We must also exercise vigilance over our other core values. When I read in the New England Journal of Medicine about psychiatrists participating in the interrogation of Guantanamo detainees, I wrote to the Assistant Secretary for Health in the Department of Defense expressing serious concern about this practice. In mid-October I found myself on a Navy jet out of Andrews Air Force Base, along with the top health leadership in the military and other leaders from medical and psychological organizations, on a 3-hour trip to Guantanamo Bay. We were given an intensive 6-hour tour of the prison and briefed thoroughly on interrogation methods and the involvement of Behavioral Science Consultation Teams, known as BSCTs (pronounced "biscuits") in the process. We were introduced to two psychologists on these teams, and we asked pointed questions about their practice and involvement in giving advice during interrogations. We were reassured repeatedly that although there may have been various "stress techniques" used in the past on detainees, today's interrogations focused on building rapport with detainees, as positive relationships were much more effective in gaining good information than anxiety-inducing stress that could rapidly evolve into frank torture. Not good enough. After returning to Andrews, we began a spirited 3-hour discussion over dinner. I found myself looking eye to eye with top Pentagon brass-they are much taller than I am, but we were sitting down. I told the generals that 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. It was clear to me that the military was not of the same mind on the subject, although within their ranks many good doctors are struggling with conflicting ethical pressures. There has been debate within our association on this topic, but we must be uncompromising about our standards in terms of working with military authorities when we are not serving a healing role. I urge those of you who are interested in this topic to attend a special Presidential symposium on Wednesday, chaired by Dr. Paul Appelbaum and myself, when top psychiatric forensic psychiatrists and Army leaders will engage in a discussion with each other and the audience as we, as a profession, try to alter the debate that now rages on within the Administration. [emphasis added]As President Sharfstein looked eye to eye with Pentagon brass, then American Psychological Association President Ronald Levant was along for the http://www.apa.org/releases/gitmo1023.html">trip to Guantanamo. While the psychiatrists' President told the brass "that psychiatrists will not participate in the interrogation of persons held in custody," here is what the psychologists' President had to say:
" 'I accepted this offer to visit Guantanamo because I saw the invitation as an important opportunity to continue to provide our expertise and guidance for how psychologists can play an appropriate and ethical role in national security investigations. Our goals are to ensure that psychologists add value and safeguards to such investigations and that they are done in an ethical and effective manner that protects the safety of all involved,' stated Dr. Levant upon his return. 'This trip gave me an opportunity to ask questions and observe a brief snapshot of the Guantanamo facility first hand,' Levant stated. 'As APA's work in studying the issues presented by our country's national security needs continues, this trip was another opportunity for the Association to inform and advise the process.' "As a psychologist who has had his share of tension with psychiatrists, it deeply saddens me to admit that President Sharfstein has it correct. What distinguishes the two professions is that psychiatrists have taken a moral position, at the cost of a potential loss of access to top military decision-makers and funding-providers, while the leadership of psychologists, in contrast, have put access and, potentially, funding, above taking a moral stand on the perversions of the War on Terror. In the process of protecting this access, the psychological association has regularly used deception and bad faith, trying to argue that participation in interrogations is, indeed, ethical. Members of the psychological association have initiated efforts to change its policies. Perhaps realizing that psychologists are becoming the butt of jokes among professionals as medical doctors, psychiatrists, and anthropologists all take moral positions will motivate more of the association's membership to actively reject their leadership's trading morality and human decency for access to the powerful. When, at last, the organization's support for abusive interrogations is changed, the members should push on to an independent, thorough, public investigation of the multiple sordid links between the psychological association and the military-security establishment. Perhaps then the differences between psychiatrists and psychologists can be refocused upon issues of best practices rather than worst practices.