The Use of Drugs in Interrogation
Originally published in The Manipulation of Human Behavior
Citation: Gottschalk LA. "The Use of Drugs in Interrogation". In: Birdman AD, Zimmer H, (Eds). The Manipulation of Human Behavior. John Wiley & Sons, Inc. 1961. 96-141.
The purpose of this chapter is to review available scientific knowledge on the use of pharmacologic agents to influence the communication of information which, for one reason or another, an informant does not wish to reveal. This problem in communication is not an unfamiliar one to the psychiatrist, who often aims to recover unconscious conflicts or memories from the neurotic or psychotic patient in the hope of producing therapeutic benefit. The purpose of this chapter, however, is not so much to review our knowledge on how to bring to a person's awareness, the feelings, impulses, and ideas of which he is not consciously aware; rather, the object is to focus particularly on the problem of getting data from a source of information when the individual is aware of the information but does not want to communicate it, either because the giving might incriminate him or put into possible jeopardy an aggregate of people toward whom he feels strong allegiance, identification, and belonging.
In the physician's customary role as a helping person and as a healer, it is generally contrary to his method of operation to employ any coercion, overt or subtle, to induce a patient to behave in a way that may be detrimental to himself or to his social or national group of origin. Coercion may be used, however, if the patient is considered to be behaving in a manner that is destructive to himself (e.g., a diabetic refusing to take insulin or an alcoholic refusing to stop drinking) or to his social group. Furthermore, the code of ethics, particularly of the psychiatrist, ordinarily binds the physician to keep confidential the secrets that his patients impart to him, whether or not the patient has been aware or unaware of their nature. In the practice of psychiatry, the code of respecting and keeping the confidences of a patient is considered to be a tool that facilitates the confession or expression of otherwise taboo material from the patient. The psychiatrist's office is, ideally, one place where the patient finds that he has immunity from punitive or disapproving action by the society in which he lives, except for the adverse criticism forthcoming from the patient's own internalized standards of behavior.
Occasionally the psychiatrist's occupation brings him into contact with patients with whom the psychiatrist himself is led into a conflict between his interest in championing the welfare and privileged communications of his individual patient and that of the welfare of the group: family, city, state, nation. In such a quandary, e.g., the question of what to do about a person who has confided his participation in a major crime, the physician's obligation to the individual and to the community may be in opposition to one another. In this position the physician may be forced to disqualify himself as a continuing confidant for the patient until the patient has remedied his social obligation to the state.
Mentioning these situations and the customary attitude of the medical profession has a bearing on the substance of this report. The use of drugs in obtaining a confession from a criminal, or in obtaining information that a source may consciously wish to keep confidential for fear of repercussion to himself or his group, is fraught with ethical conflicts for the physician. This explains in part why there is a relative paucity of systematized published scientific investigation by physiciaits on this matter. The general feeling in western countries regarding the employment of chemical agents to "make people do things against their will" has precluded serious systematic study of the potentialities of drugs for interrogation. It has not, however, precluded considerable speculation on the subject, some of it rather unrealistic.
Much relevant scientific information has been published on the therapeutic employment of drugs. The bulk of the medical articles of the last few years on the effects of drugs on behavior deals with the use and effects of these drugs on the mentally ill population. In fact, a growing avalanche of articles of this type sprang up with the advent of tranquilizing drugs. From this large body of publications, the reviewer aims to extrapolate to the problems of interrogation. Then, there is a notably smaller group of studies that deals principally with explorations in methods of assessing the psychopharmacologic effects of drugs on relatively normal individuals. From these studies, too, the reviewer aims to transfer what has been learned to the problems of interrogation. Finally, there are the relatively rare published investigations on the use of drugs for purposes of interrogation in police or security procedures; these are reviewed carefully because of their direct relevance.
No published reports have come to the attention of this author detailing the scientific application of drugs by intelligence agencies of any nation as a means of obtaining information. Apparently, what knowledge is available, whether derived from haphazard experience or systematic study, is not accessible in open sources. This reviewer found only two references touching on this topic. Rolin (112) casually claims that the Nazis used mescaline to get information from prisoners at Dachau. In discussing the methods of communist indoctrination of Americans who have fallen into the hands of communists or communist-controlled countries, Hinkle (62) has stated that the methods of Russian interrogation and indoctrination are derived from age-old police methods that have been systematized, and are not dependent on drugs, hypnotism, or any other special procedure designed by scientists.1
II. Methodological Problems in Determining the Applicability of Drugs to Interrogation Procedures: Nonspecific Effects of Drugs on Verbal Behavior
One of the crucial questions arising in evaluating the use of a drug for interrogation techniques is what responses are related to the pharmacologic activity of the drug administered and what responses are related to some other aspects of the transactions taking place when a person receives medication from another person. A large variety of nonpharmacologic factors can affect the responses of an individual after getting a dose of medication (see also Masserman and Pechtel, 102). In fact, one of the major problems plaguing investigators of psychopharmacologic relationships is how to discriminate the factors that are responsible for observed effects, how to single out factors so their sole effects can be observed, and how to study summation and combined effects of different factors. A series of nonpharmacologic factors within the total transaction of a person giving another person a drug has been found to be more or less capable of contributing to the responses occurring with administration of the drug. These factors may be listed and what is known about each will be taken up separately.
- Reactions due primarily to the "placebo phenomenon."
- Silent administration.
- Reactions to attitudes or motivations of the person administering the medication and interacting with the informant.
- Drug effects modified by the current state of the recipient organism.
Reactions Due Primarily to the "Placebo Phenomenon," i.e., Reactions to Taking a Medicinelike Substance, Even Though It Is Pharmacologically Inert
There has been an increasing interest in the importance and mechanism of action of the placebo (46, 67, 83, 135, 136). The studies of Beecher and his group (7, 8) indicate that 30 to 50 per cent of individuals are placebo reactors, that is, respond with symptomatic relief to taking an inert substance. If one is interested in the pharmacology of a new drug and tries it out on a group of patients, a third to a half of this group will be relieved of their symptoms by a placebo; they react favorably to the syringe, pills or capsule, regardless of what it contains. Thus they dilute the significant data derived from the half or two-thirds of the group that react only to the active ingredient in the syringe or capsule. In studying a new drug-whether one is interested in applying its pharmacologic effect toward the alleviation of pain, amelioration of emotional distress, or the facilitation of communication of covert information-the scientist is not primarily interested in the subjective and behavioral effects of syringes and pills. Thus the scientist is obliged to take into account the placebo reactors, who must be screened out if one is to get an accurate idea of what the drug itself does.
Of course, to relieve pain or facilitate communication in a patient or prisoner, the "placebo phenomenon" can be made use of itself and the investigator can expect that in 30 to 50 per cent of trials pain may be relieved or interrogation may be facilitated. Some additional factors are known which increase the likelihood of a placebo effect:
- A sympathetic woman investigator can obtain a higher percentage of pain relief from various niedicatimis than can a colder, more remote male (7).
- Individuals under increased stress are more likely to respond to placebos (9).
- Greater responsiveness is associated with certain personality characteristics according to Rorschach findings with placebo reactors in a group of 162 postoperative patients: (a) more than one "insides" response; (b) Sum C > M; (c) A% < 50%; (d) CF > FC; (e) more than two anxiety responses; (f) less than two hostility responses; (g) average F + % 51; (83).
- Clinical psychiatric findings in the same study regarding placebo reactors found greater responsiveness characteristic of individuals who are more anxious, more self-centered, more dependent on outside stimulation than on their own mental processes; persons who express their needs more freely socially, who are talkers, and who drain off anxiety by talking and relating to others. In contrast to the placebo reactors, the nonreactors are clinically more rigid and more emotionally controlled than average for their age and background. No sex and I.Q. differences between placebo reactors and nonreactors were found (83).
- Subjective responses are the resultant of the action of the original stimulus and the psychic modification of that stimulus.
- Man is the essential experimental subject for a definitive answer to questions in this field, and men are easier to work with than women, for with men the controls are simpler.
- The investigating staff is constant during any given series of experiments.
- The "unknowns" technique is employed throughout. The agents tested and the time they are tested are unknown not only to the subjects but to the observers as well. This requires the use of placebos, also as unknowns.
- When a new agent is to be compared with the agents of past experience, and this is nearly always the case, a standard of reference is required (morphine in standardized dosage is used as the standard for analgesics, etc.).
- Randomization of new agent, placebo, and a standard of reference is essential.
- Significant comparisons of side actions of agents can be made only on the basis of equal strength in terms of their primary therapeutic effect.
- Mathematical validation of supposed difference in effectiveness of the two agents is necessary.
- The subjective (and behavioral) effects of drugs can be quantified accurately and rapidly only when placebo reactors are screened out.
The obverse of placebo administration, the deliberate administration of an inert material, is silent administration, the unknown administration of a pharmacologically potent substance.
The act of administering a medication usually potentiates its effect since it invokes the status of a professional person and the prestige of social institutions and organizations that are a part of the setting. A general recognition of this fact has made the control of the placebo effect a routine feature of all carefully designed drug studies. Conversely, silent administration has received little or no attention.
Not all psychoactive drugs are equally suited to silent administration. A minimal requirement is the successful masking of the drug by substances otherwise introduced into the body, such as foods, liquids, smoke, or air. From this point of view the ideal drug would be tasteless, odorless, and completely soluble.
