Philosophy, Ethics, and Humanities in Medicine BioMed Central Research Open Access The ethics of interrogation and the American Psychological Association: A critique of policy and process Brad Olson*1, Stephen Soldz2 and Martha Davis3 Address: 1Human Development and Social Policy, Northwestern University, 2120 Campus Drive, Evanston, Illinois 60208, USA, 2Boston Graduate School of Psychoanalysis, 1581 Beacon St., Brookline, Massachusetts 02446, USA and 3John Jay College of Criminal Justice, City University of New York, 899 Tenth Avenue, New York, New York 10019, USA Email: BradOlson*[email protected]; [email protected]; [email protected] * Corresponding author Published: 29 January 2008 Received: 9 October 2007 Accepted: 29 January 2008 Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 doi:10.1186/1747-5341-3-3 This article is available from: http://www.peh-med.com/content/3/1/3 © 2008 Olson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights. Introduction In the wake of September 11, 2001 and the subsequent The American Psychological Association (APA) has a long "war-on-terror", the APA decided to address the ethical history of opposing the misuse of psychological knowl- implications of psychologist "contributions" to U.S. edge in practice, assessment, research and any other activ- national security. Calling the situation an "emergency", ity utilizing the tools of the field [1,2]. The APA Ethical APA President Ronald Levant authorized the APA Presi- Principles of Psychologists – Code of Conduct has long been dential Task Force on Psychological Ethics and National the guide to both acceptable and prohibited behavior Security (PENS) [6]. The task force report and process gen- [3,4], and has long ensured the proper and safe use of psy- erated a number of controversies. One set revolved chological methods. It protects U.S. psychologists, but around the appointment of task force members who were most important of all, those who are most exposed and primarily psychologists serving active military or working most vulnerable to the misuse of psychology and its tools in some then current capacity with the U.S. Department of [5]. Defense (DoD) [7]. Criticism of the task force composi- tion grew when the identification of members revealed Page 1 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 deep connections with intelligence gathering, detainee PENS Report Statement #7, concluding that "psycholo- interrogations, and related operations within the DoD [8]. gists may serve in various national security-related roles, such as a consultant to an interrogation..." [[6], p. 6]. It is The report, hereafter referred to as the PENS Report, was true the Council of Representatives never voted to completed in 2005 [6]. Shortly thereafter, the APA Board approve the PENS report in its entirety, yet while Council of Directors and the APA Ethics Committee accepted the has expressed reservations and at one point demanded a report as policy. The APA leaders had not only underlined certain set of actions, they have never fully opposed the the importance of psychologists contributing to "national policy. Controversies regarding the PENS Report and security", but that the profession had a responsibility to interrogation policy among Council members and the serve U.S. society [9]. APA rules and regulations on such APA membership have nevertheless continued unabated. task forces require "emergency" reports to be ratified by the Council of Representatives at the next Council meet- The recommendations of the PENS Report, its basic ing. This vote did not then occur and has never occurred. premises, operational definitions, and reinterpretations of However, APA leadership have on several occasions the ethics code have long warranted a detailed evaluation. claimed that Council approved the report, and on almost This is the goal of our critique. We hope to develop ethical as many occasions, publicly retracted the statements. Most considerations regarding psychologists and detainee consequential, though, is that the APA Ethics Committee interrogations, and to help work toward improved poli- did officially approve the report, calling it, without a sin- cies on the role of psychologists within these settings. We gle alteration, consistent with the APA Code of Ethics. Yet believe that this critique supports an absolute prohibition it was the content of the report, and its seeming inconsist- of psychologists' direct involvement in these interroga- ency with psychological ethics, that provoked the strong- tions, and that this is the safest, wisest and most ethical est feelings throughout the APA membership, and less course of action for the American Psychological Associa- than favorable reactions from the media, among them The tion and its members. Such a ban, we believe, may also be New York Times [10]. the safest and surest course for national security [13]. Upon adoption, the PENS report became policy binding All U.S. psychologists accountable to all sections upon members of the APA involved in detainee interroga- of the code tions and other U.S. national security activities. As psy- The PENS Report, in one of its stronger statements, explic- chologists and members of the APA, the authors will itly affirmed that all U.S. psychologists, regardless of their elucidate a number of controversial issues regarding the different applied, research-based, or practitioner roles, PENS process and weaknesses in the reasoning of the were to be held fully accountable to all sections of the APA PENS report. ethics code [[6], p. 1]. This is a key conclusion, insisting, for instance, that a "clinically-trained" psychologists act- The incompatible nature of the PENS report and ing in a "consultant role" is responsible to both clinical the ethics code and consulting sections of the code, and even those sec- It would be inaccurate to say there was nothing positive in tions applying to assessment and research. It equally reaf- the PENS report. It had, after all, reaffirmed the 1982 APA firms the task force's commitment to existing ethical Resolution against Torture and Other Cruel, Inhuman, or principles and standards within the code, supported also, Degrading Treatment. Also, in 2006 and again in 2007, the of course, by the approval of the APA Ethics Committeea. Council of Representatives supported further resolutions To a large extent, we also feel comfortable with the current against torture with ever tighter and more explicit prohi- Ethics Code (with the important exception of new 2002 bitions [11,12]. However, each resolution had its own clauses, such as 1.02, that allow compliance with local problems and serious omissions and each resolution has law, regulations, or governing authorities