# data[].attributes.headline
We Won't Torture Anymore: APA Tells U.S. to Withdraw Psychologists from Nat. Sec. Interrogations (Video #3)

# data[].attributes.subject
We Won't Torture Anymore: APA Tells U.S. to Withdraw Psychologists from Nat. Sec. Interrogations (Video #3)

# data[].attributes.body
Supposedly, they are not going to torture people anymore, but there is nothing to say that they won't go back to it in the future. Rules should be set in place to prevent that possibility.

# data[].attributes.attachment_link.title
We Won't Torture Anymore APA Tells U.S. to Withdraw Psychologists from Nat. Sec. Interrogations

# data[].attributes.headline
CIA Torture Defended By Psychologist Creator (Video #2)

# data[].attributes.subject
CIA Torture Defended By Psychologist Creator (Video #2)

# data[].attributes.body
This is more background, with some of the perspectives of those involved.

# data[].attributes.attachment_link.title
CIA Torture Defended By Psychologist Creator _ NBC News

# data[].attributes.headline
APA Colluded with CIA/Pentagon in Torture  (Video #1)

# data[].attributes.subject
APA Colluded with CIA/Pentagon in Torture  (Video #1)

# data[].attributes.body
This explains the ethical problems of the CIA torturing

# data[].attributes.attachment_link.title
APA Colluded with CIA_Pentagon in Torture

# data[].attributes.body
Principles - Even though the terrorists are responsible for horrific atrocities, the United States is no better if it tortures people.  It is also wrong to get people to use psychology for the purpose of harming others. From the spying aspect, it is wrong to spy on people without probable cause (which would require a warrant or something similar).
Consequence - If the C.I.A. is allowed to continue acting like it did it Guantanamo Bay (i.e. Trump successfully brings back torture), then many people will suffer severe mental and physical issues for the rest of their lives.  It will also hurt this country's reputation as being one of the most humane places in the world.  From a spying standpoint, the C.I.A. could cause individuals to lose privacy and security.
Conclusion - the C.I.A. must stop torturing people and using psychologists for ill means. Terrorists will still have to be eliminated, but without torture. Innocent people should not be spied on without probable cause.

# data[].attributes.headline
Top Dem: CIA Officials Thought Spying on Senate Was Flat Out Wrong (News Article #4)

# data[].attributes.subject
Top Dem: CIA Officials Thought Spying on Senate Was Flat Out Wrong (News Article #4)

# data[].attributes.body
This provides a little bit more background and information for many of the other sources.

# data[].attributes.attachment_link.readable_text
A key Senate Democrat believes that officials within the CIA disagreed with Director John Brennan's approach during a heated battle between the spy agency and the Senate Intelligence Committee.

Sen. Ron Wyden Ronald (Ron) Lee Wyden Trump struggles to get new IRS team in place CIA declassifies memo on nominee's handling of interrogation tapes Dem senators demand Trump explain ties to Koch brothers MORE (D-Ore.) said in an interview for a new episode of HBO's "Vice" that he believed lower-level staffers within the CIA disagreed with Brennan's decision to search the Senate's side of a walled-off computer network for classified documents.

"This will be the first time I've ever said this publicly: My sense is there were clearly people at the CIA who understood that what Mr. Brennan had done was flat out wrong," said Wyden, a member of the Intelligence Committee and consistent critic of government spying efforts. "And they drafted an apology letter.

"And yet Mr. Brennan was just unwilling to publicly acknowledge wrongdoing."

"We are the agency that is required by law to conduct vigorous oversight over the CIA," Wyden claimed. "We can't do vigorous oversight over the agency if the agency we're supposed to be overseeing is in fact secretly searching our files."

The battle between the CIA and the Senate Intelligence Committee came as part of a long-running investigation into the spy agency's history of brutal interrogation techniques during the George W. Bush administration.

At some point while assembling that report, Senate staffers discovered secret CIA files dubbed the "Panetta review," which the agency did not intend to hand over. When the CIA discovered what the Senate aides had in their possession, Brennan ordered officials to cross into the Senate side of a shared computer network to investigate.

The fight erupted into Congress when Sen. Dianne Feinstein Dianne Emiel Feinstein Sunday Shows Preview: Emmanuel Macron talks ahead of state dinner CIA declassifies memo on nominee's handling of interrogation tapes Senate panel punts Mueller protection bill to next week MORE (D-Calif.), then the Intelligence Committee chairwoman, accused the CIA of spying on its congressional overseers, a potentially unconstitutional act. Multiple lawmakers demanded Brennan resign, but two years later he has emerged relatively unscathed.

Wyden's interview is set to air as part of a new Vice episode, "State of Surveillance," on HBO on Friday evening.

For the episode, Vice co-founder Shane Smith traveled to Moscow to interview former National Security Agency contractor Edward Snowden, who is wanted on federal espionage charges in the U.S. after leaking documents in 2013 extensively detailing the NSA's intelligence operation.

# data[].attributes.attachment_link.title
Top Dem: CIA officials thought spying on Senate 'was flat out wrong'

# data[].attributes.attachment_link.description
A key Senate Democrat believes that officials within the CIA disagreed with Director John Brennan's approach during a heated battle between the spy agency and the Senate Intelligence Committee. Sen. Ron Wyden Ronald (Ron) Lee Wyden Trump struggles to get new IRS team in place CIA declassifies memo on nominee's handling of interrogation tapes Dem senators demand Trump explain ties to Koch brothers MORE (D-Ore.)

# data[].attributes.headline
Bodies of Evidence: Psychologists and the CIA Torture Scandal (News Article #3)

# data[].attributes.subject
Bodies of Evidence: Psychologists and the CIA Torture Scandal (News Article #3)

# data[].attributes.attachment_link.readable_text
In the summer of 1975, in the weeks before President Gerald Ford dodged the first of two assassination attempts, the Rockefeller Commission issued a report into the Central Intelligence Agency's illegal surveillance of home-grown subversives. Prompted by The New York Times ' reporting of the agency's involvement in opening the mail and tapping the phones of anti-Vietnam War protesters and civil rights activists, the 300-page report uncovered little new information. However, it did find something equally worrying: a paper trail cataloguing the large number of American psychologists whose research had been secretly funded by the CIA.

Under the auspices of its MKUltra programme, the intelligence agency had, it transpired, indirectly bankrolled upwards of 150 research projects on mind control, interrogation and counterterrorism. At the height of the Cold War, Saul B. Sells, a social psychologist at Texas Christian University, had been funded to devise EEG technologies for mind-reading and what Sells called "activating the human organism by remote electronic means". The Colgate University psychologist George Estabrooks had led military field trials to create hypnotised assassins and programmed spies. And Donald Cameron, a psychiatrist at McGill University in Montreal, had used his own patients to test a system of "psychic driving", which aimed to wipe their memories and render them "hypersensitive to suggestion".

Once the human toll of the MKUltra experiments became headline news, it was difficult to imagine that the American Psychological Association, the world's largest professional body of psychologists, would continue to turn a blind eye to research that violated its ethical guidelines on harm and coercion. Psychology had, over the course of the 20th century, greatly extended its sphere of influence, selling its expertise to every corner of American society. The MKUltra abuses should have prompted the APA to think very seriously about its future relationship with its deep-pocketed paymasters at the Pentagon and the CIA, yet the association's ethics code continued to offer little in the way of guidance for the conflicted psychologist.

Three decades on, as George W. Bush's administration embarked on its War on Terror, the APA's moral compass was about to waver again. In the autumn of 2001, after 98 out of 99 senators voted to pass amendments to the anti-terror Patriot Act, which had become law in the wake of the September 11 attacks, the CIA was given the green light to capture and detain al-Qaeda suspects without following the rules of the Geneva Convention on the treatment of prisoners of war. However, bruised by a failure to share crucial information with the Federal Bureau of Investigation prior to 9/11, the spooks were anxious to avoid further public censure. To inoculate itself against any future backlash from having its office of medical services breach the international prohibition on torture, the agency would have to outsource its interrogation programme. Their ethical rigidity meant that physicians and psychiatrists would be all but impossible to enlist, but the Rockefeller Commission report suggested that contract psychologists were another matter. With the right inducements, they might be mandated to spearhead and give credence to the idea that a new scientific approach to interrogation was being trialled at Abu Ghraib, Guantanamo Bay and other "black sites".

The foundations of what was to become known as "enhanced interrogation" were laid when Kirk Hubbard, the CIA's director of behavioural research and an APA member, commissioned James Mitchell and Bruce Jessen, two ex-US air force psychologists, to deliver a report on possible "countermeasures to al-Qaeda resistance to interrogation techniques". Neither Mitchell nor Jessen had any useful expertise in counterterrorism, or any knowledge of al-Qaeda. They did, however, have a background in Survival, Evasion, Resistance and Escape (SERE), and the lessons that they had learned while training military personnel to resist enemy interrogators could, they told Hubbard, be reverse-engineered.

Mitchell and Jessen's report, which is reproduced in the US Senate Select Committee on Intelligence's 2012 report on the CIA's "detention and interrogation programme", delivered exactly what the agency needed: it falsely claimed that the "Manchester Manual", an al-Qaeda handbook recently discovered by police in Manchester, gave operatives precise instructions on how to lie effectively to captors and make false allegations of torture. And it sketched a system of coercive interrogation that was purportedly based on research on fear conditioning that the psychologist Martin Seligman had undertaken in the late 1960s, prior to founding the Positive Psychology Center at the University of Pennsylvania and becoming one of America's leading self-help gurus.

As a postdoctoral researcher at Pennsylvania, Seligman and his colleague Steven Maier had studied the behaviour of dogs that were exposed to electric shocks. They noticed that dogs that had been previously given uncontrollable shocks were unable to learn simple escape strategies. When a flashing light signalled a forthcoming shock that could be evaded by passing over a low barrier, these dogs lay down and whined abjectly; it was only by physically lifting them, to demonstrate how the shock could be avoided, that Seligman was able to undo what he called their "learned helplessness".

