How Hospital Stays Resemble Enhanced Interrogation
Authors: Kenneth J. Mishark, Holly Geyer, Peter A. Ubel
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions6 October 2020How Hospital Stays Resemble Enhanced InterrogationKenneth J. Mishark, MD, Holly Geyer, MD, and Peter A. Ubel, MDKenneth J. Mishark, MDHospital Internal Medicine, Mayo Clinic, Phoenix, Arizona (K.J.M., H.G.), Holly Geyer, MDHospital Internal Medicine, Mayo Clinic, Phoenix, Arizona (K.J.M., H.G.), and Peter A. Ubel, MDDuke University, Durham, North Carolina (P.A.U.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3874 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The 1983 Human Resource Exploitation Training Manual from the Central Intelligence Agency (CIA) gives instructions on how to conduct enhanced interrogations of prisoners (1). Studying the parallels between these interrogation techniques and the experience of many hospitalized patients puts forth a haunting revelation—hospital stays unintentionally resemble torture.The manual begins by discussing the transition of the prisoner into a harsh, new environment with a purposely disruptive arrest, the sudden loss of freedom wreaking predictable psychological havoc. Acute illness similarly creates an abrupt transition to the hospital environment, although the abruptness is not purposeful.The CIA manual goes on to recommend ...References1. Central Intelligence Agency. Human Resource Exploitation Training Manual. CIA; 1983. Accessed at https://nsarchive2.gwu.edu/NSAEBB/NSAEBB122/ on 30 May 2020. Google Scholar2. Salas RE, Gamaldo CE. Adverse effects of sleep deprivation in the ICU. Crit Care Clin. 2008;24:461-76, v-vi. [PMID: 18538195] doi:10.1016/j.ccc.2008.02.006 CrossrefMedlineGoogle Scholar3. Cuthbertson BH, Hull A, Strachan M, et al. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med. 2004;30:450-5. [PMID: 12961065] CrossrefMedlineGoogle Scholar4. Goldwater DS, Dharmarajan K, McEwan BS, et al. Is posthospital syndrome a result of hospitalization-induced allostatic overload? J Hosp Med. 2018;13. [PMID: 29813141] doi:10.12788/jhm.2986 CrossrefMedlineGoogle Scholar5. Taylor SE. Hospital patient behavior: reactance, helplessness, or control. Journal of Social Issues. 1979;35:156-84. doi:10.1111/j.1540-4560.1979.tb00793.x CrossrefGoogle Scholar6. DuBose JR, Hadi K. Improving inpatient environments to support patient sleep. Int J Qual Health Care. 2016;28:540-553. [PMID: 27512130] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Hospital Internal Medicine, Mayo Clinic, Phoenix, Arizona (K.J.M., H.G.)Duke University, Durham, North Carolina (P.A.U.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3874.Corresponding Author: Kenneth J. Mishark, MD, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054; e-mail, mishark.[email protected]edu.Current Author Addresses: Drs. Mishark and Geyer: Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054.Dr. Ubel: Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708.Author Contributions: Conception and design: H. Geyer, K. Mishark.Drafting of the article: H. Geyer, K. Mishark.Critical revision for important intellectual content: H. Geyer, P.A. Ubel.Final approval of the article: H. Geyer, K. Mishark, P.A. Ubel.This article was published at Annals.org on 21 July 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIn-hospital stress and patient outcomes: A systematic review and meta-analysisTorture Survivors and Asylum: Legal, Medical, and Psychological PerspectivesTrust-Based Partnerships Are Essential — and Achievable — in Health Care Service 6 October 2020Volume 173, Issue 7Page: 572-573KeywordsBloodHealth careHospitalizationsPulse oximetrySleepSmellTasteVital signsWalkingWeight loss ePublished: 21 July 2020 Issue Published: 6 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...