when institu- preserved the direct role of psychologists in military and tional demands conflict with the psychologist's ethical intelligence interrogations. Each resolution had also responsibilities). However, our interpretations of the Eth- stopped far short of a "bright-line" position that, like the ics Code and its relationship to PENS differ fundamen- American Psychiatric Association and American Medical tally from the Ethics Committee's position. In fact, we Association, would prohibit the direct involvement of reach the opposite conclusion, namely that the ethics members in these interrogations [13]. code demonstrates, in our interpretation, that it is funda- mentally unethical for psychologists to directly participate Further supporting PENS reasoning, the APA Council of in military and intelligence interrogations. Representatives in August of 2007 soundly defeated an amendment attempting to restrict psychologists to health- related services in settings that deprived persons of basic human rights. In essence, the APA never swayed from Page 2 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 A "New" ethical dilemma and the national ship and enforced at the meeting [14]. The leadership per- security frame sistently refused task force members any latitude to The PENS Report stated that war-on-terror interrogations consider reports on unethical and unlawful interrogations involving psychologists produced a completely new ethi- that had been widely reported by human rights groups cal dilemma, never before encountered by the APA [10]. and the media throughout the first half of 2005. Given psychologists' long-established place in military and CIA intelligence gathering, and given the vast precau- The PENS Report, for instance, never mentions the well- tions suggested by the literature on social influence (see substantiated reports of detainee abuse. It never cites the discussion of Milgram below), there was little that should numerous reports of psychologist involvement in these have been considered new. What was a first was the APA's abuses, or even hypothetical dilemmas that psychologists vigorous and official endorsement of psychologist might encounter. In fact, throughout the PENS Report, no involvement under the banner of "national security" US detention center – Guantanamo, Abu Ghraib, nor the interests. The power of this banner – whether it was cre- CIA's black sites – is ever mentioned. This denial of infor- ated unconsciously and took on a life of its own or mation is consistent with APA leadership communica- whether it was purposefully designed to influence others tions well beyond PENS. Up through August of 2007, the – should not be underestimated. APA has never officially acknowledged any wrongdoing by any psychologist, even though the evidence has been Unresolved conflicts within the task force indisputable, some of which will be described here. Seri- Many of the problems with the task force report can be ous debate requires that the participants have the auton- understood through the biased majority influence that led omy to ponder real-world examples, as well as best and to several rather questionable (and objectively ambigu- worst case scenarios. When documented events are inten- ous) conclusions. Its contradictions were at least partially tionally ignored, group process is inevitably challenged in a product of several core issues that arose either from reaching ethical and reality-based conclusions. majority or minority members of the task force. In the report, several areas of disagreement between task force Despite the directives of the APA leadership to avoid con- members were documented. sideration of well-documented abuses, sections of the PENS Report acknowledged that "...because of a setting's One primary conflict concerned whether the content of unique characteristics, an individual [i.e., the detainee] the task force proceedings would be open and public or may not be fully able to assert relevant rights and inter- whether they would remain confidential. The majority, ests" [[6], p. 7]. However glancing and understated this the seven of nine voting task force members, insisted that statement seems, such references to the blatant violations the entire discussion and decision-making process remain of detainee rights are in stark contrast to all other sections secret. This decision continues to reverberate, casting the of the document that dwell on the patriotic abstractions of deliberations in a negative light. "national security." Another conflict among the task force concerned whether While much was known about psychologist involvement the standards and definitions of torture would be based in detainee abuse prior to the PENS report, what has solely on current U.S. administration standards or on become progressively clearer is that the methods used by international guidelines, best represented by the Geneva interrogators, guided by Behavioral Science Consultant Conventions, the U.N. Declaration of Human Rights, and Teams (BSCTs) [15-17], have been intentionally shaped the Convention against Torture. The majority members of by psychologists [18-20]. Many of the most objectionable the task force once again, with the help of the APA leader- interrogation strategies had been re-designed by psychol- ship present, favored using exclusively U.S. over interna- ogists from U.S. military programs, primarily the Survival, tional definitions, and this standard is evident throughout Evasion, Resistance, Escape (SERE) program, originally the report's final conclusions. intended to protect U.S. soldiers from undesirable thought reform [21,22,17,23]. Theoretical abstractions The PENS report also suffers from contradictions and According to international definitions, and the under- ambiguities that may be largely attributable to its remain- standing of the SERE program itself, SERE-based interro- ing on a plane of theoretical abstraction. Evident through- gation procedures constitute torture [22,23]. Official out is a complete absence of concrete examples that might reports and numerous journalists over the last several have brought further light for the task force on the ethical years have provided extensive documentation depicting challenges that psychologist-guided interrogations really how these SERE techniques were used in U.S. interroga- entail. We know now that these excessive abstractions are tion practices by SERE-trained psychologists, both in partially due to restrictions imposed by the APA leader- DOD and CIA detention facilities [24,25,21,22]. Yet, Page 3 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 however despicable, psychology should never let these coercion in research or even in Guantanamo interroga- "enhanced