Seligman - who is a former APA president and is still director of the Positive Psychology Center - went on to propose that his findings could also be usefully extrapolated to the study of human defeatism, and much of his work in the 1980s and 1990s was concerned with using cognitive therapy to change the "explanatory styles" of those at high risk from depression. Jessen and Mitchell's interest in learned helplessness was rather more left field. In December 2001, Mitchell attended - but apparently did not speak at - a meeting at Seligman's home of what Seligman describes to me in an email as "12 distinguished professors and four intelligence officers" to discuss "how to win the peace" via the "psychology of capitulation". According to Seligman, there was "not a single mention of interrogation, torture, or prisoners". But not long afterwards, the air-force psychologists proposed that learned helplessness could encourage a detainee to cooperate and provide information.

Mitchell and Jessen, who were experienced only in conducting mock torture in SERE training, were called to test out their "new" approach in the summer of 2002. The first prisoner subjected to "enhanced interrogation" was Abu Zubaydah, a Saudi national believed to have been involved with al-Qaeda recruitment in Afghanistan. Held at a black site in Thailand, Zubaydah had already been subjected by FBI agents to "informed interrogation", which aimed to slowly build trust and rapport with suspects, and he had already identified Khalid Sheikh Mohammed as the mastermind of the 9/11 attacks.

Dismissing this "throwaway information", Mitchell and Jessen began by ordering that Zubaydah be stripped and treated like a "dog in a cage", according to the Senate committee report, which was partly declassified in December 2014. Over the next 20 days, he was sleep deprived, slammed against his prison door, imprisoned in a box and waterboarded 83 times. During this time, staff physicians from the CIA's office, by now in the habit of dressing in the same black uniform as the interrogators, were in effect spectators to the wounded detainee's decline. "Longest time with [wet] cloth over his face so far has been 17 seconds. This is to increase shortly. No useful information so far," wrote one of Zubaydah's attending medical officers in case notes published in the Senate committee report. Later, when Zubaydah was said to have "partially" refused liquids, the CIA Office of Medical Services' own physicians became fully assimilated into the interrogation process, administering a series of rectal enemas whose sole purpose was to violate and degrade. In other words, Zubaydah was not only tortured, he was medically raped.

Prior to the torture of Zubaydah, who is still held at Guantanamo Bay, the CIA's legal department had requested clarification from the Department of Justice regarding the methods that Mitchell and Jessen would be able to use to acquire information from him. The "torture memos" gave specific approval for a dozen or so techniques that Mitchell and Jessen had so far outlined, from waterboarding to solitary confinement, before claiming that "cruel, inhuman and degrading treatment" did not constitute torture as long as there was no "specific intent to cause severe pain". The only mooted techniques at which the department drew the line were mock execution and burial.

Buoyed by this outlandish reinterpretation of torture, Mitchell and Jessen announced that the interrogation of Zubaydah, which had left him mentally broken and blinded in one eye, had in fact been an unqualified success: "Our goal", they wrote, in his case notes, "was to reach the stage where we have broken any will or ability of [the] subject to resist or deny providing us information (intelligence) to which he had access. We additionally sought to bring [the] subject to the point that we confidently assess that he does not...possess undisclosed threat information, or intelligence that could prevent a terrorist event."

In late 2002, enhanced interrogation claimed its first fatality. Gul Rahman, an Afghan citizen, died of hypothermia after being left naked from the waist down on the stone floor of his cell. Three months earlier, the APA - of which Mitchell was a member until 2006 - had amended its ethics code, such that psychologists could legitimately kowtow to "the requirements of the law, regulations, or other governing authority". The revision, which had been ushered in by Stephen Behnke, the association's long-standing ethics chief, ensured that any psychologist assisting in the torture and abuse of detainees would be able to invoke the same legal defence that Nazi physicians had made at Nuremberg: they were only following orders.

Mitchell and Jessen were fast on their way to becoming America's first millionaire torturers. In 2005, they founded a company, Mitchell Jessen and Associates, and agreed to provide the agency with staff for its expanding programme. Also on the board of the company was Joseph Matarazzo, a former president of the APA and emeritus professor of behavioural neuroscience at Oregon Health and Science University. A specialist in non-verbal communication, Matarazzo had, before taking up his position, argued to an advisory committee of the CIA - which no doubt fed the advice to the Department of Justice - that sleep deprivation did not constitute torture.

That the APA had travestied its council review process to ensure that psychologists would be able to participate in enhanced interrogation became slowly apparent after Jean Arrigo, an independent social psychologist, was appointed to sit on the association's Task Force on Psychological Ethics and National Security. Formed after the Red Cross had issued the first reports of torture at Guantanamo Bay in 2004, the task force would go on to issue guidelines for psychologists assisting with military interrogations. But Arrigo, the daughter of an intelligence analyst, quickly sensed that she was a token independent presence on a panel that was trying to ensure that psychologists provided the security services with policy cover for abusive interrogation. Her calls for clarification on techniques that psychologists could not participate in were duly stonewalled.

But the true extent of APA collusion with the CIA and Department of Defense was about to unravel. As other psychologists reported their concerns about ethical violations and harm in interrogations at Guantanamo and other black sites, it became obvious that "enhanced interrogation" was doublespeak at its most insidious.

Unfortunately, the US news media were rather reluctant to critically unpack the weasel language: it remained unclear to the public that "waterboarding" meant near-drowning, that "employing a stress position" could mean being left for days on end with one's arms shackled to a high horizontal bar, or that "solitary confinement" could mean being locked in a box or coffin. And "rectal feeding", the CIA's preferred method of sexual degradation, continued to pass itself off as a bona fide medical treatment.

In the summer of 2014, after the APA had spent some years belligerently rebutting most of the charges levelled at its leadership, the association commissioned former assistant US attorney David Hoffman to conduct an Independent Review Relating to APA Ethics Guidelines, National Security Interrogations and Torture. He found that although the "meaningful changes" to the APA's ethics code in 2002 were "not influenced by an effort to help the government's interrogation efforts", the association had indeed secretly collaborated with officials at the Pentagon in 2005 to draft ethics guidance so as not to bar psychologists from taking part in coercive interrogation programmes. Chiming with the Senate committee findings into CIA torture (which finally prompted President Barack Obama's graceless admission in 2014 that "we tortured some folks"), the Hoffman report demonstrated that the APA membership was serially traduced by officials who sought to stifle grass‑roots dissent. As Arrigo and fellow psychologist Roy Eidelson wrote in the LA Times in July 2015, it had been a victory for the "war entrepreneurs, careerists and yea‑sayers".

The key players implicated in the APA torture scandal, including Behnke, have now resigned or retired. Opposition to the Nuremberg Ethic has been resolved by a policy banning psychologists from assisting in interrogations by the military or intelligence agencies. Disaffected APA members have returned to the fold and Arrigo's "courage and persistence in advocating for ethical behaviour among her fellow psychologists" has been recognised by the American Association for the Advancement of Science with the award of its Scientific Freedom and Responsibility Award last year.

Still, the inquest into psychologists' participation in what the Civil Liberties Union has called "the worst systematic brutality ever inflicted on detainees in modern American history" is by no means over. Questions continue to be asked about who knew what and when. And only history will tell what the APA has learned from its latest misadventure.
Antonio Melechi is a visiting fellow in the Humanities Research Institute at the University of Leeds.

# data[].attributes.attachment_link.title
Bodies of evidence: psychologists and the CIA torture scandal

# data[].attributes.attachment_link.description
In the summer of 1975, in the weeks before President Gerald Ford dodged the first of two assassination attempts, the Rockefeller Commission issued a report into the Central Intelligence Agency's illegal surveillance of home-grown subversives.

# data[].attributes.headline
"Enhanced" interrogation of Detainees (mht format in case the PDF does not work)

# data[].attributes.subject
"Enhanced" interrogation of Detainees (mht format in case the PDF does not work)

# data[].attributes.attachment_link.provider_name
Philosophy, Ethics, and Humanities in Medicine

# data[].attributes.attachment_link.readable_text
Abstract

After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946-1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter.

Keywords

Position Statement American Psychological Association Geneva Convention Forensic Psychiatry Detention Center

Background

In June 2005 the Board of Directors of the American Psychiatric Association (AΨA) a, concerned about allegations that psychiatrists participate in detainee interrogations at the United States naval station at Guantánamo Bay, Cuba, as well as in Iraq and Afghanistan, directed a number of AΨA components to clarify ethical and professional boundaries and recommend guidelines for psychiatrists' conduct in such settings []. After much discussion and debate regarding relevant issues, the AΨA, on May 21, 2006, approved a Position Statement, "Psychiatric Participation in Interrogation of Detainees," [] declaring that no psychiatrist should participate directly in interrogation of prisoners b. News of the AΨA's action spread quickly; the Position Paper was widely acclaimed c.

At the same time, news media reported strong criticism of the American Psychological Association (APA) for permitting participation of psychologists in interrogation of detainees. Many psychologists resigned from the APA in 2007 [] when the Board of Directors, disregarding the protest d of a large number of members, accepted the 2005 recommendation of the Presidential Task Force on Psychological Ethics and National Security (PENS) that had been appointed to develop a position concerning the matter of psychologist participation in interrogations [].

Discussion

PENS

PENS describes a clearly delineated role for psychologists "at distant and sequestered detention centers" created in the interest of national security and protection of the American people. According to Dr. Beth Shinn, the nine members of PENS included active-duty military officers and psychologists who worked for Defense Department agencies []. Some of these members were "in the chain of command at the places and during the times that abuses have been documented" [].

