Last week, the American Psychological Association (APA) finally revised its ethics code so that it no longer contained the so-called “Nuremberg Defense,” allowing dispensing with professional ethics when they conflicted with “law, regulations, other governing legal authority.” This clause was added in 2002, at the heyday of the Bush administration. APA dissidents, retired military personnel, ethicists,and human rights advocates have long pushed for its removal.
A number of military psychologists who served in or trained the Behavioral Science Consultation Team at Guantanamo (BSCT) had opposed change in this code. Not coincidentally, this section had been emphasized in the instructions for the BSCTs and in the APA’s report of the 2005 task force on Psychological Ethics and National Security (PENS) where the APA let military-intelligence psychologists create ethics policy for the association.
The ethics code 1.02 has stated since 2002:
If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority.
When the change goes into effect in June, this clause will essentially revert to the pre-2002 wording:
If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights
The removal should be a cause for celebration. However, like every change in APA’s policies on psychologists providing interrogation support, this change is too little too late. APA leadership waited till over a year after the end of the Bush regime and its “enhanced interrogation” torture program before changing this clause which provided protection for psychologists aiding the torturers. While the Justice Department’s OLC torture memos provided legal protection, the APA policy complemented that protection by providing protection from future charges that psychologists aiding detainee abuse violated professional ethics.
While the infamous 1.02 is gone from the ethics code, the less well known but equally disturbing section 8.05 governing research without informed consent is still there. It allows dispensing with informed consent, the bedrock of professional ethics, whenever “law or federal or institutional regulations” say it is OK:
Psychologists may dispense with informed consent only (1) where research would not reasonably be assumed to create distress or harm and involves (a) the study of normal educational practices, curricula, or classroom management methods conducted in educational settings; (b) only anonymous questionnaires, naturalistic observations, or archival research for which disclosure of responses would not place participants at risk of criminal or civil liability or damage their financial standing, employability, or reputation , and confidentiality is protected; or (c) the study of factors related to job or organization effectiveness conducted in organizational settings for which there is no risk to participants’ employability, and confidentiality is protected or (2) where otherwise permitted by law or federal or institutional regulations. [emphasis added]
Thus, research on detainees would be acceptable as long as institutional regulations (from the CIA or Defense Department, say) gave permission.
If the APA were really interested in removing loopholes in the ethics code, they would have changed this clause without prodding. I have been calling for change in this and another problematic research ethics clause for years. Unfortunately, the battle to remove loopholes in the ethics code allowing abuse will continue into the indefinite future.
March 1st, 2010
There has been considerable controversy in the American Psychological Association regarding the association’s decision NOT to honor a boycott of the Hyatt hotel in San Diego that APA plans to use for its convention in San Diego next summer. [For background, see Olson & Eidelson's piece here and a Psychologists for Social Responsibility statement here.] In December Alice Dreger blogged on the issue for the Hastings Bioethics Forum. APA staff member Kim Kills has posted a response in the comments. In return, Roy Eidelson, President of Psychologists for Social Responsibility, has posted a reply to Mills.
I post both Mills’ comments and Eidelson’s reply here. Mills:
The American Psychological Association has been a strong advocate for full civil rights for lesbian, gay, bisexual and transgender people for nearly 35 years. We are proud of that record of advocacy based on the social science research on sexual orientation and gender identity.
APA has supported legal benefits for same-sex couples since 1997, and civil marriage for same-sex couples since 2004. Most notably, we have adopted policy statements, lobbied Congress in opposition to the Defense of Marriage Act and the Federal Marriage Amendment, and filed amicus briefs supporting marriage equality for same-sex couples in legal cases in eight states, including California. The APA brief was cited by the California Supreme Court when it ruled that same-sex marriage was legal in May 2008.
While we strongly disagree with Doug Manchester’s position vis-à-vis Proposition 8, APA has decided against joining the boycott based on several important factors that have not changed despite an expected budget surplus: a legally enforceable contract, the convention’s need for a large number of sleeping and meeting rooms, and APA’s intention to use the meeting in San Diego as an opportunity to promote public knowledge about scientific research relevant to marriage equality and communicate clearly where we stand on the issue.
This decision is consistent with that of several other large organizations—the American Public Health Association, the National Education Association and the American Educational Research Association–that are also supportive of LGBT civil rights.
Although honoring the contract is not purely a financial issue, it is important to realize that if APA were to cancel the contract, Mr. Manchester would lose nothing; his hotel would receive a $1 million penalty fee from APA. Furthermore, the reality of the situation is that the Hyatt is the only hotel in the San Diego area (other than hotels we have already booked) that offers the number of sleeping and meeting rooms required by our meeting. In short, canceling the Hyatt contract would put our ability to host the 2010 convention in jeopardy. In addition, there are several facts relevant to the decision regarding a boycott that the Dr. Dreger did not mention: the boycott has been spearheaded by the union Unite/HERE; the hotel is managed by Hyatt, which has a good record on sexual orientation non-discrimination; and the boycott will also affect the hotel’s highly diverse work force at a time when unemployment is high and jobs are difficult to find.
The bottom line is we believe our resources are better devoted to other meaningful and powerful ways to stand up for our values. We see the San Diego convention as an important opportunity to call attention to the social science research on sexual orientation, the abilities of gay and lesbian parents, and the benefits of marriage for all people.
We plan to offer significant convention programming on these topics. We also plan to devote considerable resources to a national media outreach effort to generate coverage of the APA’s support of marriage equality and the benefits of marriage for all people.
APA believes that a boycott, although a strong symbolic gesture, would not achieve the desired results. In summary, APA’s goals are to give our members full information, respect the personal choices of convention attendees, publicize the social science research on sexual orientation, and use APA resources in productive ways that will move forward the cause of marriage rights for same-sex couples.
