Stephen Xenakis | Uniformed Services University (original) (raw)
Papers by Stephen Xenakis
Oxford University Press eBooks, Jan 16, 2020
The United States is only just beginning to grapple with the fallout from the program known as Re... more The United States is only just beginning to grapple with the fallout from the program known as Rendition, Detention and Interrogation (RDI), an illegal interrogation practice designed to further the United States counter-terrorism efforts against al-Qaeda and the Taliban. One of the most consequential legacies of the program stems from the way it was justified: lawyers for the Bush administration sought to legitimize the program through distorted legal doctrines, some of which remained in currency even after the RDI program was finally abandoned. The attempt to justify illegal conduct with false legal arguments, along with the failure of the subsequent administration to hold the principal architects of the program responsible, has eroded the rule of law in the United States and done permanent damage to norms of armed conflict as well as to domestic and international law. This chapter discusses the consequences of the RDI program, with particular attention paid to the impact of legal manipulations used to justify the program as well as the failure of accountability that resulted. In Part IV, this chapter addresses the question whether torture has been permanently eliminated from U.S. law, or whether the practice is likely to return. In this connection, the chapter raises concerns about the McCain-Feinstein Amendment that tied permissible interrogation methods to the Army Field Manual (AFM), which continues to authorize the psychologically and emotionally damaging techniques of sensory and sleep deprivation through Appendix M. The chapter finally discusses ways to repair the damage the RDI program and its aftermath inflicted on the rule of law.
Journal of the American Academy of Psychiatry and the Law, Sep 1, 2020
Clinical Case Maintaining Medical Neutrality in Conflict Zones Commentary by Stephen N. Xenakis, ... more Clinical Case Maintaining Medical Neutrality in Conflict Zones Commentary by Stephen N. Xenakis, MD, and by Yishai Ofran, MD Asher is a fourth-year medical student doing an international elective in northern Uganda. The clinic he's stationed in serves primarily the local community, and he's seen everything from routine ear infections to advanced AIDS, encephalitis, parasitic infections, and disseminated tuberculosis. As one of the few Westerners the villagers have ever seen, Asher has created quite a stir. Although he's starting to feel more at home in the village, he knows that his actions are watched closely by the townspeople, and he's scrupulous about his interactions with them, always respectful and deferential to local customs and values. The organization he's working with can only staff the clinic for eight months out of the year, so when an American medical team is there, news travels fast to neighboring communities, and occasionally people come from quite a distance to seek care. One evening, Asher heard a commotion outside the clinic. Several men and women had gathered, and there was shouting. Asher asked a nurse what was causing the upset, and she explained that men thought to be affiliated with a group of rebel fighters from the north were approaching town, and some had been wounded. Asher moved to send for the local physicians and ready the procedure suites, but the nurse stopped him. "We've worked for years to establish trust among the local people here-trust that's enabled us to dramatically improve the health in these communities. It would be a grave insult if we offered care to their violent enemies, and that would surely result in a huge setback for all our hard work. We should shut down the clinic before the rebels arrive because they're not welcome here." Commentary 1 by Stephen N. Xenakis, MD Candidates for the Supreme Court react to hypothetical questions as if they are radioactive and creatively dodge them at confirmation hearings. But physicians use them for teaching. This case study could fall under the teaching module entitled, "How Physicians Serving in a Hostile Environment Can Make Ethical and Practical Decisions." Asher, the medical student in northern Uganda who is in charge of the clinic for the evening, must make an urgent decision about treating potentially hostile, even dangerous, patients and does not have time to consult with others.
Journal of the American Academy of Child and Adolescent Psychiatry, Jul 1, 1988
One hundred families with a child from ages 6 to II from a nonclinical population were surveyed t... more One hundred families with a child from ages 6 to II from a nonclinical population were surveyed to determinethe effects of child and family psychosocial and demographic characteristics on interrateragreement about children'ssymptomsand behavior problems. Results indicated that a significant proportion of the variance in difference scores among parent, child, and teacher reports about the child is a function of the family status (blended/previous divorce versus intact family), sex of parent and child, life stressors, the child's tendency to respond in socially desirable fashion, sibling position and family size, and familiarity of the child to the rater. Development of scales less sensitive to the effects of external, environmental, and child-related variables is needed to improve their reliability and validity and their usefulness as screening instruments in nonclinical populations.
Psychiatrists and other mental health practitioners are thrust into a unique role when confronted... more Psychiatrists and other mental health practitioners are thrust into a unique role when confronted with warfare in the twenty-first century. Their involvement draws them into the epicenter of the war on terrorism. The realities of modern warfare push them beyond the principle of “first, do no harm,” which has historically grounded the healing professions, and into unprecedented dilemmas that challenge roles and responsibilities.
