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Rapid Responses: Rapid Responses published:
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Psychologists and Torture
- Steven H Miles (1 May 2009)
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Historical Lessons Left Unlearned
- Jennifer A. Hoult (2 May 2009)
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My Reaction to Pope & Gutheil
- Brad Olson (2 May 2009)
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Detainees omitted from APA's ethics code
- Barbara Finn (2 May 2009)
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APA's Resistance
- Trudy Bond (5 May 2009)
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American Psychological Association Unmasked
- Martin H. Williams (5 May 2009)
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Psychiatrists and Interrogation
- Nada L. Stotland (5 May 2009)
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Profession and Confession
- David Spiegel, M.D. (5 May 2009)
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Psychology is not just a healthcare field
- Harris L. Friedman (5 May 2009)
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Re: Psychologists and Torture
- Sallie R. Tasto (5 May 2009)
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Is torture too small a target?
- Thomas E. Schacht (6 May 2009)
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A ‘Lonestar’ in Texas?
- Mark Struthers (6 May 2009)
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One happy [young] psychiatrist...
- Sohrab Zahedi, M.D. (8 May 2009)
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The Misuse of Science and Psychology
- Linda Hartling, Ph.D. (11 May 2009)
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Frightened for the future of psychology
- Paula J. Caplan (11 May 2009)
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Re: A ‘Lonestar’ in Texas?
- Mark Struthers (12 May 2009)
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Psychology and War
- Dr. Leeat Granek (15 May 2009)
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APA Supports Authors' Recommendations
- Rhea K. Farberman (15 May 2009)
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Re: APA Supports Authors' Recommendations
- Kenneth S. Pope, Thomas G. Gutheil (17 May 2009)
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The APA, not "psychologists"
- Andrew F West (18 May 2009)
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Considerations about ethics and the interrogations of detainees
- David H. Mills (21 May 2009)
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Betrayal of Ethics, Betrayal of Trust
- Jennifer J. Freyd (21 May 2009)
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Psychologists for Social Responsibility Responds
- Roy J. Eidelson (21 May 2009)
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The interrogation of detainees : how doctors's and psychologists' ethical policies differ
- Ian F Wall, C George M Fernie, Registrar Faculty of Forensic and Legal Medicine (27 May 2009)
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APA Ethics Code Doppelganger revealed
- Marsha Hammond (27 May 2009)
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No doctors in Guantanamo or Abu Ghraib?
- PC Marshall (31 May 2009)
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Pope and Gutheil are wrong about physicians
- Abigail Seltzer (25 June 2009)
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British psychologists' repudiation of torture
- Pter Kinderman (7 July 2009)
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Response to Dr. Seltzer's comments on Pope & Gutheil
- Kenneth S Pope, Thomas G. Gutheil (13 July 2009)
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Steven H Miles, Professor of Medicine University of Minnesota, 410 Church St SE, Minneapolis, MN 55455
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Drs. Pope and Guetheil nicely summarized the history of why psychology was more willing to abet the abusive interrogations of the US government during its war on terror negotiations. Recently released US government documents clearly show the magnitude of that abuse.1,2,3. The American Psychological Association was unique about US health professional associations in providing policy cover for abusive interrogations that were based on the theory of inducing learned helplessness.4 By definition, learned helplessness based interrogations profoundly damage prisoners. A full inquiry is needed into how the American Psychological Association was recruited into a collaboration with the Defense Department in this matter. Sincerely,
1. Senate Armed Services Committee. Inquiry into the treatment of Detainees in US Custody. Nov 20-08 http://armed- services.senate.gov/Publications/Detainee%20Report%20Final_April%2022%202009.pdf 2. Office of Legal Counsel. Memorandum for John A. Rizzo, Senior Deputy General Counsel, CIA. Re: Application of US Obligations Under Article 16 of the Convention Against Torture to Certain Techniques that May Be Used in the Interrogation of High Value al Qaeda Detainees. 30-May-05. http://luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05302005_bradbury.pdf 3. Asst Attorney General. Memorandum for John Rizzo Acting General Counsel of the CIA Re: Interrogation of an al Qaeda Operative. 1-Aug-02. http://luxmedia.vo.llnwd.net/o10/clients/aclu/olc_08012002_bybee.pdf 4. Olson B, Miles SH. The American Psychological Association and War on Terror Interrogations. in Oath Betrayed: America's Torture Doctors. ed. Miles SH. University of California Press, 2009, p. 186-98. Competing interests: None declared |
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Jennifer A. Hoult, public interest attorney New York, NY, USA 10034
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The appalling and active participation of mental health and legal professions in rationalizing, authorizing, crafting, executing, hiding, and defending the use of their professional training to violate the Geneva Convention, local laws, and the most basic human rights by consciously and willfully torturing prisoners is a hideous replay of the same tactics exposed at Nuremburg. Just as Nazi doctors, lawyers, and judges sanctioned and participated in torture and genocide, the Bush administration and its allies, from the highest levels to the lowest levels, replicated the same types of practices we sought to prevent with international treaties following the disclosures of that horrible era. The fact that so many individuals participated in the recent illegal, unethical, and horrific conduct demonstrates the continued and harrowing findings of the Milgram experiments. Despite the claims of former Bush officials, these methods did not yield useful information; they only resulted in polluting and confusing evidence which resulted in ironically making prosecutions impossible under the rule of law. Even more predictably, the practice of torture has increased recruiting for terrorists internationally, and now exposes our military men and women to similar horrors. We are reaping exactly what we have sown. Those legal and medical professionals who chose to violate the ethical codes of their professions, as well as local and international law, to participate in rationalizing and effectuating torture should be held fully publicly and legally accountable. And those of us who serve the public in the professions of law and medicine must find ways to strengthen individual resolve so that individuals facing similar future orders will find the courage and integrity to speak up against and defy orders from corrupt and unethical government officials who seek to misuse their authority to violate human rights by breaking the law. It is time human beings learned to stop torturing one another. Medical and legal professionals must set the example and lead the way towards an international standard that protects human rights. Competing interests: None declared |
