Lessons to psychiatrists-in-training from the CIA’s mind-control projects

My chief resident gave me a strange look when I arrived for another day of work at the Mayo Clinic one morning.

“Something you’re not telling us?” she asked, gesturing to the two letters on my desk from the Central Intelligence Agency. The jokes — about how I was secretly working for America’s international spy service — wrote themselves. I laughed along.

The letters were responses to Freedom of Information Act (FOIA) requests I had placed months earlier. Along with my clinical duties as a third-year psychiatry resident, I’d been conducting a one-person investigation into the relationship between the Mayo Clinic and the CIA’s Cold War-era mind control programs. Along the way, I became convinced that the study of psychiatry’s past can help psychiatrists-in-training learn to think critically about their work.

During my final year of medical school, I became fascinated by the troubled history of my chosen profession, hoping to reckon with — and learn from — the mistakes of previous generations of psychiatrists. In the face of immense suffering, some had reached desperately for any treatments they thought could help their patients, despite limited evidence for their safety and efficacy. Some, like insulin coma and lobotomy, often caused irreparable harm. The impulse behind these therapies — to do something, anything — resonated with me during my intern year, treating patients with severe mental illness in the inpatient unit.

Effective control of symptoms had to be balanced with the long list of adverse effects medications could cause. Providing good care, I learned, meant learning to live with imperfect outcomes, especially in the cases where the risks of pursuing a complete remission of symptoms outweighed the potential benefits of doing this.

Harder to understand were past instances where psychiatrists had allowed their skills to be used as tools of oppression and social control. In Nazi Germany, psychiatrists participated in euthanasia and sterilization of individuals with mental illness. In the Soviet Union, political dissidents were confined to psychiatric hospitals. These abuses were not limited to other nations. During the 1950s and 1960s, psychiatrists at America’s top academic institutions supported the CIA’s ARTICHOKE and MK-ULTRA projects, which aimed to identify new methods of controlling thought and behavior. This work often involved experimentation on vulnerable people, such as those who were incarcerated or in psychiatric wards. The CIA justified these projects with claims that our Cold War adversaries were already well ahead of us in the “brainwashing” arms race, giving them the upper hand in a conflict with existential stakes.

I became curious about whether my own institution had been involved in these disturbing programs. I learned that Mayo Clinic researchers, including many psychiatrists, had conducted extensive research on deep brain stimulation, hypnosis, and psychedelic drugs — all of which the CIA attempted to exploit for their mind control programs.

I reached out to Dr. Colin Ross, a psychiatrist and historian whose book “The CIA doctors: Human Rights Violations by American Psychiatrists” chronicles the many connections between the worlds of academic psychiatry and clandestine intelligence during the Cold War. Ross had not found evidence of a relationship between the CIA and the Mayo Clinic, but he found the possibility plausible and encouraged me to keep digging.

Excited by the prospect of uncovering something new about this dark chapter in the history of psychiatry, I spent increasing amounts of my free time squinting at faded CIA documents, making regular visits to Mayo’s archives, and learning how to file the FOIA requests that raised eyebrows in the resident workroom. My whiteboard filled up with a tangle of names, dates, and shadowy government agencies, even as I failed to turn up solid evidence of the connections I was searching for. My FOIA requests resulted in cryptic responses that the CIA could neither “confirm or deny” the existence of records on individuals I suspected were involved.

Eventually, I found two versions of a long report by CIA personnel describing a visit to an institution referred to as “the Clinic” in April 1955 to discuss matters related to “ARTICHOKE and other programs of interest to us.” While heavily redacted, every unclassified detail lined up with the Mayo Clinic in the mid-1950s, suggesting — but not proving — that my suspicions had been correct.

The document describes two faculty members named Bickford and Faulconer who had invented an “automatic anesthetic machine,” as well as a chief of psychiatry fascinated by the use of psychotropic mushrooms by Siberian tribes, and a former chief of anesthesiology who popularized the use of sodium pentothal in his field. Even the number of seats in the then-new Medical Sciences Building and the vast network of pneumatic tubes through which medical records were sent between hospitals described in the report are consistent with Mayo Clinic during this period. These are only a few of the details in the report I was able to link to the Mayo Clinic.

