Since the publication of the Hoffman Report a year and a half ago[i], we know with certainty that officials at the American Psychological Association (APA) colluded with Department of Defense (DOD) officials as well as the CIA to allow psychologists to participate in interrogations.

The collusion involved manipulating both the composition of panels designed to craft APA policy as well as the content of their proclamations.   A handful of individuals within the leadership of the APA—including the APA’s ethics director himself, Stephen Behnke– actively worked towards these ends.  They sought both to provide protection to psychologists who participated in torture and also to deceive the APA membership into thinking that their actions were an effort by the APA to protect the health and welfare of the prisoners at Guantanamo and elsewhere.  In fact, the APA did nothing whatsoever to promote prisoner welfare.

Why was APA leadership so eager to collude with the DOD?  I surmise that part of the reason was because of their long-standing ties to the military which date back to over a century.   During both World Wars, for example, the APA enlisted psychologists into military service to evaluate new recruits, assist in the treatment of soldiers with post-traumatic stress, and offer advice about captured enemy soldiers during interrogations. The ties have persisted and today the DOD is the single biggest provider of psychology internships in the United States.  Additionally and importantly, the DOD employs 7% of all psychologists.

The DOD also is one of the biggest funders of psychological research such that many psychologists have received large sums of money from the military for the purpose of conducting research.  Moreover, the two psychologists, James Mitchell and Bruce Jessen, who developed the brutal interrogation tactics and oversaw their administration reportedly received $81 million dollars for their efforts.

So why was the APA able to collude with DOD for roughly a decade before finally reversing course?  Why were relatively few members of the APA protesting the fact that through its policies the APA was condoning psychologist participation in torture and allowing psychologists to employ the “Nuremberg defense” and claim that they were only following the law?  Was it perhaps that psychologists were not receiving much education in military medical ethics and the duties of psychologists in military arenas?

In order to find answers, colleagues and I were curious to know what psychology students were being taught about military psychologists’ ethical responsibilities, so we surveyed 185 students at 20 different graduate programs in clinical psychology.

We found that 74% of students had received less than one hour of instruction about military medical ethics and most gave incorrect answers when tested on specific instances in which the Geneva Conventions apply, about when military personnel are expected to disobey unethical orders from superiors, or about how prisoners are to be treated.

To further explore the issue of how much training psychologists are receiving in these matters, in a separate study colleagues and I surveyed the Directors of Clinical Training (DCTs) of 100 doctoral programs in clinical psychology and asked how extensively their programs addressed various topics related to preparing students for resolving ethical dilemmas in military settings as well as about recent controversies regarding psychologists’ consulting to DOD interrogators.  Only eight percent of our respondents reported that their programs addressed dilemmas arising when a psychologist in a military setting is ordered to act in violation of ethical guidelines, and none did so extensively.  Just over 4% of DCTs said that their curriculum included instruction about conflicts between actions taken and international law.  Only about 17% reported that their programs formally addressed issues regarding psychologists’ participation in interrogations in military settings and 12.5% said that they specifically addressed issues regarding psychologists’ participation in so-called enhanced interrogations in Guantanamo.

Based on the results of both of these studies, I surmise that psychology graduate students are taught little about the professional standards that constrain unlawful and unethical practices and, in fact, may have a false sense of complacency about their knowledge of such matters.  This is troubling, given that psychologists without an understanding of their ethical obligations are less prepared to disobey, let alone protest, unethical orders, and are more likely to be compliant when told to assist interrogators in ways that violate international standards.

Had the APA followed the lead of the AMA and the American Psychiatric Association in 2005 and prohibited psychologists from participating in interrogation sessions, the entire interrogation program would likely have ended years earlier than it did, because health care personnel were essential to providing cover for interrogators to claim that their techniques were not abusive.

The fact that the detention center at Guantanamo ever opened, much less is still open and continues to abuse detainees—including recently by force-feeding hunger strikers–will likely go down as one of the United States’ most egregious ethical lapses.  The fact that any health care provider participated is even worse, compounded by the fact that those in the leadership of the APA provided cover for that participation.

All health care providers need to be educated about the Geneva Conventions and other international codes of ethical conduct to ensure they don’t become pawns of the US military establishment – inadvertently or otherwise.  And APA members in particular need to demand that psychologists who committed crimes in the name of patriotism are held accountable and ensure that the APA never again walks down the path toward colluding with torturers, no matter the cause.

Wesley Boyd, MD, PhD, is a Staff Psychiatrist, Cambridge Health Alliance and Associate Professor of Psychiatry, Harvard Medical School Faculty, Center for Bioethics, Harvard Medical School

[i] Psychologists and ‘Enhanced’ Interrogation  ( )