Human Nature: Science, Technology, and Life.

Torture, Mind, and Body

Does torture inflict lasting psychological harm?

Yesterday we examined the CIA's reasons for involving psychologists in the Bush torture—sorry, I meant detainee interrogation program. The psychologist's job was to figure out how to inflict unbearable anguish on prisoners without requiring violence, or at least without leaving visible scars.

But what about mental scars?

In the Los Angeles Times, Sarah Gantz and Ben Meyerson look into the controversy:

The conclusion in recently released Justice Department memos that CIA interrogation techniques would not cause prolonged mental harm is disputed by some doctors and psychologists, who say that the mental damage incurred from the practices is significant and undeniable. ... Interrogation techniques undoubtedly have lasting effects, [professor Nina Thomas of NYU] said, such as paranoia, anxiety, hyper-vigilance and "the destruction of people's personalities." ... "Some of these [techniques] clearly have a very real physical component," said Dr. Allen Keller, director of the Bellevue/NYU Program for Survivors of Torture. He cited waterboarding. ... A prisoner deprived of sleep may be overwhelmed with memories of torture when they become tired years later, Keller said. The same is true, he said, for the stomach growls of those tortured by starvation.

I'll go a step further. The problem isn't just that the techniques are physical. The problem is that the mind itself is physical. I just got back from a conference at Cambridge University sponsored by the John Templeton Foundation. In a series of seminars with neuroscientists and philosophers—among them, Chris Frith of University College London, Alva Noe of the University of California-Berkeley, and Fraser Watts of Cambridge—we explored how physiology, mental activity, and environmental conditions transform one another. You can't torture the mind without altering the brain. And since the brain is part of the body—in fact, the part of the body that most influences all the others—the marks you leave are pervasive. You can alter any physical process in which the mind is involved: sleep, eating, conversation, love, going out in public, or all of the above.

The U.S. military knows this. Its brochure for service members with post-traumatic stress disorder states:

PTSD is a condition that develops after someone has experienced a life-threatening situation, such as combat. In PTSD, the event must have involved actual or threatened death or serious injury and caused an emotional reaction involving intense fear, hopelessness, or horror. ... People who have PTSD have experiences from all three of these categories ["Re-experience the event over and over again," "Avoid people, places, or feelings that remind you of the event," and "Feel ‘keyed up' or on-edge all the time"] that stay with them most of the time and interfere with their ability to live their life or do their job.

I look forward to watching Bush's lawyers explain before Congress—and maybe the International Criminal Court—why this diagnosis doesn't apply to water-boarded detainees.

Poverty, Biology, and Intelligence

Why do poor kids have more trouble in school? Is it due to environment or biology?

The answer, according to a new study, may be both.

We tend to think of biological explanations as an alternative to environmental explanations. The clearest example of this conflict is the debate over genetic theories of intelligence. But biology is more than genetics. It includes physical processes that are environmentally influenced. So if poverty causes cognitive impairment, biology should be able to explain part of the effect.

That's what a study published last week in Proceedings of the National Academy of Sciences tries to do. Working with a sample of nearly 200 children, the authors set out to identify "underlying biological mechanisms that may account for the income-achievement gap." But instead of looking for genes, they look for a different kind of mechanism: measurable stress.

And they find it. "Childhood poverty no longer predicts young adults' working memory capacity once chronic stress exposure is partialed from the covariance between childhood poverty and adult working memory," they report. In other words, stress is the missing link. They conclude:

One, we demonstrate that the duration of childhood poverty is related prospectively to working memory performance later in life among young adults. Two, we show that allostatic load, an index of chronic stress, conveys a significant proportion of the covariation between childhood deprivation and an adult's working memory performance. The longer the period of childhood poverty, the higher the levels of allostatic load during childhood, and the greater the reductions in young adults' subsequent working memory. Furthermore, elevated childhood allostatic load predicts working memory in young adults and, in turn, largely explains the prospective relationship between childhood poverty and these working memory deficits.