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Brad Olson, research and community psychologist Northwestern University
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I read the Pope & Gutheil article with both a heavy heart and with a bit of hope. It does not take much to identify one of the authors as having enough of a love, and intimate knowledge of the discipline of psychology, to illuminate so many of its missteps--and the reasons behind that misdirection. A discipline is somewhat like a person--it is made up of people--and a caring psychologist can help bring out all the places where it might have gone wrong. Reading Pope & Gutheil's penetrating comparisons of the medical and psychological professions, the histories and current norms of these fields, one sees a broader theme develop: Psychology, in comparison to medicine (and psychiatry), has always been faced with a position of feeling 'second in line,' at least in its own mind, as an area of research and practice. There is often a connection between feeling "second"--experiencing a sense of inferiority, and a desire to gain advantage--and making unfortunate ethical decisions. As a famous psychotherapist, Rollo May, once pointed out, "powerlessness corrupts." A sense of inferiority and the absence of power, within a person or an organization, can often lead to tragic moral positions. And it has with the APA. For someone who cares about the discipline, that's the 'heavy heart' part. The 'hope' part is that as long as there are those out there who still care enough about the field--care enough to put a mirror up in front of it, care enough to try and heal it--then there is the chance it can eventually find its proper place in the world. That's what psychologists do, and that's what they should be doing. The torture issue has been the discipline's greatest challenge yet. The first stage of healing is for the field to look at itself closely. The issues brought up in Pope & Gutheil--the questions raised about the field's history and personality--are a good place to start as it looks for a path toward healing and redemption. Brad Olson, Ph.D. Northwestern University Competing interests: None declared |
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Barbara Finn, licensed psychologist 94025
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Pope and Guthell (BMJ, April 30, 2009) have written a masterful expose concerning the omission of detainees from the APA's ethics code. I find this information both shocking and incomprehensible. Imagine if any other group were excluded from APA's ethics code-- e.g., gays and lesbians, African Americans, amputees, etc. This would prompt a revolutionary outcry. As far as I know, detainees aren't exempt from the category of "human beings". I couldn't agree more with Steven Miles, M.D., who writes in his rapid response to this article, "A full inquiry is needed into how the APA was recruited into a collaboration with the Defense Department in this matter." Kudos to Pope and Guthell for bringing this blatant omission to worldwide attention. And shame on the American Psychological Association, to say the least. Competing interests: None declared |
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Trudy Bond, Independent Psychologist Toledo, Ohio 43606
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Drs. Pope and Gutheil have written an article with relevant questions and viable answers regarding the continued insistence of the American Psychological Association upon defending, justifying and at times denying the well-documented facts surrounding the role of psychologists involved in the interrogation, abuse and torture of prisoners at Guantanamo, Abu Ghraib and elsewhere. Drs. Pope and Gutheil write: "In 2008, the APA took a vote of its membership on a resolution stating that psychologists may not work in settings where 'persons are held outside of, or in violation of, either International Law (eg, the UN Convention Against Torture and the Geneva Conventions) or the US Constitution (where appropriate), unless they are working directly for the persons being detained or for an independent third party working to protect human rights.' . . . However, this new policy is not enforceable or part of the ethics code. Responses to a series of questions about the resolution posted on the APA’s website state: 'The petition would not become part of the APA Ethics Code nor be enforceable as are prohibitions set forth in the Ethics Code.'" This disheartening ruling did not deter Dr. Bray, current president of the APA, from presenting this selfsame resolution as an exoneration of the APA in a recent press release.1 Equally duplicitous was Dr. Bray’s statement from the same press release, “APA stands ready to adjudicate reports that any APA member has engaged in prohibited techniques.” Au contraire. 1. Bray, James H. Saying it again: psychologists may never participate in torture. http://www.apa.org/releases/editorial-bray.html Competing interests: None declared |
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Martin H. Williams, Forensic Psychologist in Independent Practice 95037
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Thank you Drs. Pope and Gutheil for your careful analysis of the role of the American Psychological Association (APA) in creating a supportive environment for those psychologists who were involved in the creation, implementation, monitoring and overseeing of nothing less than torture-- carried out in the name of the security needs of the United States. APA members were informed by public statements from the Ethics Office, without substantiation, that psychologists who were present at "interrogations" exerted a humanizing influence and could intervene if the interrogations were deemed too severe. The truth seems to have been the opposite. Psychologists apparently used their behavioral and clinical skills to design methods of psychologically cruel interrogation as well as methods that can only be called "torture." When pressed, the APA crafted numerous policy statements that repudiated various forms of harsh interrogation and seemed to prohibit the participation of psychologists in a wide variety of activities that many would term "torture." Each successive iteration of these policy statements appeared to close more loopholes and appeared to make the APA's position more ethical and more restrictive against torture in all its forms. However, as Drs. Pope and Gutheil explain, none of these policy statements were enforceable by the APA's own Ethics Code. Thus, the APA gave the appearance of taking a stand against torture but failed to modify its Ethics Code to make that stand meaningful. As with its failures, discussed by the authors, to stand against the Nazis, this becomes another shameful chapter in the history of the American Psychological Association. Competing interests: None declared |