We believe that even if the APA had adopted the same Position Statement as the AΨA, the existing interrogation programs involving psychologists would likely have continued unchanged. National obligations do not absolve clinicians of their primary commitment that we use our skills and training to heal. This societal trust or compact should never waver so it is unfortunate that the APA voted down a motion to ban participation altogether in interrogations at detention centers like Guantánamo Bay [] and to state that the role of psychologists in settings in which detainees are deprived of their human rights should be limited to providing psychological treatment [] - unfortunate because it served to strengthen the erroneous belief of many that the APA supports participation of psychologists in torture and fed into the claim by the AΨA that psychiatrists adhere, in the area of prisoner interrogations, to higher moral standards than psychologists. The fact that members of the APA Council of Representatives (COR) adopted the resolution titled "2007 Reaffirmation of the American Psychological Association Position Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment and Its Application to Individuals Defined in the United States Code as 'Enemy Combatants'" [] does not mean that members of the APA are prohibited from participating in interrogation of prisoners. This is so because the Government's position is that "enhanced interrogation techniques," or, as President Bush put it, "alternative set of procedures" [], do not constitute torture []. With "aggressive" [] interrogation of detainees at Guantánamo and at secret overseas sites [] ongoing at present, we believe, for reasons mentioned below, that these interrogations continue to include participation by psychologists and psychiatrists, as well.

APA Council of Representatives

If the PENS recommendations had first been presented to the APA Council of Representatives [COR] (comprising at least 168 members), it is likely that these recommendations would have been rejected for instead adopting a policy statement similar to the AΨA's, if not stronger, prohibiting psychologists from direct participation in interrogations. The COR, like the AΨA Assembly, is a lively debating society in which the views of many representatives are expressed with passion and conviction; it is made up of strong-minded people selected by their APA branches to represent their views []. The COR, incidentally, has vastly more power than the AΨA Assembly. It is the legislative body of the APA and has full power and authority over the affairs and funds of the Association, including the power to review, upon its own initiative, the actions of any board, committee, division, or affiliated organization. The COR is APA's major legislative and policy setting body. Many APA members were greatly upset [], not only because the COR was bypassed e, but because the APA PENS position was felt to approve what to them was clearly unethical conduct.

AΨA Assembly

The AΨA Assembly, in comparison with the COR, has, as mentioned, very little power. It serves as the representative legislative component of the AΨA. Consisting of some 250 members, of whom approximately 160 are voting members (119 representatives and an equal number of non-voting deputy representatives are elected from the District Branches), the Assembly represents the members of the Association and acts for them in the affairs of the Association. Additionally, it provides a means for representing the needs of District Branches and for reciprocal communication between the District Branches and other governing bodies of the Association []. It is comprised of representatives from the Association's district branches who are elected by the members of the district branches. They advocate for their primary and special interests within the AΨA Central Office. Only in recent years has the AΨA Board of Trustees yielded to the Assembly's demand that all policy decisions of the Board be submitted for approval by the Assembly. It almost always approves the Board's actions. On rare occasions, it submits a minor amendment, which the Board usually accepts. More important, however, Action Papers (resolutions) proposed by Assembly members or District Branches and approved by the Assembly, by majority vote, and then submitted to the Board of Trustees, are referred by the Board to the Joint Reference Committee (JRC). The JRC frequently makes changes in the resolutions and passes them to the Board for adoption, without giving the Assembly the opportunity to review the altered resolutions.

The amendment of the position statement

The amendment f [] to the position statement on psychiatric participation in interrogation of detainees, approved by the AΨA Assembly at its Nov. 2005 meeting, completely revising the third paragraph of the Position Statement, was not a minor amendment that the Assembly could just anticipate receiving automatic acceptance from the Board of Trustees. The Assembly had changed the wording of the third paragraph from "Psychiatrists should not participate in the interrogation of persons held in custody by military or civilian investigating or law enforcement authorities, whether in the United States or elsewhere. Nor should they provide information or advice to military or civilian investigative or law enforcement authorities regarding the likely consequences of specific techniques of interrogation that is in any way particularized in its application to an individual detainee" to "Psychiatrists should not participate in or assist any coercive interrogation of persons held in custody by military or civilian authorities, whether in the United States or elsewhere. Nor should they provide information or advice to military or civilian investigative or law enforcement authorities regarding the likely medical consequences of specific coercive methods. For purposes of this statement, coercive methods of interrogation include degradation, threats, isolation, imposition of fear, humiliation, sensory deprivation or excessive stimulation, sleep deprivation, exploitation of phobias, or intentional infliction of physical pain such as use of prolonged stress positions" (Emphasis added).

If these recommendations of the Assembly were accepted, the original and correct intent of the Board against any involvement in interrogations would be dangerously undermined: it would mean that the AΨA approved of participation by psychiatrists in "non-coercive" interrogations because now only the "coercive" interrogations would be off-limits. President Bush has authorized that the CIA and other agencies dealing with detainees can turn to "enhanced" techniques (i.e., coercive methods) that in the same double-speak are labeled "non-coercive." Such methods include waterboarding g, stress positions, use of military working dogs to instill fear, prolonged bombardment with loud music and flashing lights, deprivation of food, infliction of severely cold and hot temperatures, extreme sensory deprivation, shaking, striking, prolonged sleep deprivation, and isolation h [, , ]. In 2006, George Annas (Professor and Chair, Department of Health Law, Bioethics, and Human Rights, Boston University) concluded that when doctors respond to detainees' hunger strikes by using the "'restraint chair' for 'postfeed observation' during which the prisoner must urinate and defecate on himself or herself, seems designed more for humiliation and subjugation than for medical treatment" [].

It is quite concerning that the Assembly-amended version of the Statement did not mention most of these additional President-sanctioned coercive methods. According to the Pentagon's Office of the Inspector General (OIG), these techniques were transformed, with the assistance of military psychologists, into "standard operating procedure" (SOP) for interrogations at the Guantánamo Bay detention facility. This Guantánamo SOP, the OIG asserts, also was brought to Afghanistan and Iraq and, according to media reports, provided a basis for techniques used by CIA personnel, also with assistance from psychologists []. These techniques were designed to inflict physical and psychological harm for the purpose of breaking down interrogation subjects. The OIG report describes the nature and extent of that harm and the legal consequences to interrogators of employing techniques that cause it. Despite the euphemism "enhanced interrogation techniques," the International Committee of the Red Cross [], the United Nations [], Human Rights First and Physicians for Human Rights [], and many others, classify them to be torture and also consider the techniques to be ineffective. Thus, the enhanced interrogation methods approved by the U.S. Government are in violation not only of Common Article 3 of the Geneva Conventions [] but of at least three United States laws [-]. Interestingly, the British "no longer rely on assurances by the United States that it does not torture terrorism suspects" [].

Despite the formal positions of both the APA [] and AΨA [] against torture, We believe that some psychologists and psychiatrists continue their participation in "enhanced interrogation techniques" authorized by the President of the United States []. Since this Presidential Order does not specify what techniques the CIA can and cannot lawfully engage in, it is reasonable to assume that the "enhanced" techniques authorized by the Secretary of Defense in March 2002 are still in use i. Unbelievably, a document signed, on August 1, 2002, by the head of the U.S. Justice Department's Office of Legal Counsel asserts "no method was torture unless it produced pain equivalent to organ failure or death" j [, ].

The ticking time-bomb scenario

With regard to the ticking-time-bomb situation, Dr. Griffin Trotter [] strongly supports the use of torture on a detainee believed to possess information concerning, say, a nuclear device that is about to be activated with the likely result that author and everyone else in half the world would be eliminated after suffering horribly painful irradiation burns ("In certain cases," he states, "the refusal to use torture would be morally reprehensible"). To this, we responded []: "This simplistic ticking time-bomb example, in one form or another, has been postulated over the centuries. It is mischievous, if not dangerous, not to mention beyond acceptable legal, moral, and ethical bounds; and exemplifies, with the current U.S. Government, even at the very highest levels, present-day justification to torture individuals suspected of possessing information that might benefit a particular cause, however seemingly noble or malignant that cause might be. Once one accepts this suggestion to violate laws against torture, the shameful journey on the slippery slope has begun. The absurdity of the ticking-bomb example is its presumption that the prisoner (terrorist) is a naive person who cannot figure out how to lie or who had not undergone the training necessary to deal with such a situation." In fact, in the almost 50 years since the ticking time-bomb scenario was first mentioned [] there has not been a single occasion when such an incident was experienced.

Trotter is not alone in this readiness to accept torture in extreme situations. Alan Stone, M.D., a Harvard professor of law and psychiatry and past president of the American Psychiatric Association, is reported to have said: "I am unprepared to say that in a situation of great consequence, a psychiatrist who might have some ability to help our military should claim some ethical obligation that transcends all other obligations. There could come a time when I thought a person knows something and I could help find out what that is, I would certainly think it strange for me to rest on an ethical principle when there is so much greater harm [at stake]" []. Many others have called for torture in such situations; including Alan Dershowitz (a famous Harvard professor of law) [], a distinguished judge of the United States Court of Appeals for the Seventh Circuit []; and a well-known forensic psychiatrist [].