The Journal of the American Academy of Psychiatry and the Law, 2020
When I first worked with detainees at Guantanamo Bay, I was troubled by a peculiar and unsettling... more When I first worked with detainees at Guantanamo Bay, I was troubled by a peculiar and unsettling awareness, a collision of polar opposites that has shadowed all my experiences there. Here I was, focusing on torture and cruel, inhuman, and degrading treatment of prisoners and yet, these were the
Military Medicine, 1983
of time (less than one hour) have not been systematically studied. This paper reports on observat... more of time (less than one hour) have not been systematically studied. This paper reports on observations of psychiatric symptoms which spontaneously occurred during a combat field exercise in which medics (MOS 91B) managed mock chemical casualties.
American Journal of Psychiatry, 1993
Psychoanalytic Psychology, 2014
Journal of the American Academy of Child & Adolescent Psychiatry, 1988
Abstract Medical records of all children (N= 38) being treated with psychostimulants for attentio... more Abstract Medical records of all children (N= 38) being treated with psychostimulants for attention deficit disorder at one general hospital clinic were screened from birth to point of diagnosis. Frequency of medical and psychosocial conditions, including hospitalizations, ...
Journal of the American Academy of Child & Adolescent Psychiatry, 1988
One hundred families with a child from ages 6 to II from a nonclinical population were surveyed t... more One hundred families with a child from ages 6 to II from a nonclinical population were surveyed to determinethe effects of child and family psychosocial and demographic characteristics on interrateragreement about children'ssymptomsand behavior problems. Results indicated that a significant proportion of the variance in difference scores among parent, child, and teacher reports about the child is a function of the family status (blended/previous divorce versus intact family), sex of parent and child, life stressors, the child's tendency to respond in socially desirable fashion, sibling position and family size, and familiarity of the child to the rater. Development of scales less sensitive to the effects of external, environmental, and child-related variables is needed to improve their reliability and validity and their usefulness as screening instruments in nonclinical populations.
Journal of the American Academy of Child & Adolescent Psychiatry, 1989
The effects of fathers' absences during the previous year on 213 military children were e... more The effects of fathers' absences during the previous year on 213 military children were examined, using multiple measures of children's functioning and psychiatric symptoms. Children whose fathers had been absent 1 or more months during the previous 12 months experienced significantly higher self-reported depression and anxiety, but these symptoms were not apparent to adult observers (parents and teachers). These effects were not demonstrated when maternal psychiatric symptoms and intercurrent family stressors were controlled. Thus, the effects of father absence under routine conditions in relatively healthy samples may exert no significant effects independent of intervening family stressors or maternal psychopathology. Clinic referrals of children during times of father absence may partly be due to an effect of additional stressors impacting on the mother during the absence of the father.
Journal of the American Academy of Child & Adolescent Psychiatry, 1989
Journal of the American Academy of Child & Adolescent Psychiatry, 1996
To determine the mental health needs and optimal treatments for children and families in &... more To determine the mental health needs and optimal treatments for children and families in "real world" settings, data-gathering strategies are needed that can be easily implemented across a variety of clinical settings. To address this need, the authors developed and piloted a "clinician-friendly" questionnaire that includes demographic, psychosocial, medical, and family history variables, such as those routinely gathered in standard clinical evaluations. Optical scanning technology was used to encode data from more than 1,900 children, including 1,458 consecutive referrals in four military child psychiatry clinics, 285 consecutive admissions to a civilian psychiatric state hospital, 71 pediatric patients, and a community sample of 113 children. Despite geographic and logistic obstacles, clinical data were reliably obtained across multiple settings. Data analyses revealed meaningful differences across samples in subjects' presenting complaints, and a range of psychosocial, demographic, and background variables. Data were characterized by an apparently high degree of accuracy and completeness. Findings illustrate the importance and feasibility of standardized data-gathering approaches in routine clinical settings and clarify the hazards as well as the opportunities afforded by these research approaches. Such data-gathering tools appear to have significant merit and deserve further implementation and testing across a range of clinical and research settings.
Journal of Psychopathology and Behavioral Assessment, 2004
This study examined staff ratings and live observations of externalizing behavior in 149 girls wi... more This study examined staff ratings and live observations of externalizing behavior in 149 girls with and without attention-deficit/hyperactivity disorder (ADHD), who participated in all-female naturalistic research camps. Girls' popularity with adult camp staff was hypothesized to explain discrepancies between ratings and observations. Compared to behavior observations, staff ratings overestimated the externalizing behavior of girls who were disliked by staff. In contrast, ratings and observations were consistent for girls who were liked by staff. Among girls who were disliked by staff, unpopularity with peers predicted a larger discrepancy between staff ratings and observations, but peer status made little difference in rating-observation discrepancies of girls liked by staff. All results held after controlling for the participants' ADHD versus comparison status. Results suggest that staff ratings may be biased by personal feelings about children and that direct observations may be more immune to such bias.