Theoretically, the net effect of a silently administered drug should be equal to its effect following routine procedures minus its placebo effect. In practice this effect would be modified by the state of the organism, the general setting in which the subject finds himself, and his typical and persistent modes of reacting, i.e., personality-constitutional factors. One may expect a very different reaction from a subject who is sensitive to his internal, subjective processes than from one who has learned to disregard and reject them in favor of "objective" external cues. Likewise, reactions will vary between subjects who yield to and expand upon their internal experiences and those who strive to maintain a steady state by exercising deliberate control in the manner of negative feedback compensation.
For these reasons it is difficult to specify dosage levels at which a subject is likely to become aware that he is responding to a drug, since so much depends on personality and situational factors and on the subject's previous experience with drugs. In naive subjects moderate doses which noticeably modify their behavior may escape their attention, or be ascribed to other sources, such as fatigue, thirst, apprehension, dyspepsia, etc.
The judicious choice of a drug with minimal side effects, its matching to the subject's personality, careful gauging of dosage, and a sense of timing, makes silent administration a hard-to-equal ally for the hypnotist intent on producing self-fulfilling and inescapable suggestions. Surpassing "magic room" procedures in their efficacy, the drug effects should prove even more compelling to the subject since the perceived sensations originate entirely within himself.
Reactions to Attitudes or Motivations of the Person Administering the Medication and Interacting with the Informant
One of the major problems involved in the assessment of drug effects is distinguishing the psychopharmacologic effect of a drug from that consciously or unconsciously desired by the person administering the drug. Another related problem of consequence is the extent to which a drug effect, noted by one person using the drugs to achieve his special aims, may be expected to occur in the hands of another person using the same drug for an essentially different aim. Although one assumption of this present report is that drug effects are to some extent generalizable from one situation to another, the limitations of such generalizing need to be clarified. The inference exists that the reaction to a specific drug when used by a physician to relieve the symptoms of a patient will produce a similar response when used to extract covert information from a recalcitrant source. In every instance, where such extrapolations are made from one such situation to another, the reviewer does so merely because little or no germane scientific reports are available in connection with the interrogation situation. In every instance where such an extrapolation is made, it is for heuristic purposes, and the generalized ideas and concepts require careful testing and validation.
What is some of the evidence that attitudes and motivation of the giver of the drug may affect the observed responses?
A classical study by Hill et al. (61) illustrates how the behavioral effect of a drug may be influenced by the incentives given for participating in a drug study. The subjects were former narcotic addicts who volunteered for research. They were accepted after thorough screening by a board of hospital psychiatrists and other professional personnel, with a view to selecting only subjects with histories of repeated relapses to narcotic addiction and very unfavorable prognoses for future abstention from narcotic: drugs. Simple visual-manual reaction times were measured: without administration of drugs; 50 min after subcutaneous injection of morphine; and 50 min after subcutaneous injection of 250 mg of pentobarbital; each was measured under four incentive conditions, defined in terms of the schedule of morphine rewards offered for participation in the experiments. When a fixed reward was given a week in advance of the tests, morphine accelerated and pentobarbital slowed reaction times. When a fixed reward was scheduled for delivery after completion of the tests, neither drug affected reaction times significantly. When the amount of the posttest reward was made contingent upon speed of performance, morphine exerted no significant effect, but pentobarbital accelerated reaction times. When the same group of subjects were retested one to three days later, with posttest rewards again fixed for all subjects regardless of performance, morphine slowed reaction times and pentobarbital had no significant effect. In other words, depending on the incentive conditions arranged by the investigators, the same dose of either morphine or pentobarbital exerted. either no effect or acted as a "stimulant" or as a "depressant" on simple visual-manual reaction times. Nevertheless, the action of either of these drugs was "specific" with respect to the actions of the other; thus, the action of morphine changed from "stimulant" to "depressant" when conditions changed from "low" incentive (rewards fixed and delivered before testing) to "high" incentive (rewards contingent on performance and scheduled for delivery after testing); whereas the action of pentobarbital changed from "depressant" to "stimulant" when identical changes in incentive were made. Further analysis of the data of Hill et al. revealed that, in comparison with the range of changes in mean reaction times produced by varying the incentive level when no drug was administered, morphine reduced but pentobarbital increased the sensitivity of the subject's performance to changes in incentive level.
A study by Wolf and Ripley (137) illustrates further that the effect produced by a drug depends not only on the particular agent used, the dose and route of administration, but also on the circumstances under which it is given or how its effect is measured. (See also: Rinkel, 110, 111; Sargant, 116.) They observed the effects of amobarbital (0.1 to 0.5 gm intravenously) on 700 patients with various complaints, including hypertension and "tension headache." They found that after administration of the drug, the patients were "at ease" if the setting was "secure" and friendly, but the patients were tense and anxious with equal facility if disturbing topics were introduced during interviews. The effects of the amobarbital on headache and blood pressure varied similarly with the nature of the interpersonal milieu. Another illustration is the report of Beecher (7) that a higher percentage of pain relief from various medications was obtained by a sympathetic woman investigator than by a colder, more remote male.
Drug Effects Modified by the Current State of the Recipient Organism
It is now well known that many drugs when taken internally may produce a transient excitant effect where the user becomes euphoric, talkative, and sometimes emotionally responsive. For example, it has been known through the ages that alcohol loosens the tongue during an excitant phase and that a person with enough alcohol may reveal things he would not ordinarily discuss. As is also well known, however, people react differently under the influence of alcohol. Some become depressed and morose. Some become excited and volatile. Some talk freely and others shut up like a clam. As has been previously pointed out, different people may have different reactions to the same drug and similar reactions may occur to different drugs. One cannot always predict what type of reaction may be obtained.
RELEVANCE OF NONPHARMACOLOGICAL FACTORS
Various factors such as sex, intelligence, and mental and physical condition can influence the speech patterns of an individual. In order to assess the pharmacology of a drug, the predrug differences in verbal communication must be taken into account. Furthermore, there is strong evidence that the pharmacologic effect of a drug interacts with the status of the human organism receiving the drug.
EFFECT OF SEX, INTELLIGENCE AND EDUCATIONAL LEVEL ON SPEECH PATTERNS
It is obvious and requires no documentation that people with differing intelligence and educational level show large qualitative differences on tests of intelligence. That they speak differently under standardized conditions of eliciting the speech would seem to follow, but this has not heretofore been investigated systematically. It is also a common observation that the sexes use language differently, if not in a formal, structural way, then in the items of information that they choose to convey in their speech. Gleser, Gottschalk, and John (54) have studied the relationship of word-type usage to gender and intelligence as measured by the Wonderlic test. They obtained five-minute speech samples of a group of ninety occupationally adjusted, medically healthy individuals. These speech samples were elicted by standardized instructions given by a male investigator. The wordtypes were analyzed and scored according to two systems of categories: a grammatical system and a "psychologic" system. The "psychologic" system attempted to classify words according to the emotive, cognitive, and perceptive processes conveyed, and the animate and inanimate objects denoted, regardless of grammatical part of speech. Under these experimental conditions, significant differences were found to occur in the proportion of certain types of words used by men as compared to women. These differences appeared principally among the "psychologic" categories of words. For example, women tended to refer to themselves more frequently than did men. Women expressed more feeling and emotion, and used more negations. They used relatively fewer words referring to place or spatial relations and to denoting destructive action. Significant differences were also found to be associated, step-wise, with level of intelligence. These differences occurred principally among the grammatical categories. For example, the more intelligent adult was found to use significantly more adjectives and prepositions, but fewer adverbs, verbs, and interjections. A multiple correlation of . 65 was obtained between these variables and Wonderlic I.Q. scores. The differences between the sexes in word-type usage tended to decrease at the highest level of intelligence. These investigators have published tables of separate word-frequency norms for males and females and for word categories that vary with intelligence.
In summary, this study illustrates that gender and intelligence influence speech patterns at the microscopic level of word-types. In experimental studies for determining whether or not a drug will facilitate interrogation, the fact that intelligence and gender separately affect speech requires consideration. Suitable controls need to be included in the research design.
EFFECT OF INDIVIDUAL DIFFERENCES IN PERSONALITY AND CEREBRAL FUNCITIONS ON REACTIONS TO DRUGS
There is considerable evidence to support the concept that the mental and physical state of an individual can affect his reaction to pharmacologic agents.
Kornetsky and Humphries (77, 78) have shown that there are reactors and nonreactors to drugs and that the reactors are likely to be those who are more depressed (on the D scale of the MMPI), to have more unreasonable fears, and overreact to environmental stimuli (the Pt. scale of the MAIPI). These investigators explored the effects of a placebo, promazine, secobarbital, and meperidine hydrochloride on a series of objective motor, intellectual, and perceptual activities, as well as on subjective responses. The subjective responses were evaluated 30, 90, 150, and 210 min after the drug was taken. Promazine and secobarbital had an adverse effect on the performance of motor tasks but not on simple intellectual and perceptual tasks. Meperidine hydrochloride in 50 to 100-mg doses did not impair performance in any of these same psychologic functions. The more deviant a subject was on four MMPI scales (psychasthenia, depression, hypochondriasis, and hysteria) the greater the effect of the drugs. Also, those who were most affected by one drug were most affected by another. Finally, if large enough doses of a drug were given, all subjects tended to respond in the same manner.
