The article “Mental Health Professionals in the ‘Enhanced’ Interrogation Room” on the cover of this issue provides an invaluable service. It documents psychologists’ and physicians’ involvement in enhanced interrogation programs.
The impact of professional involvement goes beyond the harm suffered by the person who is waterboarded, slammed into a wall, forced to hold a stress position, or deprived of sleep for over 72 hours. Freyd1 wrote that professional participation perpetrates 3 betrayals. It betrays the trust and human rights of the person subjected to those methods; it betrays professional ethics; and it betrays society’s trust.
US psychologists embraced ethical policies that set them apart from other professionals.2 Steven H. Miles,3 author of Oath Betrayed: America’s Torture Doctors, wrote: “The American Psychological Association was unique among US health professional associations in providing policy cover for abusive interrogations.”4
After 9/11, the American Psychological Association revised its ethics code to reject the Nuremberg ethic.5 The May 16, 2009, issue of the British Medical Journal emphasized this new psychology-physician split on its cover by stating in regard to the contrasting ethical policies: “Interrogating Detainees: Why Psychologists Participate and Doctors Don’t.”
In that issue, the journal editor, Fiona Godlee,6 wrote:
"Just obeying the rules has long been insufficient for doctors. The judges at Nuremberg made clear that obeying commands from superiors didn’t remove personal accountability. Doctors couldn’t deviate from their ethical obligations even if a country’s laws allowed or demanded otherwise. . . . So deeply ingrained is this ethic in health care that it’s surprising, even shocking, to find that the same code isn’t shared by psychologists, at least in the United States."
The American Psychological Association had adopted a discredited ethical rationalization used by the Nuremberg defendants as one of its own ethical values. Fierce criticism came from those outside, like Godlee, but also from those inside the organization. Two prominent members, Lohr and Tolin, wrote that their professional association must set aside the notion of “pre-9/11 ethics” and “post-9/11 ethics,” that psychologists must realize that core ethical values “should not vary according to shifts in the political tide,” and that the rejection of the Nuremberg ethics “sets professional psychology apart from other helping and healing professions who have refused to compromise principle for expediency.”7
We cannot ethically turn away from what happened in settings like Abu Ghraib and Guantanamo. As members of the psychiatry and psychology professions, we have both individual and shared responsibilities for what we do and fail to do. We must work toward understanding what happened, how it happened, and where we need to go from here.
New works continue to document how the American Psychological Association’s policies evolved and their disastrous consequences.2,7-9 As a psychologist, I have a special responsibility to address these issues in light of psychology’s support for and key roles in the interrogations. There is much work to be done.
An open letter to the American Psychological Association from Amnesty International, Physicians for Human Rights, and 11 other organizations describes some necessary steps to address “the terrible stain on . . . American psychology.”10 Here is an excerpt:
"Any meaningful approach to this issue must start by acknowledging the fact that psychologists were absolutely integral. . . . When the Bush administration decided to engage in torture, they turned to psychologists. . . . [American Psychological Association] leadership has much work ahead to begin to repair the harm they have caused to the profession, the country, former and current detainees and their families."
References1. Freyd JJ. Rules of conscience: Betray ethics, betray trust. BMJ. 2009;338:b2191. http://www.bmj.com/ cgi/content/full/bmj.b2191?ijkey=gLzS4bmfnLfb0xp&keytype=ref. Accessed October 12, 2009.