The provenance of the AΨA Position Statement

a) The delay

Contrary to what is generally believed, adoption of the AΨA Position Statement was delayed by about six months, and did not receive unanimous approval by either the AΨA Assembly or Board of Trustees. Before describing how the Board of Trustees came to the decision to retain the Position Statement as originally drafted, it is important to further examine why the Assembly voted to so drastically amend the Statement. The then Speaker of the Assembly offered the following explanation (Joseph Rubin Email to [Assembly] Area Council members 02/16/2006): "During the November 2005 Assembly meeting, the Assembly amended the position statement, using terminology opposing psychiatric participation in coerciv e interrogation. It was pointed out at that time that military psychiatrists from the Society of Uniformed Services Psychiatrists are especially supportive of this language because they felt that the Board's language was too restrictive and could hamper their efforts to help the government and detainees. Some Assembly members also believe that there is no evidence indicating that any physician has been involved in the degrading aspects of interrogation."

b) The "forensicist"

Yet there is a much older culprit that led to the majority of Assembly members to vote as they did and it stems from the fact that many of them are engaged in forensic psychiatric practice in addition to their regular psychiatric activity (at least 13 representatives are in the full-time practice of forensic psychiatry). They, along with very many forensic psychiatrists in the United States, have been convinced that when they do forensic work, they are not required or expected to abide by all the canons in the code of medical ethics. This position was taken as a result of the very strong stand [] expounded by one of this country's foremost experts in psychiatry and the law, Paul S. Appelbaum, M.D., formerly the A. F. Zeleznik Distinguished Professor and Chairman, Department of Psychiatry, University of Massachusetts Medical School; currently Elizabeth K. Dollar Professor of Psychiatry, Medicine and Law, and Director of the Division of Psychiatry, Law and Ethics, College of Physicians and Surgeons of Columbia University; past president of the American Psychiatric Association; and past president of the American Academy of Psychiatry and the Law. Appelbaum's position was forcefully endorsed by Thomas G. Gutheil, M.D., another leading figure in forensic psychiatry []. "The forensic psychiatrist," Appelbaum writes, "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" k []. "Their functioning in the forensic setting ... is guided by a different set of principles" []. Thus, by sanctioning the participation of psychiatrists in non-coercive interrogations, the slippery slope of clearly unethical involvement in this regard is created; for example, a policy recommended by a past president of the American Academy of Psychiatry and the Law under which participation by forensic psychiatrists in police interrogation of individuals who might be dangerous would not violate professional ethics, because such interrogations "are derivative of agency and efficacy, not ethics" []. This forensic psychiatrist also states: "Police interrogation techniques not only allow, but also encourage deception" []. Dr. Jeffrey Janofsky captures the essence of the problem succinctly: "Police interrogators routinely use deceptive techniques to obtain confessions from criminal suspects. 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" [].

Dr. Appelbaum sees the forensic psychiatrist as an "advocate of justice" []. On the other hand, not only forensic psychiatrists, but all psychiatrists, must remain constantly alert to the danger of being drawn into unethical conduct in the service of an elusive and not infrequently unjust "justice" []. It has long been recognized that in countries where misuse of psychiatry has been, and in some countries still is, rampant, such as the former Soviet Union [, ], China [-], Romania [], South Africa [] and others, psychiatrists justified their unethical conduct on the grounds that they were furthering the interests of their countries' justice.

It is regrettable, but understandable, that the influential military and forensic psychiatrists in the AΨA Assembly would agree with and endorse the view of a renowned forensic psychiatrist that "The theoretical framework offered by Appelbaum has become a mainstay of our understanding of forensic ethics" []. It should be recognized, however, that Appelbaum bases his entire argument that a special code of ethics is necessary for forensic psychiatrists on his mistaken belief that AΨA's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry is restricted to the physician-patient relationship in which "the physician's role is to promote healing and/or to relieve suffering" []. Rather than needing a special set of ethics for the forensic psychiatrist, the principles and annotations of the ethics code (2001 Edition) is for all psychiatrists. As examples; Principle #1 ("A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity"); Principle #3 ("A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient"); Principle #7 ("A physician shall recognize a responsibility to participate in activities contributing to an improved community"); Annotations #6 of Section 4 ("Psychiatrists are often asked to examine individuals for security purposes, to determine suitability for various jobs, and to determine legal competence. The psychiatrist must fully describe the nature and purposes and lack of confidentiality of the examination to the examinee at the beginning of the examination"); Annotation #8 of Section 4 ("Psychiatrists at times may find it necessary in order to protect the patient or the community from imminent danger, to reveal confidential information disclosed by the patient"). Appropriate guidance to assist forensic psychiatrists in adhering to the code of medical ethics is provided in the American Academy of Psychiatry and the Law Ethics Guidelines for the Practice of Forensic Psychiatry (adopted May 2005). Thus, we unreservedly disagree with Appelbaum's position that "forensic psychiatrists cannot simply rely on general medical ethics" []. General medical ethics have considered the ethics of physician participation in interrogations and clearly forbid it. Now is the time for all clinicians to live up to the existing codes rather than attempt to weaken them.

c) The path to adoption of the AΨA Position Statement

We now describe in greater detail the events that surrounded the adoption of the final version of the AΨA Position Paper on Psychiatric Participation in Interrogation of Detainees.

The AΨA Board of Trustees approved their initial proposed Position text on October 10, 2005. Soon after, we warned Steven S. Sharfstein, M.D., the then president of the AΨA, that "there are some 'forensicists' who will try to scuttle it [the Position Statement] by amendment or tabling" it when it is presented to the Assembly for their approval at their meeting on November 11-14, 2005 (A.L.H. Email to Steven Sharfstein 11/02/2005). Dr. Sharfstein thanked us for alerting him (Steven Sharfstein Email to Abraham Halpern 11/02/2005). As mentioned above, the Assembly added the word "coercive" [], thereby sanctioning the participation of psychiatrists in "non-coercive" interrogations. Should this language be retained in the final Position Statement, given the Government's definition of non-coercive interrogation techniques, psychiatrist participation in what in actuality constitutes coercive techniques would instead be viewed as meeting with the Board's approval. Moreover, it would open the door for psychiatrists to engage in deceptive practices, already declared, as noted above, to be a matter of "agency and efficacy, not ethics" []. Since the Board would be meeting on December 11-12, 2005, less than four weeks after the Assembly adopted its amended Position Statement, we decided to contact as many members of the Board as possible to alert them to the importance of retaining the original Position Statement. Dr. Sharfstein was notified (A.L.H. Email to Steven Sharfstein 11/26/2005) that accepting the changes recommended by the Assembly would result in sanctioning the misuse of psychiatry in interrogations of detainees, such as the use of deception to elicit information with the aid of psychiatrists. Dr. Sharfstein thanked us (Steven Sharfstein Email to A.L.H. 11/28/2005). Alfred M. Freedman, M.D., emeritus professor and chairman, Department of Psychiatry, New York Medical College who is also a member of the AΨA Board of Trustees (and with whom we had collaborated on a number of related topics over the previous 10 years [, ]), was kept informed of our correspondence. Dr. Sharfstein was provided additional reasons to reject the Assembly's amendment (many of which are included in the "Forensicist" section above) (A.L.H. Email to Steven Sharfstein 11/29/2005). We also notified Herbert Peyser, M.D., a long-serving member of the Assembly, and Michael Blumenfield, M.D., Speaker-Elect of the Assembly, of the potential dangers if the Assembly's final Position Statement became AΨA policy (A.L.H. Email to Herbert Peyser and Michael Blumenfield 11/30/2005). Dr. Freedman wrote a lengthy letter to Dr. Sharfstein strongly urging him to do everything he can to obtain the Board's approval to reject the Assembly's amendments and emphasizing the likelihood that psychiatrists attending "non-coercive" interrogations would facilitate interrogators' use of techniques that are in violation of both the Geneva Accords and U.S. laws (Alfred Freedman Email to Steven Sharfstein 11/0/2005). Dr. Sharfstein fully agreed with Dr. Freedman and asked permission for Dr. Freedman's "note be distributed to the Board" for discussion at the Board meeting on December 10-11 (Steven Sharfstein Email to Alfred Freedman 12/01/2008). Other members of the Board were sent additional messages about the implications of retaining the Assembly's ammendments (A.L.H. Email to Lawrence Hartmann 12/03/05; A.L.H. Email to Pedro Ruiz 12/03/05; A.L.H. Email to Harold Eist 12/05/05; A.L.H. Email to Carolyn Robinowitz, Nada Stotland, Michelle Riba, Marcia Goin and Ann Sullivan 12/07/05; A.L.H. Email to Alan Stone 12/10/2005).

A few days prior to the AΨA Board meeting, the Board received a letter from Leonard Rubenstein, J.D., the Executive Director of Physicians for Human Rights (PHR), in essence recommending that the AΨA Position Statement "be limited to interrogations outside the U.S. justice system (Leonard Rubenstein Letter to Steven Sharfstein and members of the APA Board of Trustees 12/07/2005). Such a change would still result in the Position Statement exempting participation by psychiatrists in interrogations by police officials and other authorities within the United States, and, as such, could pose a serious risk of misuse and abuse of psychiatry. We wrote to Dr. Sharfstein and several members of the Board of Trustees, including Dr. Paul Appelbaum, on December 8, strongly urging them not to accept the suggestion of PHR (A.L.H. Email to Steven Sharfstein and several Board members 12/08/2005). We received a positive response from Dr. Appelbaum indicating that he would do what he could to see that our recommendation was accepted by the Board (Paul Appelbaum Email to A.L.H. 12/08/2005). On December 9, Mr. Rubenstein, wrote to Dr. Freedman indicating that PHR had intended only to suggest a compromise in the event that the differences in the positions of the Board and the Assembly could not be resolved, and that PHR was withdrawing its suggestion and was entirely supportive of the Board's original Statement unchanged (Leonard Rubenstein Email to Alfred Freedman 12/09/2005).

At the Board of Trustees meeting, although some members opposed the original Position Statement, the Board voted unanimously "to reaffirm the position statement approved at the October 2005 Board meeting, with the understanding that the Board will initiate a dialogue with Assembly leaders and with as many Assembly members as possible before the May 2006 Assembly meeting to approve a joint statement." The AΨA President and Speaker were to appoint Board and Assembly members representing both sides of this issue to an ad hoc work group with a charge to propose recommendations in time for the May 2006 Assembly and Board meetings (Joseph Rubin Email to [Assembly] Area Council members 02/16/2006). The purpose of this committee was to see if some revision of the Statement could be developed that would accommodate both the Board's and Assembly's versions of the Position Statement. The position of the military and forensic psychiatrists in the Assembly was clearly presented; nevertheless, although the committee members were not unanimous, the committee voted to recommend to the Assembly that the Board's original Position Statement on Psychiatric Participation in Interrogation of Detainees become official AΨA policy. The position (fully consistent with the "forensicist" views discussed above) of the forensic psychiatry and military Assembly representatives, strongly supportive of the amendment to limit the prohibition of psychiatrist participation to "coercive" interrogations, was well summarized by Joseph Rubin, M.D., as follows (Joseph Rubin (Speaker of Assembly) Email to James Nininger (Speaker-Elect) and Thomas Grieger (Representative of the Society of Uniformed Services Psychiatrists) 02/17/2006):

The Assembly representatives from the work group agreed that the revised document narrows the differences between the previously stated positions and broadens the potential role of psychiatrist participation. However, the Assembly representatives believe that there may be benefit to psychiatrists advising on non-coercive interview techniques related to particular detainees. For forensic psychiatrists, the primary value of their work is to advance the interests of justice. Trying to introduce the principles of medical ethics for treatment into a theory of ethics for forensic psychiatry heightens the problem of dual agency. When serving the interests of justice, forensic psychiatrists must adhere to the general moral rules of disclosure and respect for patients. If the role of the psychiatrist is made clear, and there are prohibitions against cruel, inhuman, or humiliating conditions, psychiatrists consulting to interviewers of detainees can adhere to general ethical principles. Enhanced gathering of information may assist in the pursuit of justice, identification of other dangerous individuals, or the curtailment of future acts against society.