In a well-controlled study, Lasagna et al. (84) concluded: "In addition to dose and route of administration, the nature of the subject and the situation in which a drug is administered are important determinants of drug effects." Using a double-blind technique, these investigators administered, in randomized order, a placebo (1 ml of physiological saline solution subcutaneously), amphetamine (20 mg/ 70 kg body weight subcutaneously), heroin hydrochloride (2 to 4 mg subcutaneously), morphine phosphate (8 to 15 mg subcutaneously), and sodium pentobarbital (50 and 100 mg intravenously) to twenty healthy "normal" volunteers,' thirty patients in a hospital for chronic diseases, and thirty former narcotic addicts serving prison sentences in an institution devoted to the treatment of narcotic addiction. At intervals, before and after administration of the drugs, the subjects completed a questionnaire designed to measure the "subjective" mood changes induced, and this was supplemented by discussing with the subjects their responses to the drugs. In "normal" and, to a lesser degree, in chronically ill patients, amphetamine surpassed morphine, heroin, pentobarbital, and a placebo in producing euphoria. In the narcotic addicts, however, morphine was reported to produce a more pleasant effect than heroin, amphetamine, or a placebo.
Laverty (85) gave randomized injections of sodium amytal and a placebo to forty subjects divided into four groups of ten each: introverted neurotics, introverted normals, extroverted normals, and extroverted neurotics, as assessed by scores on Guilford's R scale for extroversion. The sedation threshold, as measured by the onset of slurred speech, was highest for neurotic introverts and it decreased step-wise for each of the groups in the order given. In other words, the group of introverted neurotics required the largest amount of intravenous sodium amytal (6.4 mg/kg body weight) before developing slurred speech.
Weinstein et al. in a series of studies (127, 128) have explored the differential effects of intravenous sodium amytal on subjects with preexisting organic brain disease and nonbrain-damaged individuals with illness not involving the nervous system. Some of the brain-damaged patients, who before receiving the drug had expressed awareness of illness and who had good orientation for place and person, with the drug became disoriented for place and grossly misidentified the examiners and explicitly denied illness. Weinstein claims that these changes with sodium amytal occurred only in the brain-damaged individuals; whereas, in nonbrain-damaged individuals receiving sodium amytal, the subjects talked of illness in terms of a third person, used more "concrete" symbols, selectively misinterpreted questions about illness, and misnamed the examiners in "paraphasic" fashion. (Incidentally, Weinstein reports that with the types of patients he studied, sodium amytal did not make them more communicative.) The significance of Weinstein's investigations appears to be that the person with brain-damage gets his sensorium more disorganized with sodium amytal than a nonbrain-damaged individual; an instance, apparently, of the effect of adding insult to injury.
Hoch, Cattell, and Pennes (64, 65) administered sodium amytal, pervitin, and mescaline to each of sixteen patients suffering from the pseudo neurotic form of schizophrenia, twenty-four patients with an overt form of schizophrenia with slight. to moderate deterioration, and nine schizophrenic patients with severe deterioration. With these drugs, especially with mescaline, they found typical physiologic changes occurring, mainly involving the vegetative nervous system. However, with most patients, some aspects of the drug experience seemed to be a direct continuation of previous personality factors. For instance, a patient who showed obsessive compulsive features before the drug experiment would tend to show the same obsessive structure while intoxicated. The same was true about anxiety attitudes, intellectualizations of conflicts, preoccupations with artistic, philosophical, or other matters.
Although Beringer () in his drug studies, using mescaline, did not find any correlation between personality and drug reaction, Stockings (122) found that cyclothymic and schizothymic individuals responded differently. Bensheim (15) thought that the cyclothymic group responded with euphoria and depression to mescaline and the schizothymic group with ecstasy. Lindemann and Malamud (94), experimenting with sodium amytal, cocaine, hashish, and mescaline on the same patients, found that each drug has its specific characteristics, but that the changes produced by a given drug were molded by the patient's personality (see also, 92, 93). Guttman and MacClay (59) and Sarwer-Foner (118) also found correlations between personality and drug reactions. Rubin et al. (114) suggested that the drug reaction be divided into two parts: those responses that are characteristic of a drug regardless of the patient in whom they occur, and those seen in a given patient regardless of the nature of the drug used. The first could be called a collective reaction and the second an individual reaction dependent on the individual's personality.
It is perhaps of interest here that Russian scientists have also emphasized the differential response of different types of individuals to drugs, specifically chlorpromazine (86).
It has been obvious to those who listen to and study people with personality disorders that the verbal behavior of an individual suffering from an emotional disorder is relatively peculiar, both in form and in content. The depressed person is laconic. The manic person is diffusely wordy. The hysteric and schizophrenic are quite variable in the duration and length of their remarks. There are typical thematic and structural characteristics of the speech habits of patients with these types of psychiatric disorders. (See, for example, Gottschalk et al., 56.)
At present, there are more gaps than facts in our knowledge about the reactions of different personality types to the same and different drugs. Years of intensive research are needed to supply some of this unavailable knowledge.
However, it is already acknowledged that individuals with features of hysterical, conversion, or dissociative reactions are likely to be suggestible and to react strongly to all psychopharmacologic agents, including placebos (83, 85).
Drugs may tend to reinforce the need to give for individuals burdened with feelings of neurotic shame and guilt, especially if such feelings are enhanced by the interrogator. Drugs may also furnish the needed excuse and relief from personal responsibility for sources who violate internalized values and loyalties in revealing information.
The pharmacologic effect of the drug is probably of less decisive influence in facilitating information-getting (although acting as a catalyst) than is the potential readiness of individuals with such personality features to behave in a typical way under certain circumstances. The consideration of drugs as an aid to interrogation presupposes a thorough understanding of the personality characteristics of the informant and of drugs, to predict what might be expected by their use.
EFFECT OF PHYSIOLOGIC CONDITIONS ON DRUG RESPONSES: BIOLOGIC RHYTHMS, NUTRITIONAL STATES, ISOLATION, AND FATIGUE
There is evidence that the physiologic condition of the individual affects his behavior and responsivity to further incoming stimuli. If so, this propensity is pertinent to our specific interest regarding the use of drugs in affecting the verbal behavior of informants.
It is difficult to ascertain to what extent the behavioral alterations that have been noted under various physiologic conditions are mediated by biochemical changes per se, and to what extent they are secondary psychophysiologic reactions to subtle changes in body chemistry. The answer need not occupy us here, except to note that a chemical alteration within the body is probably one important feature of the varying responsivity of the individual. Under such circumstances, the addition of other chemicals complicates the problem of predicting the behavioral outcome. This is particularly true if the new chemical introduced into the body is mild in its effects, or if it is given in a small dosage.
Citation of every technical article bearing on this point would be unnecessarily burdensome here. Instead, a number of key investigations are reported to illustrate the point.
Biologic Rhythms. Benedek and Rubenstein (12, 13) have studied the relationship of associative material presented by women during psychoanalysis at various phases of their menstrual cycle, as measured by vaginal smears. These two types of data, verbal material and physiologic changes in the vaginal mucosa, were collected and analyzed independently by the two investigators, one a psychoanalyst and the other an endocrinologist. After a long period of collecting such data, the investigators related verbal productions to the phases of the menstrual cycle. A high concordance between the two types of data occurred. This has been validated in clinical studies to some extent. However, because of the importance of the psychophysiologic implications of this classical study, independent validation by other investigators would be desirable. In brief, the investigators found that during the estrogen phase of the menstrual cycle, the women were more extroverted, had more fantasies, dreams, and subjective experiences indicating strivings to be loved and impregnated and had conflicts about such strivings. During the progesterone phase, the women were more introverted, were more preoccupied with interests in their own body and self. During the premenstrual phase of the cycle, there were increased references to cleaning out, washing out, evacuating, losing something, and the women were more depressed. Again in these studies, individual variations occurred in relation to the varying hormonal phases of the sexual cycle, depending on the woman's personality type and the kinds of conflicts she had about procreation, childbirth, mothering, etc.
Nutritional States. Studies of the effects of the state of nutrition, especially vitamin deficiency, on human behavior are replete in the medical literature and indicate that neurological and psychiatric disorders may ensue with various vitamin deficiencies, particularly of the B complex. The effects of starvation, voluntary and enforced, in provoking increasing lassitude, apathy, depression, preoccupation with food, flattening of affect, and mood are sufficiently well known and are discussed in another chapter of this study. The more subtle effects of satiation with food and the brief deprivation of food typical of everyday rhythmical eating habits on response patterns to psychologic tests and interviewing procedures have received little careful study, even apart from problems of drug effects.
Clinical psychiatric experience indicates that some individuals become querulous, demanding, restless, even paranoid, and experience hunger contractions if they have not eaten for one to two hours, although they show no demonstrable pathologic, metabolic processes. Other individuals may miss several meals, yet experience no subjective reactions and show no signs of distinctly different behavior. Gottschalk and Gleser (55) did a controlled study of the effect of fasting for twelve hours on the speech patterns of six paid physically healthy and occupationally adjusted volunteers, three males and three females. MMPI's were obtained on all subjects. No homogeneous effect of fasting states on thematic speech variables or on the proportion of various categories of word-types was found under these experimental conditions. In one subject, however, characteristic and repetitive reactions occurred to the stress of the mild fasting, reactions which were principally in the form of significantly increased references to food, home, mainland, mother, and involving attempts to bridge the distances between such objects. Hypoglycemic states were induced by the injection of intravenous insulin in this same subject and the effects of these states were noted. A repetitive, but different, thematic reaction occurred to this experimentally induced hypoglycemia as compared to voluntary fasting for twelve hours. The investigators concluded that fasting for twelve hours was not enough of a stress to produce consistent effects in the speech patterns of five, out of six, paid volunteers. Susceptibility of reacting to twelve hours of fasting was considered to be due to individual personality features. These investigators did not feel that this initial study gave them enough data to be able to predict accurately which subjects might react and which might not react to this stress.