Kim I. Mills
Associate Executive Director
Public & Member Communications
American Psychological Association
Posted by: kmills@apa.org
Eidelson response:
As a spokesperson for the American Psychological Association (APA), Kim Mills offers a series of unconvincing arguments in response to Alice Dreger’s recent essay, “Attention Shoppers: LBGT Rights Apparently Not Worth $6.67 to the American Psychological Association” (http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4260). Mills attempts to defend the refusal of APA leadership to change course regarding plans to use the Manchester Grand Hyatt as the lead headquarters hotel for the August 2010 annual convention in San Diego. As is well known, the hotel’s owner Doug Manchester contributed $125,000 to the Proposition 8 campaign that abolished the right of same-sex couples to marry in California.
My reply focuses on several of the specific claims Mills makes.
First, although APA’s past advocacy efforts on behalf of civil rights for LGBT people are commendable, they are no excuse for failing to directly confront the current issues surrounding the Manchester Grand Hyatt. In 2004 APA declared that the association “shall take a leadership role in opposing all discrimination in legal benefits, rights, and privileges against same-sex couples.” Such a resolution carries with it responsibilities–otherwise it has no real meaning.
Mills’ claim that APA signed “a legally enforceable contract” provides little in the way of clarity. APA leadership has refused to reveal important details of the contract, including possible clauses relevant to cancellation for cause (e.g., failure to provide a quiet and non-controversial venue). Similarly, the $1 million “penalty fee” has been mentioned repeatedly, but requests for further information about it have gone unanswered. For example, it’s not clear what APA’s financial exposure would be if the Manchester Grand Hyatt were not used as a headquarters hotel but all of its sleeping rooms were filled during the convention anyway. There is also a troubling contrast in priorities worth noting here. When APA recently faced difficulties and embarrassment over errors in its latest publication manual, the association decided to pay as much as $1 million to provide replacement copies. In describing this potential financial loss, APA’s Rhea Farberman explained that it was “important to our long term reputation as a publisher.”
Meanwhile, Mills argues that APA has no choice but to use the Manchester Grand Hyatt because “a large number of sleeping and meeting rooms” are needed for the convention. This claim lacks credibility. A successful convention for APA might indeed bring as many as 15,000 attendees to San Diego in August. However, that is a relatively small number when compared to another event scheduled for San Diego just a month earlier. The annual July Comic-Con convention draws well over 100,000 attendees and uses dozens of local hotels.
At the same time, Mills diverts attention from the real issue when she emphasizes that APA intends to use the convention “as an opportunity to promote public knowledge about scientific research relevant to marriage equality and communicate clearly where we stand on the issue.” This is a laudable plan, but it doesn’t require APA to use the Manchester Grand Hyatt as its lead headquarters hotel (where meetings of the Board of Directors, the Council of Representatives, and other groups are currently scheduled to be held).
Finally, Mills claims that the Manchester Grand Hyatt boycott has been “spearheaded” by UNITE-HERE. This deceptive statement appears to be little more than an attempt to split the boycott organizers, a coalition of LGBT and labor groups–and it’s similar to the strategy adopted by Doug Manchester himself. Not only is this approach dismissive of the LGBT community, no explanation is offered for why APA leadership has adopted such an anti-labor stance. In this regard, it’s noteworthy that in an earlier communication about the Manchester Grand Hyatt, the APA Board encouraged association members to visit the explicitly anti-union websites of Richard Berman, a well-known lobbyist for big business.
In light of the misleading claims Kim Mills makes in responding to Alice Dreger’s essay, it’s rather stunning that she concludes by highlighting this APA goal: “to give our members full information.” Fortunately, many APA members and APA divisions have chosen a different path to knowledge. They are making independent decisions about the Manchester Grand Hyatt boycott, informed by their own core values and principles. I applaud them for doing so.
Sincerely,
Roy Eidelson, Ph.D.
APA Member
reidelson@eidelsonconsulting.com
P.S. As president of Psychologists for Social Responsibility, an organization unaffiliated with the APA, I welcome readers to review our recent statement on the APA Convention and the Manchester Grand Hyatt: www.psysr.org/apa-manchester.
February 1st, 2010
UPDATE: Dreger’s piece has been picked up by Dan Savage at his blog.
In addition to the negative attention the American Psychological Association has received for what many of us see as its collusion with torture, they are now under fire by human rights advocates in a completely different area. One of the prime sites where they are to hold their convention next summer in San Diego is a hotel under boycott by LGBT groups for the owner’s $100,000 contribution to 2008’s anti-gay marriage campaign, Proposition 8. APA has refused to honor the boycott, despite calls from activists among its membership.
A couple of weeks ago, Psychologists for Social Responsibility [note: I'm President-Elect] issued a statement urging the APA to at least arrange the Convention so no one has to violate the boycott to participate in official events. APA has so far not responded.
Now Guggenheim-ward-winning bioethicist Alice Dreger weights in on the Bioethics Forum:
Attention Shoppers: LBGT Rights Apparently Not Worth $6.67 to the American Psychological Association
By Alice Dreger
Using the power of one’s wallet to effect social change: that’s got to be one of the best-loved steps in the beautiful dance we call American democracy. And so leaders in the LBGT activist community have called for a boycott of businesses owned by individuals who contributed to California’s Proposition 8, the state constitutional amendment that rolled back the right to marriage for same-sex couples in California.
The Manchester Hyatt Hotel, in San Diego, is one of those businesses. Its owner, Doug Manchester, contributed $125,000 in an effort to stop gay and lesbian Californians from being allowed to marry. Nevertheless, executives of the American Psychological Association (APA) have opted to go ahead and use the Manchester Hyatt as a headquarter hotel for the APA’s 2010 meeting, against the vocal objections of many of the APA’s own members.
What’s especially striking is that the APA seems to be violating its own policies in this matter. As Psychologists for Social Responsibility noted on its blog, “the APA’s 2004 policy statement on sexual orientation and marriage includes a specific resolution that the association ‘shall take a leadership role in opposing all discrimination in legal benefits, rights, and privileges against same-sex couples.’” Meanwhile, the APA’s own ethics code specifically states as a principle that “psychologists respect and protect civil and human rights.” So what gives?