techniques" cause us to ignore the only some- tions? Detainees are incarcerated indefinitely without ade- what more subtle techniques prescribed in the Army Field quate legal representation. If they provide interrogators Manual [26], the common guide for all U.S. military inter- with useful information, they are rewarded with less iso- rogations. In the Army Field Manual, allowable interroga- lation and other amenities. If they do not cooperate, or tion tactics include deception, fear escalation, ego harm, have no useful intelligence, they are well aware they will isolation, and psychological disorientation. Regardless of be punished further. Quite apart from allegations of out- whether these techniques are ethical for professional right torture and abuse, these conditions make the inter- interrogators, they are morally problematic for psycholo- rogations by definition coerced. gists, given the clearly circumscribed ethical underpin- nings of the profession. One PENS term most in need of an effective definition is "degradation." Holding off on "cruel" and "inhuman" for The proposed casebook the moment, the report prohibits psychologists from To a degree, the PENS Task Force recognized the report's engaging in "degrading" behaviors (p. 1). Even if psychol- abstract nature. It was proposed that the task force would ogists were experts in human rights law, they are left with continue working after the publication of the report on a little APA guidance on the term's meaning in practice. casebook that would provide specific examples of ethical Strict psychological criteria are needed to accompany such dilemmas and concrete instances of appropriate psychol- APA statements. The definitions provided by the Ameri- ogist behaviors [27]. Despite this written commitment, can Heritage Dictionary are a start. The verb "to degrade" and a call in 2004 by the APA Council of Representatives is in part: for the casebook's completion [28], work on it only com- menced after the 2007 Convention. The 2007 APA resolu- "1. To reduce in grade, rank, or status; demote. 2. To lower tion [12] reaffirmed the APA's commitment to a casebook in dignity; dishonor or disgrace. 3. To lower in moral or and commentary, this time in the hands of the Ethics intellectual character; debase. 4. To reduce in worth or Committee. A call has been published requesting member value. 5. To impair in physical structure of function." recommendations for the casebook, but those recommen- dations are not due until March of 2008 [27]. While little As argued by Mayer [16], "only in an Orwellian world relief is in sight for detainees brought to Guantanamo in could the actions of behavioral scientists in these settings 2002, or those disappeared into the CIA's secret detention be termed anything but a process of 'degradation'." Deg- facilities, the rate of progress to date suggests the casebook radation is an ongoing, psychologist-designed experience will not be developed and made policy until the next U.S. for detainees. As stated, even outside the "cruel" and presidential election is upon us, or possibly even the next "inhuman" enhanced techniques characteristic of CIA inter- administration. This speed and style is in dire contrast to rogations, the basic Army Field Manual [26], again the the initial "emergency" call for the PENS Task Force, and guidebook for interrogations, proffers strategies of fear up the quick execution of the original report. harsh and ego down. Such techniques are indisputably degrading, and antithetical to the tenets of any mental Operational definitions of interrogation and health profession. torture It is worth examining other sources of ambiguity in the A real case study PENS Report. This includes an absence of operational def- To push through the abstractions and concretize our initions presented for the most critical interrogation/tor- understandings of degrading practice, there is fortunately ture-related terms. The PENS Report was said to be a one explicit record on a BSCT psychologist and his direc- reaffirmation of the APA's earlier Resolution Against Tor- torial function in the interrogation process. This leaked ture, yet the report never defined when interrogation interrogation log [29] included a Major L., whose identity becomes torture. The 2006 APA Resolution against Tor- was publicly revealed to be Dr. John Leso, a counseling ture [11] cites broader human rights definitions, yet what psychologist and APA member [19]. As a BSCT psycholo- the APA actually considers an "ethical" interrogation and gist, Dr. Leso consulted on the interrogation of Moham- what it constitutes as torture was never spelled out with med al-Qahtani. By any reasonable definition, the any precision in the PENS report. Sound, ethical decisions interrogation was extreme torture [30-33]. It was not clear require sound reasoning and a consistently agreed upon from the interrogation log that Dr. Leso was present at language. each and every stage of the interrogation process, and his name tends not to appear in sections documenting the Some values of the psychological profession were never most extreme tactics. Nevertheless, the log documents addressed in the PENS report, such as the ethics code's Leso's presence during an ongoing interrogation, often prohibition on coercing participants into research. What is crossing the border into torture. Page 4 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 Those clearly documented behaviors of Dr. Leso might be ically problematic for psychologists as water-boarding, considered comparatively mild; although, they are reveal- the administration of drugs, or the sexual or religious tor- ing in the light of the ethics code and what is known about ments practiced in these war-on-terror detention centers BSCT practice. Dr. Leso, for instance, asked the interroga- [36-39]. Because the risk of coercion and torture is inher- tors to play cards in front of Mr. al-Qahtani to determine ent in these settings, the bright-line position of no psy- whether Mr. al-Qahtani was moving toward a psycholog- chologist participation in the interrogation process, at ical identification (i.e., dependence) on the interrogators. least for the time being, takes precedence over our best but If Mr. al-Qahtani was seeking the interrogators' attention, highly unrealistic wishes that psychologists are there to according to Dr. Leso's sophomoric psychological reason- minimize harm [13,40]. ing, this would confirm the interrogation was progressing as planned. Dr. Leso called for the detainee to be kept The utilitarian fallacy of national security awake, and to be placed in a swivel chair, moving him in The principles and standards of the APA Ethics Code any direction according to the