Forensic psychiatrists routinely provide direct examination of individuals charged with crimes for purposes other than providing treatment (examples include assessing competency to stand trial and possible lack of criminal responsibility due to psychiatric illness). Psychiatrists also assist defense counsel in working with distrusting clients, prosecuting attorneys examining witnesses during trial and law enforcement or correctional authorities gathering information from suspects, crime witnesses, or prisoners with behavior problems. Suggestions for interviewers in these settings (or in the case of detained individuals) are similar in many ways to the supervision and training we provide to psychiatry residents and medical students as they develop their interviewing skills. These suggestions might include the pacing and phrasing of questions, observation of non-verbal cues provided by the person being questioned, selection of an alternative interviewer, and changing the length or frequency of interview sessions.

Very apprehensive that, notwithstanding the ad hoc committee's recommendation, the AΨA Assembly might persist in their efforts to amend the Position Statement (and thus create a dispute between the Assembly and Board of Trustees that would be very embarrassing for the AΨA), we urged Dr. Appelbaum to make a presentation to the Assembly when it took up the matter of the Position Statement again at its meeting on May 21, 2006 (A.L.H. Email to Paul Appelbaum 05/17/2006). Dr. Appelbaum, as noted above, had already agreed with our strong objections to the amended Position Statement, notwithstanding the position of his fellow "forensicists" in the Assembly (Paul Appelbaum Email to A.L.H. 12/08/2005). Accordingly, as a member of the Board of Trustees and designated to represent the Board, he addressed the Assembly and explained the reasons for the Board's Position Statement, emphasizing the facts that "interrogations are inherently deceptive/coercive, and hence inappropriate for physicians to be involved" and "involvement undercuts the physician's role as treater, because detainees are unlikely to trust physicians when they know that they or their colleagues participate in interrogations" l. This, apparently inadvertently overlooked by Dr. Appelbaum, negates his assertion, noted in "The Forensicist" section above, that "The forensic psychiatrist in truth does not act as a physician."

In the end, the Assembly, by a majority vote, approved the Board of Trustees' original Position Statement on Psychiatric Participation in Interrogation of Detainees, which became official AΨA policy as of May 21, 2006. (Some members of the Assembly and at least one military psychiatrist, although speaking in favor of the original Statement, urged the Assembly to somehow change the Statement to take into consideration the unique position the Statement imposes on those physicians assigned to assist interrogation personnel).

Conclusion

We believe that the AΨA Position Statement on Psychiatric Participation in Interrogation of Detainees does not justify the AΨA's presenting itself to the world as an organization adhering, in the matter of interrogation of detainees using techniques condemned by all civilized nations, more faithfully to principles of ethics than the APA. A relatively small number of psychologists and psychiatrists, no doubt, like forensicists, are convinced that they operate "outside the bounds of the doctor-patient relationship and [are] thus not required to abide by accepted ethical guidelines" [] and continue to participate in interrogation of prisoners in military and CIA detention centers. They do so in the belief that they are "doing their duty" to uncover terrorist threats against the United States, whether the interrogation procedures are "enhanced" or not, and that their presence at interrogations protects detainees from "drifting" of interrogators beyond authorized enhanced techniques []. There is no doubt that participation in interrogations of arrestees charged with crime in this country is a far more frequent occurrence. Here, their justification is, mistakenly, that, as "forensicist" psychiatrists and psychologists, they are expected to adhere to an ethics code that is different from the long-established codes of the AΨA [] and the APA [], respectively. In our view, these psychologists and psychiatrists, even when they (having been led to believe that the prisoners have vital information about planned terrorist attacks against the United States) are heavily involved in "enhanced" interrogation procedures that are clearly in violation of the Geneva Conventions and the laws of the United States, would not be subject to disciplinary action by an ethics committee. Given that they would have acted in compliance with what they believe was legally authorized by the President of the United States or the Secretary of Defense, no state licensing authority is likely to investigate such government-sanctioned participation in a time of war. Regardless of the differently worded position statements of the APA and AΨA, 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.

It is only by teaching medical students, residents in all medical specialties, and psychology trainees and interns about the ethics principles stemming from the Nuremberg trials [] and the Geneva Conventions [], together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively, that all physicians and psychologists will understand that they have an absolute moral obligation to "First, do no harm" []. It is a separate matter as to whether ongoing participation in interrogations by some psychologists and psychiatrists will result in professional sanction through official regulatory agencies or professional societies. Whether these psychologists and psychiatrists believe they are contributing to "national security" by their actions or whether or not they justify their actions by claims of Presidential approval, the damage to our professions remain the same: doctors are abusing their training in service to country at the expense of the interrogated individual. With further education and wider circulation of the Position Statements of the AΨA and APA, we may prevent the next generation of caregivers from continuing this disgraceful and unethical misapplication of medical and mental health knowledge.

Endnotes

a) We do not wish to cause any confusion with abbreviations, so we use the Greek character Psi (which is widely used to represent "Psychiatry") in our abbreviation for the American Psychiatric Association: "AΨA", and "APA" for the American Psychological Association.

b) The relevant part of the Statement is the third paragraph which reads as follows:

"3. No psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere. Direct participation includes being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees. However, psychiatrists may provide training to military or civilian investigative or law enforcement personnel on recognizing and responding to persons with mental illnesses, on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise."

c) Unfortunately, the strength of the Position Statement was significantly weakened when, immediately following the approval of the Statement by the Assembly on May 21, 2006, Steven S. Sharfstein, M.D., the then president of the AΨA, made comments in response to a reporter's questions, reported as follows: "Dr. Sharfstein acknowledged that psychiatrists in the military might have a conflict between obeying the AΨA's policy and following direct orders, noting the position statement is not 'an ethical rule.' 'Individual psychiatrists wouldn't get in trouble with the AΨA' for failing to follow the guidelines, he said. 'If they're given an Army order, that would be another question,' Dr. Sharfstein said. Currently, he said, there are only a 'few psychiatrists who are participating in the interrogations. That was not true in the past"' []. The impact of this comment is not lessened by a subsequent statement he is reported to have made following an announcement by the Defense Department that military psychiatrists were not "ordinarily" to be used as consultants to interrogators, "but may be so assigned" when psychologists are unavailable: "Those circumstances do not exempt that psychiatrist from AΨA's statement. There are no exceptions" []. Nevertheless, it remains abundantly clear that the need for involvement of psychiatrists in interrogations, as perceived by the Defense Department, trumps the prohibition by the AΨA Statement-and there are exceptions.

d) These protests have increased markedly to the point where a major challenge to the APA policy will take place at the August 2008 annual meeting in Boston [].

e) The APA Board of Directors arbitrarily approved the PENS recommendations without obtaining COR consent on the grounds that an "emergency" existed []. The Board of Trustees of the AΨA, on the other hand, referred its Position Statement to the Assembly and did not automatically declare it to be AΨA policy.

f) The relevant part of the amended Statement is the third paragraph, which reads as follows: "3. No psychiatrist should participate in or assist any coercive interrogation of persons held in custody by military or civilian authorities, whether in the United States or elsewhere. Nor should they provide information or advice to military or civilian investigative or law enforcement authorities regarding the likely medical consequences of specific coercive methods. For purposes of this statement coercive methods of interrogation include degradation, threats, isolation, imposition of fear, humiliation, sensory deprivation or excessive stimulation, sleep deprivation, exploitation of phobias, or intentional infliction of physical pain such as use of prolonged stress positions."

g) Although, as reported in The New York Times, waterboarding involves strapping a suspect in a board with feet elevated, covering his face with a cloth and pouring water on it to produce a feeling of suffocation (mock drowning) [], waterboarding is almost always referred to as "waterboarding" without any elaboration in the psychiatric and psychological literature. Christopher Hitchens gives a more vivid description [] after volunteering to go through the experience with a team of SERE veterans in North Carolina. He states, in part: "You may have read by now the official lie about this treatment, which is that it 'simulates' the feeling of drowning. This is not the case. You feel that you are drowning because you are drowning-or, rather, being drowned, albeit slowly and under controlled conditions and at the mercy (or otherwise) of those who are applying the pressure. The 'board' is the instrument, not the method. You are not being boarded. You are being watered. This was very rapidly brought home to me when, on top of the hood, which still admitted a few flashes of random and worrying strobe light to my vision, three layers of enveloping towels were added. In this pregnant darkness, head downward, I waited for a while until I abruptly felt a slow cascade of water going up my nose. Determined to resist if only for the honor of my navy ancestors who had so often been in peril on the sea, I held my breath for a while and then had to exhale and-as you might suspect-inhale in turn. The inhalation brought the damp cloths right against my nostrils, as if a huge, wet paw had been suddenly and annihilatingly clamped over my face. Unable to determine whether I was breathing in or not, and flooded more with sheer panic than mere water, I triggered the pre-arranged signal and felt the unbelievable relief of being pulled upright and having the soaking and stifling layers pulled off me." " [I]f," Hitchens adds, "waterboarding does not constitute torture, then there is no such thing as torture."

