Doctors & Torture: A Conversation with Steve Miles and Rosa Garcia-Peltoniemi Part III

Part III of our conversation with Steve Miles and Rosa Garcia-Peltoniemi about doctors and torture. In this final segment, Steve and Rosa discuss the state of accountability in the United States and lack of awareness among health care providers about torture experiences of their patients. Read Part I here and Part II here.

Where is the accountability movement in the United States?

Steve Miles: In the United States, right now the struggle against medical involvement in torture is entirely by NGOs, especially Physicians for Human Rights and the National Academy of Science. The American Medical Association and all state licensing boards have declined to get involved in the accountability movement. Typically NGOs go first before organized, formal institutions get involved in accountability. In this country, NGOs are naming physicians who are involved but the organized professionals, including the American Psychological Association, are doing nothing.

Rosa Garcia-Peltoniemi:  With the American Psychological Association (APA), there are several elements to this. Many of the psychologists do not belong to the APA because it is very costly. Among new psychologists, many simply don’t join because it just costs too much money.

There are also huge economic incentives that prevent the APA from really taking the stance that ought to be taken. The APA members receive huge grants from the federal government. That to me has always been a major impediment. When I get together with other colleagues at a conference, for example in the Twin Cities, torture is such an esoteric topic that it would never come up. People are interested in bread and butter issues, which of course are important. Most private practitioners wouldn’t know. There isn’t this kind of passion that there used to be among psychologists for human rights, particularly international human rights.

Steve: I agree but in some ways it represents both the fact that the subject is unpleasant but the failure to recognize the enormous size of the problem. We have 40,000 torture survivors in Minnesota, 500,000 in United States – that’s as many people with Parkinson’s Disease. They have tremendous psychological and physical disabilities. It affects domestic violence, parenting skills, addiction. We know the presence of torture in a country is associated with things like less access to clean water, poor vaccination rates, brain drain and immigration to this country. So in this sense, torture in Haiti does affect us. It aggravates the ability of Haitian society to rebuild after the earthquake but also causes more refugees to come to our shores.

One characteristic of torture is that it is aimed at the best and the brightest, as opposed to criminals. Torture victims tend to be labor leaders, political leaders, journalists, lawyers, and torture has a deleterious effect on those countries [because those are the leaders who leave].

Rosa: I very much agree. There is such a disconnect with the American public and the professionals that I run into, other therapists and psychologists. They don’t see this population so that is one big problem.  With my clients here [in Minnesota], I have to work very hard for them to disclose their history of torture to other [health care] providers outside of our center.

Steve: Rosa, do you think they don’t see because they are rare or because they don’t look? Once upon a time, psychologists didn’t see homosexuals or alcoholics, and we learned to ask and started seeing.

Rosa: Absolutely.

Steve: Screening is so poor. And when you see people coming from sub-Saharan Africa and East Africa, the percentage [of refugees who experienced torture] is up to 20 to 30 percent. But there is no screening system so we don’t know what we’re seeing.

Rosa: No screening and no access of this population [to providers]. I’m talking about folks in private practice. A few, hospitals, but they are fewer, and in those places where this kind of work is relegated to cultural professionals, people like me.

I think there is a segmentation as well. It’s not just because people don’t want to see it. They’re concerned with some of those older things we’re not seeing, 40, 30, years ago. Child abuse for example. So there is this time lag, most of my colleagues that I’m interacting with are not caught up with the implications of globalization and the related issues that affect us in deep ways. From the torture survivor’s perspective, why should I have to educate these folks? That comes up. They’re coming up against the lack of exposure to world news, lack of geographical knowledge of even educated professionals.

Steve: That’s absolutely true and to that list I would add, you have elected officials who do not want to include a screening question for torture on new immigrant’s mental health surveys to allow us to decide what their needs are, because to know that information would create demand for services.

Rosa:  People at the federal government level don’t really think there is anything important to know. They may have mind set, and we come across this at CVT quite often, that all refugees need is jobs. Why do we need to know whether they were tortured or not? All our efforts need to go to getting them jobs. And they would cite anthropological research on that. Even with our own or most informed mechanisms to help refugees, we have this avoidance, this conflict that does not lead to proper identification and treatment as needed.

Steve: It’s not as if there isn’t incredible expertise on this. For a taboo zone that no one will talk about, a huge amount is really known. The question is, making that knowledge part of the public discourse.

Rosa: Part of the public discourse in a way that’s not turned against the people who are suffering the consequences. That’s the fear that a lot of the survivors have and that lead them to cover up and not to seek appropriate services.

For more information about medical complicity in torture and how to get involved, visit Doctors Who Torture, an accountability project founded by Steve Miles. If you missed the first part of Steve and Rosa's conversation, Part I is posted here and Part II here.