July of 2013 was an unusual day at the Libertad (Freedom) prison in Uruguay. Miguel Angel Estrella, an Argentine pianist (and now Argentina’s Ambassador to UNESCO), was giving a concert in the same prison where he had been imprisoned and tortured 32 years earlier.
He dedicated the concert to the 50 inmates currently imprisoned. After he was liberated, Estrella had testified against Dolcey Britos, a psychologist who had masterminded the psychological torture of prisoners at Libertad.
Estrella was liberated thanks to an unprecedented international campaign on his behalf. A friend since my youth, he told me in New York about the ordeal he went through while he was a prisoner in Uruguay. A professional pianist, he was subjected to a most unusual and frightening punishment. He was beaten repeatedly on his hands and threatened with amputation, a spiritual death for a pianist.
He told me: “They [the torturers] concentrated on my hands like sadists. They applied electricity under my nails, without stopping and later they hung me from my arms. After two days of torture I hurt all over, and didn’t have any sensation left in my hands. I touched things and didn’t feel anything.
“The last time I was tortured they threatened to cut off my hands with an electric saw, saying, ‘We are going to chop off your hands, finger by finger, and then we are going to kill you, as the Chileans killed Víctor Jara [a famous Chilean folk singer and guitar player who was killed after being tortured, his hands repeatedly smashed before his death]‘.”
The goal of Estrella’s torture was to break him psychologically, to destroy his self-esteem and his hope. Such a carefully orchestrated torture raises the question of how health professionals — including psychologists and psychiatrists — could have participated in it.
When questioned by Dr. Maxwell Gregg Bloche, an American physician and lawyer who investigated the role of Uruguayan military physicians for the American Association for the Advancement of Science, Britos claimed that his role was only that of “diagnostic consultant” to the psychiatrist in the prison.
Estrella, despite all his suffering, was lucky. He survived and is now an internationally known pianist, humanitarian and Argentina’s Ambassador to UNESCO. This is not the case for thousands who are still tortured while in prison, in some cases with the collusion of medical personnel.
It is now known that both German and Japanese doctors killed thousands of people under the excuse that they were conducting medical research. The Nuremberg tribunal of war crimes brought to trial 23 German defendants, some of them physicians, who were accused of crimes involving experimentation on human subjects.
Aside from using human beings to conduct experiments, there are several ways in which medical personnel participate in torture. They range from assessing the prisoner’s health status before initiating torture to determining how much longer it is possible to continue with torture without endangering the prisoners’ survival.
It also involves reviving prisoners who have been made unconscious by pain and punishment, and actively participating in the interrogation process. That professionals who are trained to do everything in their power to alleviate suffering would instead contribute to carrying out torture is one of the most tragic perversions of the medical mandate.
It is a fundamental problem in medical ethics. In the case of physicians, their participation in torture is one of most blatant violations of basic tenets established some 2,500 years ago by Hippocrates.
What is the psychology behind doctors’ participation in torture?
Richard Goldstein and Patrick Breslin offered one explanation: “Most physicians involved in torture seem to be caught up in vast government machines and descend gradually into the torture chamber, propelled by a combination of fear, weakness and self-delusion that is all too depressingly human.”
Norberto Liwsky, an Argentine physician who had been abducted by the Argentine military and who was tortured with the complicity of a medical colleague named Héctor Jorge Vidal, told me, “No one participates in torture without first going through a process of justifying unethical values, even before he enters the torture chamber.”
Whatever the explanation, however, it doesn’t diminish its terrible consequences or the horror of the act itself. Medical associations worldwide need to be more vocal in their condemnation if this sad phenomenon has the possibility of being eliminated.
Dr. César Chelala is an Argentine physician and a co-winner of an Overseas Press Club of America award and two national journalism awards from Argentina.