This copy is for your personal, non-commercial use only.
"A torturing nation uses fear, persuasion, and propaganda to secure the assent to torture from society in general and from members of its legal, academic, journalistic, and medical professions."
– Steven Miles, M.D.,
Oath Betrayed: Torture, Medical Complicity, and the War on Terror
Bahraini national al-Dossari has been imprisoned at Guantánamo Naval Base for over four-and-a-half years. Amnesty International has obtained his account of his treatment in United States care in Afghanistan and in Guantánamo Naval Base. Here is one excerpt:
"The investigators would also put psychological pressure on me. Some of the things that happened to me during investigations are: I was threatened with being murdered, tortured and having to spend the rest of my life in jail in Cuba, my daughter Nura would be kidnapped, they would make trouble for my family in Saudi Arabia and they threatened to assassinate me after I am released. They put very strong detergent in the investigation room and poured it all around me until I almost suffocated. They put a music stereo record on very, very loudly, they put very bright torches to my face, they put me in a very, very cold room and reduced the temperature to the lowest temperature for many long hours and did not allow me to have food or drink, go to the toilet or perform my ablutions to pray.
"There were many other things such as they tied my hands to my feet in the ring on the floor of the room. All the investigation rooms have a metal ring fixed in the floor to tie the detainees’ feet to it.
"As for sexual assaults, many things happened to me and I will mention some of them here. One day, on a Saturday I will tell you the reason for why I remember this date later the soldiers took me at night for investigation. In the investigation room, they tied my feet to that steel ring and then they left me and went away. I sat alone for a long time. Then the door was opened forcefully and four soldiers wearing black masks and a female investigator came in. The soldiers started terrorising me by raising their voices and one of them had a video camera in his hand that he was taping this with. Then this investigator said to me, ‘now we want you to confess that you are with Al Qaeda or that you have some connection to the attacks in America, otherwise tonight we will show you something that you will never ever forget for the rest of your life’, and of course, I will never forget what happened for as long as I live. I told her that I had no connection to what she was talking about. They also had extra shackles with them that the soldiers moved in their hands to terrorise and frighten me. They started threatening me and when I realised that something serious was going to happen to me, I started screaming and shouting so that perhaps one of the brothers would hear my screams. However, that was out of the question as all the investigation rooms were soundproof. She said to me, laughing, ‘it’s Saturday, it’s the weekend, it’s late at night and there are no officials around’. After one final attempt to threaten me, she ordered the soldiers to start what they had previously been ordered to do; the soldiers came and took me off the chair. My feet were tied to that ring as I mentioned before. They then laid me out on my back and put the extra shackles on top of my hand shackles and pulled me by them forcefully and brutally in the opposite direction, towards my feet, while I was lying on my back. Then the investigator signalled to a soldier who [had] a pair of scissors in his hand to cut off all my clothes (sic). The soldiers cut off all my clothes, removed them and threw them in a corner of the room. The investigator then started taking off her clothes the soldier with the camera was filming everything. When she was in her underwear, she stood on top of me. She took off her underpants, she was wearing a sanitary towel, and drops of her menstrual blood fell on me and then she assaulted me. I tried to fight her off but the soldiers held me down with the chains forcefully and ruthlessly so that they almost cut my hands. I spat at her on her face; she put her hand on her dirty menstrual blood that had fallen on my body and wiped it on my chest. This shameless woman was wearing a cross on a chain. The cross had a figure of a crucified man on it. She raised the cross and kissed it, and then she looked at me and said that this cross was a present for you Muslims. She stained her hands with her menstrual blood and wiped my face and beard with it. Then she got up, cleaned herself, put her clothes back on and left the roomthen the soldiers took my hands and tied them to my feet on the ground. All the soldiers left once they had taken my clothes from the corner of the room and left me in this state tied up, naked and smeared with  menstrual blood… [J]ust before dawn. I was in a hysterical state, I was in a really bad state; I almost went mad because of what had happened, how it had happened and why it had happened."
Al-Dossari’s account is far from unique. Treatment such as that described has been routine at Guantánamo and other United States detention centers in the Global War Against Terrorism.
A significant aspect of the treatment at Guantánamo constitutes what Physicians for Human Rights has called (in their report Break Them Down: Systematic Use of Psychological Torture by US Forces) "psychological torture." Included under this term are "techniques such as sensory deprivation, forced nudity, forced grooming, isolation, and use of detainees’ phobias, such as fear of dogs" (p. 25).
Integral to the interrogations at Guantánamo, and to the psychological torture that commonly occurred during them, has been the participation of members of the so-called "helping professions," including physicians, nurses, and psychologists. Perhaps most innovative is the existence of Behavioral Science Consultation Teams, or BSCT (pronounced "biscuits" in military jargon) consisting of psychologists and psychiatrists participating in interrogations and consulting on interrogation strategies for particular detainees.