will of the interrogator(s). apply first and foremost to the protection of those individ- This rolling and swiveling mechanism was based upon uals or groups most directly impacted by the psycholo- Dr. Leso's belief that Mr. al-Qahtani was relying on a cop- gist's professionally-related engagement in the world. The ing technique consisting of the detainee focusing his ethics code does, in at least one instance, emphasize larger attention on a single point on the wall. Dr. Leso therefore societal goals that can take many forms. For the PENS directed the interrogators to disrupt the detainee's ability tasks force, the national security goal, a largely societal to hold his attention. The swivel chair served this purpose. emphasis, is the cornerstone of its recommendations (p. This combination of dependence and disorientation is 2) see also [41] for a good discussion on the excessive indeed degradingb. attention in psychological ethics on the distal, societal benefits to the neglect of proximal, individual benefits). We wish there was more known about Dr. Leso's involve- ment. We wish we knew what part, if any, Dr. Leso played The societal "national security argument" in the PENS in the more extreme forms of torture to which Mr. al- report is that the potential distal protection of Americans Qahtani was subjected. We know that Dr. Leso was poten- supersedes the psychologist's responsibility to the most tially involved in abusive techniques that likely contrib- immediately vulnerable individual (i.e., the detainee) (p. uted to harm. Regardless of what else Leso did, we have 2). This is in every sense a utilitarian argument, suggesting trouble imagining – as a professional psychologist and as that risking a certain degree of harm, whether mental or an observant human being – that he didn't notice signs of physical, to an individual (really many individuals over psychological and physical deterioration evident in Mr. al- an extended period) is acceptable to reduce the possibility Qahtani expression and in his physical behaviorc [32]. that many others will be harmed at a future date (see also What was Dr. Leso's responsibility to protect Mr. al- [9] for a further explication of this argument). Qahtani's mental health? Whatever it was, Dr. Leso's coor- dination of the interrogation only exacerbated harm. We are skeptical of this particular assessment, assuming even that its basic foundations are reasonable. What is The case of Dr. Leso and Mr. al-Qahtani speaks to the real- more, these utilitarian arguments rarely incorporate "all ity of psychologist involvement in interrogations. It is our societies" within the formula; instead, the judgments his- belief that complex ethical considerations are involved in torically tend to be biased to protect the proponent's own any instance where psychologists participate in the over- in-group, most often to the detriment of all others, i.e., the riding of the wishes of human beings. These ethical calcu- out-group [42]. lations become even more complex in situations where psychologists are dealing with humans refusing to utter a In the PENS Report, the in-group utilitarian argument is single word, under conditions lacking virtually all legal defended through appeals to the ethics code. In particular, protections and without an attorney or advocate present. Principle B: Fidelity and Responsibility is used and its tenet There is no evidence that the PENS task force or the ethics that psychologists should be "aware of their professional committee considered these complex moral issues. and scientific responsibilities to society" [[4], p. 3]. Fidel- ity and Responsibility here is extrapolated by the PENS We must also protect ourselves from falling into the pseu- Report to "gathering information that can be used in our doscience trappings recurrent throughout our discipline's nation's and other nation's defense." (p. 2). We believe history [34], regardless of ego-based and careerist tempta- this application of Principle B is particularly idiosyncratic tions. Psychologists, like others, often cannot tell when a and over-reaching. There are other psychologist "respon- detainee is reluctant to provide information or when they sibilities to society" in this context that tend to be more simply have no information to give [35]. Subtle tech- compelling, such as the responsibility to avoid participa- niques of verbal pressure, it must be reiterated, are as eth- tion in activities that could harm society's trust in the dis- Page 5 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 cipline. This explicitly utilitarian phrase, moreover, is only In this regard, one phrase in the PENS Report – critical to a small portion of Principle B, which more thoroughly its argument yet unsupported with documentation – is of asserts that psychologists should, "...seek to manage con- particular concern. The report argues that "it is consistent flicts of interest that could lead to exploitation or harm" with the APA Ethics Code for psychologists to serve in (p. 3). This clause, we believe, is far more apt to the consultative roles to interrogation...as psychologists have a present situation, characterizing the ethical dangers of long-standing tradition of doing in other law enforcement con- psychologist-involvement in "war-on-terror" interroga- texts" (p. 1, italics added). This parallel between psychol- tions. ogists involved in foreign intelligence gathering operations and forensic psychologists working with In general, any ranking of potential contributions to domestic law enforcement is fundamental to the APA national security above protections of the most vulnerable position supporting psychologist participation. There is a human clients (and trust in psychologists as caregivers) is long history of U.S. forensic psychologists interviewing a high risk proposition for psychology as a profession criminal suspects for dangerousness, fitness to stand trial, [43]. This is not only an unacceptable ranking of priori- assessment of mental status and malingering, not to men- ties; it is putting highly speculative claims that can never tion treatment of those who are incarcerated. U.S. psy- be substantiated above the reality of abuses that have chologists conduct research on detecting deception, indisputably been witnessed across settings and over mul- linguistic evidence of coercion in interrogations, and tiple occasions, spanning at this point over half a decade. many other social psychological aspects of criminal inves- There is no real way to confirm or disconfirm the utilitar- tigations. ian assessment. The very nature of these interrogations and the conditions of detention have, however, been In its brief, precedent-implying phrase, the task force widely