Isolation and Fatigue. In unnatural biologic states, such as in experimental or enforced isolation from other humans or from ordinary levels of physical stimuli (19, 25, 60, 91) or in loss of sleep (124) emotional disturbances and transient psychotic states have been reported. In states of sleep loss, paradoxical reactions to drugs may occur. In this connection, Wendt (129) is quoted as observing: "There are some interesting things about secobarbital or any of these drugs when ased in individuals under stress, e.g., after 40 hours of enforced wakefulness people become irritable, anxious, apprehensive, and difficult to keep awake. A small dose of secobarbital of 100 mg will wake them up and make them volunteer to go through another night." To this reviewer's knowledge, this phenomenon has not been reported elsewhere and it is important enough to merit. further testing. Such paradoxical effects have been noted clinically with other drugs, notably amphetamine which may have a sedative and quieting effect on restless. anxious, irritable small children with behavior problems presumably associated with psychomotor or petit mal epilepsy (see Forster, 48) and which may reduce the agitation of excited schizophrenics (21).
III. Methodologic Problems in Determining the Effects of Drugs on Verbal Behavior: Influence of Method of Sampling the Verbal Behavior on the Effect of a Drug
In this brief section, the reviewer, for the sake of completeness, wants to emphasize that the scientist studying this problem must realize that he will discover no more information than his method of evaluation will provide, and that different methods of sampling the verbal behavior of a subject under drugs may give somewhat different information about the psychopharmacologic effect of the drug. Each scientist will tend to use the measuring instrument most familiar to him, and each instrument or technique will have different merits. The questionnaire of subjective reactions and the directive interview will provide yes and no answers and some qualified answers to structured concepts and hypothesis of the investigator. These methods have the advantage of relative speed and ease of evaluation.
The nondirective interview and the free-associative technique can be applied in a systematic and quantitative way and constitute a valuable means of studying the pharmacodynamics of drugs (see also Kubie, 79 and Wikler, 132), but evaluation of the data is generally slower and more complicated. Although some specific questions in the mind of the investigator may remain unanswered (e.g., is the material fantasy or fact?), these methods may provide considerable information about the drug's effect on symbolic processes, effects, and psychodynamic relationships. To approach definitive answers regarding the potential action of drugs on human behavior, emotion, cognition, and conation, our knowledge needs to be much more complete at the physiologic, biochemical, and psychologic levels of organization. The scientist would best look at his data in as many ways as possible and use a variety of approaches in studying these phenomena (see also Wikler, 131 ; Miller, 103).
The Efficacy of Drugs in Uncovering Information
Several investigators have employed drugs to facilitate the recovery of information not freely yielded by the individual.
In 1921, R. E. House, an obstetrician in Texas, observed in deliveries in which the mother had been given scopolamine that in a certain stage of anesthesia or sedation she might be talkative and reveal things she would not ordinarily discuss. He noted that after childbirth, the mother frequently forgot that she had suffered pain, that she had complained of it, and that she had spoken of personal matters. After the use of scopolamine, often with the addition of chloroform, had proved to have certain advantages in the obstetrical management of a woman delivering a baby, House persuaded himself to extend the use of scopolamine beyond its original purpose to the interrogation of criminal suspects. He gave many enthusiastic demonstrations throughout the United States. As a result, newspapers quickly applied the term "truth serum" to this sedative drug. House's enthusiasm about scopolamine as an adjunct in obstetrics led him to overenthusiastic statements about the value of the drug in interrogation. In 1931, on the basis of two cases, he stated (69) that a person under scopolamine could not lie and that the drug could distinguish the innocent from the guilty. This statement is an example of an investigator observing the drug action he wanted to see, but which was not observed in subsequent studies (82).
Since House's early experiments with scopolamine (69), which led to the misnomer "truth serum," a great deal more has been learned about drug action. During World War II an interviewing method employing the administration of an intravenous barbiturate was used with disturbed soldiers who were experiencing acute war neuroses in order to allow them, transiently, to relive certain of their battle experiences which were believed to have aroused persistent emotional conflicts (58, 117). In psychotic patients, particularly catatonic schizophrenics, who will not talk and therefore do not participate in psychiatric therapy or reveal any clues to the mental experiences which may underlie their disorder, sodium amytal has been used to facilitate communication with the patient (117). If it works, there is a transient phase that can sometimes be prolonged by injecting the drug slowly, during which the patient will answer some questions and communicate some of his life problems. If the patient passes through this stage into a deeper stage of narcosis there may be a transient period of talkativeness as he recovers from the sedation or anesthesia.
For certain personality types, some drugs lower conscious ego control, thereby facilitating recall of repressed material and increasing the difficulty of withholding available information. The ideal drug for an interrogator would be one which not only accomplishes this feat, but does so without interfering with integrative capacities and intellectual functioning. Because of the uncertainty of the truth or falsity of statements obtained under circumstances of reduced ego control, and because certain drugs may give rise to psychotic manifestations such as hallucinations, illusions, delusions, or disorientation, the verbal material obtained cannot always be considered valid. Such data is not accepted in a court of justice and the information so obtained is not considered wholly accurate by the medical profession.
What experimental data and critical reviews are available which have examined the validity of such material from the viewpoint of the interrogator's interest in factual information?
Jean Rolin (112) has written a book entitled Police Drugs in which he inveighs strongly against the use of drugs for medico-legal purposes. His argument is in part moral, but it is also based on the grounds that there is uncertainty as to the truth of revelations obtained by such means. He concludes that ". . . from a purely medical standpoint, confessions obtained by drugging are valueless and do not give grounds for determining responsibility."
In the same book, E. V. Saher's (115) chapter on narcoanalysis provides an extensive review of the literature. In summarizing the viewpoint of the medical profession on narcoanalysis, he says:
Narcoanalysis is not a sure method of bringing out the truth and nothing but the truth. Any confession made is not necessarily true; and if no confession is made this does not necessarily prove that the patient has not committed the crime with which he may be charged. Does this mean that narcoanalysis has no importance at all from the angle of the administration of justice? The answer to this question is again in the negative, because in many cases the confession is true and often facts are brought out which are very helpful to the public prosecutor in proving his case. It seems fair to say that in the present stage of development narcoanalysis can be of great help in finding the truth. But it is also a dangerous means of investigation as the right interpretation of statements made depends largely on the skill of the analyst. 2The published experimental studies on the validity of confessions obtained with drugs are few. Much further careful investigation is needed to clarify the problems involved. This reviewer was able to locate only four studies worth reporting here.
The first study is only of borderline relevance and involves the use of intravenous barbiturates as an aid in the differential diagnosis between conversion hysteria and malingering. The author (104) claimed that the use of intravenous sodium amytal was found to be helpful in detecting (and treating) individuals who were suspected of consciously distorting and feigning disability. He found such individuals to be negativistic, sullen, and nonproductive at first under amytal but prone to reveal the fact of and causes for their malingering as the interview proceeded. It was common in his experience to turn up a neurotic or psychotic basis for the malingering. (See Chapter 7.)
The other three studies deserve more detailed review because of their relative superiority, and thus rarity, as research studies in this highly specialized and untouched area.
Redlich, Ravitz, and Dession (109) asked a total of nine university students and professional persons to relate some true shame- or guilt-producing life incident. Then the subjects were asked to invent a "cover story" to be told to another examiner who interrogated them after the intravenous injection of amobarbital, 0.25 to 1.0 gm. In six of the subjects, the "cover story" was given during the amytal interrogation, in one it was mixed with the true story, and in two the true story was given. In nearly all subjects, the "cover story" contained elements of the guilt involved in the true story. However, except in the cases of those who confessed the truth, the true story could not be inferred from the story told under amobarbital. An additional finding of interest was that the more normal, well-integrated individuals could lie better than the guilt-ridden, neurotic subjects.
Gerson and Victoroff (53) used amytal interviews on neuropsychiatric patients who had charges against them at Tilton General Hospital, Fort Dix, New Jersey. The patients were told that none of the material from the interviews would be used in the prosecution of charges against them, since it was considered a breach of medical ethics and because the material, derived with the full knowledge and consert of the patient, could not have been presented in court without violating the Twenty-fourth Article of War and the Bill of Rights of the Constitution of the United States.
The researchers first gained the confidence of the patients by discussing their life history. They were not informed that amytal would be used until a few minutes before narcoanalysis was undertaken. It was explained that the drug would make them sleepy and encourage them to discuss things with the doctor that might enable him to gain fuller understanding of the patients' personality and motivations. Under these circumstances, the patients' attitude varied from unquestioning compliance with the procedure to downright refusal to submit to the injection. (One gram of drug in 10 cc of distilled water was injected slowly in the median cubital vein.) Questions relevant to the charges against the patient were not brought up until later, the initial discussion involving relatively innocuous material about the patient's personality and life history which had been discussed previously. A follow-up, waking interview was carried out on the day following narcoanalysis, during which the covert material unearthed during the amytal interview was brought up, and possible psychologic factors in the patient's criminal behavior were discussed. During the follow-up interview, nine patients admitted the validity of their confessions and eight repudiated their confessions. Gerson and Victoroff examined the following factors interfering with the completeness and authenticity of the confessions: (a) inept questioning, (b) tendency of the patient to perseverate on unrelated topics, (c) mumbled, thick, inaudible speech and paralogia, (d) fantasies, (e) contradictory but apparently truthful evidence, and (f) poor rapport between doctor and patient. These experimenters concluded from their study that under sodium amytal subjects could sometimes lie and that their reasoning powers were sometimes present, although much distorted. Although they found amytal narcoanalysis successful for the revelation of deception, they felt that the validity of the information garnered by this method was not so decisive that it could be admissible in court without further investigation and substantiation. They acknowledged that the doctor could not tell when the patient's recollections turned into fantasy, could not positively state whether he was simulating deep narcosis and actually maintaining his lies, and could not, without social investigation, determine which of contrary stories told under narcoanalysis was true.
