March 28

2006: American Psychiatric Association Hypocrisy

In the wake of the revelations that psychiatrists participated in torture at Abu Ghraib and Guantanamo prison, in June 2005, the Board of Trustees of the American Psychiatric Association (APA) solicited input from divisions within the APA  to clarify ethical and professional boundaries, and to recommend guidelines for psychiatrists’ conduct in such settings.

The official APA Position Statement (“Psychiatric Participation in Interrogation of Detainees”) was approved May 21, 2006. Psychiatrists are explicitly prohibited from participating in, or otherwise assisting or facilitating, the commission of torture of any person in military or civilian interrogations under any circumstances; psychiatrists are prohibited from participating or assisting in any way, the interrogation of their patients on behalf of military or civilian agencies or law enforcement authorities; psychiatrists are prohibited from disclosing any part of the medical records of any patient, to persons conducting interrogation of the detainee; and psychiatrists may not be present in the same room where an interrogation takes place.

The APA Position Statement appeared to reflect the ethical view articulated by psychiatrist Jeffrey Janofsy, who was elected President of the American Academy of Psychiatry and Law (AAPL) in 2008:

“When a psychiatrist directly uses, works with others who use, or trains others to use deceptive or coercive techniques to obtain information in police, military, or intelligence interrogations, the psychiatrist breaches basic principles of ethics” (Lies and Coercion: Why Psychiatrists Should Not Participate in Police and Intelligence Interrogations, Journal American Academy of Psychiatry & Law [JAAPL], 2006)

However, an illuminating article  in Philosophy, Ethics & Humanities in Medicine, (2008) by psychiatrists Abraham Halpern, past President of the American Academy of Psychiatry & Law, and John Halpern of Harvard, reveals that behind the scenes a largely unreported conflict took place within the APA prior to its adoption of the much publicized Position Statement. Drs. Halpern provide documentation showing that contrary to the public perception, thanks to its effective public relations pronouncements, the adoption of APA’s Position Statement was anything but smooth; nor did it signify that the restrictions would be enforced by the APA.

After the Board issued the text of its proposed Position Statement in Oct. 2005, approval was delayed because of strong resistance from an influential group of forensic and military psychiatrists who argued that when they work in police or intelligence interrogation activities, they are not providing treatment as physicians. Therefore, they contended, they should not be required or expected to abide by the provisions of the code of ethics. In Nov. 2005, the forensic and military group persuaded the APA Assembly—comprised of representatives from APA divisions – to pass a resolution amending the Board’s Position Statement by inserting a semantic loophole. (Halpern, 2008)

Prominent psychiatrist calls forensic psychiatrists “advocates of justice”
The position taken by forensic psychiatrists was endorsed by psychiatry’s foremost apologist, Paul Appelbaum, MD, who has defended psychiatry’s use of psychotic and severely depressed mental patients – even those who were hospitalized involuntarily – as human subjects of research. (Researchers Under Fire, 1998)

Paul Appelbaum, a past President of the APA, the American Academy of Psychiatry and the Law, and the Massachusetts Psychiatric Society, who serves as Chair of the Council on Psychiatry and Law for the APA, provided the theoretical framework that has become a mainstay of forensic ethics; he has consistently defended forensic psychiatrists’ breach of ethical conduct on the grounds that they function outside the realm of medicine. He wrote the following in The Parable of the Forensic Psychiatrist: Ethics And The Problem Of Doing Harm. International Journal of Law Psychiatry 1990:

“The forensic psychiatrist, in truth does not act as a physician… If the essence of the physician’s role is to promote healing and/or to relieve suffering, it is apparent that the forensic psychiatrist operates outside the scope of the role… Were we to call such a person a ‘forensicist,’ or some similar appellation, it might more easily be apparent that a different–nonmedical–role with its own ethical values is involved… [P]sychiatrists operate outside the medical framework when they enter the forensic realm, and the ethical principles by which their behavior is justified are simply not the same.” (quoted by Halpern, Philosophy, Ethics and Humanities in Medicine, 2008)

Appelbaum justifies the actions of forensic psychiatrists even as they cause suffering and harm; rationalizing that psychiatrists working for government are “advocates of justice.” The same justification was made by psychiatrists who had used their knowledge to abuse political dissidents in dictatorships such as the Soviet Union, South Africa, Romania and China.

After a heated debate within the APA, followed by an ad hoc committee review of both sides, the original Position Statement was approved on May 21, 2006. Nonetheless, other than issuing its much publicized Position Statement, there is no evidence that the APA intended to enforce its ethics code. Indeed, psychiatrists –whose identity is concealed – continue to participate in “enhanced interrogations” –i.e., torture – in  violation of the Geneva Conventions and U.S. laws, without any disciplinary action by the APA.

“Speaking in forked tongues”
Psychiatry’s leadership has consistently shown a proclivity for “speaking in forked tongues” to suit political or professional expediency. This “talent” was in evidence immediately following the APA’s approval of the Position Statement, when Steven Sharfstein, MD, (then) President of the APA, undercut the authority of that ethics position statement when he responded to a reporter’s question. Drs. Halpern cite a news report in MedPage Today (May 22, 2006) quoting Sharfstein who downplayed the significance of the Position Statement:

“Psychiatrists in the military might have a conflict between obeying the APA’s policy and following direct orders… The position statement is not an ethical rule. Individual psychiatrists wouldn’t get in trouble with the APA for failing to follow the guidelines… Currently, there are only a few psychiatrists who are participating in the interrogations.”

Two weeks later, following the Pentagon’s announcement that it would use only psychologists in interrogations, Sharfstein used hyperbole to draw a contrast between the ethics of psychologists and psychiatrists, in the American Journal of Psychiatry (2006):

“psychiatrists will not participate in the interrogation of persons held in custody. Psychologists, by contrast, had issued a position statement allowing consultations in interrogations. If you were ever wondering what makes us different from psychologists, here it is. This is a paramount challenge to our ethics and our Hippocratic training. Judging from the record of the actual treatment of detainees, it is the thinnest of thin lines that separates such consultation from involvement in facilitating deception and cruel and degrading treatment.

Innocent people being released from Guantanamo – people who never were our enemies and had no useful information in the War on Terror – are returning to their homes and families bearing terrible internal scars. Our profession is lost if we play any role in inflicting these wounds.” (p. 1713).

But as the Halpern authors document,

“Regardless of the differently worded position statements of [each of the two APAs] there is no difference in the end result of some psychologists and psychiatrists continuing to participate in interrogations of detainees where a threat to national security or danger of terrorist attack is believed.”

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