[Ppnews] Involuntary Drugging of Detainees

[Political Prisoner News]

May 16, 2008
http://www.counterpunch.org/

A Pattern of Mistreatment by Health Professionals


Involuntary Drugging of Detainees

By STEPHEN SOLDZ

In Soviet Russia, psychiatrists sometimes 
collaborated with the repressive regime by 
locking up dissidents in mental hospitals and 
injecting them with powerful psychotropic drugs, 
"antipsychotics" designed to treat schizophrenia. 
The Soviet psychiatrists were rightly condemned 
for their misuse of medicine for the 
un-therapeutic  purpose of social control.

American health personnel are not immune from 
cooperating with efforts to misuse psychiatric 
drugs for social control purposes having no 
connection with those drugs' intended uses. The 
U.S. Immigration and Customs Enforcement agency 
(ICE) has been systematically administering 
psychotropic drugs to immigrants in the process 
of being deported as the 
<http://www.washingtonpost.com/wp-srv/nation/specials/immigration/cwc_day4_printer.html>Washington 
Post reported this week. Deportees who in the 
past had resisted deportation were injected with 
drugs, often a three drug "cocktail," in order to 
keep them pliant during deportation. These drugs 
included the powerful antipsychotic drug Haldol, 
as well as the antianxiety drug Ativan, and 
Cogentin, a drug used to treat the often severe 
Parkinsons illness like side effects of Haldol.

These drugs were prescribed by psychiatrists and 
administered by specially selected nurse "medical 
escorts." The drugs were administered in 
extremely high doses, sometimes rendering the 
deportees unable to speak.  It sometimes took 
deportees days or even weeks to get the drugs out 
of their system. Thus 
<http://www.washingtonpost.com/wp-dyn/content/graphic/2008/05/13/GR2008051302779.html>Michael 
Shango was injected with 32.5 milligrams (mg) of 
Haldol, as well as 8.5 mg of Ativan and some 
Cogentin over 11 hours. His initial Haldol dose 
was 10 mg. Compare this with a usual Haldol dose 
of 
<http://www.rxlist.com/cgi/generic/haloper_ids.htm>2 
to 5 mg repeated in 4 to 6 hours for "control of 
the acutely agitated schizophrenic patient with 
moderately severe to very severe symptoms" and 
<http://www.rxlist.com/cgi/generic/loraz_ids.htm>2 
to 6 mg of Ativan daily for patients whose bodies 
have already adapted to the medication; lower 
doses of these drugs are recommended for new 
patients as people need time to adjust to them.

These drugs, especially Haldol are extremely 
powerful and are almost never utilized in 
individuals not diagnosed as actively psychotic. 
They can be extremely uncomfortable, especially 
if first administered in high doses and can 
disorient an individual for days. When Shango was 
imprisoned upon his return to the Congo, he was 
so disoriented that he didn't know where he was 
fortunately, friends helped him escape. It was 
weeks before he fully recovered from the drugs.

This use of powerful medications to control 
detainees is likely illegal. In fact, the Clinton 
administration 
<http://media.washingtonpost.com/wp-srv/nation/specials/immigration/documents/sedation_clintonadmin_policy.pdf>had 
concluded:

"Regarding detainees who are not mentally ill, 
involuntary medication of such persons for the 
sole purpose of subduing them during deportation, 
without a court  order, is not supported by any 
legal authority and raises ethical issues as well."

Regardless of whether this use of drugs is legal, 
it violates the professional ethics of most 
health professions and constitutes a profound 
threat to the role of healer. Doctors, nurses, 
and other health professionals rely upon trust 
between healing professional and patient, trust 
that the interests of the patient are forefront 
in the doctors mind. We incorporate recognition 
of the importance of trust in the crucial 
importance given to patients' informed consent in 
medical decision-making. Except in the most 
extreme of circumstances, drugs and other medical 
interventions should be administered only with 
the consent of, and in the interests of, the person receiving the intervention.

The ethics of most medical professions do allow 
for involuntary intervention in extreme 
circumstances to protect the patient or public 
from imminent harm. Further, in order for a 
medical treatment to be used involuntarily, the 
treatment must be, as the Supreme Court stated in 
considering involuntary drugging of 
prisoners,  "in the inmate’s medical 
interest."  Thus, the American Psychiatric Nurses 
Association, in a 
<http://www.apna.org/i4a/pages/index.cfm?pageid=3348>position 
statement on Mandatory Outpatient Treatment 
(MOT), endorses mandatory treatment, but insists that it is a last resort:

All patients have the right to make their own 
decisions and MOT should be used as a last 
resort. 
  If MOT needs to be implemented, 
measures must be taken to ensure that each 
patient is treated with respect and dignity, and 
that full consideration is given to the patient's 
rights, civil liberties, and confidentiality issues.