and repeatedly denounced across much of the obscures three profound differences between the "long- world [44,45]. And many expert political analysts have standing traditions" of forensic psychology in U.S. "law made sound arguments that they have placed everyone at enforcement contexts" and the context of psychologists in higher risk for acts of terrorism. At a minimum, utilitarian "war-on-terror" detainee interrogations. First, psycholo- arguments, to be valid, would need to encompass these gists do not conduct interrogations in the U.S. and do not unintended side effects of the government activities being have authority over the law enforcement officers involved aided by psychologists. in them, as BSCTs have over the military interrogators they train and advise during interrogations [33] (see also The truth is that APA interrogation policy has never ade- log on Dr. Leso [29]). In the domestic criminal justice sys- quately weighed the radiating international effects of tem, psychologists either offer training workshops on spe- detainee abuse, and their devastating impact on trust. cific topics of value to investigators, or they present the With psychologists actively involved in detainee interro- results of linguistic or behavioral analyses of prior inter- gations, reports of abuse are a threat to the whole profes- views, using methods developed that are too labor inten- sion. The damage to public trust may also be difficult to sive for the investigators to master. They do not sit in on measure, but it is likely to be considerably more serious interrogations and help shape those events as members of than any benefits believed to accrue from this policy. The the interrogation team. Any who do this in the U.S. are utilitarian position is better framed as: what is best for the considered former psychologists, and now considered law most people is what protects the dignity of the single indi- enforcement officers, answerable to the chain of command vidual, because the effects of endangering the single indi- of the police force or agency. vidual, to any degree, are far-reaching indeed [46]. Second, and most important, research and consulting Domestic forensic psychology vs. foreign forensic psychologists work in settings where prisoners intelligence work: A false comparison are afforded basic protections, including the right to an The battle over the APA endorsement of "psychologist- attorney, habeas corpus, and the right against self-incrim- involved interrogations" continues a long, historical bat- ination. In contrast, psychologists aiding detainee interro- tle within psychology to preserve its reputation against the gations are operating in systems in which violations of the fear that members may attempt to psychologically control rule of law are systemic and legal representation and other or obtain information from people against their will and protections are denied. Such extreme violations of liberty outside their awareness [47]. Whether psychologists could are inevitably, in and of themselves, psychologically ever successfully accomplish such feats remains an open harmful and demeaning to the profession of psychology question. Historically the profession has treated any effort [48,49]. Despite the claim of precedent, information by psychologists to control or extract information against about domestic enforcement contexts bears little on a person's will, and in ways detrimental to their mental whether psychologist involvement in detainee interroga- health, as problematic, if not definitively unethical. tions is adequately covered by the ethics code. Page 6 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 Third, military and CIA psychologists have far fewer inde- might have had in a provider would inevitably erode with pendent outlets for advice and external support than the practice of psychologists as interrogators (see also on mainland forensic psychologists. PENS Statement #12 dual relationship risks [54,48,55]. A report from the U.S. asserts that "psychologists consult [with other psycholo- Army Surgeon General hints at the danger, stating that gists] when they are facing difficult ethical dilemmas," detainees have requested healthcare from BSCTs [56]. and cites Ethical Standard 4.06 on Consultations (p. 8). News travels, and that impacts the perception of psychol- Unfortunately, legally-binding secrecy, the chain of com- ogy within detention centers and well outside the bounds mand, geographical separation, and other elements of detention centers. Illusory firewalls will do little to pro- within the social climate of national security work can tect vulnerable human beings from the misuse of psychol- hamper the psychologist's ability to confer with objective, ogy and the radiating effects of that mistreatment. fellow psychologists outside, for instance, Guantanamo, a CIA black site, or a U.S. Navy Brig. The safety officer and behavioral drift In order to clarify further the issue of multiple relation- The mixed-roles rule ships, it is necessary to examine the "safety officer" and A mainstay argument for prohibition against psychologist "behavioral drift" claims found in the PENS Report and involvement is that the role inherently forces ethical com- other APA sources, all suggesting that psychologists make promises, and these constitute too great a risk for psychol- interrogations safe and legal [6,57-59]. One APA Monitor ogists and detainees, not to mention the discipline of article implied that psychologists' involvement in interro- psychology and national security itself [13,40]. These gations had less to do with making interrogations "effec- compromises are evident in the PENS Report's "no mixed- tive" and focused instead on maintaining the mental roles" rule as anywhere. The no mixed roles rule is against health of the interrogator, preventing what was called "...mixing potentially inconsistent roles such as health "behavioral drift". In other words, the psychologist's pri- care provider and consultant to an interrogation..." (p. 6). mary role is to prevent an interrogator's actions from esca- The intention is to make it more difficult for mental lating into torture [60]. It should not surprise anyone that health information (e.g., on specific phobias, as in the interrogators or other professionals can lose their temper, classic novel 1984) to so easily transfer from medical experience moral lapses, or generally succumb to sadistic office to interrogation booth. The transfer is most easy impulses [61]. when it is within one and the same person, although the practice of passing this information on through other Yet if preventing "behavioral drift" involves a psychologist modalities was common practice in Guantanamo [50,51]. providing