The report documents meetings between CIA operatives and two physicians — including the “Chief of Psychiatry” and “former Chief of Anesthesiology” — who were both enthusiastic about supporting the CIA’s mission, though at times were ambivalent about the ethical implications of doing so.

I found the matter-of-fact manner in which these physicians expounded on how medical science could be repurposed for coercion and domination jarring and nauseating to read. One faculty member reportedly believed that sensory deprivation, in combination with LSD, mescaline, and other psychotropic drugs, might be developed into a highly effective “intelligence weapon” of great promise for use on “unwilling or even violently objecting subjects.” The merits of various other psychiatric techniques, such as electroconvulsive therapy and frontal lobotomy, were discussed at length; the latter was written off not for humanitarian reasons, but because it was too unpredictable and technically complex.

More unnerving than the details of these discussions, however, was the fact that the values and motivations of these physicians were far more relatable than I’d expected them to be. They were aware they were on difficult ethical terrain and were attempting to strike a delicate balance between their duty to their country — then engaged in a conflict many believed could lead to nuclear war — and their duty to do no harm. They were wary of conducting human experimentation to support the CIA’s brainwashing efforts, and “made it clear that their work was to help those that were ill and pointed out that their specialties were all aimed in that direction.”

I found no evidence they did anything other than provide advice and offer material and intellectual support in the future. While other individuals and institutions who supported these projects received substantial grant funding, these doctors refused any compensation. They made it clear to their CIA visitors that they were motivated only by patriotism.

Though that does not excuse their actions, the moral ambivalence of the physicians at “the Clinic” made it far easier to imagine me or my colleagues in their position. Psychiatrists in both clinical and research settings have to live with ambiguity, and are often forced to make difficult ethical decisions based on incomplete evidence. It made me wonder what treatments and research practices that are now widely accepted in psychiatry will be hard to justify to the next generation of mental health professionals.

Studying the strange and often disturbing history of psychiatry has helped me reflect critically on my actions as a clinician and researcher, a view echoed by the Mayo Clinic’s current chair of psychiatry, Dr. Jeffrey Staab, with whom I shared my findings. “You’re quite right that we can and should learn from our past, especially from decisions that were made in difficult situations in which multiple ‘right things’ motivated our predecessors,” he wrote to me by email.

Mayo Clinic’s director of communications for media relations declined to comment on whether Mayo collaborated with the CIA on their mind control research during the 1950s. A CIA spokesperson also declined to comment on whether or not any such collaboration took place, but sent me the following statement that blandly recapitulates the facts but offers no insight: “The MKULTRA program ran from 1953 until the lack of productive results and ethical concerns about unwitting testing led to its cessation in 1963. It was reauthorized as MKSEARCH in 1965 on the understanding that no further experimentation on unwitting subjects was authorized. From 1965 until 1972, all subjects were witting, and CIA ceased all human experimentation in 1972. CIA is committed to transparency regarding this chapter of its history, including by declassifying information on the programs and making it publicly available on CIA.gov.”

The CIA’s true commitment to transparency on these matters is open to debate: many of the documents describing these programs were destroyed in 1973 at the order of Richard Helms, who was then the CIA’s director. Among the surviving documents that have been declassified, many contain substantial redactions.

There is evidence that incorporating reflection-based learning in medical residency programs can increase empathy and improve the ability of trainees to manage complex and challenging situations. Based on my experiences investigating a possible shadowy connection between the Mayo Clinic and the CIA, I believe that residency programs should consider creating opportunities for psychiatrists-in-training to study the troubled history of their profession, which may help them learn to approach their work with humility, humanity, and a healthy skepticism of the status quo.

Casimir Klim is a fourth-year psychiatry resident at the Mayo Clinic.