In an interview with Rob Stein of the Washington Post, the study's lead author enumerates various ways in which poverty can cause stress: "You may have housing problems. You may have more conflict in the family. There's a lot more pressure in paying the bills. You'll probably end up moving more often."

This study alone doesn't settle anything. It hasn't monitored cognitive performance over time, doesn't measure performance beyond working memory, and doesn't rule out other underlying factors. But it shows how biological and environmental explanations can help each other. And that's an important lesson in a field too often polarized between the two.

The Purple Brain

Are mental disorders as important as physical injuries? Many advocates say that they are and that we should treat them accordingly. Most of the fight is over insurance coverage of mental health. But part of the action is in the U.S. military. There, the question has been whether to award the Purple Heart for post-traumatic stress disorder. This week, the Defense Department announced its decision: No.

Eight months ago, when we first checked in on this debate, I was skeptical for two reasons. One was that PTSD would turn out to be widely overdiagnosed. In general, mental wounds are harder to define and identify than physical wounds are. There are obvious cases, but there are also fuzzy ones. Where do we draw the line? How do we keep the Purple Heart from being cheapened?

The second reason was that the Purple Heart, unlike basic health insurance, isn't a policy instrument. It's an honor. Officially, it denotes "meritorious action." And honor isn't the first step in a cultural transformation, no matter how worthy that transformation may be. It's the last.

I've been reading DoD's explanation of its decision and looking back at what I wrote eight months ago. And I'm beginning to think the decision may be wrong.

The reason has to do with gay marriage. The "honor" argument against the Purple Heart for PTSD is a lot like the argument against same-sex marriage. Marriage isn't a right or benefit, conservatives argue. It's a special commitment, a moral institution. Gays may deserve equal employment opportunity, just as mental-health patients deserve basic health insurance coverage. But marriage, like the Purple Heart, is a higher standard. It's an honor that should be awarded last, or maybe never.

Andrew Sullivan nailed this argument 20 years ago: Conservatives are largely right about what marriage is. They're just wrong that this understanding precludes extending it to homosexuals. In fact, they have it backward: Marriage would anchor gays, like straights, against "the chaos of sex and relationships to which we are all prone. It provides a mechanism for emotional stability, economic security, and the healthy rearing of the next generation." The key is to preserve the definition of marriage as commitment: to let go of the heterosexual requirement while fortifying the distinction between marriage and shacking up. My favorite proposal, to prove the point, is same-sex covenant marriage.

Something like that should be the solution to the Purple Heart debate. Opponents of the Purple Heart for PTSD say mental disorders can't qualify because the warrior doesn't "shed blood." That's foolish fundamentalism: Lots of people are wounded without literally shedding blood. DoD also says the wound must be "intentionally caused by the enemy." But the Purple Heart is already awarded for wounds that weren't precisely intended by the enemy. The enemy just throws his grenade at your platoon. Exactly which of you gets incapacitated and how—shrapnel, shock, whatever—isn't his concern.

On the other hand, DoD rightly points out that there have to be "objective" medical ways to distinguish clear-cut PTSD from fuzzy or fake versions. Otherwise, Purple Heart awards will become cheap or arbitrary. Along these lines, the department articulates three clear, reasonable, and tight criteria. First, the wound must be "the result of enemy action where the intended effect of a specific enemy action is to kill or injure the servicemember." Second, it must be "an injury to any part of the body." Third, it must be "caused by the enemy from an outside force or agent."

Can PTSD satisfy these criteria? In principle, I think so. The first criterion is relatively easy to address: You must face the same physical risks as any other Purple Heart recipient. The second is more difficult: Objective physical measures of PTSD must be established. This could be done, for example, with brain scans. We aren't there yet, so consider this a research project for the PTSD movement. The third criterion is a nexus of the first two: You would have to assemble some kind of case file showing that the signs of PTSD in the brain scans or other physical measures postdate the combat incident.

Will service members and veterans with PTSD actually meet these standards? Some won't, and even the most qualified cases will be hard to prove. But they should be, because the Purple Heart is sacred. It's just that there's nothing inherently more sacred about being wounded in your backside than in your brain.