A July 2004 New Yorker article by Jane Mayer presented circumstantial evidence that these BSCT staff received specialized training by psychologists from the military’s Survival, Evasion, Resistance, and Escape (SERE) program. This SERE program teaches military officers how to resist torture by subjecting them to a brief period of extreme psychological abuse. At the time of Mayer’s article, hard evidence that Guantánamo interrogators had been trained in SERE techniques was lacking, despite the fact that top SERE staff were kown to have consulted at Guantánamo. Recently Salon found direct evidence that SERE techniques were indeed taught to Guantánamo interrogators. The Salon article details some SERE techniques reportedly utilized at Guantánamo (and at Abu Ghraib): "forced nudity, stress positions, isolation, sleep deprivation, sexual humiliation and exhaustion from exercise." Also used were extremely loud music and prolonged cold. Physician and bioethicist Steven Miles has reported the participation of BSCT psychologist Maj. John Leso in the brutal and prolonged interrogation of Mohammed al-Qahtani. (See also the detailed interrogation log on al-Qahtani, referred to as Detainee 063.) During al-Qahtani’s interrogation he was subjected to extreme cold to the point where his heart slowed and he was hospitalized (he was then warmed up and again subjected to extreme cold), he was injected with several bags of saline solution while being strapped to a table until he urinated on himself, and he was forced to bark like a dog; we are not told what was done to him to get him to bark.
As the nature of the treatment of detainees at Guantánamo was revealed, this treatment was condemned as an illegal violation of human rights by numerous international organizations including the United Nations Commission on Human Rights, the United Nations Committee Against Torture, the European Union, the International Committee of the Red Cross, and Amnesty International.
Al-Dossari described the involvement of psychiatrists, other doctors, and nurses in his interrogation. As a result of repeated accounts like these, the American Psychiatric Association and the American Medical Association have barred the participation of psychiatrists and, indeed, all medical doctors in interrogations.
Unlike the medical and psychiatric associations, the American Psychological Association, as I documented in my recent article, A Profession Struggles to Save Its Soul: Psychologists, Guantánamo and Torture, has steadfastly refused to condemn (mis)use of psychological techniques to break detainees at Guantánamo or elsewhere and has consistently refused to forbid members to participate in interrogations at these facilities. In fact, the Association leadership has worked persistently to protect the ability of psychologists to participate in "national security" interrogations, even, at times, claiming an ethical obligation to do so to prevent harm to society, presumably from the "terrorists" imprisoned there for the last four-and-a-half years. (See also Olivia Moorehead-Slaughter’s report on the Presidential Task Force on Psychological Ethics and National Security (PENS) she chaired: "as experts in human behavior, psychologists contribute to effective interrogations.")
In recent months the opposition to Association policy from within has strengthened. However, these efforts have been limited in nature and opponents have, in every instance, been outmaneuvered by the Association leadership. In addition to the disturbing events reported in my previous article, more evidence on the smokescreen of manipulations, distortions and downright lies used by the Association raises additional questions as to what the Association leadership is up to.
Ethics Code Exempts Government and Military Employees: Endorsing the Nuremberg Defense
"Psychologists strive to benefit those with whom they work and take care to do no harm."
– American Psychological Association Ethical Principles of Psychologists and Code of Conduct
One questionable action concerns the Association ethics code that governs members’ professional behavior, which was changed in 2002 so as to exempt psychologists working for the government (including the military) from being bound by the Association code. Thus, the 1992 code had a somewhat ambiguous clause:
"1.02 Relationship of Ethics and Law.
"If psychologists’ ethical responsibilities conflict with law, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict in a responsible manner."
In 2002 this clause was changed to read:
"1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority
"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."
Note that the new wording explicitly exempts psychologists aiding torture or abuse under military or government orders from being charged with ethics violations as long as they can claim they took steps to resolve the conflict. By this change the Association in 2002 would have implicitly endorsed the defense of Lieutenant William Calley (convicted for ordering the My Lai massacre), Adolf Eichmann and other Nazi war criminals, and many others who claimed they were simply following orders, a defense that was rejected by the United States and the world through the Nuremberg and other war crimes trials.
In addition to directly incorporating the Nuremberg Defense into the ethics code, this change also has other harmful effects. By weakening the prohibition against acting in conflict with the ethics code, the Association significantly weakened the standing of any military psychologists desiring to refuse an immoral order or to refuse orders that violate international law. They could no longer call upon the ethics code as requiring refusal. While military personnel are allowed to refuse illegal or immoral orders, they do so at profound risk to themselves. In the case of military psychologists contemplating refusal of orders, the Association has increased this risk tremendously.