Clark and Beecher (30) tested the ability of twenty, paid, volunteer male college students while under drugs to withhold deliberately information during four to eight hours' sessions from a male interviewer, who also administered the drugs intravenously. Thiopental, atropine, amphetamine, methamphetamine, sodium amobarbital, ethyl alcohol, scopolamine hydrobromide, pentobarbital sodium, morphine, caffeine sodium benzoate, and mescaline sulfate were given singly and in combination. The subjects were motivated by their desire for monetary compensation, their perceived importance of the experiment, and pride in their integrity and "will power." The information which the subjects were asked to withhold consisted of (a) two items of personal information (e.g., birthplace, mother's maiden name, etc), (b) an "experimental secret" devised to resemble military intelligence, and (c) a guilt-laden personal experience for which the subject devised a "cover story." All of this information was reduced to writing and deposited with a technician. To check possible forgetting, the subject was asked to produce the withheld information at the end of the experiment, and this was verified against the written version.
The drugs and combinations of drugs used in these experiments were given in such large amounts that they produced grossly abnormal states of mind. At various times, subjects became semicomatose, mildly delirious, panicky, markedly loquacious, euphoric or underwent transient dissociative reactions; yet, curiously, at no time was there sufficient ego impairment that they were unable to identify the significance of questions about the suppressed information and avoid answering them in response to direct questioning. As long as they remained in auditory contact with the interrogator, they consistently refused to reveal the suppressed items.In evaluating the considerable ego-integrity maintained by these subjects, it is important to consider that they may have felt relatively secure in a protected experimental situation, in the hands of a responsible experimenter and physician.
The experimental secret was not given up by any of the subjects. Similarly, none of them revealed the suppressed items of amnestic data in response to specific questioning. However, on two occasions the names of close relatives being used as suppressed information were revealed, apparently as slips of the tongue, in the course of spontaneous, dissociative rambling while severely intoxicated with scopolamine and thiopental in combination.
The findings with the "cover story" technique were essentially those of Redlich et al. Under thiopental narcosis, two subjects produced significant variations in the cover story which betrayed the content of the true story.
These individuals were of a more neurotic character pattern than the other subjects, and their true stories centered on problems of unresolved guilt. However, the remaining subjects, if they were able to talk at all coherently, reproduced the cover stories with remarkable fidelity to the original version.
In summary, then, clinical experience and experimental studies indicate that, although a person's resistance to communicating consciously withheld information can be broken down with drugs, and particularly sodium amytal, the interrogator can have no easy assurance as to the accuracy and validity of the information he obtains (see also MacDonald's discussion, 100, and that of Inbau and Reid, 71). Furthermore, a lack of crucial information from a subject under a drug does not mean that the subject has no information. An interrogator would have to evaluate many other factors — the personality of the subject, the milieu, other sources of evidence, etc. — to decide how to interpret the outcome of an interview with a drugged informant.
IV. Specific Effects of Drugs on Verbal Behavior, Particularly Drugs Potentially Applicable to Interrogation Procedures
After looking at these efforts to elicit information with a variety of drugs, it may be well to consider each psychopharmacologic agent in turn, for its possible applicability to the interrogation situation.
Barbiturate Sedatives and Calmatives
The major share of studies on the use of drugs in interviewing procedures involves the barbiturates: amobarbital, secobarbital, and pentothal. These drugs have been found useful in treating the acute war neuroses (58, 116, 117), and in civilian practice (23, 32, 106). In psychiatric practice, the purpose of these drugs is to effect a violent emotional response which may have cathartic value for the patient. In the hands of some psychiatrists (117), the emotional reliving enhanced by the drug is not considered necessarily related to a real experience. In order to bring about a high degree of excitement, Sargant (117) has recommended putting the patient back into a past which has been modified by the therapist's invention. In his drugged state the patient accepts a false version of the facts as if it were the truth, and experiences the appropriate emotional response.
Sodium amytal has been found helpful in determining whether or not a subject is feigning ignorance of the English language (96). It is reported that familiarity with a language will show up under the influence of intravenous barbiturates.
Kelley et al. (74) reported that more reliable estimations of intelligence are frequently possible under amytal. They also found that patients under sodium amytal injection gave a greater number of Rorschach responses and fewer rejections of cards. This made diagnoses possible in cases previously considered unreachable. The responses were found to be qualitatively less bizarre and stereotyped, permitting more nuances in personality descriptions.
Brickner (22) has recorded many interviews of patients receiving deep narcosis therapy with barbiturates. The detailed analyses of the verbal productions of these patients have indicated certain typical peculiarities worthy of mention in this review. If they are present, obtained information should be discounted as factual data, although they certainly may reveal in an indirect way some of the gamut of life experiences of the interviewee. Brickner noted the processes of "fractionation" and "recombination" in the verbal productions of patients under deep amytal narcosis. These processes were operative not only at the level of words and word elements, prefixes and suffixes, but also at the level of phrases and clauses, ideas and concepts. The fractionation and recombination manifested itself in the juxtaposition of word fragments, phrases, and concepts which are not ordinarily brought together and in which the connection was often illogical. Brickner believed that this drug process is a caricature of the waking process of comparing new stimuli, percepts, and concepts with others, new and old. He believes that this process of comparison has survival value and is built into human neural structure.
Sodium amytal injections have not been useful in alleviating aphasic speech defects, secondary to cerebral insult (17, 108).
Although the detection and study of such phenomena are of basic research interest to the investigator studying the neurophysiologic correlates of psychologic processes, the decoding of such verbal material by any interrogator seeking factual information is likely to present a very difficult problem. It is probably such phenomena which Gerson and Victoroff (53) observed in their interviews of criminal suspects under barbiturates and which they found to be one of the obstacles to assessing the validity of their informants' verbal productions.
n summarizing the specific effects of barbiturates as facilitants in interviewing, the references already presented and the work of others (32, 101) indicate that, with some exceptions, the following effects on behavior may be expected from the administration of barbiturates to human subjects: (a) decreased attention to stimuli; (b) warmer and more appropriate mood; (c) decreased anxiety; (d) increased contact and communication; (e) reduction of psychotic manifestation.
Nonbarbiturate Sedatives and Calmatives
An increasing variety of nonbarbiturate sedatives have been compounded in recent years. Although they are in wide use, no experimental studies have compared these drugs to the barbiturates as adjuncts to interviewing individuals, either to relieve emotional disturbances or to obtain consciously withheld information.
A list of the chemical and trade name of some of these drugs may be worth including as an illustration of their variety and for heuristic purposes: ethchlorvynol (placidyl), glutethimide (doriden), methyprylon (noludar), methylparafynol (dormison), captodramin (suvren), oxanamide (quiactin).
Stimulants and Antidepressives
AMPHETAMINE AND ITS DERIVATIVES
A drug that has been used to a fair extent in pharmacologic therapy, but not, as far as is known, in interrogation work is amphetamine (benzedrine) and a similar drug, methamphetamine.
Administered intravenously to nonpsychotic individuals, researchers have found amphetamine to produce a "push": an outpouring of ideas, emotions, memories, etc. (24, 31, 37, 39, 73, 90). It is of diagnostic help with psychiatric cases by itself (24, 49, 90, 95, 121), or following an intravenous barbiturate (37, 39, 70, 113). It is widely marketed and used in combination with a barbiturate as a mild stimulant drug for patients having neuroses and neurotic character problems.
Brussel et al. (24) claim that methamphetamine hydrochloride is useful in the interrogation of the psychopath who feigns amnesia or withholds vital information which he covers with lies or cautiously alters as he shrewdly weighs his words. These authors claim, perhaps extravagantly, that such a psychopath is powerless under the influence of methamphetamine. Once the drug takes effect, they hold, the tempo of productivity and the insurmountable urge to pour out speech gives the liar no time to think. They also claim that functional aphasics can be expected to recover their speech under the influence of intravenous methamphetamine.
It should be noted again that amphetamine and its derivatives are among the main drugs that have been employed in well-designed and controlled studies, showing that the effects of drugs are variable and influenced by personality differences (83, 84, 126).
Pipradrol (meratran) is another drug of the stimulant type which increases not only psychological activity but motor activity as well. In reaction to the "inner push" of ideas, emotions, and speech, some normal subjects report mild euphoria, but others report tension and displeasure. The occurrence of the predominant pharmacologic effects of this drug depends to some extent on the typical personality of the subject (57). Like amphetamine, pipradrol in single, small doses improves the performance of normal subjects in tracking tests (107). It has an advantage over amphetamine in having fewer undesirable side effects, particularly on the cardiovascular system.