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Nada L. Stotland, President American Psychiatric Association, 22191
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The American Psychiatric Association has taken an unequivocal position opposing the participation of psychiatrists in interrogations-- that is, the questioning of an individual who has not agreed to be questioned. We are aware of the very dubious credibility of information obtained through coercion. The reason for our stance, however, is that we are physicians. We are proud that the American Medical Association adopted our recommendation and has taken the same position. Physicians are healers, not interrogators. Nada L Stotland, MD, MPH President, American Psychiatric Association Competing interests: None declared |
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David Spiegel, M.D., Willson Professor & Associate Chair of Psychiatry & Behavioral Sciences Stanford University School of Medicine
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The word 'profession' is derived from the Latin meaning to swear an oath involving adherence to ethical standards. The closely related professions of medicine and psychology share the obligation to define the boundaries of morally acceptable conduct, which requires putting the patient’s interests above all others. In the use of psychological and physical torture techniques the safety of the individual being tortured is not the highest priority. The subjugation of professional ethical responsibility to the prerogatives of government or other organizations is a breach of fundamental professional principles. Ethical obligations cannot be donned and removed like clothing. There is no doubt that psychology or medicine could contribute to torture, but they should not. The failure of a given professional organization to make clear their primary commitment to the well-being of the people they serve in all circumstances reveals a fundamental problem in constituting itself as a profession. This is the slippery slope by which profession leads to the need for confession. Competing interests: None declared |
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Harris L. Friedman, Research Professor University of Florida, Gainesville, FL 32611 USA
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In their otherwise excellent paper, Drs. Pope and Guetheil omitted one salient distinction between the medical and psychological professions in regard to their respective stances toward abusive interrogation practices. Medicine is unambiguously a healthcare profession, whereas psychology deals with a much broader range of applications, including diverse concerns spanning the alphabet from advertising research to zoological park management. Since many psychologists are not involved at all in healthcare, ethics prohibitions germane to healthcare professionals may or may not fit those psychologists who are not healthcare providers (e.g., organizational psychologists). Where psychological abuses seem to have been the worse involved widespread violations of important role boundaries, such as when healthcare psychologists treating detainees then used privileged information obtained in that healthcare role to later devise strategies to abusively interrogate those same detainees they were charged with helping. The appropriateness of psychologists not involved in healthcare advising interrogators using psychological knowledge does not seem any more unacceptable than professionals from other fields, such as the law, but it was the widespread intermixing of healthcare services with other roles that is most grievous. With that said, it is inexcusable that psychologists participated, and even took leadership roles, in abusive interrogation practices, as well as that the American Psychological Association resisted taking a firm stance against these abuses. Competing interests: Fellow, American Psychological Association |
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Sallie R. Tasto, clinical psychologist 550 Hamilton Ave. # 201, Palo Alto, CA 94301
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As a member of APA, and a practicing clinical psychologist I am appalled and sickened to know that American, and perhaps APA, psychologists have been complicit, and beyond, in the torture of their fellow human beings. And let's not dance on the head of a pin. To create agony in another is to torture. Further, I am astonished that out of a membership of over 148,000, only close to 15,000 APA members even voted on the resolution that psychologists would not work in an environment where persons are being held outside of, or in violation of, International Law and/or the U.S. Constitution. To know that 6,157 of my colleagues did not support this resolution is beyond my understanding. Though the APA may assume that our Ethics Code covers the issue of "do no harm," and is not alarmed that the above resolution is unenforceable, clearly, with the vast majority of membership not even concerned enough to vote, and over 6,000 voting against, we as a profession are in moral peril. I take great satisfaction in my work, and in the work of my colleagues and friends. At the moment, I am horrified that our professional moral bar has sunk to these depths. If APA cannot find a way to reflect, from its membership, a strong, unambiguous prohibition to psychologists assistance in torture, and a way to enforce that prohibition, I will no longer be a member. Competing interests: None declared |
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Thomas E. Schacht, Professor, Psychiatry & Behavioral Science, James H. Quillen College of Medicine 37614
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Drs. Pope and Gutheil discuss the setting of boundaries on the military use of professional expertise in relation to the issue of torture. With all due respect to these thoughtful scholars, perhaps they aim at too small a target. I would like to suggest that the root problem isn’t so much torture as it is war itself. Accordingly, I ask Drs. Pope and Gutheil: why do we even need to reach the issue of torture? Given that war systematically brings wholesale death and destruction to large populations, how can it ever be ethical for physicians and health-care psychologists to serve the military in war? Except for suicide bombers, whose acts generally relieve them of the need for medical care, doesn’t patching up physically and mentally wounded combatants ultimately, if indirectly, contribute to the ability of the military to continue the larger killing enterprise? Perhaps this is the greater and ultimately more important ethical question. Competing interests: None declared |
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Mark Struthers, GP and prison medical officer Bedfordshire, UK
