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Weaponizing Psychology

With the publication of the James Risen’s book “Pay Any Price: Greed, Power and Endless War”and the release of the Senate Torture report, it has become abundantly clear that the American Psychological Association colluded with the CIA and DOD in enabling torture. A large number of military psychologists as well as private vendor psychologists participated in torture.  The American Psychological Association provided ethical cover for the psychologists as well as for the Bush administration. A small number of the top leadership of the APA, including presidents Koocher and Levant, successfully pushed through guidelines designed to enable psychologists to participate in “torture by another name”despite the fact that the membership disapproved of them. APA actions included:  holding secret meetings with the DOD and CIA in order to craft guidelines that would enable torture; lying to its membership and the public repeatedly about salient facts; undemocratically promulgating guidelines without allowing the council of representatives review or to vote on the guidelines; resisting calls by the broad membership to rescind the torture policies; demeaning and bullying whistleblowers who objected that the task force set up to review Bush interrogation policies was corrupt and stacked with military psychologists who had participated in torture; denying that psychologists participated in torture when they knew otherwise; and refusing to take action against psychologists who participated in torture. (1)

Why did the American Psychological Association take this unethical course when every other healthcare discipline, including the American Medical Association, the American Nursing Association, and the American Psychiatric Association, did the very opposite and in no uncertain terms absolutely forbade their members from participating in torture?

To understand how this happened, we need to consider the economically distressed position of the field of psychology in the early 2000s.  While this is not an excuse for what happened, it explains why some in the APA leadership were responsive to anything that might relieve this distress.

By the early 2000s, clinical psychology which represents the largest percentage of APA members, was in serious trouble. Psychologists incomes had been falling precipitously for years.  Between 1990 and 2010 reimbursements from commercial insurance—the largest share of many psychologists income– had fallen 33% in absolute terms and 59% in inflation-adjusted terms. (2)

The precipitous collapse in psychologists incomes was due to a number of factors. First, was the increase in the number of providers offering psychotherapeutic services.  In the 1960’s psychologists were the first non-medical profession to win the right to insurance reimbursement for psychotherapy.  By 1980, other disciplines, including social work, and mental health counselors had become mandated providers. Thus, there was a large increase in the number of clinicians in the market. And most of these clinicians held a master’s degree and would work for lower fees.

A second factor was the arrival of fluoxetine– prozac– to the market in 1987. Prozac became spectacularly successful.  It worked on the most common psychiatric problem, depression, without causing unpleasant side effects and it was easy to use and prescribe. Soon regular GPs were prescribing prozac in record numbers while psychiatrists retooled their practices to focus on higher paying medication management over lower paying psychotherapy.

Within a matter of a few years mental health practice was reinvented in America. Between 1998 and 2007 the proportion of patients in outpatient mental health facilities receiving psychotherapy alone fell by one third  from 15.9 percent to 10.5 percent, while the number of patient receiving medication alone increased from 44.1% to 57.4%. (3) Not only were fewer patients going for psychotherapy, but the average number of sessions of care had dropped. This was due in no small measure to the baleful impact of managed care.

Declining demand for psychotherapy, new treatment choices, and increasing numbers of psychotherapists, many of whom would take lower fees, were the perfect storm that put the field of clinical psychology under siege in the years before and during the the arrival of the so called global war on terror.

Aware of these developments, specifically the erosion of income and the loss of status of psychologists, the APA made concerted efforts to reverse these trends. On the political front, it worked with the psychologist, Pat Deleon, Ph.D., who would become APA president in 2000. DeLeon was a top assistant to Daniel Inouye who was the chairman of the Senate Defense Appropriations subcommittee which oversaw the largest chunk of federal discretionary spending. For nearly 25 years DeLeon was the APAs man on capital hill and effectively lobbied on behalf of the APA for increased funding for research, training and employment (mainly the VA) for psychologists.

On the intellectual front the APA, by the early 2000s, had begun supporting the evidenced based practice (EBP) movement which it believed would have major ramifications for the future of psychology.  The evidenced based practice position holds that some therapies (most developed in manualized, scripted form by psychologists) are more effective than others and that ethical providers must choose the most efficacious approach. (4) This APA position which is incorporated in its ethics guidelines, is, however, contradicted by overwhelming research support for the so called “Dodo bird hypothesis” which has consistently found in empirical studies and meta-analyses that all therapies result in comparable outcomes.  In other words, that the specific therapies for specific problems approach (EBP) championed by the APA is largely a myth. (5)  Behind APAs support for evidenced-based practice was not so much science as it was its concern for the eroding status of psychologists in the marketplace. Should the EBP movement prevail, a “major ramification” would be that insurers would demand that clinicians use manualized treatments created by psychologists. This would result in psychology gaining pre-eminent status in the world of psychotherapeutic practice.

