Physicians, the Spanish Inquisition, and Commonalities With Forensic Psychiatry.

The Spanish Inquisition was founded in 1478 by the Catholic monarchs and operated with the goal of controlling heresy in society. Religion was omnipresent, and Jewish conversos (Jews who had converted to Christianity) who continued to observe Jewish practices were many of the accused. In cases in which the defendant was thought to have mental illness, the Inquisition's physicians were to evaluate the person and provide reports and expert evidence. Those defendants who were found to have genuine mental illness were generally freed or transferred to specific hospitals for those with mental illness. Case examples elucidate the methods used by the Spanish Inquisition physicians to differentiate mental illness from malingering and heresy. Physicians also treated inmates and participated in evaluations regarding the appropriateness of torture. Understanding the events of the Spanish Inquisition and the role of physicians holds relevance for contemporary forensic psychiatry.

Ahmadreza Djalali, MD, PhD is Dying.

Editor-in-Chief Note:Dr. Djalali is a well-known member of the international disaster medicine community. He is a man always with a smile and sincere in seeking the best for all mankind. His now extremely prolonged imprisonment without due process to allow him to defend himself represents one of the most profound inhumane acts on the globe. His torture and starvation are beyond comprehension for the international health and medicine community as well as all men and women. The pictures that accompany this editorial are published with proper permissions and have been authenticated as untouched from the originals.

Johan Lansen 1933-2019.

Johan Lansen, a deeply-valued colleague, teacher, advisor, clinical supervisor and personal mentor for many, died at age 86 on November 26, 2019 in his hometown of Amersfoort in the Netherlands.

Paul Broca's clitoridectomy as a cure for "nymphomania": A pseudo-medical mutilation.

Paul Broca (1824-1880) is considered one of the founding fathers of modern neurology, mainly because of his major contribution to the anatomo-clinical method (Figure 1) (Sagan, 1979). He has also distinguished himself by his fascination with cranial measurements at the origin of modern physical anthropology and, unfortunately, racial theories based on cranial indices (facial angle and brain volume, mainly) (Gould, 1981).But what is less known is that Broca has been illustrated by particularly archaic and mutilating therapeutic practices, such as what is now considered to be female genital mutilation.

Showers: from a violent treatment to an agent of cleansing.

In the early nineteenth century, physicians designed the first manufactured showers for the purpose of curing the insane. Sustained falls of cold water were prescribed to cool hot, inflamed brains, and to instil fear to tame impetuous wills. By the middle of the century showers had appeared in both asylums and prisons, but shower-related deaths led to their decline. Rather than being abandoned, however, the shower was transformed by the use of warm water to economically wash the skins of prison and asylum populations. In stark contrast to an involuntary, deliberately unpleasant treatment, by the end of the century the shower was a desirable product for the improvement of personal hygiene and population health.

From Nuremberg to Guantanamo Bay: Uses of Physicians in the War on Terror.

Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

From Hohenschönhausen to Guantanamo Bay: Psychology's role in the secret services of the GDR and the United States.

This paper presents a historical analysis of the genesis, context, and function of "Operative Psychology," a little-known branch of applied psychology developed by employees of the Ministry of State Security in the German Democratic Republic. For 25 years, theories and practices of Operative Psychology were taught to elite agents at the Juridical Academy in Potsdam, introducing them to various "silent" psychological techniques of persuasion, interrogation, and repression. After highlighting the economic and political context that increased the need for "silent" techniques of observation and repression, an overview of the topics that were taught and researched at the chair for Operative Psychology is given. Examples of how these techniques were put into practice are provided and the consequences for the victims of Operative Psychology are discussed. Furthermore, commonalities and differences between Operative Psychology and the use of psychological torture by the CIA during the "war on terror" are discussed and questions regarding the relation between methodological and moral strategies of justification are addressed.

The Medicinal Rod: Slave Health and Redhibition Law in George Washington Cable's The Grandissimes.

The economic transactions and litigation necessary for slavery to function, coupled with the South's honor culture, meant skepticism and posturing frequently attended the buying and selling of enslaved people. This atmosphere provided opportunities for enslaved individuals familiar with the symbiotic ways their health and value intertwined to manipulate owners by feigning illness or adopting behaviors contrary to those of a "sound and sane" captive under Louisiana's redhibitory (slave warranty) law. Such actions offered a chance at preserving that which slavery denied its victims: proximity to family, a reduced chance of being sold, and an opportunity to exert agency within a strictly oppressive system. In dramatizing these paradoxes, George Washington Cable's The Grandissimes illustrates the vile hollowness of owners' paternalistic attitudes towards the enslaved, acknowledges the subjectivity and will of enslaved individuals, and castigates the return of slavery-like conditions in the form of the convict lease system.