mental health care to another interrogator, Regardless of this PENS rule, national security interroga- where is the separation of roles? How is conflict of interest tions take place in closed settings where the superordinate avoided when a psychologist contributes to the gathering goal is to gather information. If it serves this goal, infor- of intelligence from detainees while clinically monitoring mation can get passed from one professional to another the interrogator's behavioral drift? The psychologist can- [40,52,53]. not play the protector of a detainee while concurrently coaxing information from that same detainee. The psy- The no mixed-roles rule also fails to recognize that chologist cannot guide an interrogator on manipulation licensed counseling and clinical psychologists are fre- while working to monitor and restrain that same interro- quently used in these interrogation roles (as in the case of gator. What about potential conflicts of interest between Dr. Leso). Such psychologists are very possibly used with interrogators, BSCT psychologists, and the chain of com- the assumption that they can derive information about mand? Any interrogation psychologist role in preventing weaknesses or psychopathology from the statements, "behavioral drift" involves, by definition, multiple and mannerisms, and other behaviors of the detainee. The no conflicting relationships. Meanwhile, who is monitoring mixed-roles rule therefore seems to be little more than an the behavioral drift of the psychologist? inadequate, quick fix, which is simply an attempt to main- tain psychologist involvement. The overlap of responsi- The APA argues that psychologists are uniquely qualified bilities within the same person is not the only source of for the role of "safety officer." Why they, better than oth- role conflict detrimental to the detainee. The coexistence ers, should be able to detect an interrogator's mounting of psychologists as providers and interrogators, whether frustration and progression to abuse compared to an army or not they are within the same person, produces ethical officer who was trained as a lawyer, linguist, anthropolo- dilemmas in the form of multiple relationships, dual-roles, gist or school teacher is not explained. The term "behavio- dual loyalties, and conflicts of interest. Despite any role ral drift" is used as if it were a subtle process that demarcation, interrogated detainees are not likely to trust psychologists, with their clinical acumen, would be any professed distinction between care-giving and interro- uniquely able to monitor. Behavioral drift is simply a gating psychologists. Any semblance of trust a detainee euphemistic expression that obscures reality. It gives a Page 7 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 pseudo-professional frame to what anyone could observe: stars" and "lofty" [66]. Others have rejected any taking of the interrogator, through frustration, anger, and subse- the principle seriously, pointing to silly counterexamples; quent aggression, is beginning to abuse the detainee. stating that punishing a child or giving a student a bad grade or producing therapeutic transference in a client If psychologists are to prevent behavioral drift, ethical could all be considered acceptable examples of "doing practice would require their total removal from the infor- harm", and contrary to naïve notions of "beneficence." mation-gathering context (see [61] for more on ethical Such straw person arguments ignore that each of these drift interventions). Such psychologists could just as easily examples possess the ultimate goal of bringing about ben- be independent from the chain of command, and have no efits to the individual targeted by the intervention, an aim role in monitoring or providing services to detainees. Psy- which is wholly absent in interrogation work on a chologists could also train anyone who enters the interro- detainee. gation booth against behavioral drift, and perform that training from a comfortable geographical distance.d The PENS Report attributes beneficence to war-on-terror interrogations in two highly suspect ways. First, psycholo- A more fruitful way to protect detainees lies in studying gist involvement in intelligence gathering and detainee how to facilitate whistle-blowing – a concept in need of a interrogations is a positive good, the report claims, less stigmatizing label. The term refers to raising concerns because it contributes to national security. In this frame- outside the chain of command, and, if needed, through- work the psychologist conceptualizes the "client" as the out the public sphere [62]. In these detention centers, military, or U.S. society as a whole (p. 2)(see also [9]). The there are interpreters, NGO observers independent of the APA Ethics Code is based, in contrast, primarily on the chain of command, and military psychologists, all privy individual or group receiving the psychological service, to acts of abuse. There is no evidence that practicing psy- research attention, or consultation [4]. To make the "cli- chologists have any special qualifications for whistle- ent" the U.S. military, intelligence, or U.S. society, is to blowing, or are any more likely to do so than others. The make a radical shift in the focus of the ethics code, too rad- empirical record produces only one potential case, that of ical to be considered a traditional or widely accepted Michael Gelles in Guantanamo. Unlike most potential interpretation. If every time "client" was mentioned in the whistle-blowers, Gelles was reporting abuse occurring in a code, it could be replaced by "the military", beneficence chain of command other than his own. Perhaps more would be, "strive to benefit the military." As one moves importantly, he was supported by his own command through the ethics codes, the examples only become more [63,64,40]. It was nevertheless a brave act, and one that absurd all the way into "Psychologists do not have sexual needs to be more frequently emulated. intimacies with clients". There are many cases where industrial/organizational psychologists are serving corpo- Beneficence and non-maleficence ration interests and not the consumer per se. But these As pointed out above, the PENS Report is skewed in the relationships are rarely as direct and potentially harmful direction of supporting psychologist involvement. It as psychologists attempting to get information from presents one side of an argument where clear pros and unwilling detainees. cons exist. The report selectively chooses sections of the ethics code supporting its recommendations and omits Another distortion of "beneficence" is the misconception more salient standards that would oppose the task force's that it