h) These techniques were based in large part on techniques of torture and cruelty used by the U.S. military in its Survival, Evasion, Resistance, and Escape (SERE) program. The SERE program, itself "based on Chinese techniques used in the 1950s that produced false confessions from American prisoners" [], was intended to train pilots, special forces, and other potential high-value captives against torture, should they be captured by a power that does not respect the Geneva Conventions [, ]. The SERE program "rests on the belief that inflicting a controlled level of pain and humiliation on those who might face it in combat would help them survive the real thing if they were captured. For the C.I.A. after 2001, SERE became not a tool for resisting torture, but a template for inflicting it-a template soon adopted by interrogators in the far-flung 'black sites' where detainees were imprisoned" [, ]. "Behavioral scientists" took part in the training of interrogators in the use of SERE "aggressive" techniques of interrogation [].

i) Later in 2002, the "Behavioral Science Consultation Team" (BSCT) was created at Guantánamo in order to develop new strategies for interrogation and assess intelligence production [, ]. The staff included a psychiatrist and a psychologist []. The "strategies" [], approved by Justice Department and National Security Council lawyers (and over the secret objections of every branch of the military services and the Federal Bureau of Investigation) had, for decades prior to 2002, been judged by the United States to be illegal torture [].

j) This opinion defining torture was ostensibly withdrawn two years later; however, a Justice Department spokesman has stated, according to an Associated Press report [], that "the conclusions of the opinion approving specific interrogation methods are still in force." That these methods continue to be used is, in fact, confirmed by the June 17, 2008, report of the Senate Armed Services Committee Hearing [].

k) This brings to mind the comment by George Annas []: "Bloche and Marks have reported, on the basis of their interviews with some of the physicians involved in interrogations at Guantánamo Bay and in Iraq, that the physicians believed 'that physicians serving in these roles do not act as physicians and are therefore not bound by patient-oriented ethics"' [].

l) Dr. Appelbaum's persuasive comments are noted in a memorandum to the Speaker just prior to the stormy session in the Assembly about the Position Statement: "Why should psychiatrists not advise interrogators on strategies to take with particular detainees? Interrogations, even when conducted legally, are inherently coercive and deceptive; coercive because a detainee who wanted to talk would not have to be interrogated; deceptive because interrogators are trained to mislead suspects and are supported by the law in doing so. The purpose of an interrogation is to pressure or trick the detainee into revealing information that the detainee does not want to disclose. These may be legitimate functions for law enforcement. But psychiatric ethics-even as applied in forensic evaluations, which may be the closest analogue-require us to obtain consent before questioning a person, and preclude our lying to them to obtain information. When forensic psychiatrists conduct an interview, the purpose is to assess the person's mental state. Here, however, the purpose of involvement is to extract information, and the psychiatrist's job is to guide interrogators in doing so. Having psychiatrists so closely allied with the policing function of the state threatens to compromise our healing mission. That most people consider this to be an inappropriate role for any physician seems apparent from the public reaction to recent allegations of physician involvement in interrogations. Our profession would be best served if we too recognized the inappropriateness of our playing this role." It is clear to the authors of this article that Dr. Appelbaum by his statement, particularly his reference to "the inappropriate role for any physician," has failed to see that, by extrapolation, his words can apply to the "forensicist." It is hoped that forensic psychiatrists will now understand that a special ethics code for forensic psychiatrists is unwarranted, and that they, along with all other psychiatrists, are honor bound to abide by The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.

Author information

Abraham L. Halpern M.D. is Emeritus Professor of Psychiatry at New York Medical College. He is a past president of both the American Academy of Psychiatry and the Law, and the International Academy of Law and Mental Health.

John H. Halpern M.D. is Assistant Professor of Psychiatry, Harvard Medical School; Director of the Laboratory for Integrative Psychiatry, Addictions Division, and Associate Director of Substance Abuse Research, Biological Psychiatry Laboratory, McLean Hospital.

Sean B. Doherty BSc. (Hons) is a fifth year medical student at Cardiff University (as part of the Swansea University GEP medicine course). He received the 2008 Royal College of Psychiatry Medical Elective Bursary, which helped fund his current two-month placement as a research assistant at the Laboratory of Integrative Psychiatry, Addictions Division, McLean Hospital, Belmont, MA.

Declarations

Competing interests

Authors' contributions

ALH conceived this paper's topic, and all authors participated in the coordination of reviewed materials and helped draft the manuscript. All authors read and approved the final manuscript.

The authors declare that they have no competing interests.

# data[].attributes.attachment_link.title
"Enhanced" interrogation of detainees: do psychologists and psychiatrists participate?

# data[].attributes.attachment_link.description
After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations.

# data[].attributes.headline
"Enhanced" interrogation of Detainees: Do Psychologists and Psychiatrists Participate?  (Academic Source #2)

# data[].attributes.subject
"Enhanced" interrogation of Detainees: Do Psychologists and Psychiatrists Participate?  (Academic Source #2)

# data[].attributes.body
This article focuses on the fact that some of the psychologists and psychiatrists who work for the C.I.A. are involved with torture. This is a major ethical dilemma.

# data[].attributes.headline
The Experiment (mht format in case the PDF does not work)

# data[].attributes.subject
The Experiment (mht format in case the PDF does not work)

# data[].attributes.body
This article talks about the experiments in Guantanamo Bay.  The article is a little bit old (2005), but shows some of the effects of torture.  This helps to explain the ethical issues the C.I.A. faces in reference to torture.

# data[].attributes.body
Obviously, Putin is not American, so it may not make sense that he is a stockholder for the C.I.A. There is much debate over Putin's role in getting Trump Elected. Russia ordered the hacks that favored Trump, U.S. Spies conclude. He relates to the C.I.A.'s ethical issue of spying.

# data[].attributes.body
Pompeo is Trump's new C.I.A. Director. He can certainly be considered a stakeholder in these ethical issues, because he will be deciding what the C.I.A. does about them.

# data[].attributes.body
Cheney was a former Vice President of the United States (during the George W. Bush Administration) He was responsible for initiating the Bush Administration waterboarding tactic. He was also partially responsible for illegally spying on innocent Americans.

# data[].attributes.body
Trump is the one who was saying he would bring back waterboarding, which makes him a very relevant stakeholder in this ethical issue.

# data[].attributes.headline
C.I.A. Torture breaks rule on human experimentation (News Article  #2)

# data[].attributes.subject
C.I.A. Torture breaks rule on human experimentation (News Article  #2)

# data[].attributes.attachment_link.readable_text
The Central Intelligence Agency had explicit guidelines for "human experimentation" - before, during and after its post-9/11 torture of terrorism detainees - that raise new questions about the limits on the agency's in-house and contracted medical research.

Sections of a previously classified CIA document, made public by the Guardian on Monday, empower the agency's director to "approve, modify, or disapprove all proposals pertaining to human subject research". The leeway provides the director, who has never in the agency's history been a medical doctor, with significant influence over limitations the US government sets to preserve safe, humane and ethical procedures on people.

CIA director George Tenet approved abusive interrogation techniques, including waterboarding, designed by CIA contractor psychologists. He further instructed the agency's health personnel to oversee the brutal interrogations - the beginning of years of controversy, still ongoing, about US torture as a violation of medical ethics.

But the revelation of the guidelines has prompted critics of CIA torture to question how the agency could have ever implemented what it calls "enhanced interrogation techniques" - despite apparently having rules against "research on human subjects" without their informed consent.

Indeed, despite the lurid name, doctors, human-rights workers and intelligence experts consulted by the Guardian said the agency's human-experimentation rules were consistent with responsible medical practices. The CIA, however, redacted one of the four subsections on human experimentation.

"The more words you have, the more you can twist them, but it's not a bad definition," said Scott Allen, an internist and medical adviser to Physicians for Human Rights.

The agency confirmed to the Guardian that the document was still in effect during the lifespan of the controversial rendition, detention and interrogation program.

After reviewing the document, one watchdog said the timeline suggested the CIA manipulated basic definitions of human experimentation to ensure the torture program proceeded.

"Crime one was torture. The second crime was research without consent in order to say it wasn't torture," said Nathaniel Raymond, a former war-crimes investigator with Physicians for Human Rights and now a researcher with Harvard University's Humanitarian Initiative.

Informed consent, the director and his 'human subject research' panel

Facebook Twitter Pinterest

The CIA director's powers over 'human subject research' have not been previously disclosed. Photograph: Guardian / via ACLU

The document containing the guidelines, dated 1987 but updated over the years and still in effect at the CIA, was obtained under the Freedom of Information Act by the ACLU and shared with the Guardian, which is publishing it for the first time.

The relevant section of the CIA document, "Law and Policy Governing the Conduct of Intelligence Agencies", instructs that the agency "shall not sponsor, contract for, or conduct research on human subjects" outside of instructions on responsible and humane medical practices set for the entire US government by its Department of Health and Human Services.

A keystone of those instructions, the document notes, is the "subject's informed consent".

That language echoes the public, if obscure, language of Executive Order 12333 - the seminal, Reagan-era document spelling out the powers and limitations of the intelligence agencies, including rules governing surveillance by the National Security Agency. But the discretion given to the CIA director to "approve, modify, or disapprove all proposals pertaining to human subject research" has not previously been public.

The entire 41-page CIA document exists to instruct the agency on what Executive Order 12333 permits and prohibits, after legislative action in the 1970s curbed intelligence powers in response to perceived abuses - including the CIA's old practice of experimenting on human beings through programs like the infamous MK-Ultra project, which, among other things, dosed unwitting participants with LSD as an experiment.

The previously unknown section of the guidelines empower the CIA director and an advisory board on "human subject research" to "evaluate all documentation and certifications pertaining to human research sponsored by, contracted for, or conducted by the CIA".

CIA doctors, waterboarding and blurred lines of policy

CIA doctors helped revive Abu Zubaydah, the first terrorism detainee known to be waterboarded in CIA custody. Photograph: AP

Experts assessing the document for the Guardian said the human-experimentation guidelines were critical to understanding the CIA's baseline view of the limits of its medical research - limits they said the agency and its medical personnel violated during its interrogations, detentions and renditions program after 9/11.