Apparently, the APA is just not willing to put its money where its mouth is. A letter from APA President Carol Goodheart indicates that it would cost the APA about a million dollars to reneg on its contract, made years earlier, with the Manchester Hyatt. Sounds like a lot of money, and it is, but that amount comes to only about 1.03% of the APA’s annual budget. This was pointed out to me by James Cantor, a psychologist at the University of Toronto and the Centre for Addiction and Mental Health, who is among those now calling for a reactive boycott of the APA’s meeting.
Cantor writes, “That APA would trade its support of civil rights for a (max) 1.03% budgetary interest is unacceptable to me as an APA member.” Moreover, “The APA President wrote recently that $3.5 million in unanticipated funds had been acquired.” Yet the APA still won’t consider pulling out of the Manchester Hyatt? Concludes Cantor, “This isn’t financial stewardship; this is civil rights having lost its place as an APA priority.”
As a consequence, those calling for a boycott of the APA’s meeting are hoping to convince at least 3,700 APA members who would otherwise attend the conference to skip it. (Usually about 14,000 attend.) The cost to the APA would come to about the million dollars they are claiming is at stake.
What’s particularly troubling in this whole controversy is that the APA leadership has refused to provide copies of the contract with the Manchester Hyatt to those members who have wanted to see if there might be a viable “escape” clause in the contract. Where’s the transparency? Writes Cantor, “this blocks any kind of independent review. Moreover, there have been no statements regarding why the APA legal office would have failed to protect APA by using such clauses, nor how APA might review its procedures for handling million dollar contracts.”
Other professional associations have backed out of holding their meetings at the Manchester Hyatt, including the American Association of Law Schools, the American Association of Justice (formerly the Association of Trial Lawyers of America), the Gay & Lesbian Alliance Against Defamation, the California Nurses Association, the Conference of Delegates of California Bar Associations, and the International Foundation of Employee Benefits.
That the APA would choose to put its members’ money in the pockets of Doug Manchester seems especially ironic given that psychological studies suggest sexual minorities’ mental health is negatively affected by discrimination. Imagine if the most prominent association of pulmonologists held their meeting at a hotel owned by a tobacco pusher. Only here we’re talking not just about health, but about civil rights. It’s really hard to imagine the APA knowingly funneling its members’ dollars into the coffers of someone who supported legislation to roll back the civil rights of, say, African-Americans or Jews.
As a member of the American Historical Association (AHA), I’d be remiss if I did not mention that the AHA went through with its contract to use the Manchester Hyatt, but, as Cantor notes, the AHA “allocated $100,000, or $6.67/member, for educational campaigns regarding same-sex marriage. Had the 150,000-member APA also allocated $6.67 per member, it would have covered the costs of a worst-case Hyatt lawsuit.”
Apparently, the APA has decided that civil rights for LBGT people comes at a cost, and that the cost is just too high at $6.67 per member. Talk is cheaper.
January 4th, 2010
While psychology is riven with conflicts over the profession’s role in interrogations, torture, and detainee abuse, and anthropology is fighting over military (mis)use of Human Terrain Systems counterinsurgency efforts, psychiatry, too, has its civil war. In the case of psychiatry, the battle is over the revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), now in edition IV. The lead psychiatrists for the third and fourth editions are among the fiercest critics of the process for developing the fifth edition.
While the controversy may seem arcane, it has major real world consequences. If, as expected, the DSM radically expands the number and scope of “mental disorders,” it will likely lead to a major increase in the number of people receiving psychotropic medications. For DSM is not really about understanding mental or emotional problems so much as it is about identifying target conditions for medications. While medications have their uses in treatment of mental or emotional problems, they are far from the only, and should often not be the primary approach to treatment.
While the National Institutes of Health usually requires psychotherapy researchers to study therapy for identifiable DSM conditions, there is really little evidence that the DSM way of carving up emotional problems is relevant to psychosocial treatments. For psychotherapies deal with emotional or interpersonal conflicts, (maladaptive” thoughts, problematic coping strategies, or dysfunctional behavior patterns and the like. None of these therapy targets map onto DSM categories in any systematic way. Yet, therapists are often required to assign DSM diagnoses to their patients.
Thus, the DSM is part of an imperial effort by psychiatry to make medication the dominant treatment modality for anyone experiencing problems in living. Unfortunately, the American Psychological Association, which might be expected to lead the opposition to this medicalization of human problems is more interested in helping their members get a share of this lucrative business. The psychological association has made getting psychologists the right to prescribe psychotropic drugs their #1 legislative priority. If the succeed, it is likely that psychologists, like psychiatrists, will find prescribing medications much more lucrative than listening to patients, and psychosocial approaches will be further marginalized.
New Scientist covers the controversy in a new article and recomends doing away with the lucrative DSM books altogether in an accompanying editorial:
Psychiatry’s civil war
By Peter Aldhous
Since this article was first posted, the American Psychiatric Association has announced that the publication of DSM-V will be delayed until May 2013. “Extending the timeline will allow more time for public review, field trials and revisions,” says APA president Alan Schatzberg.
When doctors disagree with each other, they usually couch their criticisms in careful, measured language. In the past few months, however, open conflict has broken out among the upper echelons of US psychiatry. The focus of discord is a volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which psychiatrists turn to when diagnosing the distressed individuals who turn up at their offices seeking help. Regularly referred to as the profession’s bible, the DSM is in the midst of a major rewrite, and feelings are running high.
Two eminent retired psychiatrists are warning that the revision process is fatally flawed. They say the new manual, to be known as DSM-V, will extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs. Leaders of the American Psychiatric Association (APA), which publishes the manual, have shot back, accusing the pair of being motivated by their own financial interests – a charge they deny. The row is set to come to a head next month when the proposed changes will be published online. For a profession that exists to soothe human troubles, it’s incendiary stuff.
Psychiatry suffers in comparison with other areas of medicine, as diseases of the mind are on the whole less well understood than those of the body. We have, as yet, only glimpses into the fundamental causes of the common mental illnesses, and there are no biological tests to diagnose them. This means conditions such as depression, schizophrenia and personality disorders remain difficult to diagnose with precision. Doctors can only question people about their state of mind and observe their behaviour, classifying illness according to the most obvious symptoms.