Oxford University Press eBooks, Jan 16, 2020
The United States is only just beginning to grapple with the fallout from the program known as Re... more The United States is only just beginning to grapple with the fallout from the program known as Rendition, Detention and Interrogation (RDI), an illegal interrogation practice designed to further the United States counter-terrorism efforts against al-Qaeda and the Taliban. One of the most consequential legacies of the program stems from the way it was justified: lawyers for the Bush administration sought to legitimize the program through distorted legal doctrines, some of which remained in currency even after the RDI program was finally abandoned. The attempt to justify illegal conduct with false legal arguments, along with the failure of the subsequent administration to hold the principal architects of the program responsible, has eroded the rule of law in the United States and done permanent damage to norms of armed conflict as well as to domestic and international law. This chapter discusses the consequences of the RDI program, with particular attention paid to the impact of legal manipulations used to justify the program as well as the failure of accountability that resulted. In Part IV, this chapter addresses the question whether torture has been permanently eliminated from U.S. law, or whether the practice is likely to return. In this connection, the chapter raises concerns about the McCain-Feinstein Amendment that tied permissible interrogation methods to the Army Field Manual (AFM), which continues to authorize the psychologically and emotionally damaging techniques of sensory and sleep deprivation through Appendix M. The chapter finally discusses ways to repair the damage the RDI program and its aftermath inflicted on the rule of law.
Journal of the American Academy of Psychiatry and the Law, Sep 1, 2020
Clinical Case Maintaining Medical Neutrality in Conflict Zones Commentary by Stephen N. Xenakis, ... more Clinical Case Maintaining Medical Neutrality in Conflict Zones Commentary by Stephen N. Xenakis, MD, and by Yishai Ofran, MD Asher is a fourth-year medical student doing an international elective in northern Uganda. The clinic he's stationed in serves primarily the local community, and he's seen everything from routine ear infections to advanced AIDS, encephalitis, parasitic infections, and disseminated tuberculosis. As one of the few Westerners the villagers have ever seen, Asher has created quite a stir. Although he's starting to feel more at home in the village, he knows that his actions are watched closely by the townspeople, and he's scrupulous about his interactions with them, always respectful and deferential to local customs and values. The organization he's working with can only staff the clinic for eight months out of the year, so when an American medical team is there, news travels fast to neighboring communities, and occasionally people come from quite a distance to seek care. One evening, Asher heard a commotion outside the clinic. Several men and women had gathered, and there was shouting. Asher asked a nurse what was causing the upset, and she explained that men thought to be affiliated with a group of rebel fighters from the north were approaching town, and some had been wounded. Asher moved to send for the local physicians and ready the procedure suites, but the nurse stopped him. "We've worked for years to establish trust among the local people here-trust that's enabled us to dramatically improve the health in these communities. It would be a grave insult if we offered care to their violent enemies, and that would surely result in a huge setback for all our hard work. We should shut down the clinic before the rebels arrive because they're not welcome here." Commentary 1 by Stephen N. Xenakis, MD Candidates for the Supreme Court react to hypothetical questions as if they are radioactive and creatively dodge them at confirmation hearings. But physicians use them for teaching. This case study could fall under the teaching module entitled, "How Physicians Serving in a Hostile Environment Can Make Ethical and Practical Decisions." Asher, the medical student in northern Uganda who is in charge of the clinic for the evening, must make an urgent decision about treating potentially hostile, even dangerous, patients and does not have time to consult with others.
Journal of the American Academy of Child and Adolescent Psychiatry, Jul 1, 1988
One hundred families with a child from ages 6 to II from a nonclinical population were surveyed t... more One hundred families with a child from ages 6 to II from a nonclinical population were surveyed to determinethe effects of child and family psychosocial and demographic characteristics on interrateragreement about children'ssymptomsand behavior problems. Results indicated that a significant proportion of the variance in difference scores among parent, child, and teacher reports about the child is a function of the family status (blended/previous divorce versus intact family), sex of parent and child, life stressors, the child's tendency to respond in socially desirable fashion, sibling position and family size, and familiarity of the child to the rater. Development of scales less sensitive to the effects of external, environmental, and child-related variables is needed to improve their reliability and validity and their usefulness as screening instruments in nonclinical populations.
Psychiatrists and other mental health practitioners are thrust into a unique role when confronted... more Psychiatrists and other mental health practitioners are thrust into a unique role when confronted with warfare in the twenty-first century. Their involvement draws them into the epicenter of the war on terrorism. The realities of modern warfare push them beyond the principle of “first, do no harm,” which has historically grounded the healing professions, and into unprecedented dilemmas that challenge roles and responsibilities.