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The following short letter from a Texas physician was published in 'The Independent' on Monday 4 May. [1] “A doctor writes ... What's wrong with a little torture? If we can get information from enemy combatants and save lives, we should use all the means we can devise. The left's soft position on enemies of the state costs US soldiers' lives. Would we rather protect enemies of the US than our own soldiers in harm's way, or residents of the US? When we are kind to those who are cruel, we are cruel to those who are kind. Alan J Winters, MD, JD. Bellaire, Texas “ What can one possibly say about a letter like this? And what can one infer about the state of the Union? [1] http://www.independent.co.uk/opinion/letters/letters-kenyan-visa-staff-1678650.html Dr Mark Struthers MB ChB, mark.struthers@which.net Competing interests: None declared |
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Sohrab Zahedi, M.D., Fellow in Forensic Psychiatry California
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Throughout my training in psychiatry, I was often told by non- physicians that the field "is moving away from the medical model." After reading Pope and Gutheil's article, I am wondering, even for the sake of being ethical, if it is too late for the field to make a U-Turn. Competing interests: None declared |
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Linda Hartling, Ph.D., Director, Research Scientist Human Dignity & Humiliation Studies
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All current and future members of the American Psychological Association should read Pope and Gutheil’s informative article contrasting the ethical policies of physicians and psychologists. The APA’s position to allow “consultation and monitoring of individual interrogations” of detainees—refusing them the "humane treatment" accorded to laboratory animals—is deeply troubling. I fear this position is a realization of the misuse of science, psychology, and power portrayed in George Orwell’s literary masterpiece, 1984: “The scientist of today is either a mixture of psychologist and inquisitor, studying with real ordinary minuteness the meaning of facial expressions, gestures, and tones of voice, and testing the truth-producing effects of drugs, shock therapy, hypnosis, and physical torture; or he is chemist, physicist, or biologist concerned only with such branches of his special subject as are relevant to the taking of life.” Orwell, George (1949). 1984. Project Gutenberg of Australia eBook, 2009, May 10. http://gutenberg.net.au/ebooks01/0100021.txt Competing interests: None declared |
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Paula J. Caplan, Research Associate, DuBois Institute Harvard University 02138
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The American Psychological Association used to be an organization one could be proud to be a part of. It used to take progressive stands on a wide variety of important issues. More recently, its refusal to stand firm against psychologists' participation in various ways in torture has been horrifying and has led many of us to withhold our dues (but remain members in the hope of changing APA for the better) or resign. That APA has lost its former bearings is reflected not only in this but also in the massive use of its resources to try to get prescription privileges for psychologists (great -- just what this country needs: hundreds of thousands more people prescribing psychotropic drugs rather than considering a wider variety of ways to help people) and its complicity with the unscientific nature and harmful consequences of psychiatric diagnosis. Competing interests: None declared |
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Mark Struthers, GP and prison medical officer Bedfordshire, UK mark.struthers@which.net
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What could one possibly say about a letter like the one from an MD in Bellaire, Texas? I may have been stuck for words but other readers of ‘The Independent’ were not. On 6 May came the following replies, [1] 1. “It would be helpful if Dr Winters (letters, 4 May), who is in favour of "a little torture" of enemy combatants to save US lives, would clarify his position. Would he think it equally right for people fighting US forces to use torture on US captives if it would help to protect their own comrades, or is torture to be a privilege of US forces and their allies? What evidence would he require that captives have relevant knowledge before sanctioning torture? Would it be permissible also to torture arrested non-combatants if it were thought they might have information that could help to save American lives, and if not, why not? How much torture is "a little torture"? And where would he draw the line in type and duration of torture? S G Norris, London SW14” 2. “Dr Winters, of that God-fearing state of Texas, asks, "What's wrong with a little torture?" The answer is that with such a mindset there follow such questions as, "What's wrong with a little capital punishment?", "What's wrong with a little ethnic purity?", "What's wrong with a little nuking?", and so on. I have to ask another question, "What's wrong with some God-fearing Texans?" Derek Brundish, Horsham, West Sussex” 3. “The arguments deployed by Dr Winters can be as readily deployed by those who would put less value on US soldiers than on their compatriots. The "ticking-bomb" justification might, for example, excuse the torture of US soldiers to obtain advance knowledge of a missile strike into Pakistan that could do collateral damage. At least, now Independent readers can take care never to seek medical attention in Bellaire, Texas. Bryn Hughes, Wrexham, North Wales.” And then Sean Cordell from Sheffield followed on 7 May [2] with, 4. “Of your pro-torture correspondent Dr Winters, S G Norris (Letter, 6 May) asks: "What evidence would he require that captives have relevant knowledge before sanctioning torture?" Surely incriminating statements from known associates would suffice. And it's well known that such sincere testimony is reliably obtained by applying electric shocks until they come out with it. You liberals always have to complicate everything.” What’s wrong with a little torture, asked that unlikely lone star twinkling high above Texas. One can reasonably assume that Dr Alan J Winters is unhappy about his colleagues’ role, or lack of it, in the application of a 'little torture' on enemy detainees, confined within the expansive American gulag. Perhaps this thoughtful Texas physician will now defect to the APA, who, as we know, is not averse to their membership being involved in interrogations involving torture. [1] http://www.independent.co.uk/opinion/letters/letters-the- unwilling-pioneers-of-the-id-cards-scheme-1679738.html [2] http://www.independent.co.uk/opinion/letters/letters-aid-for- afghanistan-1680342.html Competing interests: None declared |
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Dr. Leeat Granek, Researcher Sunnybrook Odette Cancer Centre and University Health Network M4N 3M5