First published in 1952, the DSM has its origins in a book used by the US military to determine if recruits were mentally fit for combat. The difficulty of separating mental disorders from normal variation in behaviour made it controversial from the start. Over the years, the book’s influence has grown, and today it is used by doctors across the globe.
The wording used in the DSM has a significance that goes far beyond questions of semantics. The diagnoses it enshrines affect what treatments people receive, and whether health insurers will fund them. They can also exacerbate social stigmas and may even be used to deem an individual such a grave danger to society that they are locked up.
Some of the most acrimonious arguments stem from worries about the pharmaceutical industry’s influence over psychiatry. This has led to the spotlight being turned on the financial ties of those in charge of revising the manual, and has made any diagnostic changes that could expand the use of drugs especially controversial. “I think the DSM represents a lightning rod for all kinds of groups,” says David Kupfer of the University of Pittsburgh, Pennsylvania, who heads the task force appointed by the APA to produce the revised manual.
Few would claim that the DSM’s current version is perfect. With each revision, the number of conditions it defines has swelled, many surrounded by bewildering lists of symptoms that must be checked to assign a diagnosis. Using current DSM checklists, for example, 114 different combinations of symptoms can lead to a diagnosis of schizophrenia. At the same time, many patients prove hard to fit into the framework.
One aim of the work groups compiling DSM-V is to cut through this chaos. They are streamlining diagnoses by removing various subtypes of schizophrenia, for example, and intend to address the confusion created by the fact that many people with one condition meet criteria for other disorders as well. The DSM-V task force is expected to propose a series of “dimensions” to be considered with a patient’s main diagnosis. So as well as deciding whether someone has, say, bipolar disorder, doctors would determine whether they are suffering from problems such as anxiety and sleeping disturbances, and assess them on a simple scale of severity.
Grandiose claims
This is widely seen as a first step towards a future in which psychiatric diagnosis has a more scientific base, where sprawling checklists of symptoms are replaced by sliding-scale measurements of the underlying determinants of mental health. Yet critics worry that even a limited embrace of this “dimensional” approach is running ahead of the science. Until we understand more about the biological basis of psychiatric disease, this approach will not be helpful, they say.
Some of the harshest criticisms have come from those who led previous revisions of the DSM, in 1980 and 1994. In July, Robert Spitzer and Allen Frances, both now retired, wrote a stinging letter to the APA, accusing it of planning unworkable changes and making grandiose claims. In a separate editorial in the magazine Psychiatric Times, Frances complained that most of the authors are university-based researchers who are cut off from typical doctors and patients.
Spitzer and Frances also criticise the fact that members of the various DSM-V work groups have had to sign confidentiality agreements. “The main problem is that we don’t know what they’re doing,” says Spitzer. The APA says the confidentiality agreements are to stop the manual’s authors writing their own diagnostic handbooks alongside the official manual. Kupfer points out that discussion does go on: work groups proposing major changes debate their ideas in papers and at meetings. “We’ve done everything we can to encourage it,” he says.
Another focus for Spitzer and Frances’s concern is the suggestion that DSM-V could include new categories to capture milder forms of illnesses such as schizophrenia, depression and dementia. “The result would be a wholesale… medicalization of normality that will lead to a deluge of unneeded medication,” Frances said in his editorial.
For example, one work group is considering whether it is possible to catch people in the early stages of schizophrenia or other psychotic illnesses before they have their first full-blown psychotic episode (Schizophrenia Bulletin, vol 35, p 841). Some doctors prescribe antipsychotic drugs at this early stage in the hope of stopping the illness from progressing.
Libido loss
These medicines can have serious side effects, such as loss of libido, weight gain and distressing tremors and spasms, so no one would want to take them without good reason. Yet it’s hard to separate distressed people who will go on to develop a psychotic disorder from the “false positives” – those who will recover or develop a different illness. The available evidence suggests that only about 30 per cent of people identified as being at risk of psychosis will go on to develop it within two years.
Nevertheless, William Carpenter, a psychiatrist at the University of Maryland in Baltimore who chairs the DSM-V work group on psychosis, believes the needs of the “true positives” are so great that adding a diagnostic category to cover “psychosis risk” would, on balance, be a good thing. Frances brands this proposed diagnosis as “the most worrisome suggestion entertained”.
Given the controversy, psychosis risk may not make it into the DSM proper, and may instead appear in the appendix, as a condition needing more research. But even that designation might boost prescribing.
Frances and Spitzer are not the only ones with concerns, and there are other flashpoints (see “Hebephilia”, “Transgendered” and “Bereavement”). In March, Jane Costello of Duke University in Durham, North Carolina, resigned from the work group on disorders in childhood and adolescence, worried about what she saw as a lack of scientific rigour across the whole DSM revision. “I felt that there was not enough empirical work being achieved or planned,” she says.
The disputes are getting ugly. Senior APA figures have even suggested that Spitzer and Frances are motivated by a desire to safeguard their flow of royalties from clinical guides linked to the current DSM. “The fact that Dr. Frances was informed… that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique,” leading APA figures said in a response to Frances’s editorial.
Spitzer and Frances reject this charge. “To suggest that I have no concern other than the royalties is a little absurd,” says Spitzer. “My annual royalties from DSM-IV related books are $10,000 per year,” notes Frances. “These have nothing to do with concerns I expressed.”
Attention has also turned to the financial interests of those working on DSM-V. The APA has ruled that members of the task force and work groups may not receive more than $10,000 per year from industry while working on DSM-V, and must keep their stock holdings below $50,000. This doesn’t satisfy Lisa Cosgrove of the University of Massachusetts, Boston, who studies financial conflicts in psychiatry (New Scientist, 29 April 2006, p 14). She notes that the APA’s ruling places no limit on industry research grants, and has found that the proportion of DSM-V panel members who have industry links is exactly the same as it was for DSM-IV, at 56 per cent (The New England Journal of Medicine, vol 360, p 2035).
The final version of DSM-V is scheduled to be published in 2012, but given the level of controversy and the need to test whether psychiatrists can reliably use the proposed diagnoses, that date seems certain to slip.