This drug has been used in the treatment of patients with "simple depressions" (3, 44, 120). Pharmacologic effects are noticeable in mentally ill patients, but more than a transient therapeutic effect has not been established. No studies are reported on the use of this pharmacologic agent for psychotherapeutic or interview purposes.
Phenidylate (ritalin) is another one of the newer compounds having analeptic effects, such as producing arousal and elevation of mood and increasing the rate of communication. In psychiatric practice this drug has been reported to exert beneficial effects on psychotic patients receiving reserpine (a rauwolfia tranquilizer), which sometimes induces manifest depressive reactions in patients as a side effect (45). But a double-blind, placebo-controlled study has not found ritalin to be of any benefit in chronic schizophrenia (29). The analeptic effects of this drug are well established. The utility for interrogation purposes of the analeptic properties of this drug, as compared to those of other stimulants, such as amphetamine, cannot be evaluated from existing information.
Iproniazid is another antidepressive drug. Its analeptic features were first noted in chronic debilitated tuberculous patients who were receiving the drug as part of an experimental chemotherapeutic regimen (35). It has been said to improve the performance of normal individuals, enabling them to work more energetically and more effectively, and to need less sleep. Iproniazid has been used in the treatment of mental depression (97) with encouraging results. Definitive well-controlled studies, however, have been reported for neither normal subjects nor mentally ill patients. Several instances of fatal toxic hepatitis have occurred when doses over 150 mg a day were given. Nevertheless, the advent of drugs of such a presumably powerful therapeutic effect in depression, owing either to psychologic conflicts or secondary to chronic somatic illness, opens up further areas of exploration of relevance to the present topic.
Hallucinogenic or Psychotomimetic Drugs
It has been common knowledge for centuries that many drugs may modify the behavior of man to the extent of producing psychotic behavior. Hoch et al. (66) have pointed out that acute and chronic psychosis of the toxic type can be produced in susceptible individuals by central nervous system depressants (barbiturates, bromides); central nervous system stimulants (amphetamine, caffeine); analgesics (acetylsalicylic acid, acetanilid); autonomic activators and blockers (atropine, scopolaniine); local anesthetics (cocaine, novacaine); antimalarials (quinine, atabrine); oxytocics (ergot alkaloids); heavy metals (lead, mercury, arsenic); hormones (thyroid, cortisone, ACTH); gases, including low and high oxygen concentration in the inhaled air, and even water in toxic amounts. The interests of psychiatrists in these phenomena have stemmed largely from the supposed resemblance of these psychoses to schizophrenia, because of the time-honored, though as yet unproven, hypotheses (11) that schizophrenia is due to a "toxin." Since Wikler (131) has recently reviewed the literature on this subject critically it will not be done here. Two psychotomimetic drugs are discussed briefly here as examples, from the viewpoint of their psychopharmacologic effects and their possible pertinence to interrogation procedures.
Mention was made earlier of an alleged use of mescaline against concentration camp inmates by German interrogators (112, page 15).
Mescaline has also been studied as a potential diagnostic and therapeutic adjunct with psychiatric patients. Cattell (27) found mescaline to be a useful drug in investigating personality structure, but of no value in the therapy of psychiatric patients. He studied fifty-nine patients, seventeen with pseudo-neurotic schizophrenia (Group I), twenty-six with overt schizophrenia but without deterioration (Group II), and sixteen deteriorated schizophrenics (Group III). New psychodynamic material was gained from the first two groups, but relatively little from the last group. Cattell reasoned that the new material obtained in the mescaline state had been condensed and repressed in the drug-free state. Mescaline in general (63, 65, 66, 110) has been found to produce perceptual distortions and hallucinations, accentuation of affective experiences, and increased psychotic manifestations. In some patients contact and communication were increased and in others decreased. Denber and Merlis (40, 41) using 0.5 gm of mescaline in water intravenously on both psychoneurotic and psychotic patients claimed that mescaline induced the production of suppressed and repressed sexual and aggressive conflicts, with a predominance of emotional rather than ideational reactions.
Hoch (63) noted that mescaline in "normals" produced more of an "organic reaction" with some schizophrenic features, as compared to its effect in schizophrenics and latent schizophrenics where mescaline produced more complete schizophrenic disorganization. Hoch also emphasized that mescaline produced a falling off in intellectual functioning.
These articles are typical of the reports on the psychopharmacologic effects of mescaline. When interrogators extrapolate clinical psychiatric observations of this kind to the problems of interrogation, mescaline might serve their purposes in attempting to create an atmosphere of fear or terror in the informant and the illusion of magical overpowering omnipotence about himself. After such a transient state has been created, the susceptible informant might be induced subsequently to reveal information. The perceptual and cognitive disturbances produced by the drug make it unsuitable for obtaining undistorted information while the source is under its influence. From the viewpoint of the informant, the creation of a transient psychotic state by the ingestion of mescaline or lysergic acid might offer him some temporary protection against being successfully interrogated. An interrogator is not likely to consider an individual in a psychotic state a suitable candidate for providing reliable and useful information, at least until the drug effect wears off.
LYSERGIC ACID (LSD)
Lysergic acid (d-lysergic acid diethylamide tartrate) has been studied recently as a drug which might contribute additional knowledge about the mechanisms and treatment of mental disease in general and schizophrenia in particular.
Busch and Johnson (26) gave 30 to 40 gamma of LSD-25 to twentyone chronic psychotic patients (mostly schizophrenics) and later to some psyclioneurotic patients. They noted that the drug transiently increased the mental activity of their patients 30 to 60 rain after ingestion. The effect was a transitory toxic state in which repressed material came forth "sometimes with vivid realism" and emotional expression. Busch and Johnson thought that LSD might be useful as an adjuvant in psychotherapy.
Deshon et al. (42) studied the effect of the ingestion of 1 gamma per kg body weight of LSD on fifteen normal volunteers. Alterations were observed in thinking, speech, emotions, mood, sensation, time perception, ideation, and neurologic signs. The reaction lasted 12 to 16 hr in most cases, but several days in one case. The reaction was typical of an exogenous toxic state, simulating a schizophrenic reaction. The reaction was not specific and the extent to which it was dependent on the basic personality was not determined.
Bercel et al. (16) studied the relation between the type of LSD psychosis produced in normals and of the Rorschach Test findings of the subjects. They could not predict the type of psychotic reactions from the pre-LSD Rorschach, but they could often say from the Rorschach records which normal subjects would show psychotic symptoms.
Abramson et al. (1, 2) found, after administering large doses of LSD-25, that intellectual functioning, as measured by a battery of tests, was disturbed in many spheres. In another study, Levine et al. (89) showed that Rorschach Test scores were altered in the direction of a more psychotic picture.
Davies and Davies (36) treated sixteen mental defectives with LSD-25 in dosages of 20 to 400 gamma in water for as many as twenty-six treatments in three months. Seven patients became more talkative and cooperative. Their "memories were stimulated," but emotional reactions were limited. No lasting benefits were observed. An interesting, unexplained phenomenon was that only two out of the sixteen cases had the expected bizarre hallucinatory experiences.
There are many other reports of experimental and clinical studies employing LSD-25, but those reported here are fairly representative. There is enough given here to suggest the possible applications of LSD to interrogation techniques. It is apparent that this drug impairs perceptual and intellectual functioning. The conclusions reached on mescaline hold equally for the possible applications of this drug to interrogation. As a tool in the advancement of knowledge of psychopharmacology, LSD-25 is a drug on which clinical and experimental research is likely to continue.
Recently a large number of new compounds with sedative and anxiety-relieving properties have been introduced, sufficiently different from the classical sedatives, such as paraldehyde, chloral hydrate, barbiturates and bromides, to warrant using new terms to describe them. These compounds are referred to as "tranquilizers" or "ataraxics." They have been investigated clinically on an unprecedented scale in the treatment of psychiatric disorders, particularly the psychoses, and to a lesser extent in the psychoneuroses. The use of these drugs has revolutionized psychiatric therapeutic procedures, especially within the mental hospitals. A thorough review of their effects and mechanism of action in mental illness would be out of place here. Unfortunately, the usefulness of these tranquilizers in exploring psychologic processes and in facilitating communication has not been very extensively tested. Their applicability to interrogation procedures is still speculative. Yet, for the sake of completeness, and to indicate the directions further research might take, the psychologic actions of these drugs deserve mention.
Among the phenothiazine derivatives now in medical use are: chlorpromazine (thorazine), mepazine (pacatal), perhenazine (trilafon), proclorperazine (compazine), promazine (sparine), thiopropazate (dartal), and triflupromazine (vesprin). Of these, chlorpromazine has been most widely used and investigated at this time. Therefore, the psychopharmacologic actions of only this compound are discussed here.
Chlorpromazine (thorazine) Delay and his associates (38) appear to have been the first to explore chlorpromazine in the treatment of mental illness. They found that the effects of chlorpromazine in patients with manic psychoses were somnolence, decreased responses to external and internal stimuli, pleasant indifference, and decreased spontaneity of speech. Subsequent reports (5, 20, 28, 32, 75, 81, 87, 88, 134) have been in agreement that chlorpromazine is effective in quieting or abolishing severe agitation and psychomotor excitement, whether of manic-depressive, schizophrenic, or toxic origin. Most of these reports agree that the basic disorder in these conditions is not altered by the drug. In the psychoneuroses, chlorpromazine was reported (52, 80) to decrease anxiety and tension temporarily, but to have no specific ameliorative effects on conversion symptoms, obsession, piaobia, depression, or physical pain. A recent, controlled investigation (123) on the effect of chlorpromazine on the communication processes of psychiatric patients has indicated no specific facilitating effect. In normal subjects, the effect of 10 mg of proclorperazine (a phenothiazine derivative) was compared with that of 10 mg of phenobarbital. No specific differences were found on tests of mental performance, hearing, and pain perception, although a decrement in muscular coordination and efficiency occurred under proclorperazine (14).