This change in the Association’s ethics code has the effect of making other Association statements on allowable psychologist behavior largely irrelevant. Thus, statements forbidding psychologists from participating in torture or other abusive behavior have no standing if the psychologists are ordered to participate by a "governing legal authority," e.g., a commanding officer.
As long as Section 1.02 remains in the Association ethics code, efforts to get the Association to adopt statements on torture, coercive interrogations and the like (see next section) are essentially exercises in futility as these statements would not be binding on psychologist members working for the military or other government agencies (e.g., the CIA). Association critics working for such changes should realize that they have been wasting their time for the last several years pursuing what would have been ineffective changes in the ethics code. Some critics have recognized the problem and have tried for years, unsuccessfully, to get Section 1.02 amended to require adherence to international human rights standards when following laws or government orders.
Given the long history of discussion of the "following orders" defense, there is no possibility that the Association "ethics" leadership did not know exactly what they were doing. The only question is why they felt the need to build the Nuremberg Defense directly into the ethics code. Were there particular ethics violations they were aware of and were trying to protect, or did they have a more general goal of allowing free reign to psychologists enlisted in the then-beginning "Global War on Terror?" It is interesting that this revision occurred just as the first information was coming out about the torture occurring at Guantánamo and in Afghanistan and prior to the public awareness that psychologists were an intimate part of the interrogation apparatus there.
Revising Anti-torture Statement to Reduce Influence of International Law
"Every torturing government tries to apply a patina of law to these crimes. Any government can find lawyers or legislators to renounce, suspend, or define away the world’s settled opinion opposing torture, expressed in documents like the Geneva Conventions." -
- Steven Miles, M.D., Oath Betrayed: Torture, Medical Complicity, and the War on Terror
At the APA Convention this August, the Association’s Peace Psychology Division introduced a resolution to reaffirm long-standing APA opposition to torture. At the same time, this Division and the Association’s Divisions for Social Justice (a coalition of 10 divisions supporting social justice initiatives) declined to put forward a resolution banning psychologists’ participation in coercive interrogations, at least partially out of concern that such a resolution would be defeated. Between the final draft version of the anti-torture resolution prepared by proponents and the version that was actually adopted and published, crucial wording defining proscribed behavior was changed in a subtle, but profound way.
The original Final Draft clearly defined torture and abuse using the United Nations Declaration and Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. It contained the following language:
"[T]he term ‘torture’ means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted upon a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official [e.g., governmental, religious, political, organizational] capacity. It does not include pain or suffering arising only from, inherent in, or incidental to lawful sanctions [in accordance with both domestic and international law]."
The inclusion of this statement would seem to be a clear and unambiguous acceptance by the Association of international law and understandings as to what constitutes torture.
However, in the published version the following paragraph defining "cruel, inhuman, or degrading treatment of punishment" was added:
"BE IT RESOLVED, that the term ‘cruel, inhuman, or degrading treatment or punishment’ means treatment or punishment by any psychologist that is of a kind that, in accordance with the McCain Amendment, would be prohibited by the Fifth, Eighth, and Fourteenth Amendments to the Constitution of the United States, as defined in the United States Reservations, Declarations and Understandings to the United Nations Convention Against Torture and Other Forms of Cruel, Inhuman or Degrading Treatment or Punishment done at New York, December 10, 1984."
This all sounds relatively benign. But the phrase "United States Reservations" should raise one’s interest. Just what are these Reservations and what are they doing in the Association’s resolution? It turns out that, when the United States ratified this UN Convention, the U.S. government took steps to significantly reduce or even eliminate its potential impact. (Several countries, namely Sweden, the Netherlands, and Finland took exception to the U.S. Reservations at the time.) As I, a non-lawyer, read these Reservations, there are two potentially relevant clauses (Daily Kos diarist Valtin provides a somewhat different discussion of the impact of the second of these clauses but seems to have missed the first). The first of these clauses states:
"That the United States considers itself bound by the obligation under article 16 to prevent ‘cruel, inhuman or degrading treatment or punishment’, only insofar as the term ‘cruel, inhuman or degrading treatment or punishment’ means the cruel, unusual and inhumane treatment or punishment prohibited by the Fifth, Eighth, and/or Fourteenth Amendments to the Constitution of the United States."
That is, for behavior not rising to the level of "torture," U.S. ratification of this Convention did not make anything illegal that was not already illegal according to U.S. law. No international understandings will be binding. Interpretations of "cruel, inhuman, or degrading treatment of punishment" by other countries, by the United Nations, or by other international organizations and institutions are irrelevant. By this means, also, the U.S. made its obligations under the Convention subject to the vagaries of U.S. law in this area. If U.S. courts interpret U.S. law as constitutionally allowing a certain type of behavior, that behavior would then by definition not be banned by U.S. adherence to the Convention. As long as that behavior was not quite "torture," it wouldn’t matter if it was proscribed by every other country on earth. Unfortunately, it is not at all clear that the "psychological torture" techniques used by U.S. interrogators are violations of the U.S. Constitution.