For now, there is an uneasy ceasefire, but next month the work groups will post their proposed changes on the APA’s website. Stand by for renewed hostilities.
December 13th, 2009
Several public accounts of abusive interrogations at Guantanamo have praised psychologist Dr. Michael Gelles for his opposition to these abuses. Similarly, the American Psychological Association (APA) has repeatedly pointed to actions of Dr. Gelles to instantiate their claim that psychologists played a crucial role in opposing abuses and protecting detainees. Gelles also has been a regular public presence, discussing the errors at Guantanamo while advocating for the APA’s “policy of participation” in interrogations. The APA policy encourages psychologists to aid interrogations to keep them “safe, legal, ethical, and effective.” But a recently released Defense Department document challenges Dr. Gelles’s role as an exemplar of psychological ethics in interrogations.
As reported by Bill Dedman, Phillipe Sands, and Jane Mayer, Gelles objected to the “harsh” interrogation tactics being used at Guantanamo. In particular, he strenuously objected to the plans to “reverse engineer” the tactics used by the military’s Survival, Evasion, Resistance, and Escape (SERE) program to inculcate strategies for resistance to torture in US service members at high risk for capture.
In November 2002, the military planned to use these SERE-based techniques on prisoner 063, Mohammed al Qahtani, one of several US captives dubbed the “20th hijacker.” Gelles and colleagues from the Criminal Investigative Task Force (CITF), the FBI, and other agencies proposed an alternative interrogation plan for al Qahtani, one that did not involve use of SERE techniques. This plan was rejected. Instead, al-Qahtani was subjected to an interrogation that met the legal definition of “torture,” according to Bush Administration appointee Susan Crawford, convener of the Guantanamo Military Commissions. [Phillipe Sands detailed the development of the al-Qahtani torture plan in his book, The Torture Team, an extract from which was published in Vanity Fair. Sands also describes the alternate CITF/FBI plan as written by "Gelles' team" (p. 130).] Gelles reported his concerns regarding use of SERE techniques and the al-Qahtani interrogation up the chain of command, leading Navy General Counsel Alberto Mora to protest and force at least temporary change in official interrogation policy in early 2003.
A few weeks ago, in response to an ACLU’s years-long Freedom of Information Act Request, the alternative interrogation plan for al-Qahtani was quietly released, apparently unnoticed between other documents on FBI and CITF concerns about Guantanamo practices. According to the alternative plan document, it was drafted:
“by representatives of the FBI’s Behavioral Analysis Unit (BAU), and behavioral specialists, psychiatrists and psychologists with the Criminal Investigation Task Force (ClTF).”
Given the prominent roles of mental health professionals in its drafting, the alternative “rapport-based” plan should be examined for consistency with Gelles’ and the other authors’ ethical responsibilities as psychologists and psychiatrists.
At the time the plan was written, on November 22, 2002, al-Qahtani had been in isolation for three months and was exhibiting signs of severe mental deterioration to the extent of psychosis. An FBI agent described this deterioration in a report to headquarters:
“In September or October of 2002 FBI agents observed that a canine was used in an aggressive manner to intimidate detainee __ after he had been subjected to intense isolation for over three months. During that time period, __ was totally isolated (with the exception of occasional interrogations) in a cell that was always flooded with light. By late November, the detainee was evidencing behavior consistent with extreme psychological trauma (talking to non-existent people, reporting hearing voices, crouching in the corner of a cell covered with a sheet for hours on end).”
Gelles and the other authors on the CITF/FBI interrogation plan also noticed his psychological distress:
“#63’s behavior has changed significantly during his three months of isolation. He spends much of his day covered by a sheet, either crouched in the corner of his cell or hunched on his knees on top of his bed. These behaviors appear to be unrelated to his praying activities. His cell has no exterior windows, and because it is continuously lit, he is prevented from orientating himself as to time of day. Recently, he was observed by a hidden video camera having conversations with non-existent people. During his last interview on 11/17/02, he reported hearing unusual sounds which he believes are evil spirits, including Satan.”
After discussing whether al-Qahtani was faking his symptoms, without coming to a conclusion, the interrogation plan proposed exploiting al-Qahtani’s distress from his prolonged isolation:
“Although we are uncertain as to his mental status and recommend a mental evaluation be conducted, there is little doubt that #63 is hungry for human interaction. Our plan is designed to exploit this need and to create an environment in which it [is] easier for #63 to please the interviewer with whom he has come to have complete trust and dependence thus developing a motivation to be forthright and cooperative in providing reliable information.”
In order to exploit this hunger for human contact, the CITF/FBI plan recommended that he be kept in continued isolation for up to an additional year:
“The long-term strategy would be to create an environment in which total dependence and trust between #63 and the interviewer is established at its own pace. Such a plan should be given up to a year to complete although the actual time may be considerably shorter depending on how events unfold.”
Al-Qahtani’s hunger for human contact would be exploited by making his interrogator the only person he saw over this year:
“To help foster an environment conducive to the establishment of dependence and trust, we propose that the interviewer initially meet with #63 every other day. This should be his only contact with other people, and we believe he will anxiously look forward to these meetings.”
It was recommended that al-Qahtani be periodically subjected to additional stresses so that his interrogator could become his savior:
“Built into this plan will be periodic stressors such as the stripping of certain items of comfort from him by guards, such as the removal of his mirror or the issuance of a sheet, half the size of the one he likes to drape around himself. These and other stressors will be carefully and subtly introduced not by the interrogator, but by guards. We believe that #63 will likely look to his only human contact, his interviewer, in an attempt to gain help. The interviewer status as a caregiver and problem-solver will thus be increased…. [D]emands by #63 for restoration of things taken from him should be honored slowly so as to create the impression that the interviewer can ultimately help him although not necessarily quickly or with ease.”