Other phenothiazine derivatives are being extensively investigated at this time in psychiatric practice with the hope of finding one with equal or better therapeutic effects and fewer of the side effects of chlorpromazine, such as Parkinsonism, obstructive jaundice, dermatitis, tachycardia, etc.
There are no reports of the use of the phenothiazine derivatives in interrogation and no evidence to support the thesis that these drugs might be of avail to an interrogator's work, except perhaps with excited and agitated informants who might be encouraged to report material in exchange for peace of mind. On the other hand, such drugs might help a harried informant to keep his knowledge to himself
The principal rauwolfia alkaloids being used in psychiatric practice are reserpine (serpasil), deserpidine (harmonyl), and rescinnamine (moderil). Of these, reserpine has been most thoroughly studied. Its actions are discussed here as representative of the group.
Reserpine (serpasil). Reserpine, believed to be the most active of the rauwolfia alkaloids, was identified by Müller et al. (105), and its sedative and antihypertensive effects were noted in animals by Bein (10). Initially the drug was used in the United States for treating high blood pressure (133). From such experiences it was noted that reserpine produced a state of calmness without significant impairment of sensory acuity, muscular coordination, and alertness. The effects of single doses of reserpine (2.5 to 10.0 mg intramuscularly) were found (98) to be more marked in patients exhibiting high levels of psychomotor activity, regardless of the clinical psychiatric diagnosis. Repeated doses of reserpine over long periods of time reduced or abolished hyperactivity, combativeness, destructiveness, insomnia, flight of ideas, etc., in the majority of disturbed psychiatric patients, regardless of clinical diagnosis (4, 6, 47, 51, 68, 76).
The tranquilizing action of reserpine and chlorpromazine appears to be quite similar. This similarity extends to some of the side effects, such as miosis, lowering of blood pressure and body temperature, increase in appetite, nasal congestion, and Parkinson syndrome. Although certain differences in side effects do occur, they do not require our attention here.
The literature on the effectiveness of reserpine and chlorpromazine as aids to individual (119) and group (34) psychotherapy is extensive. Whereas there is agreement that the drugs lower anxiety and tension, there are such notable differences of opinion about the aims of psychotherapy and about what constitutes psychotherapy that no definite statement can be made regarding this point. If the reviewer were to add his voice to the disharmonious chorus of viewpoints on this subject, he would, on the basis of impressionistic evaluations only, say that the tranquilizers are of some aid in the psychotherapy of those patients who are so agitated, anxious, and hyperactive that they cannot sit still very long for psychotherapy. However, working out the finer nuances of emotional conflicts of a patient in psychotherapy is precluded when the patient is regularly taking a tranquilizer, because the patient appears to become too insulated against emotional reactions to realize or care that he is responding with feeling in some pertinent way.
As with the phenothiazine derivatives, the place of the rauwolfia alkaloids in the potential armamentarium of the interrogation has not been established. There are no relevant articles on this matter. Speculatively, the tranquilizers might be of avail in selected informants who are highly agitated and disturbed, and who might yield information in return for the relaxation they experience with such a sedative. On the other hand, less emotionally disturbed informants might strengthen their resolve to retain information under a tranquilizer. The only way to decide this problem is by experiment. Furthermore, tranquilizers in moderate dosage do not notably impair intellectual and sensory functioning. Therefore, their use probably does not contribute to the distortion of factual information produced.
The dependence of the drug addict on the supplier of drugs has figured in speculations regarding the use of drugs to control behavior.
Such speculations assume that the need of an addict for a drug is so strong as to override many other values, including strong social proscriptions when these conflict with the satisfaction of drug-created needs.
The writer is unaware of any actual or alleged utilizations of drugs in this manner for the purposes of interrogation.
One of the cardinal criteria of addiction is the occurrence of severe reactions when the drug is withdrawn. Withdrawal syndromes occur with opiates, barbiturates, and, recently, an animal study has made this claim for meprobamates (43). Beyond a minimal dosage and time period, the continuous usage of these drugs produces addiction in almost everyone (72). No demonstrable impairment of cognitive or psychomotor functions has been identified in subjects operating under the maintenance dosage to which they are habituated.
Under most of the opiates, the subject is likely to show a keen awareness of a limited segment of reality, a decrease in spontaneity and creativity, a decrease in suggestibility, and an increase in rigidity and compartmentalization of thinking. As with other drugs, the reaction varies widely from individual to individual 50, 131).
Information contributed by an addicted source is naturally suspect, since many addicts have gone to great length, fabrication of information being the least of them, to maintain their drug supplies. If a source became addicted as a sequel to the treatment of injuries, the ability of the interrogator to give or withhold the drug would give him a powerful hold on the source. It appears unlikely that this weapon is so unique as to lead an interrogator to create addiction deliberately. An interrogator who would be willing to produce addiction would not hesitate to employ more reliable and instantly effective means for inducing results as unpleasant as withdrawal symptoms. Since the initial reactions of most subjects to drugs of addiction are unpleasant, these drugs would not appear to have a role as positive motivators, except for subjects experiencing pain.
IV. Counteracting Drug Effects
When the effects of a drug are not consonant with the subject's wishes, the extent to which the subject can successfully counteract these effects without the aid of other drugs becomes an important problem. Inasmuch as this is an unusual condition, little or no empirical information is available. Yet, it may be worthwhile to indulge in some speculation.
If the subject marshals his efforts to fight a drug, one may surmise that he has become alarmed about its effects on him, and that this alarm most likely is in the form of anxiety over losing control. Other instances of this type of anxiety in neuroses, psychoses, and cerebral insult have demonstrated that it feeds on itself. Specifically, the anxiety increases in something like a geometric progression whenever the source of concern is put to the test and adequate control is indeed found to be wanting, with the mounting anxiety itself contributing to further loss of control. Some persons more than others habitually use the mechanism of control and might presumably attempt to do so in this situation.
Small to moderate doses, although affecting the subject, might not alarm him, since the drug effects may be within the range of his ordinary experiences, and since none of the functions which form the basis for his sense of control may have been seriously impaired. Because it is difficult for most persons to succeed in their efforts to relax, the main resultant of any effort presumably is anxiety and arousal. If this is so, the effect of stimulants would be intensified, whereas the effect of sedatives might be counterbalanced to some extent. Here, the question of how massive a dosage of a sedative the subject could counteract would need to be considered. The phenothiazine tranquilizers might be expected to produce a sufficient lack of concern in the subject to prevent his attempting to undo their effect, or, more directly, preclude a state of arousal.
All these speculations deserve careful experimental study.
V. Summary and Conclusions
Nature of Reviewed Studies
A distinction has been made between interviews carried out for psychotherapy and those to obtain factual information. Although there has been considerable speculation regarding the possible use of drugs for the latter purposes, open publications of serious research dealing directly with such cases are scant. The paucity of reported studies on the matter has obliged the reviewer to include related published material of psychopharmacologic studies. When extrapolations are made from published material of this sort, they are presented as hypotheses, and in every instance require testing and validation.
Drug Research that May Produce Knowledge Applicable to Interrogation
Apart from any applied research that governments may sponsor for improving interrogation or for aiding their own personnel to resist interrogation, the pursuit of various current scientific and medical interests will doubtless result in developing knowledge of drug action applicable to interrogation. The interest of scientists in employing drugs in research transcends an interest in drug effects, per se. Drugs constitute valuable tools for experimentation directed toward developing basic physiologic and psychologic knowledge, such as the study of neurophysiologic correlates of symbolic and psychodynamic processes. Work by scientists in such areas is also likely to increase knowledge of drugs which may be applicable to interrogation.
Methodologic Problems in Determining the Applicability of Drugs to Interrogation Procedures
A large initial section of this report is devoted to a survey and discussion of the nonspecific effects of drugs and to the difficulties involved in discriminating these effects from the pharmacologic effects of the drugs used. The time spent in describing some of these nonspecific factors is needed to illustrate how the many variables involved complicate the problem of making a judgment regarding the present or potential usefulness of a drug for either therapeutic or intelligence purposes. This section has been included to point out some of the problems which require consideration in designing well-controlled studies in this area. The complexity inherent in psychopharmacologic research requires the integration of all levels of research on drug action: biochemical, neurophysiological and psychological. These problems are multiplied and prediction is lessened when the actions of drugs on living human beings are considered, rather than on isolated nerves, tissues, or animals of simpler neural structure. This reviewer has included only very few bibliographical references to work with animals, and yet a significant portion of excellent experimental, psychologic studies involve animals. This relative omission can be explained by the problem being one unique to human beings: the use of language symbols to communicate and interact with other human beings.
A review of the literature illustrates a variety of effects produced by pharmacologically inert substances which simulate medication (placebos). Depending on the personality of the subject and the circumstances under which the placebo is administered, 30 to 50 per cent of individuals show or experience a reaction. Well-designed studies can distinguish the pharmacologic effect of a drug from the placebo effect. The possibility is raised that an interrogator might exploit the "placebo phenomenon" with a susceptible subject, instead of employing a pharmacologically active drug.