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Pope and Gutheil offer excellent insights into how psychologists and the APA steered shamefully off course when it comes to the torture of detainees. As a critical psychologist I have been actively involved in protesting the involvement of APA members in torture and other military operations, and have tried to publish a similar article in several psychological publications, including Psychology Today to no avail. Nonetheless, I join the chorus of historians who have come before me, and who are sure to follow, when I lament our short memories. While torture and ethical guidelines in Psychology are the current issue at hand, Psychology as a discipline has a long history of profiting from, and being actively involved in wars and in government operations. Even a cursory glance at the history of the discipline will show unequivocally that without the wars, we would not exist today as a profession. For example, Yerkes, the president of APA in 1917 was working on intelligence testing when World War I was declared. He and many other psychologists seized the opportunity to make themselves useful and were involved in the war effort from day one by serving as consultants and test administrators. Millions of these tests were given to recruits in order to eliminate the “feeble-minded” and to classify soldiers into appropriate positions. Yerkes aggressive popularization of intelligence tests in the public domain and shameless ingratiating towards the military had an enormous impact on the public’s perception of Psychology. This foundational episode in our history has been described as ‘putting psychology on the map’. World War II expanded the domain of psychology yet again. Whereas in World War I we worked as test administrators, World War II saw psychologists taking over clinical settings because psychiatrists could not longer handle the workload created by the hundreds of thousands of veterans returning from war. Essentially, without the war, there would be no clinical psychology today. To echo Schacht, another commenter on this site, we need to be asking ourselves whether “torture is too small a target?” when it comes to ethical guideline for ourselves, not only because of what is happening now, and what will happen in the future, but also on what has happened in our past. We have a lot to be ashamed of. It is time to reckon with it. Competing interests: None declared |
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Rhea K. Farberman, Executive Director, Public Communications American Psychological Association
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American Psychological Association Supports Authors’ Recommendations The American Psychological Association (APA) wholly endorses the three recommendations proposed by Kenneth Pope and Thomas Gutheil at the conclusion of their article. I would like to elaborate on these points, while taking the opportunity to clarify several critical issues pertaining to our APA Ethics Code. The authors first recommend that adherence to a code of ethics should govern professional conduct and that one should not be allowed to escape personal responsibility by following orders or laws. When APA convened the 2005 Presidential Task Force on Psychological Ethics and National Security (PENS Task Force), the very first order of business was to state that the APA Ethics Code applies to all of psychologists’ professional activities regardless of whether a psychologist is acting in a health care -related role or not. The task force also stated that the best ways to ensure ethical behavior are: “The development of professional skills and competencies, ethical consultation and ethical self-reflection, and a willingness to take responsibility for one’s own ethical behavior” [emphasis added], mirroring the very words Drs. Pope and Gutheil encourage APA to adopt. In this context, it is critical to emphasize that the APA Ethics Code prohibits torture and that when the current version of Ethical Standard 1.02 (which addresses conflicts between ethics and law) was drafted in the fall of 2000, the language was in no way intended or foreseen to provide a defense to engaging in torture based on “following orders.” In light of the Bush administration interrogation policies, the APA Ethics Committee views it as crucial to clarify that “following orders” can never be a defense to torture under the APA Ethics Code. APA’s governing body, the Council of Representatives, will be reviewing this ethical standard with association-wide input at its upcoming meeting at the APA convention in August. APA's most recent policy action has restricted the scope of the earlier PENS Task Force recommendations related to the involvement of psychologists in national security investigations by prohibiting psychologists from working in detention settings that are in violation of international law and the U.S. Constitution, except in very narrowly defined roles. Immediately after a membership vote in 2008, APA informed key Bush administration officials and members of Congress of this new policy. APA is ensuring that officials in the Obama administration are likewise informed of APA’s position. The authors’ second recommendation relates to the importance of enforceable ethical standards to protect at-risk groups. Although the APA Ethics Code does not specifically use the word “detainee,” multiple standards in the Ethics Code—such as the ethical standard mandating that psychologists avoid doing harm—clearly apply. To suggest that the APA Ethics Code provides greater protections to laboratory animals than to U.S. detainees abroad (or prisoners in U.S. correctional facilities, who are also not explicitly mentioned in the code) is simply absurd. Their third and final recommendation stresses the importance of educating APA members and encouraging their involvement in critical issues before the profession, such as the humane treatment of detainees. To this end, APA has used all available means to inform our members and the general public of our policies through APA publications, our Web site, regular mailings, and press releases. The relatively small percentage of members who voted on our most recent policy resolution noted above may indeed be more reflective of the general public’s limited response to voting opportunities than to our members’ lack of attention to the role of psychologists in interrogations. The clear majority of those members who voted did so in favor of the resolution, which is now official APA policy. Competing interests: None declared |
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Kenneth S. Pope, Independent Licensed Psychologist 06856, Thomas G. Gutheil