This plan for prolonged manipulation to develop al-Qahtani’s complete dependency might or might not be ethical as an interrogation strategy. However, former police investigator and veteran Army counterintelligence operative David DeBatto, who has supervised many hundreds of interrogations, disparaged the use of isolation in the CITF/FBI interrogation plan for al Qahtani (personal communication, November 28, 2009):
“That [the initial three-months isolation] is an excessively long time and on the face of it, violates the UCMJ [Uniform Code of Military Justice] and international law. Two major problems I have with this is first, solitary is a punishment reserved for the worst kind of behavior by inmates in a prison, not for refusing to answer questions. Second, it is the worst possible way to interrogate anyone and will almost always produce negative results.”
At a minimum, there is no question that the participation of psychologists and psychiatrists in the development of this interrogation plan led to the recommendation of strategies that would be likely to cause severe psychological distress and clearly violated psychological and psychiatric ethics.
Prolonged isolation frequently causes severe emotional distress, including psychotic symptoms identical to those appearing in al-Qahtani, such as hearing non-existent voices and talking to non-existent people. Physicians for Human Rights summed up the psychological and psychiatric evidence regarding the harmful effects of isolation or “solitary confinement” in their Leave No Marks report on the US use of psychological torture:
“Findings from clinical research performed by prominent psychologists such as Dr. Stuart Grassian and Dr. Craig Haney, highlight the destructive impact of solitary confinement. Effects include depression, anxiety, difficulties with concentration and memory, hypersensitivity to external stimuli, hallucinations and perceptual distortions, paranoia, suicidal thoughts and behavior, and problems with impulse control.
“According to Dr. Haney many of the negative effects of solitary confinement are analogous to the acute reactions suffered by torture and trauma victims, including posttraumatic stress disorder and the kind of psychiatric consequences that plague victims of what are called ‘deprivation and constraint’ torture techniques” (pp. 32-33).
The American Psychiatric Association, concerned about the conflicts inherent in such interrogation assistance, in 2006 explicitly condemned any direct involvement of their members in interrogations of specific detainees or prisoners, in domestic or national security settings. The Association stated in May 2006:
“No psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere. Direct participation includes being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees.”
Until the membership forced a change in APA policy in September 2008, psychologists were allowed to aid interrogations as long as they did not participate in torture or “cruel, inhuman, or degrading treatment or punishment” and followed the APA’s ethics code. Psychologists like Michael Gelles are subject to the APA ethics code, if they are members of the Association, as is Dr. Gelles. In addition, the military requires psychologists consulting to interrogations to be licensed by a state as health providers and most states require adherence to the APA ethics code as a requirement of licensure.
According to the APA, the prolonged use of isolation to aid interrogations, as was clearly the case with al-Qahtani, constitutes “cruel, inhuman, or degrading treatment.” In August 2007, the APA, under member pressure, banned psychologist participation in a number of interrogation techniques as constituting either “torture” or “cruel, inhuman or degrading treatment or punishment,” including
“the following used for the purposes of eliciting information in an interrogation process… isolation… used in a manner that represents significant pain or suffering or in a manner that a reasonable person would judge to cause lasting harm.”
After this resolution was passed, it came under withering criticism from dissident psychologists and the press. As a consequence, the APA’s Ethics Director was forced to issue a clarifying statement in response to reports of four weeks mandatory isolation for new detainees at Guantanamo:
“[T]he 2007 Resolution should never be interpreted as allowing isolation, sensory deprivation and over-stimulation, or sleep deprivation either alone or in combination to be used as interrogation techniques to break down a detainee in order to elicit information.”
In February 2008, in response to criticism, the APA amended its 2007 Resolution to unambiguously condemn psychologist involvement in the use of isolation. The revised resolution proclaimed:
“An absolute prohibition against the following techniques…: … isolation…. Psychologists are absolutely prohibited from knowingly planning, designing, participating in or assisting in the use of all condemned techniques at any time and may not enlist others to employ these techniques in order to circumvent this resolution’s prohibition.”
The CITF/FBI interrogation plan for al-Qahtani indicates that Gelles clearly engaged in a prohibited activity: “knowingly planning, designing… the use of … condemned techniques… and may not enlist others to employ these techniques….” Interestingly, when I raised concerns about the loophole regarding isolation in the 2007 Resolution at the APA convention the day after its passage, Gelles said to me “Steve, you have to understand that isolation is often used only very temporarily, only for a few hours” [quote from memory]. He did not mention its use for months at Guantanamo nor his team’s recommendation that it be used for up to a year on al-Qahtani.
Another ethical concern arises from the reported psychological distress that al-Qahtani was experiencing prior to the CITF/FBI interrogation plan being developed. The interrogation plan notes al-Qahtani’s psychotic symptoms, but, other than suggesting a mental evaluation, they simply view his vulnerability as an opportunity for exploitation. This ignoring of al-Qahtani’s mental distress violates the fundamental Principle A undergirding the entire APA ethics code:
“Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons…. When conflicts occur among psychologists’ obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm.”
There is simply no evidence that Gelles and the other authors of this plan sought to “avoid or minimize harm.” Rather, as the plan makes clear, their intention was to systematically increase and exploit distress and disorientation experienced by al-Qahtani, in violation of the ethics code.
The entire plan, with its emphasis on “exploit[ing]” al-Qahtani’s need for human contact violates the ethic’s code’s ban on exploitation:
“Psychologists do not exploit persons over whom they have supervisory, evaluative, or other authority such as clients/patients, students, supervisees, research participants, and employees.” [Ethics Standard 3.08]
Clearly Gelles and the other mental health professionals had, at a minimum, “evaluative authority” over al-Qahtani as they developed their plans to exploit his weaknesses.
Counterintelligence operative DeBatto also expressed concerns regarding the plan’s proposal to impose additional stressors on al-Qahtani in order to render him more dependent upon the interrogator. As expressed by DeBatto:
“Depriving him of sheets, a mirror and adding other `stressors’ is utter nonsense and counterproductive. He has already endured months of stressors. Forcing him to endure more as a form of a ’stick and carrot’ approach will produce nothing of value. It also violates the interrogators’ ethical training and is blatantly in violation of U.S. and international law.”
