The unhealthy alliance of medicine and state
The American Psychological Association (APA) has had a black eye over the scandal for some time now. This past summer, the APA’s Council of Representatives voted (nearly unanimously) to prohibit psychologists from further participation in the government’s detainee interrogations at places like Guantanamo Bay and other CIA black sites. The APA had little choice in the matter, as the facts surrounding their active collusion with the CIA in the latter’s torture regime have leaked out little by little, culminating with the infamous “Hoffman Report.” The APA’s exposure has provoked international outrage over the organization’s blatant disregard for basic standards of medical ethics and international law. According to the Hoffman Report, previous APA denials over the extent of the organization’s role in the CIA torture program masked direct involvement in the program by the uppermost ranks within the APA.
Like most hindsight reviews of government scandals, it’s now easy to incriminate the APA and the twisted psychologists who helped implement and carry out the CIA’s ghastly torture regime. But we ought to be wary of all present and future attempts at collaboration between the medical establishment and the state. Nothing good can come of such a partnership, no matter how benevolent or necessary either side claims the partnership is.
Let us be clear, no reader can point to a time during his or her life when American medicine was divorced from the state. The point is not to call for a return to some recent past when medicine was pure and free from state meddling. Instead, we simply ought to recognize that increasing the level of the medical-state partnership will result in less focus on the health and well-being of patients, and more on the unrelated, and often deadly demands of Washington powerbrokers.
The CIA-APA partnership, though relatively small in scope, shows how easily the practice of medicine can be perverted and corrupted to suit the needs of some very bad people. We shouldn’t ignore the obvious implications for other medical-state enterprises like Medicare, Medicaid and Obamacare. Those programs, though they now appear to be mainstays of American life, are ripe for corruption as well. One could certainly argue they’ve been corrupt from their inception.
No, we haven’t yet seen the institutionalization of torture in the neighborhood family practice facility. But not all corruption of medicine need resemble the CIA-APA scheme. In Insanity: The Idea and Its Consequences, Dr. Thomas Szasz (writing in 1987) explained the slippery slope of bureaucratized medicine thusly:
With its progressive removal from the free market, medicine has assumed many of the economic and political features, and problems, that have long characterized psychiatry. This is why diagnosis and therapy are now increasingly politicized, and politics is increasingly medicalized.
With what now seems like a bi-monthly mass shooting and Americans desperately seeking an explanation, mental illness has become a convenient scapegoat. It doesn’t seem far away when gun ownership will be off-limits for those diagnosed with mental illness. How long after that will the American government go a step further, marking those who’ve seen a mental health professional as criminal suspects?
Mental illness won’t be the only stigmatized disease as medicine is increasingly politicized. Diseases with high-cost treatments also risk being targeted as state-medicine’s budget is pushed to its limits.
It’s not that the state and the medical profession conspire to gang-up against citizens. It’s merely the natural downward trajectory of any service that comes under the control of state and corporate bureaucrats. Szasz summarizes the trajectory as follows:
As patients stopped and third parties started to pay doctors, doctors lost interest in pleasing patients and became more interested in pleasing those who pay them — insurance companies (regulated by the government) and the State. How do you please a patient? By making him feel better and respecting his wishes. How do you please a bureaucracy? By dramatizing and justifying the great things you are doing for your impersonal beneficiaries.
The CIA-APA scandal is but a symptom (albeit a graphic one) of the larger disease that is the medical-industrial complex. Patients’ health suffers whenever the state injects itself into the medical profession. Sometimes the suffering just takes a more violent, visible and immediate form.
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