Pestilence, riots, lynchings and desecration of corpses. The sleep of reason produces monsters.

Vampirism has been a component of Central European and Balkan folklore since the Middle Ages and was often believed to be responsible for the transmission of serious infectious diseases such as plague and tuberculosis/consumption. Vampirism was believed to be spread within the same family or village and if the rite of the so-called second burial after death was not performed. The practice of "second burial" entailed exhumation of the body and the removal of the shroud from the mouth of the corpse, and a search for evidence if the corpse had chewed the cloth. If the shroud was chewed, a handful of earth or a brick was put into the body's mouth so that the vampire could no longer harm others. In some cases, the corpse was decapitated and an awl, made of ash, was thrust into its chest. Furthermore, the limbs were nailed down to prevent its movements. Remarkably, these beliefs were not restricted to the popular classes, but were also debated by theologians, political scientists at the height of the eighteenth century (Enlightenment). In the Habsburg Empire, this question attained such important political, social as well as health connotations as to force the Empress Maria Theresa to entrust an ad hoc study to her personal physician Gerard van Swieten with a view to determining what was true about the apparitions of vampires that occurred throughout central Europe and in the Balkans. The result of this investigation led to a ban on the "second burial" rites. Despite this prohibition, the practice of necrophilia on the bodies of suspected people continued, and both a cultured and popular literature on vampirism continued to flourish well into the nineteenth century.

Incommunicado detention and torture in Spain:Part I: The Istanbul Protocol Project in the Basque Country.

There is increasing evidence to show that torture is a serious problem in the Basque Country. Whilst such evidence can be found in reports of international human rights monitoring bodies, sentences of Spanish and international courts, and empirical studies, they are limited in not having followed the Istanbul Protocol (IP) in order to evaluate the reliability of torture. A working group composed of professional associations of psychiatrists, psychologists, physicians and lawyers, in collaboration with the University of the Basque Country, conducted a four-year study on the medical and psychological consequences of torture in incommunicado detainees, including an assessment of credibility in line with the IP. The methodological design included a multi-level peerreviewed blind assessment and input by an external expert (from the Independent Forensic Expert Group facilitated by International Rehabilitation Council for Torture Victims (IRCT)). A sample of 45 Basque people held in short-term incommunicado detention under anti-terrorist legislation (between 1980 and 2012) in Spain who had reported ill-treatment or torture was selected. The findings are divided into four papers: the present introductory paper; the second analyses the credibility of the allegations of torture and introduces an innovative methodology that enhances the IP, the Standardized Evaluation Form (SEC); the third provides an analysis of the methods of torture and introduces the concept of Torturing Environments; and, in the last paper, the psychological and psychiatric consequences of incommunicado detention are analyzed. The collection of papers are intended to be useful not only in the documentation of torture in the Basque Country and Spain, but also as an innovative example of how the IP can be used for research purposes.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol.

BACKGROUND: The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture. OBJECTIVE: Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP. METHOD: Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent. FINDINGS: According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports. INTERPRETATION: When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.

Incommunicado detention and torture in Spain, Part III: 'Five days is enough': the concept of torturing environments.

BACKGROUND: Torture is changing in western societies, evolving from pain-producing torture to more subtle mixed psychological methods that are harder to detect. Despite this, there is not an adequate understanding of the complexities of contemporary psychological techniques used in coercive interrogation and torture. METHODS: The interrogation and torture techniques used on 45 detainees held in short-term incommunicado detention in Spain during the period 1980-2012 were analyzed. The list of torture categories set out in the Istanbul Protocol (IP) were assessed quantitatively. Software-aided qualitative analysis of the testimonies was conducted, using both inferential and deductive approaches to deduce a classification of torture techniques from the point of view of the survivor. FINDINGS: The most frequent methods according to the IP categories used against detainees were isolation and manipulation of environment (100%), humiliation (93%), psychological techniques to break down the individual (91%), threats (89%) and forced positions and physical exercises until extenuation (80%). Additionally, with a frequency of between 51 and 70%, mild but constant blows, being forced to witness the torture of others, hooding (mainly dry asphyxia) and unacceptable undue conditions of detention were also frequent. Sexual torture was also widespread with sexual violence (42%), forced nudity (38%) and rape (7%). Qualitative analysis showed that most detainees were submitted to coercive interrogation using a wide array of deceptive techniques. This is often a central part of the torturing process, frequently used in conjunction with many other methods. It was found that giving false or misleading information or making false accusations was most frequently used, followed by maximization of responsibility or facts and giving false information regarding relatives or friends. Different patterns of harsh interrogation, ill-treatment and torture are described that appear to have been tailored to the profile of Basque detainees. INTERPRETATION: The study shows the need to improve the conceptualization of psychological torture suggested by the IP. Key to this view is the idea that we must not concern ourselves with 'torture methods' but with Torturing Environments. The concept of Torturing Environments is defined and proposed as a focus for future study.

