News accounts and court records of detainee interrogations in such settings as the Guantnamo Bay detainment camp and the Abu Ghraib prison have sparked controversy over involvement of mental health professionals and behavioral scientists. Authors of articles in medical, psychological, legal, and scientific journals have struggled with complex ethical questions about psychiatrists and psychologists who participate in planning or implementing detainee interrogations.
Psychologists at the center of the controversy
Psychologists have moved to the center of this controversy for diverse reasons. First, the Pentagon's stated intention to rely on psychologists rather than psychiatrists fits well with the American Psychological Association's stated belief in contributing to detainee interrogations to prevent terrorism. As the New York Times reported:
“Pentagon officials said . . . they would try to use only psychologists, not psychiatrists, to help interrogators devise strategies to get information from detainees at places like Guantnamo Bay, Cuba. The new policy follows by little more than two weeks an overwhelming vote by the American Psychiatric Association discouraging its members from participating in those efforts. Stephen Behnke, director of ethics for the counterpart group for psychologists, the American Psychological Association, said psychologists knew not to participate in activities that harmed detainees. But he also said the group believed that helping military interrogators made a valuable contribution because it was 'part of an effort to prevent terrorism.'”1
Second, in contrast to the American Psychological Association's position, the American Psychiatric Association voted overwhelmingly to discourage its members from participating in any interrogation activities. In May 2006, after extensive debate and careful consideration of all points of view, the American Psychiatric Association's Board of Trustees and the Assembly of District Branches approved a clear prohibition.
“No psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere. Direct participation includes being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees.”2
This policy was based on a tradition of medical ethics reaching back to the Hippocratic oath and its fundamental principle to do no harm. Similarly, the AMA adopted a prohibition: “Physicians must not conduct, directly participate in, or monitor an interrogation with an intent to intervene, because this undermines the physician's role as healer.”3
Third, disagreements among psychologists on the issues have tended to be sharp and have been reported on vividly in the media. For example, the Associated Press, in describing how the American Psychological Association “scrapped a measure” to prohibit its members from assisting interrogators at any US military detention center, illustrated what was at stake.
“If we remove psychologists from these facilities, people are going to die,” said Army COL Larry James, who serves as a psychologist at Guantanamo Bay. . . .
“If psychologists have to be there so detainees don't get killed, those conditions are so horrendous that the only moral and ethical thing is to leave,” said Laurie Wagner, a psychologist from Dallas.
The association's vote follows reports that mental health specialists were involved in prisoner abuse scandals at Guantanamo Bay and Abu Ghraib prison.4
Fourth, some articles began to focus on psychologists' participation when exploring the development of what became known as extreme interrogation techniques. For example, it was recently documented that “psychologists weren't merely complicit in America's aggressive new interrogation regime. Psychologists, working in secrecy, had actually designed the tactics and trained interrogators in them while on contract to the CIA.”5
Fifth, some articles examined psychologists' presence during interrogations. Medical ethicist Steven Miles,6 for example, used declassified US Army investigation and interrogation logs to document an especially vivid instance of a psychologist's presence during the use of a technique that involved using a dog to “exploit individual phobias.” Federal Bureau of Investigation (FBI) agents found these tactics so objectionable that they withdrew themselves. The FBI filed a complaint that led to the US Army investigation of this case.
Similarly, the American Civil Liberties Union obtained declassified documents from the Department of Defense through the Freedom of Information Act and issued a news release with links to the original Defense Department documents. That news report confirmed the support of psychologists in illegal interrogations in Iraq and Afghanistan.7
Examples of diverse publications focusing on psychologists' involvement include the Houston Chronicle's “Human wrongs: Psychologists have no place assisting interrogations at places such as Guantanamo Bay” (an editorial)8; the Seattle Post-Intelligencer's “Psychologists implicated in torture”9; Harper's “The psychologists and Gitmo”10; Tikku's “Psychologists aiding and abetting torture”11; and Washington Monthly's “Collective unconscionable: how psychologists, the most liberal of professionals, abetted Bush's torture policy.”12
American Psychological Association's ethics code
How have psychologists addressed ethical concerns about their work with detainee interrogations? Historically, when concerns arose about the effect and ethics of psychologists' behavior on groups at risk, the American Psychological Association moved decisively to create specific protections for these groups along with explicit requirements governing the specialized work with them in the ethics code's enforceable standards. The code provides specific protections to groups “for whom testing is mandated by law or governmental regulations,” “persons with a questionable capacity to consent,” research participants, “subordinates,” clients, students, supervisees, and employees.13
Facing concerns about the effect of psychologists' behavior on research animals, the American Psychological Association added to its ethics code an enforceable standard that supports the “humane treatment” of laboratory animals.13 In some cases, the code addresses extremely specialized forms of work performed by psychologists, such as serving as a reviewer of grant proposals, being called to provide testimony in divorce proceedings after serving as a family therapist, or conducting “surgical procedures” on laboratory animals.