primarily refers to psychologists in the "helping majority position. A number of APA documents assert professions," and not to "applied/consulting psycholo- that the PENS Report and the APA position on interroga- gists" whose clients are institutions. Again, the PENS tion are based on Principle A of the Ethics Code [6,65]. Report correctly asserts that all sections of the ethics code While "do no harm" tends to be the half promoted by the holds for all U.S. psychologists, whether providers, APA, there are actually two sides to Principal A: Benefi- applied consultants, or researchers. Until beneficence is cence, or essentially "do good," which is a world of differ- removed from the APA ethics code – which would be a ence from the other side, non-maleficence, or "do no mournful day for the profession – both halves of Principle harm" [41]. Wisely, the creators of the APA Ethics Code A should be taken seriously and applied comprehensively. made beneficence the first part of its first principle, sym- bolically preceding non-maleficence. According to the Other principles as commentary on beneficence principle of beneficence, "Psychologists strive to benefit The APA Ethics Code in general is replete with fundamen- those with whom they work..." [[4], p. 3]. In various con- tal principles, as shown here, that are avoided in the PENS versations with psychologists, there has been a tendency Report, and that the APA leadership fails to discuss in its to regard the principle of beneficence as somehow quaint; defense of its interrogation policy. Chapters could be writ- too ideal for actual practice. Others have described Princi- ten about each of a dozen principles and standards in the ple A as "a high level of abstraction, up with the moon and code and their incongruence with psychologist involve- Page 8 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 ment. For example, Principle C: Integrity, Honesty and dictions of future harm impossible. What is more impor- Truthfulness (p. 3) is relevant to the extensive deception tant in our opinion, is that such competence is outside the that often takes place in war-on-terror interrogations. The psychologist's ethical domain, because it assails the abso- majority of the original PENS task force, in opposition to lute character of "do no harm." integrity, honesty, and truthfulness, took a stand against the imperative psychological principles of informed con- Standard 1.02 sent and debriefing (p. 9). The most consequential and controversial flaw in the cur- rent ethics code is Standard 1.02 as it is written in the lat- Principle D: Justice (p. 3) must also be addressed. Some est, 2002 version of the code [4]. In the Introduction and ethicists argue that a special relationship exists between Applicability of the code, it is stated that should any con- the ethical principles of justice and beneficence (i.e., the flict arise between a law and the ethics code, psychologists wellness-justice nexus) [67]. In fact, reports from the should take whatever steps they can to resolve the American Bar Association and numerous human rights dilemma. If that fails, the code permits psychologists to organizations about detainee treatment at Guantanamo follow the law, but, and this is critical, within the bounds Bay give more than adequate cause for a moratorium of "human rights." Unfortunately, the mention of based on Principle D alone. The same can be said for Prin- "human rights" is only in the Introduction and Applicability ciple E: Respect for People's Rights and Dignity (p. 4) that section. It is merely aspirational, not enforceable. The emphasizes confidentiality, self-determination, and enforceable section, standard 1.02, on precisely the same respect for culture and national origin [68]. Abusive reli- topic, does not include language on human rights. Nor gious and cultural techniques were once the bread and does it simply say that psychologists may follow the law butter of war-on-terror interrogations. over the ethics code. In addition to law, standard 1.02 includes the somewhat militaristic sounding "regula- Do no harm: Principle and standard tions" and "governing authority" as additional forces that "Do no harm" is one of the few aspirational principles in permit a psychologist to abandon the ethics code. Moreo- the code that is also an enforceable standard. Do no harm ver, unlike the Canadian ethics code for psychologists, is the other side of the coin from beneficence; it has a pro- 1.02 makes no mention of civil disobedience, nor does tection function on the future actions of the psychologist 1.02 provide guidance from the APA in resolving disputes or the psychologist's team; it is ostensibly the "safe" in the based on moral conscience. Therefore, in rather plain lan- APA catch phrase, "safe, legal, and effective." It would also guage, the 2002 Code's enforceable 1.02 condones plac- be akin to the "safety officer" role or in the prevention of ing military commands and priorities over the ethical "behavioral drift" except that the phrase do no harm is an responsibilities of the psychologist. absolute for psychologists' participation. In contrast to some other "ethicists", we do not believe the standard The practical implications of 1.02 are evident in the case should be weakened with qualifications or continuums of of Dr. Leso. Despite the objectionable nature of Dr. Leso's harm [9]. When harm is treated as a legal set point, as in behaviors, he had been following the standard operating the interrogation safety officer role – when it is a degree of procedures (sop) of Guantanamo and of the Army Field mental anguish that the psychologist decides should not Manual. "Regulations", the "governing authority", and go further – it places the psychologist in the insidious role U.S. administration interpretations of "law" all supported of determining variations in the degree of harm. When his actions, even if he violated enforceable standards such harm is treated as a gradation to be gauged, when the psy- as do not harass, do not harm, and do not exploit [70]. We are chologist is charged to judge how much harm, mental or aware of at least four ethics complaints against Dr. Leso physical – whether the harm is likely to be temporary, per- filed with the APA Ethics office, dating back to at least manent, prolonged, substantial, or significant [12,69] – a August 2006e. Because standard 1.02 allows psychologists dangerous door is opened up for the profession. A psy- to treat these as superordinate to the code, it will be inter- chologist safety officer role is better off as part of the Inter- esting to see what actions the APA ethics committee will national Committee of the Red Cross that would strictly take, if any, to hold Dr. Leso