An examination of the literature demonstrates that the effects of drugs vary with the attitude and motivation of the person administering the medication and the person interviewing the informant. The sex and intelligence of the subject, the presence of mental or physical illness, the occurrence of biologic rhythms (e.g., mensis), state of nutrition (e.g., fasting or nonfasting), degree of fatigue, and experimental or enforced isolation have been found to affect the capacity to react and the reaction of individuals to testing procedures, with or without drugs. The method of sampling the verbal behavior of an individual under the influence of a drug, directive, nondirective, free-associative, etc., also determines the kinds of reactions observed. For these reasons, it is recommended that a variety of sampling methods be used in experimental studies.
The Efficacy of Drugs in Uncovering Information
When one examines the literature for experimental and clinical studies that bear directly on the use of drugs in interrogation procedures, one finds relatively few studies. Reports dealing with the validity of material extracted from reluctant informants, whether criminal suspects or experimental subjects, indicate that there is no "truth serum" which can force every informant to report all the information he has. Experimental and clinical evidence indicate that not only the inveterate criminal psychopath may lie or distort under the influence of a drug, but the relatively normal individual may, with many drugs, successfully disguise factual data. Less well-adjusted individuals, plagued by guilt and depression, or suggestible individuals, who are compliant and easily swayed, are more likely to make slips revealing withheld information. Even they may, at times, unconsciously distort information and present fantasies as facts. The anesthetic action of the drug, as in narcosis with barbiturates, can interfere with cerebral functioning and promote the presentation of fantasy material as fact, or otherwise alter the form of verbalizations to render them relatively unintelligible. It would be very difficult under these circumstances for an interrogator to tell when the verbal content was turning from fact to fantasy, when the informant was simulating deep narcosis but actually falsifying, which of contrary stories told under narcosis was true, and when a lack of crucial information coining from a subject under a drug meant the informant had none to offer. To derive useful information from an interrogation in which drugs are employed, an interrogator would have to consider and weigh many important factors: the personality of the subject, the milieu, other sources of evidence, the rapport obtained, and the skill of the questioning. These and other factors affect the validity of information obtained from an informant under sedation. Analogous considerations apply to stimulants.
Specific Effects of Drugs in Interrogation Situations
Advantages and limitations of a number of different types of pharmacologic agents as adjuncts to interrogation can be examined by reviewing clinical and experimental data from the works of psychiatrists, neurologists, psychologists, physiologists, and pharmacologists.
Barbiturates tend to increase contact and communication, decrease attention, decrease anxiety, decrease psychotic manifestations, and make the mood more appropriate and warmer. When combined with interview techniques that aim at arousing emotions, strong emotional reactions may be catalyzed for psychotherapeutic purposes. Barbiturates have been found helpful in detecting whether an individual is feigning knowledge of the English language and in getting mute catatonic schizophrenics and hysterical aphasics to talk. They are of no avail, however, in remedying the speech defects of true aphasics, even transiently. The use of barbiturates has helped to get more reliable estimates of intelligence and personality through psychological tests, particularly in emotionally upset individuals.
The use of various stimulant and antidepressive drugs has been explored, for diagnostic and therapeutic purposes in psychiatric practice, but not to any extent for interrogation. Amphetamine, pipradrol, methylphenidylacetate have in common the capacity to produce an outpouring of ideas, emotions, and memories. An injection of amphetamine following an intravenous barbiturate is said to provoke a striking onrush of talking and activity from psychiatric patients. Without adequately controlling his study, one author claims that methamphetamine produces such a strong urge to talk that the criminal who feigns amnesia or withholds vital information cannot control himself and thus gives himself away. Iproniazid, an antidepressive drug which is relatively slow and sometimes dramatic in its therapeutic effect, should be considered for experimentation. This drug, and similar, less toxic analogs which are being developed, might be considered for use in special instances. For example, informants suffering from chronic depression, whether due primarily to emotional factors, situational stress, or physical debilitation, might become very responsive after using a medication of this type. As a class, the stimulants probably present the most obvious exploitative potential for an interrogator.
The psychotomimetic and hallucinogenic drugs, mescaline and LSD-25, have been used largely to study the nature of psychotic conditions and, in a minor way, as an adjuvant in psychotherapy. The use of such drugs by an interrogator would tend to produce a state of anxiety or terror in most subjects, and promote perceptual distortions and psychotic disorientation. Their use could constitute a definite threat to most medically unsophisticated subjects, i.e., the threat of making the subject "crazy." Thus, they emphasize the unrestricted control of the source by the interrogator. When the subject is not under the influence of such drugs, vital information might be extracted as a price for ceasing further medication. An enlightened informant would not have to feel threatened, for the effect of these hallucinogenic agents is transient in normal individuals. The information given during the psychotic drug state would be difficult to assess, for it may be unrealistic and bizarre. On the other hand, from the informant's viewpoint, taking LSD-25, secreted on his person (it is effective in minute dosage), might offer him temporary protection against interrogation, for it is not likely that an interrogator would consider an individual in a psychotic state a reliable source.
The introduction of new drugs like tranquilizers that sedate but do not impair intellectual functioning in moderate dosage (e.g., phenothiazine derivatives and rauwolfia alkaloids) has caused a minor revolution in the psychiatric therapies of agitated psychotic conditions regardless of type or etiology. There is a possibility that these tranquilizers might be of use with selected informants who are highly agitated and disturbed, and who might give information they prefer to withhold in return for the tranquility they experience with such a sedative. Under the influence of this drug, the less emotionally upset informant might find that he can better master his anxieties and keep his resolve to remain silent. These are all speculations which require testing and experimentation.
Addiction is an added vulnerability to influence. The ability of the subject to give information is not notably affected by a maintenance dosage. The motivational effects of obtaining drug supplies, while extreme, are not of a different order for most subjects than those which the interrogator could produce by other more rapid means. The exploitation of addiction probably constitutes a threat to persons previously addicted, or to those who become addicted in the captivity situation as a sequel to other aspects of their treatment, rather than through the deliberate creation of addiction for exploitative purposes.
Another use to which interrogators might put drugs and placebos would involve their ability to absolve the subject of responsibility for his acts. The popular meaning of being "drugged" or "doped" implies that an individual in this state has lost control over his actions and that society will not hold him responsible for them. When the transmittal of information is likely to induce guilt in the source, the interviewer can forestall some of this reaction by the administration of a placebo or drug. In some cases, this will be all that is require4l to remove the barrier to information transmittal. In the avoidance-avoidance conflict between the source's guilt over yielding information and his anxieties over the possible consequences of noncooperation, the "inescapable" power of the drug or placebo serves to justify the source's actions to himself.
What are the over-all conclusions that can be drawn from this review and critical analysis of the use of pharmacologic agents in obtaining information? Are pharmacologic agents of any value to the interrogator in eliciting vital information? The answer is that drugs can operate as positive catalysts to productive interrogation. Combined with the many other stresses in captivity that an individual may be obliged to undergo, drugs can add to the factors aimed at weakening the resistance of the potential informant. However, for many reasons, the use of drugs by an interrogator is not certain to produce valid results. The effects of drugs depend to a large extent on the personality make-up and physical status of the informant and the kind of rapport that the interrogator is able to establish with him. Knowing the pharmacologic actions of a number of drugs, an interrogating team might choose that chemical agent which is most likely to be effective in view of the informant's personality, physical status, and the various stressful experiences he has already undergone. Even under the most favorable circumstances, the information obtained could be contaminated by fantasy, distortion, and untruth, especially when hallucinogenic or sedative drugs are employed.
Are there ways in which the informant can resist revealing vital information under interrogation with drugs? The answer is yes.
Means are available to the informant faced with the prospect of being given a drug to loosen his tongue. The informant should know that a drug of itself cannot force him to tell the truth, although it may make him talkative, overemotional, mentally confused, or sleepy. He should also know that the effects of drugs are quite variable from individual to individual, and that those who may use drugs against him cannot predict with certainty what effects will occur in his particular case. To a victim of such attempts the imperfect predictability of many of the direct effects and side effects of any drug offers many opportunities for simulation. It is likely that most nonfatal drugs will have a transient, time-limited action rather than a permanent one. There is no need for the informant to become panicky at any bizarre or uncomfortable reactions he may experience, for these reactions will probably disappear. Instead of passively accepting the administration of a drug, without challenging the interrogator's right to apply such pressure, the informant should effectively delay it, and thus stall a possibly stressful interrogation under a drug. Finally, since the interrogator wants accurate and factual information, the informant can confound the interrogator as to what is fact and fiction by a number of means. He can simulate drowsiness, confusion, and disorientation early during the administration of the drug. He can revel in fantasies; the more lurid the better. He can tell contradictory stories. He can simulate a psychosis; or, if he cares to go so far, he can even induce a transient psychotic state by ingesting a small amount of LSD secreted on his person. By these devices, he can raise serious doubts in the interrogator's mind as to the reliability of the information given by him.
As a final suggestion, this reviewer is inclined to agree with West (130) that the basic training of military personnel can be helpful in developing techniques of resistance to interrogation. A brief course on the limitations of the use of drugs in interrogation and on the kinds of pharmacologic effects to be expected from the different types of drugs would be helpful. Such training could decrease the fear, hypersuggestibility, and other deleterious reactions that evolve from the uncertain, the unpredictable, and the unknown.