The presence of medical personnel during brutal interrogations of men like Abu Zubaydah, they said, was difficult to reconcile with both the CIA's internal requirement of "informed consent" on human experimentation subjects and responsible medical practices.

When Zubaydah, the first detainee known to be waterboarded in CIA custody, "became completely unresponsive, with bubbles rising through his open, full mouth", he was revived by CIA medical personnel - known as the Office of Medical Services (OMS) - according to a CIA account in the Senate intelligence committee's landmark torture report.

The OMS doctors were heavily involved in the torture of detainees in CIA custody. They advised interrogators on the physical and psychological administration of what the agency called "enhanced interrogation techniques". After observation, the doctors offered perspectives on calibrating them to specific detainees' resilience.

OMS staff assigned to the agency's black sites wrote emails with subject lines like: "Re: acceptable lower ambient temperatures".

The CIA, which does not formally concede that it tortured people, insists that the presence of medical personnel ensured its torture techniques were conducted according to medical rigor. Several instances in the Senate torture report, partially declassified six months ago, record unease among OMS staff with their role in interrogations.

There is a disconnect between the requirement of this regulation and the conduct of the interrogation program

Steven Aftergood, Federation of American Scientists

But other physicians and human rights experts who have long criticized the role of medical staff in torture said the extensive notes from CIA doctors on the interrogations - as they unfolded - brought OMS into the realm of human experimentation, particularly as they helped blur the lines between providing medical aid to detainees and keeping them capable of enduring further abusive interrogations.

Doctors take oaths to guarantee they inflict no harm on their patients.

Zubaydah "seems very resistant to the water board", an OMS official emailed in August 2002. "No useful information so far ... He did vomit a couple of times during the water board with some beans and rice. It's been 10 hours since he ate so this is surprising and disturbing. We plan to only feed Ensure for a while now. I'm head[ing] back for another water board session."

Doctors and intelligence experts said they could imagine legitimate, non-abusive CIA uses for human experimentation.

Steven Aftergood, a scholar of the intelligence agencies with the Federation of American Scientists, suggested that the agency might need to study polygraph effects on its agents; evaluate their performance under conditions of stress; or study physiological indicators of deception.

But all said that such examples of human experimentation would require something that the CIA never had during the interrogation program: the informed consent of its subjects.

"There is a disconnect between the requirement of this regulation and the conduct of the interrogation program," said Aftergood. "They do not represent consistent policy."

A director's decision, oversight and an evolving rulebook

Facebook Twitter Pinterest

George Tenet at the White House in 2003, after his historic approval of so-called 'enhanced interrogation techniques'. Photograph: Eric Draper/EPA

Months after Zubaydah's interrogation, Tenet issued formal guidance approving brutal interrogation techniques, including waterboarding. Tenet explicitly ordered medical staff to be present - a decision carrying the effect of having them extensively document and evaluate the torture sessions.

"[A]ppropriate medical or psychological personnel must be on site during all detainee interrogations employing Enhanced Techniques," Tenet wrote in January 2003. "In each case, the medical and psychological staff shall suspend the interrogation if they determine that significant and prolonged physical or mental injury, pain or suffering is likely to result if the interrogation is not suspended."

In response to the Guardian's questions about the newly disclosed document and its implications for the CIA's post-9/11 torture program, CIA spokesperson Ryan Trapani provided the following statement:

"CIA has had internal guidelines interpreting Executive Order 1233 in place continuously from 1987 to present. While some provisions in these guidelines have been amended since September 11, 2001, none of those amendments changed provisions governing human experimentation or were made in response to the detention and interrogation program."

Ironically, the only part of the CIA's torture program in which agency officials claimed they were hamstrung by prohibitions on human experimentation is when they were asked by Senate investigators if torture was effective.

Their response to an issue first raised by the agency's own inspector general a decade earlier was framed as an example of the agency respecting its own prohibition on human experimentation. As political pressure on the agency intensified last year, the CIA used it as a cudgel against the Senate report's extensive conclusions that the torture was ultimately worthless.

"[S]ystematic study over time of the effectiveness of the techniques would have been encumbered by a number of factors," the agency CIA told the Senate intelligence committee in June 2013. Among them: "Federal policy on the protection of human subjects."

Harvard's Raymond, using the agency's acronym for its "enhanced interrogation technique" euphemism, said the CIA must have known its guidelines on human experimentation ruled out its psychologist-designed brutal interrogations.

"If they were abiding by this policy when EIT came up, they wouldn't have been allowed to do it," Raymond said. "Anyone in good faith would have known that was human subject research."

This article was amended on 16 June 2015 to reflect a CIA response to the Senate intelligence committee, which had been misattributed as a CIA response to its inspector general.
Topics

# data[].attributes.attachment_link.title
CIA torture appears to have broken spy agency rule on human experimentation

# data[].attributes.attachment_link.description
The Central Intelligence Agency had explicit guidelines for "human experimentation" - before, during and after its post-9/11 torture of terrorism detainees - that raise new questions about the limits on the agency's in-house and contracted medical research.

# data[].attributes.attachment_link.title
Facebook CIA Project - The Onion News Network

# data[].attributes.body
This is a graph showing detainees held by the CIA and how many they used "Enhanced Interrogation techniques" on (Enhanced Interrogation Techniques is the same thing as torture.

# data[].attributes.headline
The C.I.A. is an Ethics-Free Zone (Blog Post Entry)

# data[].attributes.subject
The C.I.A. is an Ethics-Free Zone (Blog Post Entry)

# data[].attributes.attachment_link.readable_text
I joined the CIA in January 1990.

The CIA was vastly different back then from the agency that emerged in the days after the 9/11 attacks. And it was a far cry from the flawed and confused organization it is today.

One reason for those flaws - and for the convulsions the agency has experienced over the past decade and a half - is its utter lack of ethics in intelligence operations.

It's no secret that the CIA has gone through periods where violating U.S. law and basic ethics were standard operating procedure. During the Cold War, the agency assassinated foreign leaders, toppled governments, spied on American citizens, and conducted operations with no legal authority to do so. That's an historical fact.

I liked to think that things had changed by the time I worked there. CIA officers, I believed, were taught about legal limits to their operations - they learned what was and wasn't permitted by law.

I was wrong.

After 9/11, the CIA seemed to believe the rules of engagement had fundamentally changed. But when it came to prohibitions against torture, assassination, and other rights violations, they hadn't. We had to fight al-Qaeda, but we should have done it within the law.

All CIA officers should have been trained in carrying out intelligence operations ethically. That never happened - and today we can see the results.

Let's say you're a CIA officer and you've recruited an amazing source. Your source has direct access to the leadership of the Islamic State, and everything he's reported to you so far has checked out. You've vetted him, so you know he's telling you the truth about the details of his access.

One day you're meeting with him. He tells you that he's done everything you've asked and he feels that you "owe" him. He says that he wants a prostitute, and if you don't get him one, he's going to stop cooperating.

Would you?

Frankly, just about every case officer I've ever known would. But what if he asks you to get him a child prostitute? Would you do it?

The answer, clearly, ought to be no. But some case officers would. There's no training to say that they shouldn't. Instead, CIA officers are trained to violate the law. They're in a foreign country, after all, and they likely have diplomatic immunity. They don't care about local laws.

Want a real-life example?

Last December, the Senate Select Committee on Intelligence issued its report on the CIA torture program, which detailed gruesome and systemic human rights violations by agency employees. The CIA hadn't only tried to cover up its actions - it actually spied on the Senate's investigators, too.

The report concluded that these brutal tactics weren't even useful for gathering intelligence. But that's not the issue. The issue is that something about the CIA's culture, its collective mindset, allowed it to make a crime against humanity into policy. It's become an ethics-free zone.

Officers of the CIA, FBI, NSA, and other U.S. intelligence agencies are told to penetrate terrorist cells and prevent attacks against Americans. They're pressured to "go do it" or suffer the consequences. But no one's able or willing to tell them the rules.

That's what's wrong with the CIA today. And that's where the moral and ethical rebuilding of the organization should begin.

# data[].attributes.attachment_link.title
The CIA Is an Ethics-Free Zone - OtherWords

# data[].attributes.attachment_link.description
I joined the CIA in January 1990. The CIA was vastly different back then from the agency that emerged in the days after the 9/11 attacks. And it was a far cry from the flawed and confused organization it is today.

# data[].attributes.headline
Wyden Vs. CIA on nominee in reference to data collection and spying (News Article #1)

# data[].attributes.subject
Wyden Vs. CIA on nominee in reference to data collection and spying (News Article #1)

# data[].attributes.attachment_link.readable_text
Oregon Sen. Ron Wyden on Thursday heatedly questioned CIA director nominee Mike Pompeo, a Republican congressman from Kansas, about his support of widespread data collection on American citizens and the use of intelligence provided by foreign entities.

Wyden, a member of the Senate's intelligence committee known for championing privacy, said Pompeo, if confirmed, would face "an enormous challenge" pursuing "honorable policies" given statements made by President-elect Donald Trump.

Members of Trump's national security team "advocate illegal policies," Wyden, a Democrat, said during a confirmation hearing. He also said Trump has made statements supporting torture and Russian hacking of his political opponents.

Pompeo said in testimony he would act within the limits of the law. He said he would not use so-called enhanced interrogation techniques such as waterboarding if they are illegal, even if ordered by the president.

Asked about Russian intervention in the election, Pompeo said it's "pretty clear" that the foreign power was behind hacks of the Democratic National Committee, which he called an "aggressive action."

Wyden raised questions about an opinion piece written by Pompeo, in which he said Congress should establish new programs to collect "all metadata" on Americans -- including financial and lifestyle information.

Metadata is information that describes other, more detailed data, and can be used by intelligence officials to monitor someone's activities.

U.S. intelligence agencies have wielded broad metadata collection programs in the post-Sept. 11-era to gather information about millions of Americans through phone records. Those questionably legal efforts were scaled back after being made public in the press through documents leaked by former defense contractor Edward Snowden.