As John Shifton argued in a recent article in Slate (Criminal, Immunize Thyself: The Bush administration’s get out of jail card for torturers; see also Marty Lederman: The CIA Cruelty Authorization Act of 2006), the Bush administration is currently pushing to amend the U.S. War Crimes Act to legalize all abusive behavior that fails to meet the legal definition of torture. The added paragraph in the Association resolution will thus pass any new immunity down to psychologists engaged in interrogations. As U.S. law changes with regard to "cruel, inhuman, or degrading treatment," so potentially will the ethical obligations of psychologists.
The second potentially relevant clause in the U.S. Reservations is concerned with limiting the definition of the most severe behaviors, those that are clearly proscribed by U.S. ratification of the UN Convention:
"That with reference to article 1, the United States understands that, in order to constitute torture, an act must be specifically intended to inflict severe physical or mental pain or suffering and that mental pain or suffering refers to prolonged mental harm caused by or resulting from (1) the intentional infliction or threatened infliction of severe physical pain or suffering; (2) the administration or application, or threatened administration or application, of mind altering substances or other procedures calculated to disrupt profoundly the senses or the personality; (3) the threat of imminent death; or (4) the threat that another person will imminently be subjected to death, severe physical pain or suffering, or the administration or application of mind altering substances or other procedures calculated to disrupt profoundly the senses or personality." (Emphases added)
Interestingly for psychologists, this, the longest clause in the U.S. Reservations, is explicitly designed to circumscribe the definition of torture so as to exclude most psychological torture. With the exception of attempts to create a "profound" disruption of "senses or the personality" or of threats to self or others of death or severe physical pain, the prolonged mental harm has to arise from the infliction of "severe physical pain or suffering." Further, the requirement of "prolonged mental harm" allows for great interpretive creativity. If a person recovers in a year, or in five years, was the harm "prolonged?" Is it OK to subject resilient individuals to more severe treatment? Further, as psychologists should know well, proving that a given behavior was the cause of a given negative psychological outcome can prove difficult, if not impossible?
The clever phrasing of this Reservation makes sure that the types of psychological torture that have historically been employed by the CIA and have been utilized by the American military in Guantánamo, Abu Ghraib, and elsewhere are not considered to be torture. (Alfred McCoy has detailed the critical role of psychologists in developing these techniques.) Thus, much of the treatment al-Dossari describes receiving or that described in the interrogation log for al-Qahtani would likely not be considered torture under this definition. In fact, it appears that, according to the US reservations, Saddam Hussein’s technique of having a man’s daughter raped in front of him would not constitute torture as long as the daughter didn’t suffer severe physical pain.
If one reads the Association resolution very literally, it appears that this second Reservation may not apply to the resolution, as the document only includes the phrase "U.S. Reservations" in the section defining "cruel, inhuman, or degrading treatment or punishment." Thus, a lawyer might reasonably argue that these Reservations may not apply to the definition of torture and thus the exclusion of many forms of psychological torture may not apply. However, this interpretation is not certain. As Nat Hentoff points out, the recent McCain Amendment supposedly banning torture and cruel, inhuman, or degrading treatment provides that the standard applicable to accused interrogators is that a "person of ordinary sense and understanding would not know the practices were unlawful." Any aspects of the new resolution which muddy its interpretation increase the chances of such a successful defense. At a minimum, it is extremely disturbing that the Association would include in its resolution any reference to the U.S. Reservations, a document which attempts to protect the right to use psychological torture.
The Association’s Press Release, entitled "American Psychological Association Reaffirms Unequivocal Position Against Torture and Abuse" states:
"The Council of Representatives of the American Psychological Association (APA) has approved a resolution reaffirming the organization’s absolute opposition to all forms of torture and abuse, regardless of the circumstance. The resolution furthermore affirmed United Nations human rights documents and conventions as the basis for APA policy."
Unfortunately, as we have seen, this new Resolution is anything but an unequivocal position against torture and abuse. Further, "United Nations human rights documents," except in the most literal sense, were decidedly not the basis of the resolution’s policy toward "cruel, inhuman, or degrading treatment." Not surprisingly, the Association’s Military Psychology Division, which had reportedly succeeded in defeating a related resolution the previous year supported this one. Further, the Association’s leadership, which has steadfastly acted to protect psychologists’ participation in national security interrogations, threw no roadblocks in the path to passage of this resolution. Presumably they realized that the new resolution was, at best, an abstract and very equivocal public relations effort with little or no actual impact on interrogations.
