Malignant Normality

Malignant Normality

The participation of American physicians and psychologists in torture during the Iraq War era became part of an American version of “malignant normality”—a phenomenon I first attributed to Nazi doctors during the Holocaust.

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Thirty years after the publication of The Nazi Doctors: Medical Killing and the Psychology of Genocide, and an additional decade after first encountering them, Nazi doctors remain unwelcome inhabitants of my mind. They are exemplars of what I would now call the normalization of evil. And they further suggest the relative ease with which physicians—members of my own medical profession with its claim to healing—could be socialized to killing.

Most of those involved simply carried out what was expected of them, at times requiring a combination of pressure and guidance from others, heavy drinking, and what could be called faux psychotherapy from more experienced colleagues. But there were some who could be seen as ahead of the curve in improvising and improving the killing machinery.

Nazi doctors, in their reversal of healing and killing, would surely qualify as the most extreme transgressors in the history of the medical profession. But from the beginning of my work with them I was aware of doctors who, in various parts of the world, lent themselves to harming, killing, and experimenting on their fellow human beings. I would also learn that the duality of doctors (or those who are designated as healers in pre-modern societies) was given expression in Greek medical mythology. Asclepius, the son of Apollo and the first skilled healer, made use of a magic potion, which when drawn from the right side of the Gorgon (a monstrous female form) would kill, and from the left side would cure. That mythology gives special intensity to the biblical admonition, “Physician, heal thyself!” I am far from an authority on biblical meanings, but this one surely has something to do with the ultimate capacity of designated healers to kill as well as cure.

Recently, however, the issue has arisen in a particularly troubling fashion. I have in mind the participation of American physicians and psychologists in torture during the Iraq War era.

What emerged was that American physicians, medics, nurses, and psychologists colluded in torture in a number of ways. They failed to report on wounds that could only have been caused by abuse, delayed and falsified death certificates, and contributed medical and psychological information to interrogators in ways that rendered prisoners more vulnerable to what came to be called “enhanced interrogation,” which spilled over into torture.

I found it significant that the New England Journal of Medicine, a much respected professional periodical, asked me to write an article on the subject because of my earlier work on Nazi doctors. I made it clear that I was not saying that American medical and psychological personnel were the same as Nazi doctors. Rather I argued that, from the massive transgressions of Nazi doctors, one could learn much about lesser but still grave transgressions of other professionals.

More recently it has been revealed that two psychologists were architects of the CIA’s torture program. They designed, oversaw, and personally conducted torture sessions, at the same time engaging in a form of unethical experimentation on detainees. That could happen because torture had been approved from above, and in that way became part of an American version of malignant normality. It also became clear that the American Psychological Association, a group that oversees (or should oversee) ethical issues in a profession, instead provided legitimation and cover for psychologists participating in torture. I came to think of this behavior of a professional organization as a scandal within a scandal. Not just individual psychologists but their vast professional organization had succumbed to malignant normality.

The problem of socialization to malignant normality exists in other areas as well. I have encountered it in my recent work comparing nuclear and climate threats. It has long been “normal” for us to build and stockpile nuclear weapons and embrace a policy of nuclear deterrence that includes the possibility of their use. Those who have questioned what has been called “living with nuclear weapons” have been derided as “unrealistic” or “neurotic.”

In terms of global warming, normality is the condition into which we are born, as our society has long run on energy derived from fossil fuels. Those seeking to break out of this dangerous normality have been denounced as job killers and advocates of strangling government regulations.

Our continuing struggles with nuclear and climate threats are bound up with efforts to break out of the malignant normality prevailing in each of them.

Nazi normality took shape around a genocidal ideology, originally put forward by Hitler himself. It was what I call a biomedical vision as a kind of explanation of history: namely, that the Nordic race had once been healthy and dominant as the only culture-creating race; that it became “infected” by destructive Jewish influence and rendered weak and ill; and that it could become healthy and strong again only by ridding it of that Jewish influence. That biomedical vision set the parameters for Nazi normality, and culminated in the mass murder of Jews.

Significantly, very few Nazi doctors believed fully in that ideological vision, the majority holding to little more than the existence of a “Jewish problem” that somehow had to be “solved.” Extreme ideologues do much to create a malignant normality, which comes to pervade most institutions, including medical ones. Then ordinary people who work in those institutions adhere to that normality, often aided by bits and pieces of the extreme ideology. The prevailing normality can be decisive because it excludes alternatives and provides strong pressures for destructive behavior.

Some Nazi doctors experienced a degree of psychological resistance to this reversal of medical function, but they eventually adapted to it. In the process they internalized much of the required “normality”: the sense that this is what one did as a doctor in Auschwitz.

American doctors and psychologists could also be socialized to existing group behavior. The normality they internalized had been much influenced not only by messages from above that torture was acceptable but by dubious legal rationalizations for it, including the denial that some forms of torture were actually that.

But the American colluders in torture did so as part of a democratic society, in which they—and above all the torture itself—could be called to task. Their behavior was uncovered by a number of human rights organizations, by journalists, and by various physicians and others who could write about it in professional journals, as I did. Most important, psychologists could organize and protest, strongly condemn colleagues who had transgressed, and condemn even more their professional organization for undermining, rather than preserving, ethical principles. Eventually President Obama made clear that American torture was to end, and there was a congressional report on many of the details. But we still lack a comprehensive accounting of medical and psychological behavior during the Iraq War era, the kind of study that would tell us a great deal more about vulnerabilities to transgression among professionals in general.

We can begin to grasp those vulnerabilities by looking at professionals’ relation to normalization. The great majority of professionals in any society—of lawyers, doctors, teachers, and others—function within its moral parameters, within its designated normality. This can contribute to a society in various ways and serve a healing function. At the same time such compliance among professionals tends to deepen existing normality and help others to adapt to it.

When normality becomes malignant professionals can be all too ready to serve that version of it as well. Indeed professionals are required for maintaining that malignant normality and bringing others into it.

The Nazis did not try to destroy the medical profession. Rather they subjected it to Gleichschaltung or “synchronization”—which meant getting rid of opposition and Nazifying professional behavior. Along with the coercion and purging, there was a certain claim to idealism. The doctor was not to concern himself with a “selfish” focus on the individual but was rather to be a “physician to the Volk,” the part-mystical term for the German people, collectivity, or race. While American physicians are submitted to no such Gleichschaltung, they can all too readily be socialized to the claims of nationalism and to more specific policies of military command, including torture.

As physicians, as professionals in general, we need to reexamine our relation to societal normality and seek a more universal healing ethic. That is, after all, what the Hippocratic Oath is all about. But beyond that oath, and certainly beyond our adaptation to societal normality, we can be what I call witnessing professionals. We can extend our training and knowledge beyond its technical elements and make use of it to expose and reject, rather than become part of, unethical normality. In that way one would commit oneself not only to “do no harm,” but to function only as a healer in any environment.

We can best honor the victims of Nazi doctors by not only documenting the actions of those doctors but by confronting the conditions of malignant normality that produced them.

Robert Jay Lifton is an American psychiatrist and author. This essay is excerpted from the preface of the new edition of The Nazi Doctors: Medical Killing and the Psychology of Genocide by Robert Jay Lifton. Copyright © 1986, 2017. Available from Basic Books, an imprint of Perseus Books, LLC, a subsidiary of Hachette Book Group, Inc.