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The American Psychological Association's (APA) response to our article underscores APA's departure from fundamental ethical values, a departure that BMJ's editor rightly termed "shocking."1 Triskel reminds us that APA's ethical standards stand in stark contrast to those of not only medical associations but also some other psychological associations.2 First, APA emphasized that its PENS Task Force called for "a willingness to take responsibility for one's own ethical behavior." But the Task Force's "very first order of business" was to reaffirm an ethics code, adopted in the aftermath of 9- 11, that freed psychologists of personal ethical responsibilities whenever those ethical responsibilities stood in irreconcilable conflict with laws, military orders, governmental regulations, and other forms of governing legal authority. Second, APA noted that its ethics code's ability to "provide a defense to engaging in torture based on 'following orders'" was in "no way intended or foreseen." The APA Ethics Committee has scheduled a review of that section of the code, "[i]n light of the Bush administration interrogation policies," at a future meeting. During the Bush administration, APA emphasized the valuable contributions psychologists were making to these interrogations. It is unclear why APA declined to change ethics code section 1.02 during the Bush administration, and has yet to do so. Third, APA defends its refusal to recognize detainees as one of the diverse at risk groups--such as those "for whom testing is mandated by law or governmental regulations," "research participants," "students," "supervisees," and "employees"--to whom it accords special protection in the code's enforceable section. Why not eliminate the ambiguity, loopholes, and controversy by acknowledging that detainees are an at- risk group deserving explicit, enforceable protection? Finally, APA highlights its "most recent policy action" in this area, a 2008 ballot initiative. However, APA previously clarified that this ballot initiative would not be enforceable under its ethics code. Similarly, APA's numerous policies, public statements, etc., addressing torture have never been added to the enforceable section of its ethics code. Human rights require more than calls for voluntary compliance. 1. Godlee, F. Rules of conscience. BMJ 2009;338:b1972. http://www.bmj.com/cgi/content/full/338/may14_1/b1972 2. Triskel, N. Fortunately UK psychologists don't use the APA Code of Ethics. BMJ http://www.bmj.com/cgi/eletters/338/may14_1/b1972#213695 Competing interests: None declared |
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Andrew F West, Consultant Child and Adolescent Psychiatrist, Berkshire Healthcare NHS Foundation Trust, 3 Craven Rd, Reading, Berkshire. RG1 5LF
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Pope and Gutheil's paper is important, but the wording of the title is unfortunate. Whilst the paper denounces the stance of the American Psychological Association on the issue of torture, it purports to answer a question predicated on two implied statements; namely that psychologists participate in torture and doctors don't. If some psychologists are complicit in this practice we know that they are a very tiny minority. We also know that the medical profession has not been immune to complicity with state violence in the past, and we should not be complacent now. The authors make the point that some doctors participate in capital punishment, even though the AMA instructs them not to. The AMA has not taken a stance against capital punishment in the way that the APA has done. As Friedman points out in his rapid response of 5th May, the medical and psychological professions differ in that the former is a healthcare profession, whilst only a proportion of the latter could be considered so. The APA as a whole might therefore be expected to have a different ethical position to that of the AMA. I deplore torture and I am pleased to have the position of the APA exposed, but I shudder at the thought of my own profession preening itself on reading this paper, and I am embarrassed at the inaccurate generalisation implied in the title. Competing interests: I am a practising psychiatrist |
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David H. Mills, retired psychologist-past Director of the APA Ethics Office 04650
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Drs. Pope and Gutheil have performed a valuable service in this brief but comprehensive contrast of the differing positions of medicine and psychology concerning the interrogation of detainees. While my ll year tenure as Director of the Ethics Office of the American Psychological Association had expired before the recent development of a revised code which allows for psychologists to be involved in interrogations, I have followed this issue with great interest. I am distressed that the current code does not take a categorical stance against psychologists being involved in the development or the use of interrogation techniques. To hide behind a charge to involve oneself in interrogation techniques in order to keep those techniques safe and humane, while appearing laudable, simply opens the matter up the individual interpretation. I believe we see from reports emerging from the Red Cross, the ACLU, and others, that psychologists have been involved in what can be seen as illegal interrogations to the level of what appears to be torture. The recent vote within the APA membership appears to support non- involvement by psychologists in settings where persons are held in violation of international law (such as the UN Convention Against Torture and the Geneva Conventions). This, I believe, supports a position that the APA members are outstripping the governance of their professional association in this very important matter. This vote should be reflected in a revision of the APA Code. Competing interests: None declared |
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Jennifer J. Freyd, Professor University of Oregon
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The harm caused by the interrogation methods described in this article goes far beyond the considerable damage, sometimes fatal, of methods commonly understood to be torture. When psychologists or physicians design and help inflict such methods, they engage in three betrayals. They betray the trust and human rights of those who are tortured. They betray fundamental professional ethics.1 And they betray the trust society places in such professionals.2 Research shows that harm caused by acts that are physically, sexually, or psychologically damaging (e.g., child abuse) is greater when a trusted figure is involved.3,4 The Orwellian transformation of trusted professionals into those who use their training and skills to design and help inflict methods whose reality is masked by euphemisms like "harsh" or "extreme" can interfere with the ability to reason realistically.5 The trauma that occurs when professionals betray individuals, fundamental ethics, and society causes trauma to us all. 1 Miles, SH. Oath betrayed: America's torture doctors, 2nd edition. Berkeley, CA: University of California Press, 2009. 2 Gallagher, HG. By trust betrayed: patients, physicians, and the license to kill in the Third Reich. New York: Henry Holt, 1990. 3 Freyd, J.J., Klest, B., & Allard, C.B. Betrayal trauma: Relationship to physical health, psychological distress, and a written disclosure intervention. Journal of Trauma & Dissociation, 2005, 6(3): 83-104. 4 Freyd, J.J. What is a Betrayal Trauma? What is Betrayal Trauma Theory? 2009. Retrieved 19 May 2009 from http://dynamic.uoregon.edu/~jjf/defineBT.html 5 Zurbriggen, EL (2005). Lies in a Time of Threat: Betrayal Blindness and the 2004 U.S. Presidential Election. Analyses of Social Issues and Public Policy, 2005, 5: 189-196. Competing interests: None declared |
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Roy J. Eidelson, President-Elect, Psychologists for Social Responsibility 19004