Wyden said Pompeo's plan is "far more sweeping" than anything ever considered by Congress and would get the nation "back into the business of collecting millions and millions of phone records on law-abiding people."

He asked if Pompeo envisions any limits on data sweeps, and Pompeo said "legal boundaries" already restrict such programs, though intelligence agencies have an obligation to monitor foreign targets.

Wyden interjected: "No Congressman -- that's not what you were talking about. You said collecting all metadata."

Pompeo said he intends to "keep Americans safe by conducting lawful intelligence collection," but acknowledged his metadata gathering plan would be "unlawful" today.

Still, Pompeo did not shy away from supporting anti-terrorism efforts that involve collecting data on Americans.

"If someone's out there on a Facebook page talking about an attack or plotting an attack against America, I think you would find the director of the CIA and the intelligence community grossly negligent if they didn't pursue that information," Pompeo said.

Wyden reacted with a raised voice: "Congressman, I don't take a back seat to anybody in terms of protecting this country when our security is on the line," he said.

Pompeo said he intended no disrespect, and that privacy protections are "incredibly important."

The conversation turned to encryption, which is technology that encodes information to prevent unauthorized access. Trump, the FBI and some members of Congress have called for giving the government a digital backdoor into encrypted communications.

Encryption is "a complicated issue," said Pompeo, who said he knows just enough about the technology to "begin to form judgments."

Wyden then asked Pompeo about foreign surveillance -- specifically what he would do if given information by a foreign government about Americans. Pompeo said the question is "complex" and noted that the U.S. government can't request surveillance from foreign countries.

"That's not the question," Wyden said. "The question is what happens if it's provided to you, especially since it's being encouraged" -- a seeming nod to Trump's comments encouraging Russia to hack into Democratic presidential rival Hillary Clinton's emails last year.

Pompeo said he would treat foreign-sourced intelligence as if it were gathered by U.S. agents, in accordance with his understanding of CIA rules.

-- Gordon Friedman

gfriedman@oregonian.com; 503-221-8209
@gordonrfriedman

# data[].attributes.attachment_link.title
Wyden spars with CIA nominee Pompeo over data collection, foreign spying during confirmation hearing

# data[].attributes.attachment_link.description
Oregon Sen. Ron Wyden on Thursday heatedly questioned CIA director nominee Mike Pompeo, a Republican congressman from Kansas, about his support of widespread data collection on American citizens and the use of intelligence provided by foreign entities.

# data[].attributes.headline
The Lingering stench of Torture Op-ed piece #2

# data[].attributes.subject
The Lingering stench of Torture Op-ed piece #2

# data[].attributes.attachment_link.readable_text
Let the record show that these claims are misleading in the extreme.

The most prominent test case where a single terrorist suspect was interrogated using both the F.B.I.'s traditional approach and the C.I.A.'s enhanced techniques was Abu Zubaydah, the first high-value Qaeda operative captured after Sept. 11. Held at a C.I.A. secret "black site" prison, Mr. Zubaydah, who was badly wounded during his capture in Pakistan, was initially interrogated by a two-man F.B.I. team consisting of Special Agents Steve Gaudin and Ali Soufan. They went well beyond "tea and sympathy," to the point of reading the suspect passages from the Quran as he hovered close to death. By building a rapport with the suspect and painstakingly breaking down his cover story, the agents learned for the first time from Mr. Zubaydah that the mastermind of the 9/11 attacks was Khalid Shaikh Mohammed. They also extracted the potentially critical intelligence that an American Qaeda operative, Jose Padilla, was plotting to explode a radiological "dirty bomb" inside the United States.

Later the C.I.A. took over the interrogation, and for the first time a prisoner was subjected to the regime of "learned helplessness." The methods included sleep deprivation, hard slaps, stress positions, prolonged confinement in coffin-like containers and more than 80 rounds of mock drowning. The torment so profoundly disturbed C.I.A. personnel that some were "to the point of tears and choking up," as a team member wrote in an email published in a 2014 report by the Senate Select Committee on Intelligence. At the end of it, Mr. Zubaydah was indeed a broken man, but he had surrendered no more actionable intelligence.

In an Orwellian twist, Mr. Mitchell and Mr. Jessen concluded that their experiment had succeeded because it proved that Mr. Zubaydah could not possibly have any additional intelligence to surrender. In a later brief to the president, senior C.I.A. officials summarized some of the "key intelligence" gleaned from Mr. Zubaydah as information identifying Khalid Shaikh Mohammed as the mastermind of 9/11, and the terrorist suspect Jose Padilla, both of whom were later captured. No mention was made that the critical intelligence was gleaned by F.B.I. agents without using torture.

By that point the F.B.I. had wisely distanced itself from the C.I.A.'s interrogation program. The bureau sent profilers from its Behavioral Analysis Unit to interview failed suicide bombers in Afghanistan to better understand their motivations and psychology. Armed with those insights, and using its traditional approach, the bureau gleaned important intelligence from the would-be New York subway bomber Najibullah Zazi; the would-be Times Square bomber Faisal Shahzad; and the "underwear bomber" Umar Farouk Abdulmutallab, who wanted to bring down a Northwest Airlines flight over Detroit.

In calling for a return to waterboarding, Mr. Trump was playing to the crowd. A Reuters/Ipsos poll conducted last year found that nearly two-thirds of Americans believe that torture of terrorism suspects can be justified. But a number of Mr. Trump's cabinet nominees have recently made clear they disagree, including his pick for secretary of defense, Gen. James Mattis; for C.I.A. director, Representative Mike Pompeo; for attorney general, Senator Jeff Sessions; and for secretary of state, Rex Tillerson.

# data[].attributes.attachment_link.title
Opinion | The Lingering Stench of Torture

# data[].attributes.attachment_link.description
Let the record show that these claims are misleading in the extreme. The most prominent test case where a single terrorist suspect was interrogated using both the F.B.I.'s traditional approach and the C.I.A.'s enhanced techniques was Abu Zubaydah, the first high-value Qaeda operative captured after Sept. 11. Held at a C.I.A.

# data[].attributes.headline
C.I.A. Doctors, Ethics, and Torture Op-ed piece #1

# data[].attributes.subject
C.I.A. Doctors, Ethics, and Torture Op-ed piece #1

# data[].attributes.attachment_link.readable_text
Re " When Doctors First Do Harm " (Op-Ed, Nov. 23):

M. Gregg Bloche quotes memos from the Central Intelligence Agency's Office of Medical Services that made clear what was expected of its doctors at clandestine interrogation sites: to flout medical ethics by deceiving and brutalizing detainees and generally collaborating in abuse that included designing a waterboarding method more extreme than the one condoned by lawyers in the George W. Bush administration.

That is, engineering and participating in torture was expected behavior for C.I.A. doctors. There was thus created what can be called a malignant normality in a subculture of torturers.

For me this is reminiscent of Nazi doctors, whose more vast and systematic participation in torture and murder I studied some decades ago. The doctors in charge of the gas chambers in Auschwitz had not killed anyone before their assignment to that death camp. They, too, had been socialized to a subculture of killing in what was also a manifestation of the normalization of evil.

President-elect Donald Trump has advocated waterboarding and other forms of torture, but you report ( front page, Nov. 29) that if he seeks to resume it, he would meet with resistance from within the C.I.A., and especially from its medical professionals.

In a democracy we are able to carry out what Dr. Bloche rightly asks for: "an independent inquiry into what those physicians did and how they lost their ethical moorings." Such an inquiry could go far toward reasserting humane medical principles as well as acknowledging and rejecting the malignant normality that can prevail when condoned from above and hidden from ordinary citizens.

ROBERT JAY LIFTON

New York

The writer, a psychiatrist, is the author of " The Nazi Doctors: Medical Killing and the Psychology of Genocide."
To the Editor:
No physician or other medical professional should be allowed to use his or her education, training and professional status to cooperate in the torture or improper treatment of prisoners.

The states that license medical professionals should bar them from participating in torture or improper treatment of prisoners.

Widely accepted principles of medical ethics - from the World Health Organization, the United Nations, the American Medical Association and others - ban such conduct. The law needs to enforce it.

Dr. M. Gregg Bloche is right that "C.I.A. doctors may be America's last defense against a return to savagery." I believe that there would be much less abuse of prisoners if even a few physicians said, "Sorry, sir; I could lose my license if I do that." As President-elect Donald Trump talks about resuming the use of torture, this is especially important.

RICHARD N. GOTTFRIED

New York
The writer, chairman of the New York Assembly health committee, is the sponsor of A. 4489, to prohibit physicians and other medical professionals licensed in New York from participating in torture or improper treatment of a prisoner.
A version of this article appears in print on , on Page A22 of the New York edition with the headline: C.I.A. Doctors, Ethics and Torture. Order Reprints | Today's Paper | Subscribe

# data[].attributes.attachment_link.title
Opinion | C.I.A. Doctors, Ethics and Torture

# data[].attributes.attachment_link.description
Re " When Doctors First Do Harm " (Op-Ed, Nov. 23): M. Gregg Bloche quotes memos from the Central Intelligence Agency's Office of Medical Services that made clear what was expected of its doctors at clandestine interrogation sites: to flout medical ethics by deceiving and brutalizing detainees and generally collaborating in abuse that included designing a waterboarding method more extreme than the one condoned by lawyers in the George W.

# data[].attributes.headline
Waterboarding Issue Political cartoon #2

# data[].attributes.subject
Waterboarding Issue Political cartoon #2

# data[].attributes.body
This cartoon shows Cheney, who supports waterboarding and other forms of torture. He thinks they are terrific, but there is a major ethical issue here.

# data[].attributes.headline
Waterboarding issue Political Cartoon #1

# data[].attributes.subject
Waterboarding issue Political Cartoon #1

# data[].attributes.body
This cartoon is pointing out that the police are supposedly misbehaving, when in reality the government is (possibly) going to be in charge of waterboarding.