Gelles’ proposals in the al-Qahtani case must be deemed unethical and, if executed, would have constituted gross violations of the APA Ethics code, as the APA itself asserted in detailing unethical conduct in detainee treatment in its resolutions of 2007 and 2008. The APA’s parading Gelles as a “heroic” upholder of ethical standards for military interrogations must be revisited. Gelles now joins the ranks of other APA psychologists, including Morgan Banks, Larry James, and Bryce Lefever, whom the organization upheld as models for ethical military interrogation processes, but who subsequently appeared sympathetic to or may have aided abusive practices.
As psychologist Jeffrey Kaye pointed out last summer in two articles [see my commentary here] ethical concerns about Gelles’ pre-Guantanamo interrogation actions had already been raised with the APA long prior to APA’s lauding him as the standard-bearer for psychological ethics in interrogations. Attorney Jonathan Turley reported filing an APA ethics complaint against Gelles for abuses in the prolonged isolation and interrogation of Navy Chief Petty Officer Daniel King, following an ambiguous polygraph result. As described by Turley in testimony before the Senate Intelligence Committee, King requested a mental health consultation because he felt he was losing his grip on reality. Dr. Gelles met with King for a consultation and, according to Turley, ignored King’s reports of suicidal thoughts. Instead, Gelles made help for King contingent upon King’s confession to espionage charges he had denied. Turley, who represented King, reports that the APA did not respond to his ethics complaint against Gelles. To our knowledge, the APA has never commented publicly on Turley’s charges, or on the ethics of Gelles’ treatment of King.
In any case, it turns out that Gelles was well aware of the potential ethical conflicts involved in his work with the CITF. In a 2003 paper in the Journal of Threat Assessment, apparently written at about the same time, Gelles and colleague Patrick Ewing argued that psychiatrists and psychologists involved in national security work should not be subject to professional ethics codes:
“Given the grave dangers faced by the United States and its allies post September 11, the government can ill afford to lose the input of psychologists, psychiatrists and other mental health professionals in cases involving national safety and security. Such input has been and will continue to be vital to protecting the lives of many Americans, civilian and military, at home and abroad. In order to maintain the ability and willingness of these dedicated professionals to continue in these roles, we cannot continue to place them in situations where the ethics of their conduct will be judged, post hoc, either by rules that have little if any relevance to their vital governmental functions or by professional organizations or licensing authorities based upon the weight the members of these bodies chose to afford competing interests…” (p. 106).
In 2005, two years after this article appeared, Gelles, along with James, Banks, and Lefever, was appointed by the APA, to the seminal APA Presidential Task Force on Psychological Ethics and National Security (PENS). This military- and intelligence-dominated group gave the ethical go-ahead for psychologists to aid detainee interrogations at Guantanamo and elsewhere.
In an open letter in 2007, psychologist Uwe Jacobs posed a series of questions to Dr. Gelles including:
“[W]hat were the techniques used that you did not find objectionable? To cite a few examples, did you believe it was ethical to transport prisoners to Guantanamo under conditions of sensory deprivation, i.e. wearing hoods, goggles, earmuffs, and other devices designed to create sensory deprivation and isolation, along with very restrictive shackling? Did you believe it was ethical to keep prisoners in solitary confinement for very long periods of time? Is it ethical to deprive prisoners of sleep? Is it ethical to subject them to severe heat and cold, constant noises or lights, stress positions, short shackling, screaming abuse etc.? You know the list I am referring to. Do you agree that these techniques have long been proven to produce severe nervous system dysregulation and often lasting psychological damage? Do these techniques not by definition constitute torture, just as stated by the UN?”
Gelles refused to answer Jacobs’ questions. We can surmise, from his earlier statements, that Gelles simply did not believe that intelligence psychologists should “be judged, post hoc, either by [ethical] rules that have little if any relevance to their vital governmental functions….” The APA has yet to explain why it appointed to the PENS task force someone who had already expressed disdain for the APA ethics code and why it continues to extol Gelles as a paragon of psychological ethics in interrogations.
Note: I would like to thank Jeffrey Kaye for pointing me to the Ewing and Gelles paper.
December 7th, 2009
Psychologist Jeffrey Kaye asks:
Who Will Investigate CIA/RAND/APA Torture ‘Workshop’?
By Jeffrey Kaye
Back in May 2007, while researching the activities of the American Psychological Association (APA) in support of the U.S. government’s interrogation program, I came across evidence that the APA had engaged in a discussion of torture techniques during a workshop organized by APA and the RAND Corporation, “with generous funding from the Central Intelligence Agency (CIA).”
The workshop was held at the Arlington, Virginia, headquarters of the privately-held but long linked-to-the-government RAND think tank. APA Director of Science Geoff Mumford acted as liaison to the CIA for the meeting. Susan Brandon, a key APA “Senior Scientist”, and former member of the Bush White House’s Office of Science & Technology Policy, helped organize the affair, along with psychologist Kirk Hubbard, who was then Chief of the Research & Analysis Branch, Operational Assessment Division of the CIA.
The workshop was titled the “Science of Deception: Integration of Practice and Theory”, and it discussed new ways to utilize drugs and sensory bombardment techniques to break down interrogatees. Those are signal techniques of psychological torture long utilized by the CIA and other intelligence agencies and military around the world.
According to the brief APA account:
Meeting at RAND headquarters in Arlington, VA, the workshop drew together approximately 40 individuals including research psychologists, psychiatrists, neurologists who study various aspects of deception and representatives from the CIA, FBI and Department of Defense with interests in intelligence operations. In addition, representatives from the White House Office of Science and Technology Policy and the Science and Technology Directorate of the Department of Homeland Security were present…. Following brief introductions and welcoming remarks… workshop participants divided into break-out groups to discuss thematic scenarios….
It was one of the particular “break-out groups” that concerned me. According to APA’s Public Policy Office, which publishes an online newspaper called (with perhaps an unconscious taste for irony) “Spin,” the workshops covered Embassy “Walk-in” informants, Law Enforcement Threat Assessment, and Intelligence gathering (”What are the dimensions of truth?”). But the workshop on Law Enforcement Interrogation and Debriefing had some shocking language (emphasis added, quoted material from APA Government Relations: Science Policy website):
Law enforcement routinely question witnesses and suspects regarding criminal activity. How do you tell if the individual is telling the truth, lying, or something in between? Acts of omission and acts of commission are both important to identify.
