This post was co-authored by Nancy Sherman, Ph.D.
Recently, the American Psychological Association (APA) revealed that psychologists colluded with the Department of Defense and CIA to design and implement so-called "enhanced interrogation techniques" (EITs) on detainees. The implications of these revelations extend far beyond the American Psychological Association and the government.
"First do no harm" is not simply an aphorism, but the fundamental underpinning of all clinical care. There is no doubt that waterboarding, sleep deprivation, walling, cramped confinement, stress position, death threats, etc., violate human rights, undermine fundamental ethics of medicine and psychology, negate basic values of moral conduct, and shake the foundations of institutions. From the beginning, the term "Enhanced Interrogation Techniques" was little more than a euphemism meant to detach the horrors of the acts from morality.
Generals and senior officials, through conduct and action, set "command climate" -- the moral tone for a mission and the moral culture of a unit. Through their example, they communicate what's permissible and what isn't. More importantly, they lay the groundwork for what is right and not just in compliance with law. By repeatedly approving of and engaging in deception, and approving of and covering up torture, DoD and CIA leaders drifted over to the "dark side" and compromised the credibility and effectiveness of the military medical departments.
And, in the recent disclosures, leaders did it by influencing the very ethics report meant to guide the clinical practitioner. In June 2005, the APA issued its Psychological Ethics and National Security Report (PENS), which repeatedly emphasized psychologists' special contributions to national security. Contrast this with the ethics section of General Petraeus' Counterinsurgency manual that appeared shortly thereafter (COIN-FM3-24). In the latter, it is clear that soldiers have an imperative to strive toward the highest moral behavior in the tough environments where the push of impulse and frustration can lead to barbarous acts. Leaders in combat seemed to grasp ethical challenges in ways that should have led psychologists working with them also to understand. Instead, an odd role reversal occurred. The military focused on "doing no harm" while the psychologists did the opposite.
American military and civilian leaders have long justified going to war, and the behavior it requires, by appeal to interpretations of just war theory, and in the recent wars, views of just resort that are simply far too permissive--such as regime change and democratization. Still, many American service members marched off to war believing in the morality of the cause. The psychologists who participated and designed the EITs were no different and rationalized their conduct as a vital war effort. And they justified torture by the thoroughly discredited belief that it secured important intelligence.
Medics were subordinated to interrogators and abandoned the ethical roles and responsibilities that have long guided them. In fact, the New England Journal of Medicine referenced Dr. David N. Tornberg, and other senior DoD officials, that doctors working in interrogations served in the role of "combatant" and not "clinician." These policies and directives, even after modification some years later, shifted the practice of military medicine and have had a pernicious effect on military medical care, particularly on psychologists and mental health.
The practice of torture requires that the torturer depersonalize the victim. But such a degrading and dehumanizing attitude cannot be contained in prisons or the closed environments of the war zones. The psychological and working boundaries are permeable. As the practitioners move back and forth from detention center, to war zone, to garrison clinic, they carry with them their full bucket of attitudes and beliefs.
We have seen the inept and often callous treatment of service members with emotional problems and injuries over the years. Too often, these men and women are subjected to ridicule and demeaning treatment, as if they were "less" than human for disclosing their suffering or not "manning up" for combat. With an epidemic of suicides to somehow explain, military mental health professionals have ignored or diminished posttraumatic stress disorder and colluded with practices to administratively discharge soldiers suffering with injuries. Reviews of medical records of detainees at Guantánamo have disclosed similar lapses in documentation and failures to diagnose and treat. It appears that depersonalization has become pervasive--a part of the climate of command, extending to soldiers themselves.
Military medical culture gets corrupted by violations of fundamental tenets of care and alleviation of suffering that are the bedrock of all clinical practice. We should worry not just about the APA's violations and massive collusions, but the implications of it for all clinicians when there is high-level pressure to compromise professional values and conscience.
Stephen N. Xenakis is a psychiatrist, retired Army brigadier general, and the Erik Erikson Scholar at The Austen Riggs Center.
Nancy Sherman is University Professor of Philosophy at Georgetown. She is the author of Afterwar: Healing the Moral Wounds of our Soldiers (2015).