The criterion of "use as a last resort" and 
treatment "with respect and dignity
 and that 
full consideration is given to the patient's 
rights [and] civil liberties" is clearly not met 
in the ICE use of these powerful drugs.  The 
psychiatrists and nurse escorts are serving only 
the interests of the ICE and are oblivious to the 
interests or the wishes of those receiving drugs, 
who, because they manifest no medical need, are 
not in any meaningful sense "patients." These 
drugs are being used to control the deportees as 
they attempt to assert their rights. These drugs 
thus are in fact often a way of destroying the 
deportees' ability to resist disturbing and often 
questionable deportations. What could be more 
disrespectful of a person's dignity than to 
chemically destroy his or her ability to resist?

The ICE has recently amended thepolicy that 
allowed involuntary drugging of 
deportees.  Unfortunately, as Physicians for 
Human Rights pointed out in a 
<http://physiciansforhumanrights.org/library/letter-2008-04-29.html>January 
28th 2008 letter to the ICE, the new rules are 
still inadequate and open to abuse:

The new policy, in fact, largely ratifies ICE’s 
past practice, allowing court-ordered forced 
sedation “to effectuate removal” when a 
detainee’s resistance is deemed “dangerous.” The 
Amended Policy also requires evidence from a 
medical doctor that the drug or drugs to be 
forcibly administered are “medically appropriate.”

While we welcome this recognition of medical 
concerns, the Amended Policy offers no criteria 
for the vague standard of “appropriateness,” 
providing far too little guidance and presenting 
far too great a risk that ICE’s sole interest in 
removal will subvert the physician’s obligation to the patient’s health.

The use of drugs by ICE is, unfortunately, part 
of a pattern by the Bush administration of the 
misuse of the health professions for 
non-therapeutic purposes. 
<http://psychoanalystsopposewar.org/blog/psychologists-and-interrogations-key-articles/>I 
and 
<http://www.vanityfair.com/politics/features/2007/07/torture200707?printable=true&currentPage=all>others 
have written extensively about the role of 
psychologists in aiding national security 
interrogations, interrogations that often cross 
the line into torture. Recently the 
<http://www.washingtonpost.com/wp-dyn/content/article/2008/04/21/AR2008042103399_pf.html>Washington 
Post and 
<http://www.cqpolitics.com/wmspage.cfm?docID=hsnews-000002697912>CQ 
reported on likely involuntary drugging of 
detainees (see my commentary: 
<http://counterpunch.org/soldz04232008.html>Involuntary 
Drugging of US Detainees: A Crisis for the Health 
Professions). It is beginning to look as if there 
is a pattern of inappropriate use of 
psychopharmacological agents for overcoming resistances of various types.

So far Congress and the health professions have 
failed to systematically confront the abuses of 
these professions by the current administration. 
The failures, until recently, of Congress to stop 
or actively expose administration abuses are well 
known.  While at times making strong statements 
against certain abuses, none of the health 
professions has taken active steps to investigate 
abuses or to expose or discipline members 
participating in abuses. All too often, good 
sounding words have been a substitute for action. 
Bioethicist Steven Miles, author of 
<http://www.amazon.com/Oath-Betrayed-Torture-Medical-Complicity/dp/140006578X/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1210801587&sr=8-1>Oath 
Betrayed: Torture, Medical Complicity, and the 
War on Terror, said in response to these latest revelations:

Governments do not inject people with antipsychotics, medical personnel do.

In 35 years of practice, I have never had to give 
such high doses of antipsychotics to any person 
with any mental illness as is described in this story.

Again, we have an utter breakdown of the 
accountability of health professionals.  As with 
the behavior of nurses and doctors in the war on 
terror prisons and the use of drugs for the 
CIA-State Department's rendition flights, we have 
a failure of understanding of professional ethics 
and complete passivity of the AMA and the American Nurses Association.

It is time for both Congress and the health 
professions themselves to investigate. Recently 
Senators Levin, Biden and Hagel 
<http://psychoanalystsopposewar.org/blog/2008/05/08/senators-call-for-investigation-of-involuntary-drugging-charges/>wrote 
the Defense Department Inspector General 
requesting an investigation of the reports of 
involuntary detainee drugging. This new report of 
involuntary drugging may be investigated as well.

We need a mechanism, however, for a detailed 
examination of the perversions of the health 
professions by the current administration. I have 
previously called for a Truth and Reconciliation 
process to deal with the shameful cowardice of 
the health professions in actively and/or 
passively aiding the administrations' detention 
and interrogation abuses. Perhaps this process 
needs to be expanded to confront the broad range 
of health profession failures to actively oppose 
their professions' perversion by the forces of the state.

Stephen Soldz is a psychoanalyst, psychologist, 
public health researcher, and faculty member at 
the <http://www.bgsp.edu/>Boston Graduate School 
of Psychoanalysis. He maintains the 
<http://psychoanalystsopposewar.org/ORR.htm>Psychoanalysts 
for Peace and Justice web site and the 
<http://psychoanalystsopposewar.org/blog/>Psyche, 
Science, and Society blog. He is a founder of the 
Coalition for an Ethical Psychology, one of the 
organizations leading the struggle to change 
American Psychological Association policy on 
participation in abusive interrogations. He can 
be reached at: <mailto:ssoldz at bgsp.edu>mailto:ssoldz at bgsp.edu




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