times. And I think we need to be very cautious of going down that road because ultimately torture is not effective and it will make the world a much more dangerous place. But I think in many ways we become numbed to torture. We've become numb to it by using ridiculous terms such as "enhanced interrogation techniques" or even the term "waterboarding" seems to sanitize what are really just horrific and abusive methods. And then also the way that torture is often presented in the media, where it's now being romanticized; that it's heroes who are using torture often in the "ticking bomb" scenario, which, if one watches TV, one thinks that the ticking bomb scenario happens at least 10 times a week, which couldn't be farther from the truth. The ticking bomb scenario is fine as a law school hypothetical, but its application in the real world, I think, is dubious at best.
And actually having spoken, you know, recently to a number of individuals who dedicated their careers to interrogation, they tell me that, you know, even in the case of needing information in a time-sensitive manner that these methods are not effective. There's a saying in science, "garbage in, garbage out." And these methods, you know, result in inaccurate and, I believe, in unreliable information.
But I believe we as a society have become numbed to the horror of this torture. We as a society have become numbed to the horror that is torture. We've been led to erroneously believe that these methods are effective when we see on television that somebody is tortured, of course they give away information, which saves hundreds of thousands of lives. Or that they see individuals who have been tortured and then they kind of afterwards walk away and shrug it off. And all of these things couldn't be farther from the truth, that torture does not help elicit accurate information, that torture is somehow benign and that it may be a necessary evil and it's really not so bad. That couldn't be farther from the truth. These methods are horrific and result in both short and long-term physical and psychological harm.
When I first started working with torture survivors and evaluating individuals subjected to these abusive methods, you know, I thought, well, clearly, this is a medieval phenomena, not something part of our modern world. But as we've learned from recent events, recent debates, this is very much a part of our modern world. Torture is documented to occur in more than 90 countries around the world. And all too terrifyingly, and I believe shamefully, those dungeons that we like to think of as a medieval phenomena have, in fact, occurred under our own country's watch, with, I believe, horrific consequences for us as a society and for the safety of individuals around the world.