Forerunner of the Science of Psychoanalysis? An Essay on the Spanish and Portuguese Inquisition.

The inquisitions in Spain and Portugual were state organs, rather than church-run enterprises; their purpose to modernize disparate jurisdictions during the final stages of Reconquista (return of Moorish areas to Christian administration) to ensure security and loyalty. So many Jews converted (under duress or willingly for strategic reasons) and inter-married with middle-class and aristocratic families, that their sincerity and loyalty was suspected, This meant going beyond traditional monitoring of ritual acts and social behaviour; there was a need to look below the surface, to interpret ambiguity, and to break codes of duplicity. Inquisitors developed techniques of a form of psychoanalysis before the discoveries of Freud: methods of questioning to bring out repressed beliefs and motivations, unriddling equivocational performance and speech-acts, and integrating fragments of information from family members, business associates and neighbours collected over many years. Torture, more threatened than actual, and lengthy incarceration punctuated by periods of exile and re-arrest after years quiet, provoked desperate confessions and specious denunciations, all of which had to be subject to intense scrutiny and analysis. The assumption was modern: a person's self was no longer equivalent to their words and actions; instead, a deep dark and traumatized inner self to be revealed.

From punishment to education--juvenile delinquency in Romanian criminal law.

For centuries children were considered "mini-adults". Together with expressing the need to educate children and putting a stop to their integration in the work field from the earliest years the 19th century also displayed a new image of the child, which clearly separates him from the adults. In this paper the authors analyze the Romanian legislation addressing juvenile delinquency in criminal temporal evolution. On the one hand the minority age limits are sought and modulation of legislative provisions according to these, and on the other hand, types of penalties for minors are discussed. The authors conclude that the approach to juvenile delinquency in the current Romanian Criminal Code is the result of a long process of reflection of the legislators on adopting a different system of sanctions for juvenile offenders and on creating special regulations concerning the prosecution, trial and enforcement of the decisions regarding them.

A Horrible Experiment.

A patient presented to my office who had been tortured in the course of a wartime medical experiment many years ago. Seeing him prompted me to explore my personal reaction to his case and to reflect on the history of the ethics of medical experimentation in the 20th century.

How was the Turin Shroud Man crucified?

As the literature is not exhaustive with reference to the way the Turin Shroud (TS) Man was crucified, and it is not easy to draw significant information from only a "photograph" of a man on a linen sheet, this study tries to add some detail on this issue based on both image processing of high resolution photos of the TS and on experimental tests on arms and legs of human cadavers. With regard to the TS Man hands, a first hypothesis states that the left hand of the TS Man was nailed twice at two different anatomical sites: the midcarpal joint medially to the pisiform between the lunate/pyramidal and capitate/uncinate bones (Destot's space) and the radiocarpal joint between the radio, lunate and scaphoid; also the right hand would have been nailed twice. A second hypothesis, preferred by the authors, states that the hands were nailed only once in the Destot's space with partial lesion of the ulnar nerve and flexion of the metacarpophalangeal joint of the thumbs. With regard to the TS Man feet, the imprint of the sole of the right foot leads to the conclusion that TS Man suffered a dislocation at the ankle just before the nailing. The entrance hole of the nail on the right foot is a few inches from the ankle, and excludes a double nailing. The nail has been driven between the tarsal bones. The TS Man suffered the following tortures during crucifixion: a very serious and widespread causalgia due to total paralysis of the upper right limb (paradoxical causalgia); a nailing of the left wrist with damage to the ulnar nerve; a similar nailing of the right wrist; and a nailing to both feet using one only nail that injured the plantaris medialis nerves. The respiratory limitation was probably not sufficient to cause death by asphyxiation. Also considering the hypovolemia produced by scourging and the many other tortures detectable on the TS, the principal cause of death can be attributed to a myocardial infarction.