How do we find out if the informant has knowledge of which s/he is not aware? How important are differential power and status between witness and officer?
What pharmacological agents are known to affect apparent truth-telling behavior?
What are mechanisms and processes of learning to lie? Can these be demonstrated within relatively short periods of time (e.g., within a polygraph test session)?….
What are sensory overloads on the maintenance of deceptive behaviors? How might we overload the system or overwhelm the senses and see how it affects deceptive behaviors?
According to writer, Katherine Eban, who wrote about the APA/RAND/CIA workshop in an August 2007 article at Vanity Fair, SERE-cum-CIA psychologists Bruce Jessen and James Mitchell were attendees at the workshop. Eban elaborated in a July 30, 2007 interview with Amy Goodman:
KATHERINE EBAN: …The attendance list is divided into two parts. One was really academic researchers, and the other one was operational, operational psychologists. So these were a lot of people who were associated with the CIA, some whose identity was so classified that they were only listed by first name in italics. Mitchell and Jessen were there on the list, listed as CIA contractors. And I think without that attendance list, I don’t know if we would have been able to put out this article.
AMY GOODMAN: The CIA funded this APA-RAND conference?
KATHERINE EBAN: Correct. And one of the main CIA participants and organizers, a man named Kirk Hubbard, told a key participant before the meeting, “Don’t ask these psychologists what they do for a living. Don’t ask them to identify themselves, because basically their identity is secret and classified.”
AMY GOODMAN: They debated the effectiveness of truth serum and other coercive techniques.
KATHERINE EBAN: Right. That’s correct.
“Secrecy is the freedom tyrants dream of”
So, one participant is told not to even reveal names of who attended this CIA/APA/RAND affair. At least one APA member has written to Geoff Mumford and Stephen Behnke (the latter is Director of the APA’s Ethics Office) asking for more information on the content of the meeting. To date, they have not bothered to respond.
The secrecy is not surprising, nor even relatively new. The APA and CIA have a very long history of working together on interrogation techniques, in particular on sensory deprivation and use of drugs like LSD and mescaline in interrogations, and other methods of breaking down the mind and the body of prisoners.
Use of drugs to influence interrogations, in addition to sensory deprivation, distortion and overload or bombardment were signal techniques in a decades-long interrogation research program that came to be known by its most famous moniker, MKULTRA (although these torture techniques were studied and tested by the CIA even earlier, in its 1950s projects Bluebird and Artichoke). Such techniques were codified by the early 1960s in a CIA Counterinsurgency Interrogation Manual, also known by its codename, KUBARK.
According to numerous researchers, the CIA, and the psychologists and psychiatrists they contracted to work with them, including many of the top behavioral scientists of their day, experimented with many drugs in their quest to find a “truth” drug that would open up the recalcitrant and expose the liar and the dissembler. The CIA has declassified a paper from its in-house intelligence journal from the early 1960s, “‘Truth’ Drugs in Interrogation,” where they discuss research on drugs for interrogation ranging from scopolamine, amphetamines, and barbiturates to cannabis, LSD, and mescaline. The CIA authors discuss the limitations of using drugs, based on research, and conclude that a special use for drugs may be found in detection of deception.
(A discussion of CIA research into truth drugs, use of LSD, and other topics is thoroughly discussed in H.P. Albarelli’s recently published book, A Terrible Mistake: The Murder of Frank Olson and the CIA’s Secret Cold War Experiments.)
But the quotes from the CIA/RAND/APA deception workshop are not from 40 years ago. They are from 2003. Evidently the research into using drugs on captured or arrested or incarcerated prisoners or “enemy combatants” has not ended.
In an article last June, I noted that the current Army Field Manual carries an allowance for use of drugs on certain prisoners which is less restrictive than even John Yoo allowed for in the Bybee memos. For months, the the Pentagon Inspector General has been investigating the use of drugs upon prisoners at Guantanamo and elsewhere, but we have not heard where that investigation is headed, nor when it will be concluded. An email request for more information was not returned.
It is infuriating that the planning and implementation of torture, such as that which took place under almost public purview–i.e., it was practically bragged about by the APA on its own website–does not lead to a full set of investigations. Psychologists within APA who attempted to bring the issue up were unable to get any answers.
On November 9, members of Psychologists for an Ethical APA jettisoned its attempts to (for the most part) reform the APA from within, stating on their website that they have “initiated a movement to coordinate a mass resignation from the American Psychological Association (APA) on the part of APA members who are concerned about APA’s actions and policies regarding psychologists’ participation in interrogations and detention in extra-legal War on Terror prisons, as well as about APA’s unresponsiveness to widespread member efforts to change these policies.” They set up a petition site to record member’s resignation statements, as well. Who can blame them, at this point? (For the record, I resigned from APA in January 2008, citing the APA/CIA/RAND workshop as one reason for leaving.)
Something very rotten is going on at the heart of American behavioral science, and I’m not talking about decades-old scandals — I’m talking about right now. Along with collaboration with the CIA and military on possible new abusive interrogation methods, the APA is fighting to keep its links with the military, and to keep psychologists as essential components of their interrogation practice. This is the program behind the Intelligence Science Board’s Educing Information (large PDF) report, which was accepted recently by the Obama administration as their new template for interrogation practice. In a future article, I’ll discuss how this report was set up by the CIA and military as a snow job to mask the use of pernicious interrogation methods that include techniques of psychological torture.
In the meantime, won’t someone with political clout open up an investigation of the CIA/RAND/APA meeting that plotted torture?
************
This report was originally published on FireDogLake.com.
Jeffrey Kaye, a psychologist living in Northern California and a regular contributor The Public Record, has been blogging at Daily Kos since May 2005, and maintains a personal blog, Invictus. E-mail Mr. Kaye at sfpsych at gmail dot com.
November 22nd, 2009