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Along with other human rights organizations, Psychologists for Social Responsibility (PsySR) has condemned the prominent participation of psychologists in planning and carrying out the systematic abuse of U.S. detainees and has called for an independent commission to examine the role of psychologists and the American Psychological Association (APA) in this abuse. PsySR has also posed six key questions for the APA to answer: 1. Did the APA's 2005 Presidential Task Force on Psychological Ethics and National Security (PENS) provide an independent evaluation--without outside interference--of the ethics of psychologists' participation in these interrogations? 2. Has the APA responded appropriately and adequately to official ethics complaints registered against APA members regarding their involvement in abusive interrogations? 3. Was the APA's sponsorship of post-9/11 invitation-only workshops with security agencies such as the CIA consistent with its "do no harm" core principles? 4. Why did the APA adopt unrealistic assumptions about the impact and autonomy of psychologists present in detainee settings in spite of well- known psychological research to the contrary? 5. Have financial and career considerations--such as the funding of psychological research and practice by the defense-intelligence establishment--influenced APA actions and policies in regard to psychologists' participation in abusive interrogations? 6. What was the basis for the APA's revision of Standard 1.02 of its Ethics Code in 2002 to the effect that psychologists may ignore the code where it conflicts with the regulations of an undefined "governing authority" --and why was this standard not modified after APA Council identified its potential to allow for torture? Given the evidence received from diverse sources, PsySR believes that an independent national investigation is an absolute necessity in ensuring that members of the American psychological community do not find themselves repeating their involvement in such widespread human rights abuses ever again. Competing interests: None declared |
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Ian F Wall, President Faculty of Forensic and Legal Medicine Faculty of Forensic and Legal Medicine, 116 Great Portland Street, London W1W 6PJ, C George M Fernie, Registrar Faculty of Forensic and Legal Medicine
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Pope and Gutheil are right to submit recommendations for consideration of the ethical responsibilities of those who look after detainees suspected of committing acts of terrorism. In the UK, the Faculty of Forensic and Legal Medicine have already issued guidance (1) on the medical care of persons detained in police custody under the Terrorism Act 2000. This guidance was partly based on the experience of our members from Northern Ireland. Ensuring fitness for detention and interview requires Forensic Physicians to be appropriately trained, skilled and experienced in assessing detainees who are potentially vulnerable during a possible prolonged period of detention. Occasionally these detainees may require treatment in hospital. Forensic Physicians may also have a role in assessing fitness for interview of these detainees whilst in hospital as they possess the necessary skills to advise on this complex assessment which has such important and serious medicolegal ramifications. Yours sincerely Dr I F Wall, President Faculty of Forensic and Legal Medicine
1. Wall I F. Medical care of persons detained under the Terrorism Act 2000. Faculty of Forensic and Legal Medicine. 2007. https://fflm.ac.uk/upload/documents/1189093340.pdf Competing interests: None declared |
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Marsha Hammond, licensed psychologist, NC 28806
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APA's response regarding the ethics code continues the double-talk that some APA members have been howling about for the past 5 years. On the one hand, APA 'supports the conclusions' of the Pope/ Gutheil article. Barely taking a breath, APA engages in this maddening double speak as evidenced by the APA Executive Director of Public Communications' Farberman's statements. Trotting out the APA Code of Ethics, surely threadbare from the severe handling it has received over the past several years, APA makes the point that prior to the initial PENS meeting, they read,one imagines, drone-like, the APA Code of Ethics. Contrarily, many psychologists see this as a living, breathing guide to their professional behavior as this was drilled into them in graduate school as well as the licensing exam. Then Farberman softshoes the for-crying-out-loud conflict between ethics & the law which essentially states that if the law states you have to do it, well then, shut up and get to it. Then, evidencing an inability to appreciate nuance and the coupe de grace, Farberman alludes to the 'fact' that psychologists---that includes military psychologists-----cannot work in dentention centers 'except in very narrowly defined roles.' And what would those 'narrowly defined roles' be, APA? That must be some kind of hold that the Division of Military Psychology has on APA for these kinds of statements to pass muster. Marsha V. Hammond, PhD Competing interests: licensed psychologist who is member of APA |
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PC Marshall, Clinical Psychologist Canberra, Australia 2620
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Though I owe no particular loyalty to the American Psychological Association, to which I send a few dollars a year for international affiliateship, I was unimpressed with the depth of Pope and Gutheil's analysis. A simple websearch (Google if I may name it) throws up myriad references to medical doctors, including psychiatrists, being involved in force-feeding, advising or monitoring torture, in Guantanamo Bay detention camp and elsewhere. This article seemed to be just a shallow exercise in "doctors are better than psychologists". They may well be, but to draw on evidence dating back to 1938 suggests the authors were struggling to find material to back up their claim. That this was published in the BMJ just strengthens the perception of ulterior motivation. Would the BMJ have published an opinion-piece article saying psychologists' practice was more ethical than doctors'? Many professions have had mud stick to them from the antics of the "Western" world since 11th September 2001. Personally I think it's a waste of energy to claim one profession is less muddy than another, when the whole "Western" world bears a lot of responsibility for some pretty shoddy behaviour by its governments and their employees in the last 8 years. Competing interests: International Affiliate of the APA. |
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Abigail Seltzer, Consultant Psychiatrist, Health and Human Rights Adviser Medical Foundation for the Care of Victims of Torture, N7 7JW