In stark contrast to these enforceable protections and standards, the American Psychological Association decided against adding enforceable standards for psychologists' work with detainees. Why refuse to give detainees the enforceable ethical mandate of humane treatment that the code explicitly accords to laboratory animals?
The American Psychological Association has issued various public statements condemning torture as unethical and unacceptable, yet it has chosen not to make these statements enforceable on its own membership through inclusion in the enforceable section of its ethics code. The code itself emphasizes that the numbered ethical standards “set forth enforceable rules of conduct.”13 It also points out that although other code sections should be given consideration, even the code's “Preamble and General Principles are not themselves enforceable rules.”13 The statements on torture that the association has adopted and publicized were not included in the general principles, let alone included as enforceable standards in the code.
Interestingly, the American Psychological Association did take a decisive step that changed members' relationship to their ethical responsibilities and accountability. The change involved a principle that became a focus of attention and concern during the Nuremberg trials following World War II.14,15 Could the defendants escape accountability for violating their most basic ethical responsibilities by claiming that they had adhered to laws, regulations, and other forms of state authority? Were assertions of “just following the law” or “just following orders” a valid defense? The Nuremberg tribunals did not accept this reasoning as valid.
The American Psychological Association ethics code that was in effect before and through the September 11, 2001, terrorist attacks set forth the following enforceable standard regarding conflicts between ethical responsibilities and various forms of state authority. “1.02 Relationship of Ethics and Law: If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict.”16
Although giving psychologists the option to violate their ethical responsibilities in order to follow the law, regulations, or other forms of legal authority had been discussed before September 11, it was only after that date—on August 21, 2002—that the American Psychological Association Council of Representatives adopted a new code (which took effect June 1, 2003) that added a new enforceable ethical principle to section 1.02: “If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority.”13 It is worth noting that this new option is absolute and unqualified and applies not just to the specific requirements enumerated in the code but more generally to all “ethical responsibilities.”
This addition to the American Psychological Association's enforceable standards continues the association's move away from its previous ethical foundation, historic traditions, and basic values. A later attempt to qualify and limit the scope of this new enforceable standard was relegated to the unenforceable section of the ethics code. In the 6 years since creating this new standard in a sharp break with the past, the American Psychological Association chose to make no qualifications, restrictions, or other modifications to section 1.02 in the code's enforceable section.
The 89 enforceable standards of the American Psychological Association's ethics code identify diverse ethical responsibilities, some representing the profession's deepest values. The code recognizes that these ethical values can stand in stark, irreconcilable conflict—no matter what steps the psychologist takes to resolve the conflict—with a regulation, law, or governing legal authority. The association's creation of an enforceable standard that allows psychologists to violate these fundamental ethical responsibilities in favor of following a regulation, law, or governing legal authority contrasts not only with the values affirmed at Nuremberg but also with the American Psychological Association's own previous ethical foundation, historic traditions, and basic values.
Since the American Psychological Association took this exceptional step, neither the American Psychiatric Association nor the AMA has followed suit. Many organizations and individuals continue to refer to and affirm the Nuremberg values. The president of the World Medical Association, for example, reminded the world: “At Nuremberg in 1947, accused physicians tried to defend themselves with the excuse that they were only following the law and commands from their superiors. . . . [T]he court announced that a physician could not deviate from his ethical obligations even if legislation demands otherwise.”17 What are the implications of the American Psychological Association promoting, teaching, modeling, and mentoring an ethics code that includes an enforceable ethical standard in conflict with a basic ethical mandate that Nuremberg reaffirmed and underscored?
Psychology prides itself as being a scientific discipline that is empirically grounded and open to questions. In addition to the other questions raised in this article, it is worth carefully considering the answers that the American Psychological Association provides for such fundamental questions as: What methods did it use to determine that “psychologists knew not to participate in activities that harmed detainees”? In addition, what methods did it use to determine that psychologists' behavior would not, however unintentionally, depart from such knowledge?