Steven Reisner, an activist against involvement of psychologists in coercive national security interrogations who addressed the Association Council meeting on the issue, was mortified when he became aware of the addition of the U.S. Reservations to the resolution. He asserts that he and others at the Association Council meeting became aware of the absence of a definition of "cruel, inhuman, or degrading treatment" and that he, in consultation with others, drafted a "friendly amendment" tying the definition of these behaviors to the May 2006 report of the United Nations Committee Against Torture. When he tried to describe it to the Council, he was cut off by Association President Gerald Koocher, allegedly because he was not a Council member, even though he had earlier, by invitation, addressed the Council on the interrogation issue. Dr. Reisner then sought a Council member to introduce the amendment, but was turned down by three members.
As Dr. Reisner relates in an email, there was then a short break, "during which time a small group changed some minor wording based on the Council debate, which had focused on the words ‘knowingly’ and ‘punishment.’ During the break, the resolution was revised, a new version was typed up and printed, and placed on a table for people who wanted to read [it]. No one raised the idea of more specific definitions of CID ["cruel, inhuman, or degrading treatment"] and I thought the point was lost. The Council members reconvened, were told about additions of one ‘knowingly’ and two ‘or punishment’s. A vote was called and the resolution passed unanimously." Only later did Reisner discover to his horror that, apparently during that break, the resolution was revised by the addition of the U.S. Reservations, thus severely weakening it. A number of others involved in anti-torture efforts were similarly horrified.
Others associated with the development of the resolution from the leadership of the Association’s Peace Division have asserted that the reference to the U.S. Reservations was included because the Reservations contain the only definition of "cruel, inhuman or degrading treatment or punishment" in international law. It appears that this absence may be intentional as some in the human rights community feel that there should not be an explicit definition of these behaviors. The Peace Division leadership has not explained how references to the American Constitution, which has been subject to over two hundred years of complex and ever changing interpretation provides any kind of clear definition for the resolution. They also have not explained why, if they valued clarity so much, they did not include a clear list of proscribed behaviors in the resolution.
Both the Association President, Gerald Koocher, and its Ethics Director, Stephen Behnke, have denied, in emails to me, having any knowledge of these revisions or any view as to their interpretation. Both declined to respond, claiming lack of knowledge, to explicit questions as to which of the clauses in the United States Reservations were relevant to interpreting the Association resolution. Both also denied any intent to weaken the prohibition against torture.
If they and other Association leaders are indeed correct that the inclusion of the U.S. Reservations does not weaken the Resolution and that the Association stands "unequivocally" against torture and abusive interrogation, they can demonstrate this by swiftly adopting new ethics code statements that specify exactly which interrogation techniques (e.g. waterboarding, sleep deprivation, loud music, heat and cold, exploitation of phobias, forced nudity, sexual abuse, etc.) are actually proscribed. If it was critical to include a definition of "cruel, inhuman or degrading treatment or punishment" in the resolution, then surely it is even more important to clearly state what is proscribed. If Association leaders refuse to issue such a list we should presume that the new resolution was just a public relations gambit and the U.S. Reservations were included to weaken, not to strengthen it.
While the Association Council overwhelmingly adopted the equivocal anti-torture resolution that makes no mention, in its text or in its Justification Statement, of the reports of psychologist participation in torture at Guantánamo and elsewhere, only a few members of the Association Council were willing to stand up and propose a moratorium on psychologists’ participation in national security interrogations. Without a bending of the rules, any such proposal now will require at least another year to be considered by the Association Council. At that point it will have been almost five years since psychologist Maj. Leso took part in the torture of Mohammed al-Qahtani, Detainee 063. The unwillingness of the Association leadership to unambiguously cut the ties to the torturers runs deep.
Distorting the Position of Other Organizations
"Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology."
– American Psychological Association Ethical Principles of Psychologists and Code of Conduct
As the criticism of the Association has mounted, its leadership has engaged in a concerted public relations effort. Allowing the passage at their recent Convention of the abstract and seriously weakened anti-torture resolution that made no mention of the claims of psychologist participation in abuses was one part of this effort. Another was the repeated claim that the Association’s position did not substantively differ from that of the American Medical Association. This claim was asserted by Association President Gerald Koocher in a June 16, 2006 debate on Democracy Now! But its most full statement came in the form of an extended comparison of the position of the Association with those of the American Medical and Psychiatric Associations (Ethics and interrogations: Comparing and contrasting the American Psychological, American Medical and American Psychiatric Association positions) by Stephen Behnke, Director of the Association’s Ethics Office.
The AMA policy statement adopted at their June 2006 meeting states unequivocally:
"Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession."
It further states that:
"physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation."
It does allow that:
"physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals."