accountable. enforce among interrogators a "no harm" ethic. To the extent that the military desires a figure to judge gradations In August of 2005, the Council of Representatives of harm, they are better off finding legal experts, who can requested that the ethics committee address the loophole better evaluate the procedures in the face of international of 1.02. No changes in the ethics code have been made. law, without the illusion of a health professional's stamp The 2007 APA resolution against torture, to its credit, did of approval. Many critics have argued these decisions are include language that stated orders could not excuse tor- outside the competence of psychologists. We agree. Com- ture or cruel, inhuman, and degrading treatment; petence is not a feasible goal when so many factors, although, whether this resolution truly supersedes Ethics including the protracted periods of detention, make pre- Code provision 1.02 and whether actions like Dr. Leso's Page 9 of 15 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine 2008, 3:3 http://www.peh-med.com/content/3/1/3 fall under the APA's definition of "degrading" treatment, Without empirical evidence that psychologists positively remains unclearf. Further, the 2007 APA Resolution only contribute to these interrogations – that their presence addresses conflicts between laws/regulations and the improves the veracity of the information obtained – then injunction against participating in torture or cruel, inhu- there is little reason to assume unique competencies. man, or degrading treatment or punishment. Laws or orders Meanwhile, social psychological research indicates that if violating other established human rights are not anything, estimates of one's own competency can be seri- addressed. ously overestimated. No expert of any kind possesses error free methods of determining who is or who is not telling Competence and conscience the truth in an interrogation, or who is and who is not a The APA ethics code warns psychologists to "...take pre- "terrorist." In fact forty years of research on the detection cautions to ensure that their potential biases, [and] the of deception shows there is a very high risk of error even boundaries of their competence...do not condone unjust among trained interviewers, and that deception detection practices" (p. 3). In an overly optimistic stance on compe- accuracy is little better than chance [35]. The conse- tence, the PENS Report states, "...special safeguards may quences of psychologist error in military detention sites be necessary to protect the rights and welfare of persons or could be severe, and perhaps most important, lead to communities whose vulnerabilities impair autonomous punitive actions toward a detainee that is beyond the psy- decision-making" [[6], p. 8]. Boundaries of competence chologist's control. are perhaps most severely tested in issues of religion and culture where, as the PENS Report mentions, "knowledge Research ethics and detention center practice of race, ethnicity, culture, and national origin" is involved It is a bitter irony that war-on-terror interrogations are so (p. 6). While there are no doubt efforts on the part of perilous for the research participant that no study resem- some U.S. military figures to become more culturally sen- bling their conditions could be devised following the APA sitive [71], there is overwhelming evidence that knowl- Ethics Code on Research. Internal Review Boards (IRBs) in edge of culture has been abused to coerce information the U.S., overseeing the protection of human participants, from detainees [16]. In settings where cultural knowledge would never allow experiments in public or private uni- has been abused, particularly capitalizing on sexual and versities that would approach the conditions in Guantan- religious taboos, even a mental health provider knowl- amo. IRBs and university researchers are sensitive to edgeable about cultural issues would find it difficult to potential research abuse and afford research participants utilize diversity education in a positive sense [68]. Fur- extensive protections [41,72]. Furthermore, without sim- thermore, psychologists rarely possess sufficient knowl- ulating high-risk degradation, no US study could provide edge about how other collaborators will use information the ecological validity to approach the conditions of "war- that a psychologist identifies and shares. Even more chal- on-terror" interrogations. We have no doubt that to coun- lenging is the fact that the ethics code permits psycholo- ter criticisms about generalizability, psychologists have gists to work outside their areas of competence in considered secret research conducted within military or emergencies. Unfortunately for the detainees, the military intelligence settings on detainees as research participants. defines the "war-on-terror" – much as the PENS task force We strongly object to such non-transparent research on itself – as a perpetual emergency. the most vulnerable of populations [73]. However, since the APA has tied its interrogation policy to its ethics code, The paucity of research and the high risk of error we hope that the APA would also find such research unac- Professional competency demands a research base, espe- ceptable. cially when work in such high stakes contexts is involved, and the lack of a good research base is a major reason to Our optimism is tempered by awareness that, parallel to prohibit psychologist involvement in detainee interroga- the changes to standard 1.02, clauses governing research tions. There is no established evidence that psychologists were also weakened, providing greater leeway to dispense are the least bit helpful in ensuring ethical ways of elicit- with informed consent, and permit the increased use of ing information. There is no scientific literature that deception. Thus, standard 8.05 now allows informed con- would lead us to conclude that psychologists in these sent to be disregarded "where otherwise permitted by law interrogation settings provide unique competencies. We or federal or institutional regulations" [4]. Similarly, in a question the statement in the PENS report that U.S. statement resembling the very definition of torture and national security interrogations have been "significantly the qualifying limits of "severe", clause 8.07 allows decep- developed and refined" [[6], p. 5]. We do not doubt that tion, except "Psychologists do not deceive prospective par- this work has expanded into more worldwide use, but dis- ticipants about research that is reasonably expected to semination itself does not portend positive growth. cause physical pain or severe emotional distress" [4]. Page 10 of 15 (page number not for citation purposes)