Psychiatrists, nurses, and physicians in general in the early 2000’s were in a very different economic situation. Unlike psychologists whose numbers were plentiful, there was an undersupply of physicians and nurses in the US, and, in the case of psychiatrists, a severe undersupply.  The AMA or American Psychiatric Association could take the high road and denounce torture absolutely without harming their members incomes. This is not to denigrate the principled stands of these organizations, but only to state a fact.  On the other hand, for the American Psychological Association to spurn the overtures of the DOD, CIA, and the Executive branch of government, carried more risk for the APA and the income of its members.

For the plain fact is that the field of clinical psychology depends on the DOD for its very livelihood. The DOD channels most of its 400 million dollar behavioral science research budget to psychologists. Fully 5% of all licensed psychologists in the US (almost 4000 clinicians) are employed by the Veteran’s Administration—and the VA pays their hefty APA dues!  The VA, moreover, provides 15% of all APA accredited internships in clinical psychology and 40% of post doctoral training programs.

The APA has been unusually candid about their dependence on and vulnerability to DOD budgetary issues. Geoff Mumford, a high APA official, himself implicated in the torture scandal, wrote in 2006 that supporting the McCain Amendment prohibiting torture “…would likely put in jeopardy funding for …psychology and psychologists.” (6)

That the APA went all in and came through for the DOD, the CIA, and the Bush administration is now a matter of record.  On offer to psychology for participating in the torture regime was money and power, and the conferrence of prestige and credibility on a beleaguered profession that was reeling from scientific developments and practice changes.

The APA has taken withering criticism from a broad range of medical ethicists for its unwillingness to unambiguously repudiate participating in “torture by another name.”  Yet it continues to resist the desires of its membership. A member-initiated resolution was passed overwhelmingly in 2009 by the membership to restrict psychologist participation in any operation that violated the Geneva Conventions or the United Nations Convention Against Torture. The referendum was made official APA policy yet the APA leadership refuses to this this day to implement it citing technical reasons.

But the APAs fealty to the DOD has not gone unrewarded.  Martin and Jessen the psychologists who started a company to provide torture services (along with the retired head of Behavioral Science for the CIA) made 81 million dollars for providing said services to the US Army. The number of  psychologists employed by the VA has skyrocketed since 2000. Martin E. P.  Seligman, former APA president, who has been implicated in the enhanced interrogation program, was awarded a 31 million dollar no bid, single source contract for his Comprehensive Fitness Soldier Training (CSF) program (which is not a training program but an experiment.) And in 2011 the APA announced a 125 million dollar US Army/APA collaboration to further deploy the experimental CSF program. (7)

Medical ethicists say that the Bush era torture program architected and overseen by psychologists will go down as one of the greatest scandals in the history of medical ethics, on a par with the Tuskeegee experiments of the mid twentieth century.  This will happen because a small cabal of insiders in the APA traded honesty and ethical conduct for the kudos of the powerful. In becoming a player on the national scene, an incalculably large stain has been left on the profession of psychology.

Geoff Gray has a Ph.D. in psychology.

Notes.

1. PSYCHOLOGISTS: HEALERS OR INSTRUMENTS OF WAR? A dissertation submitted to the Wright Institute Graduate School of Psychology, in partial fulfillment of the requirements for the degree of Doctor of Psychology by DEBORAH KORY,  MAY 2011.

2. http://ivanjmiller.com/disparity_action.html

3. https://news.brown.edu/articles/2013/08/psychotherapy

4. http://en.wikipedia.org/wiki/Dodo_bird_verdict

5. http://www.apa.org/practice/resources/evidence/evidence-based-statement.pdf

6. Mumford, G. (2006, March). When legislative objectives are in conflict. Monitor on Psychology, 37(3),68.

7. http://www.truth-out.org/archive/component/k2/item/93742:armys-spiritual-fitness-test-comes-under-fire

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