In the face of this text sounding strikingly different than anything coming from the American Psychological Association , Behnke states:
"the AMA report states that physicians may consult to interrogations by developing interrogation strategies that do ‘not threaten or cause physical injury or mental suffering’ and that are ‘humane and respect the rights of individuals.’ Substitute ‘psychologist’ for ‘physician,’ and the relevant passages in the AMA report could be inserted into the PENS report with no change in APA’s position whatsoever-that ‘It is consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national-security related purposes’ when acting in accordance with strict conditions. While one recommendation in the AMA report places physician consultation in a training context, numerous statements in the body of the report and in the report’s ‘Conclusion’ convey a scope of involvement that extends well beyond training. As one example, the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation, i.e., information-eliciting process. The AMA report must be carefully read in its entirety to understand and appreciate the breadth of its position on the appropriate role for physicians in interrogations."
Thus, Behnke claims that the AMA policy recommendations do not mean what they appear to mean, or what they actually say. In both written and verbal statements, AMA officials claim otherwise. On August 22, the President of the AMA wrote a letter to the Executive Director of Physicians for Human Rights reiterating these differences. The letter states:
"I certainly believe that the recommendations pertaining to the ethical role of physicians are unambiguous. In developing its recommendations, I know that the members of CEJA [the AMA's Council on Ethical and Judicial Affairs] deliberated the meaning of every word; I also know that the AMA Code of Medical Ethics does not use the words ‘must not’ lightly. The guidelines, therefore, leave no room for confusion. The AMA has adopted a strict prohibition on physician participation in the interrogation of an individual, and only permits that medical knowledge be used to develop strategies that can be presented in the context of general training. This was clearly reiterated in the statement the AMA released on June 12, 2006.
"The AMA is aware of the article published in the July/August issue of the Monitor on Psychology. We have found that the commentary analyzing the AMA and the American Psychological Association positions did not accurately represent our ethical guidelines. By arguing that the two positions are similar and by failing to point out critical differences, we believe the readers of the Monitor could be induced in serious error regarding the ethically acceptable role for physicians. For this reason, the chair of CEJA, Dr. Robert Sade, has submitted a letter to the editor of the Monitor to refute the proposition that the policies are similar. In his words: ‘AMA and APA policy differ substantially in ethical acceptability of supporting interrogation.’"
In the letter by Sade referred to, he explicitly takes issue with Behnke’s quote from the AMA which Behnke claims allows physician participation in interrogations:
"Behnke misrepresents the substance of the AMA guidelines when he says: ‘…the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation.’ He has taken this statement out of its context in a discussion of potential roles of physicians, and has failed to observe that it is negated by the guidelines themselves."
Sade goes on to state:
"To clarify the crux of AMA’s new ethical policy: Physicians must not conduct, monitor with an intent to intervene, or directly participate in any way in an interrogation, because each of these actions undermines the physician’s role as healer. Because it is often justifiable for physicians to serve the public interest, AMA’s policy permits physicians to develop general interrogation strategies that are not coercive, but are humane and respect the rights of individuals. In contrast, APA prohibits psychologists from participating in cruel, inhuman or degrading treatment but accepts that they can ‘serve in the role of supporting an interrogation’ and as a consultant. Thus, AMA and APA policy differ substantially in ethical acceptability of supporting interrogation."
(To be fair, it should be noted that Behnke, in his original article as well as in his response to Sade’s letter, refers to the "body of the [AMA] report" and insists that this report must be read in its entirety. I have so far not been able to get access to the text of this full report. AMA officials state that the report is being prepared for publication in a medical journal. Most such journals have a strict policy against publishing papers that have already been reported in the popular press. Thus, they refuse to release the report prior to publication (a position I find understandable yet troubling in matters with significant public policy import).
I was told by the AMA officials, however, that the report has no official standing with the AMA. Only the Recommendations were adopted by vote, the report was not voted on but simply "filed." These officials stated that the Recommendations stand on their own. Only with the publication of this full report can we be certain, but, at this point, it certainly looks like the claim that the Association’s and AMA’s policies are virtually identical is yet another smokescreen thrown up to obscure the Association’s long-standing practice of protecting psychologists’ participating in the abuses at Guantánamo and elsewhere.
A detailed article in Psychiatric News, a publication of the American Psychiatric Association (note for non-mental health professionals: psychiatrists are medical doctors specializing in mental health treatment, psychologists are not medical doctors), also tends to refute Behnke’s interpretation of AMA policy and supports the interpretation that the AMA policy means what it appear to say: no participation in interrogations. For example, the article quotes Steven Sharfstein, the Psychiatric Association’s immediate past President, as saying "I really think this is a very strong statement that closely corresponds to and reinforces the APA [American Psychiatric Association] position that physicians, including psychiatrists, should not be participating in any way in the interrogation of individual detainees." (emphasis added) This article also indicates that the wording of the AMA statement was changed the day before approval to strengthen the prohibition against physician participation:
"In a letter dated June 8, Appelbaum [chair of the Psychiatric Association's Council on Psychiatry and Law] wrote on behalf of APA to members of CEJA to address concerns about the wording of the passage as it stood at the time, just one day prior to the opening of the AMA meeting. It read: ‘Physicians may participate in developing effective interrogation strategies that are not coercive but are humane and respect the rights of individuals.’