Finally, the president of the American Psychological Association wrote in 2007: “The Association's position is rooted in our belief that having psychologists consult with interrogation teams makes an important contribution toward keeping interrogations safe and ethical.”18 Over the years that the detainee interrogations have been conducted, what methods of assessment has the association used to determine that the interrogations have been kept safe, causing no harm to detainees, and what methods has the association used to determine that the interrogations have been kept ethical, in accordance with the detainees' human and legal rights?
Citations for over 270 articles and books addressing this controversy can be found at http://kspope.com/interrogation/index.php.
1. Lewis NA. Washington: psychologists preferred for detainees. New York Times. June 7, 2006. http://tinyurl.com/2gfjdz. Accessed June 5, 2008.
2. American Psychiatric Association. Psychiatric participation in interrogation of detainees: position statement. May 2006. http://archive.psych.org/edu/other_res/lib_archives/archives/200601.pdf. Accessed June 5, 2008.
3. American Medical Association. New AMA ethical policy opposes direct physician participation in interrogation. June 12, 2006.http://www.ama-assn.org/ama/pub/category/16446.html. Accessed June 5, 2008.
4. Thanawala S. US psychologists scrap interrogation ban: psychology group scuttles proposed ban on aiding military interrogations. Associated Press. August 20, 2007. http://abcnews.go.com/US/wireStory?id=3499544. Accessed June 5, 2008.
5. Eban K. Rorschach and Awe. Vanity Fair. July 17, 2007. http://tinyurl.com/2zkg9p. Accessed June 5, 2008.
6. Miles S. Medical ethics and the interrogation of Guantanamo 063. The American Journal of Bioethics. 2007;7:5. http://www.bioethics.net/journal/j_articles.php?aid=1140. Accessed June 5, 2008.
7. American Civil Liberties Union. Newly unredacted report confirms psychologists supported illegal interrogations in Iraq and Afghanistan: documents obtained by ACLU also uncover “widespread use” of rescinded unlawful interrogation techniques and failure of medical personnel to report abuses. April 30, 2008. http://www.aclu.org/safefree/torture/35111prs20080430.html. Accessed June 5, 2008.
8. Human wrongs: Psychologists have no place assisting interrogations at places such as Guantanamo Bay. Houston Chronicle. August 23, 2007. http://www.chron.com/CDA/archives/archive.mpl?id=2007_4410052. Accessed June 5, 2008.
9. Goodman A. Psychologists implicated in torture. Seattle Post-Intelligencer. June 6, 2007.http://seattlepi.nwsource.com/opinion/318745_amy07.html. Accessed June 5, 2008.
10. Horton S. The psychologists and Gitmo. Harper's. November 18, 2007. http://www.harpers.org/archive/ 2007/11/hbc-90001695. Accessed June 5, 2008.
11. Kory D. Psychologists aiding and abetting torture. Tikkun. July/August, 2007. http://www.tikkun.org/archive/backissues/tik0708/frontpage/torture2/view?searchterm=abetting. Accessed June 5, 2008.
12. Levine A. Collective unconscionable: how psychologists, the most liberal of professionals, abetted Bush's torture policy. Washington Monthly. January/February 2007. http://www.washingtonmonthly.com/features/2007/0701.levine.html. Accessed June 5, 2008.
13. American Psychological Association. Ethical principles of psychologists and code of conduct. Am Psychol. 2002;57:1060-1073.
14. Taylor T. Final Report to the Secretary of the Army on the Nuremberg War Trials Under Control Council Law No. 10. Buffalo, NY: William S. Hein & Company; 1997. (Originally published August 15, 1949.)
15. Taylor T. Anatomy of the Nuremberg Trials. Boston: Little, Brown & Company; 1992.
16. American Psychological Association. Ethical principles of psychologists and code of conduct. Am Psychol. 1992;47:1597-1611.
17. World Medical Association. Physicians under threat, warns WMA president. Press release. June 23, 2003. http://www.wma.net/e/press/2003_9.htm. Accessed June 5, 2008.
18. Brehm S. Regarding “Collective unconscionable,” a few relevant facts that Mr Levine chose not to include in his reporting. American Psychological Association news release of letter from the APA president to the editor of the Washington Monthly. January 9, 2007. http://www.apa.org/releases/washingtonmonthly.pdf. Accessed June 5, 2008.