The Journal of the American Academy of Psychiatry and the Law, 2020
When I first worked with detainees at Guantanamo Bay, I was troubled by a peculiar and unsettling... more When I first worked with detainees at Guantanamo Bay, I was troubled by a peculiar and unsettling awareness, a collision of polar opposites that has shadowed all my experiences there. Here I was, focusing on torture and cruel, inhuman, and degrading treatment of prisoners and yet, these were the
Military Medicine, 1983
of time (less than one hour) have not been systematically studied. This paper reports on observat... more of time (less than one hour) have not been systematically studied. This paper reports on observations of psychiatric symptoms which spontaneously occurred during a combat field exercise in which medics (MOS 91B) managed mock chemical casualties.
American Journal of Psychiatry, 1993
Psychoanalytic Psychology, 2014
Journal of the American Academy of Child & Adolescent Psychiatry, 1988
Abstract Medical records of all children (N= 38) being treated with psychostimulants for attentio... more Abstract Medical records of all children (N= 38) being treated with psychostimulants for attention deficit disorder at one general hospital clinic were screened from birth to point of diagnosis. Frequency of medical and psychosocial conditions, including hospitalizations, ...
Journal of the American Academy of Child & Adolescent Psychiatry, 1988
One hundred families with a child from ages 6 to II from a nonclinical population were surveyed t... more One hundred families with a child from ages 6 to II from a nonclinical population were surveyed to determinethe effects of child and family psychosocial and demographic characteristics on interrateragreement about children'ssymptomsand behavior problems. Results indicated that a significant proportion of the variance in difference scores among parent, child, and teacher reports about the child is a function of the family status (blended/previous divorce versus intact family), sex of parent and child, life stressors, the child's tendency to respond in socially desirable fashion, sibling position and family size, and familiarity of the child to the rater. Development of scales less sensitive to the effects of external, environmental, and child-related variables is needed to improve their reliability and validity and their usefulness as screening instruments in nonclinical populations.
Journal of the American Academy of Child & Adolescent Psychiatry, 1989
The effects of fathers' absences during the previous year on 213 military children were e... more The effects of fathers' absences during the previous year on 213 military children were examined, using multiple measures of children's functioning and psychiatric symptoms. Children whose fathers had been absent 1 or more months during the previous 12 months experienced significantly higher self-reported depression and anxiety, but these symptoms were not apparent to adult observers (parents and teachers). These effects were not demonstrated when maternal psychiatric symptoms and intercurrent family stressors were controlled. Thus, the effects of father absence under routine conditions in relatively healthy samples may exert no significant effects independent of intervening family stressors or maternal psychopathology. Clinic referrals of children during times of father absence may partly be due to an effect of additional stressors impacting on the mother during the absence of the father.
Journal of the American Academy of Child & Adolescent Psychiatry, 1989
Journal of the American Academy of Child & Adolescent Psychiatry, 1996
To determine the mental health needs and optimal treatments for children and families in &... more To determine the mental health needs and optimal treatments for children and families in "real world" settings, data-gathering strategies are needed that can be easily implemented across a variety of clinical settings. To address this need, the authors developed and piloted a "clinician-friendly" questionnaire that includes demographic, psychosocial, medical, and family history variables, such as those routinely gathered in standard clinical evaluations. Optical scanning technology was used to encode data from more than 1,900 children, including 1,458 consecutive referrals in four military child psychiatry clinics, 285 consecutive admissions to a civilian psychiatric state hospital, 71 pediatric patients, and a community sample of 113 children. Despite geographic and logistic obstacles, clinical data were reliably obtained across multiple settings. Data analyses revealed meaningful differences across samples in subjects' presenting complaints, and a range of psychosocial, demographic, and background variables. Data were characterized by an apparently high degree of accuracy and completeness. Findings illustrate the importance and feasibility of standardized data-gathering approaches in routine clinical settings and clarify the hazards as well as the opportunities afforded by these research approaches. Such data-gathering tools appear to have significant merit and deserve further implementation and testing across a range of clinical and research settings.
Journal of Psychopathology and Behavioral Assessment, 2004
This study examined staff ratings and live observations of externalizing behavior in 149 girls wi... more This study examined staff ratings and live observations of externalizing behavior in 149 girls with and without attention-deficit/hyperactivity disorder (ADHD), who participated in all-female naturalistic research camps. Girls' popularity with adult camp staff was hypothesized to explain discrepancies between ratings and observations. Compared to behavior observations, staff ratings overestimated the externalizing behavior of girls who were disliked by staff. In contrast, ratings and observations were consistent for girls who were liked by staff. Among girls who were disliked by staff, unpopularity with peers predicted a larger discrepancy between staff ratings and observations, but peer status made little difference in rating-observation discrepancies of girls liked by staff. All results held after controlling for the participants' ADHD versus comparison status. Results suggest that staff ratings may be biased by personal feelings about children and that direct observations may be more immune to such bias.