"’This language appeared to allow physicians to consult on the planning of interrogations of particular detainees,’ Appelbaum told Psychiatric News. ‘In contrast, APA’s statement explicitly rules out advising authorities on the use of specific techniques of interrogation with particular detainees.’
"The final wording in the CEJA report was changed to emphasize that the development of strategies be for ‘general training purposes.’"
The pattern of behaviors going back at least to 2002 documented here and in my previous article by the American Psychological Association leadership supportive of psychologist involvement in national security interrogations strongly suggests that sections of the leadership are working, probably intentionally, to avoid the development of any position, guideline, or ethics code statement that would unambiguously forbid members from engaging in national security interrogation, even though these interrogations frequently involve the kinds of psychological torture documented as occurring at Guantánamo and elsewhere by Physicians for Human Rights and condemned by numerous United States and international organizations. This effort appears to have begun before the issue became controversial among the membership or the public. Thus, the 2002 ethics code revision was pushed through before the controversy regarding health professionals’ roles in interrogation became a major issue, resulting in pressure for Association change. (For early works on these issues, see 2004’s New York Times article by Neil Lewis: Red Cross Finds Detainee Abuse in Guantánamo; 2005’s Bloche & Marks: Doctors and Interrogators at Guantánamo Bay; and Susan Okie: Glimpses of Guantánamo – Medical Ethics and the War on Terror).
Let’s put together in one place what is known about Association protection of psychologist participation in torture and inhumane treatment:
* 2002 Ethics code changed to allow government laws or orders to supersede psychological ethics
* 2005 PENS task force formed with membership and deliberations kept secret. Turns out membership includes a majority of members from the military, including several involved in interrogations and with histories of consulting on interrogations at Guantánamo, Abu Ghraib, and Bagram Air Base.
* 2005, June PENS Task Force issues final report concluding "It is consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national security-related purposes." Also concludes that no changes are necessary to ethics code. Fails to even mention accusations of psychologist participation in torture at Guantánamo. In a highly unusual procedure, the report was immediately adopted by the Association’s Board of Directors without the usual discussion and approval by the broader-based Council of Representatives.
* 2005, October Association President Levant travels to Guantánamo. Praises contributions of psychology to national security investigations. Neglects to mention persistent reports of torture and abuse during these interrogations.
* 2006, February Incoming Association President Koocher devotes monthly President’s Column in Association newsmagazine to defending Association against critics. Without a shred of evidence nastily attacks critics: "A number of opportunistic commentators masquerading as scholars have continued to report on alleged abuses by mental health professionals."
* 2006, June Association Ethics Director writes article claiming there is little difference between the position of the Association and the AMA. In August, AMA President denies similarity.
* 2006, August Association anti-torture resolution gets surreptitiously modified, substantially weakening its meaning.
There is thus a long history of bad faith and active efforts to resist calls for the Association to take a clear, unequivocal stand against psychologists’ participation in coercive national security interrogations, to respond in any way to persistent reports of torture and abuse during those interrogations, or to strongly condemn psychological torture. The only reasonable conclusion is that the Association leadership is committed to doing everything they can to protect psychologists’ involvement in torture under the guise of national security interrogations. They are thus in the role of enablers of that torture.
Association critics have largely addressed this issue as one of professional ethics. They have been very polite, forming committees, writing letters, introducing motions, and asking for case examples to be added to the ethics code. At every step these polite critics have been stymied, manipulated, and out-maneuvered.
It is time for Association critics to accept that the issue is larger than one of ethics statements. Yes, the Nuremberg Defense needs to be excised from the ethics code and involvement in national security interrogations needs to be unambiguously banned. But reform needs to go far deeper. There is something truly rotten in the Association. The organization has had a long-standing symbiotic relationship with the American "defense" establishment which has led it to go all out to support the participation of psychologists in national security interrogations, and to avoid any Association investigation into reports of psychological torture. Its leadership apparently has acted in bad faith in their efforts to protect the torturers.
The leadership’s actions have undermined the faith of many Association members in the entire Association. After my first article appeared, many members wrote asking if it was time to resign membership in such an organization. I suggested that they wait, in hopes that the Association could be changed from within. The August Convention with the Association Council not interested in even discussing ending psychologist participation in abusive interrogations and the experience of an anti-torture resolution being surreptitiously substantially weakened raises questions for me as to whether reform is possible. It remains for the Association’s members to decide what kind of organization we are going to allow to represent us.