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In 2007 I was invited to examine the detainee log of an inmate of Guantanamo in order to provide a medical opinion as to whether the treatment amounted to torture.1 It has now been concluded that it did.2 It was evident from my scrutiny of this log that medical staff were not only present during the interrogation, but made no attempt to intervene in order to stop it. A military radiologist was even flown in from a US naval base in Puerto Rico to report a CT scan performed on this detainee when he became seriously dehydrated from hunger strike. Newly declassified legal memos from 2002 and 2005 concluded that certain ‘enhanced interrogation techniques’ did not constitute torture, partly based on the assurance that medical personnel would be on hand to ensure that the techniques used did not cause ‘severe pain or suffering’.3 The Red Cross report leaked in April details the involvement of medical personnel present at and supplying medical interventions during the use of these ‘enhanced techniques’, some of which they described as torture.4 This seems clear evidence that military medical personnel acted in contravention to the WMA’s Declaration of Tokyo that a “physician shall not be present during any procedure during which torture or any other forms of cruel, inhuman or degrading treatment is used or threatened”.5 I do not therefore understand how Pope and Gutheil (BMJ 2009;338:b1653) can assert that “physicians limited their involvement in detainee interrogations to such a degree that they prohibited even monitoring an interrogation with intent to intervene” and that “physicians do not design interrogation plans for specific detainees or observe interrogations with the intent to intervene because this undermines the physician’s role as healer”. I therefore call on these authors to explain how they reached these erroneous conclusions. Finally, physicians have no grounds to feel superior to psychologists: to date, no US military physician has had their licence to practice revoked as a consequence of their involvement, whatever the AMA's policies. References 1. Sands P Torture Team Allen Lane, 2008 2. Woodward B ‘Detainee was tortured, says US official’ Washington Post, Jan 14th 2009 3. ACLU accessed at http://www.aclu.org/safefree/general/olc_memos.html 4. Accessed at Danner M ‘The Red Cross Torture Report: What It Means’ The New York Review of Books Volume 56, Number 7 April 30th 2009 http://www.nybooks.com/articles/22614 5. Accessed at http://www.wma.net/e/policy/c18.htm Competing interests: None declared |
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Pter Kinderman, Professor of Clinical Psychology University of Liverpool, UK. L69 3GB
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Dear colleagues, I have to confess to becomming aware of this article only recently. I believe it to be be a thoughtful and accurate position of American psychologists' institutional response to torture. But I do have to strongly draw readers' attention to the fact that psychologists in the UK had a much more robust response. On 4th June 2005, the British Psychological Society endorsed a repudiation of torture (drafted by myself with help from colleagues) which, in my opinion, fully and completely dissociated UK psychologists from this appaling practice and clearly indicated our revulsion of the practice, as well as the professional body's transparent view that any involvement in torture is unethical for psychologists. It is worth reproducing the declaration, for the avoidane of doubt: Declaration of the British Psychological Society Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment The British Psychological Society regretfully notes that the existence of state-sponsored torture and other cruel, inhuman, or degrading treatment has been documented in many nations around the world. We note that torture victims may suffer from long-term multiple psychological and physical problems. The British Psychological Society condemns torture wherever it occurs, and supports the United Nations Declaration and Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. We further condemn the misuse of psychological knowledge and techniques in the design and enactment of torture. For the purpose of this Declaration, torture is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason. This definition includes the use of threats, insults, sexual or cultural degradation or degrading treatment of any kind. DECLARATION Psychologists shall at all times comply with the standards set out in the British Psychological Society’s Code of Conduct for Psychologists. Psychologists shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife. Psychologists shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment. Psychologists shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment is used or threatened. Psychologists must have complete professional independence in deciding upon the care of a person for whom they are responsible. I hope, therefore, that it is clear that the article's reference to 'psychologists' should be read only as 'some psychologists'. I woudl not like my entire profession to be inappropraietly slurred. Peter Competing interests: None declared |
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Kenneth S Pope, Independent Licensed Psychologist P.O. Box 777; Norwalk, CT 06856-0777, Thomas G. Gutheil
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We appreciate Dr. Seltzer's thoughtful comments [1] and BMJ providing us the opportunity to respond. Our article "Contrasting Ethical Policies..." [2] examined the ethical policies of the American Medical Association (AMA) and American Psychological Association (APA). What Dr. Seltzer described as our "erroneous conclusions" are our restatement of AMA's formal ethical policy. For example, Dr. Seltzer suggested that we had concluded that "physicians do not... observe interrogations with the intent to intervene because this undermines the physician's role as healer." However, we wrote: "Priscilla Ray, chair of the American Medical Association (AMA) council on ethical and judicial affairs, stated: '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.'" Physicians who conducted, directly participated in, or monitored an interrogation with an intent to intervene violated AMA's explicit ethical prohibition. APA's ethical policies different significantly. As our article documented, APA claimed that psychologists, unlike physicians, were uniquely qualified for this work, "knew not to participate in activities that harmed detainees," and were contributing to national security. Works appearing after our article's publication provide additional documentation of how APA's ethical policies supported psychologists' extensive, integral roles in interrogations. One example is the carefully researched 10-minute documentary "No Place to Hide: Torture, Psychologists, and the APA." [3] Another example is the open letter to APA from Amnesty International, Physicians for Human Rights, and 11 other organizations. [4] The letter describes necessary steps to address "the terrible stain on...American psychology." 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... APA 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." Kenneth S Pope Thomas G Gutheil References: 1 Seltzer A. Physicians have been involved. BMJ 2009;339:b2818 2 Pope KS, Gutheil TG. Contrasting ethical policies of physicians and psychologists concerning interrogation of detainees. BMJ 2009;338:b1653. (30 April.) 3 Eidelson, R. No place to hide: torture, psychologists, and the APA. Available at: http://tinyurl.com/lz8vb5 4 Open letter in response to the American Psychological Association Board. Available at: http://tinyurl.com/mttp6f Competing interests: None declared |
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