At this point, mere resolutions or even a change in the ethics code are not enough to save the Association. Nothing less than a leadership change in conjunction with an independent investigation of the entire involvement of the Association with the national security state and its torture apparatus can possibly excise the rot. We have learned from South Africa and Latin America the importance of public testimony and the pursuit of truth to the ability to successfully move on. As psychologists we know all too well that mental health cannot be built on a foundation of either lies or denial.
Al-Dossari’s Torment Continues
Let’s return to al-Dossari’s treatment
"Nurse ‘Irish’ and some people and soldiers from the psychiatric clinic were waiting for me at the camp so that they could keep me under special guard. After that and before they removed my shackles, a soldier with scissors came forward and cut off my shirt and left me naked in the metal cell under the cold air conditioner without clothes, a pillow, a blanket, shorts, a small plastic mat [or] even plastic bathroom slippers. The doctor issued an order to prevent me having these things. This happened in mid January 2004.
"The metallic cell was very cold as I have already mentioned and the air conditioner was on directly above the metal bed. The light in the cell was very poor. The cell was very small: if I got off the metal bed, the toilet was just underneath me so I slept next to the toilet to avoid the chill from the air conditioning. However, I was happy when I found that there were some other detainees in the camp. They welcomed me dearly and they helped me. Were it not for Allah, the Exalted, and them, I would have killed myself in that situation.
"The doctor did not allow me to have any toilet tissue or water (as they had blocked the washbasin), except for a glass of drinking water if I asked for it. For more than two weeks, I used the toilet without toilet tissue or water. I would clean myself with water from the flush. After that, they allowed me to have very little toilet tissue, which was not enough at all. The soldiers from Camp Delta [the Guantánamo prison camp] who came especially for me harmed me a lot and followed a set programme of harming me. They would harass me and they would harm my food: they would put the plate of food besides their shoes and sometimes I had to take pieces of rubbish out of the food. I later found out that they spat in the water they gave me in the cup so I started to drink and make my ablutions from the flush water. As I mentioned before, the toilets in Camp Delta were metallic Turkish toilets, so I would pull the chain and put my hands next to the toilet and cup the water in my hands and drink from it and perform my ablutions. I had no other choice. I did this for more than three months and when I told the doctor that a soldier had spat in my water and that a number of soldiers had seen this and he had done this in front of the psychiatric nurse, he said, ‘what do you want me to do about it?’ He knew about everything that had happened and these orders came from him, as I was later told by a soldier (who felt sorry for me). This doctor who had violated my rights was responsible for the washbasin being welded shut because when I was in the hospital, I had asked to take a bath. He even prevented me from performing the compulsory ghusl (full ablutions). I told him, ‘when I was in the camps, I used to bath everyday’. That was why he ordered the washbasin in my cell to be turned off."
In October 2005, Mr. al-Dossari was found by his attorney hanging by his neck in an apparent suicide attempt. Though other Guantánamo detainees succeeded in their suicide attempts, this time al-Dossari was revived in time. Al-Dossari had left a suicide note for his attorney. In it he states:
"I hope you will always remember you met and sat with a ‘human being’ called ‘Jumah’ who suffered too much and was abused in his belief, self, dignity, and also in his humanity. He was imprisoned, tortured, and deprived from his homeland, his family and his young daughter who is in the most need of him for four years with no reason or crime committed. Remember that there are hundreds of detainees in Guantánamo Bay, Cuba they are in the same situation of suffering and misfortune. They were captured, tortured and detained with no offense or reason. Their lives might end like mine When you remember me in my last gasps of life before dying, while my soul is leaving my body to rise to its creator, remember that the world let us and our case down."
The American Psychological Association still believes it is appropriate for psychologists to participate in interrogations at the institution where, less than a year ago, Mr. al-Dossari was tortured till he lost the will to live. Mr. al-Dossari made at least one more suicide attempt in 2006, his 12th. Does this constitute enough evidence of "prolonged mental harm" to move psychologists? Those psychologists and citizens of goodwill who don’t believe in torture as public policy should cry out with one voice at such indifference to human barbarity. If we fail to act we cannot claim, as did so many Germans, "We didn’t know!"
STEPHEN SOLDZ, a researcher and psychoanalyst, is Director of the Center for Research, Evaluation, and Program Development at the Boston Graduate School of Psychoanalysis. He is a member of Roslindale Neighbors for Peace and Justice and founder of Psychoanalysts for Peace and Justice. He maintains the Iraq Occupation and Resistance Report web page. He can be reached at: firstname.lastname@example.org.