Reflections on the APA Scandal

Last Friday, James Risen published an article describing an independent investigation of the American Psychological Association (APA) by a team of lawyers at Sidley Austin, headed by former prosecutor David Hoffman. The APA commissioned Sidley to investigate the conduct of its own leadership in connection with the role of psychologists in the torture of detainees. To put it mildly, the Hoffman Report is damning. It provides a detailed account of something unparalleled: the corruption of an esteemed professional organization through coziness with the government, when the government has decided to torture.

This is different from the much-discussed role of the "torture lawyers," which was bad enough. Here, the issue is a major organization engaging in a decade of duplicity to permit its members to participate in abusive interrogations while seeming to forbid it. For those of us who have long argued that the torture debate should focus on torture's corrupting effect on real institutions rather than on imaginary ticking bombs, seeing it in action is a bitter vindication.

An episode from the Hoffman Report provides a window into the problem.

A Moment of Moral Insanity

The Report describes a by-invitation-only "Ethics and National Security Forum" that APA organized in 2004. Participants included APA staff and "representatives of the FBI, CIA, and DoD." The APA's ethics director, lawyer-psychologist Stephen Behnke, hoped to discuss a vexed question: the "goodness of fit" between the organization's ethics code and "the situations with which many professionals struggle during their practice in national security settings" (p. 200). Much of the discussion indeed revolved around this issue (p. 201). A CIA psychologist complained that

"the current [ethics] code does not apply at all [to] the national security investigation situations--it's not mental health we're concerned with, but national security; we are supposed to exploit and manipulate the interrogatees to gain crucial information." He later emphasized that "beyond [torture], we have no ethical duty to the interrogatee" (p. 201).

Some might think that if bedrock ethical principles like "do no harm" prohibit participating in coercive interrogations, psychologists should comply, rather than retooling their principle. That is not how the group saw matters:

Some participants raised the idea of "relative ethics," such that there was a "continuum of coercion from benign to not at all benign, depending on how high the stakes are." Shumate invoked the "ticking bomb scenario," and queried how the ethics standards applied in practice "in the context of competing duties and oaths," such as the oath to protect and defend. Behnke seemed to agree with this "relativist" position, stating that "there are exceptions to each rule in the code, where some other value or goal trumps another" (p. 202).

But it seems that not all rules have exceptions:

Another consistent concern was the lack of empirical data available to assess risk, and the inability to conduct the necessary research because it would be unethical (p. 202).

A remarkable conclusion: Studying the risks abusive interrogation tactics pose to detainees would be unethical. Devising the tactics would not.

This is a moment of moral insanity. The organization has turned ethics upside down.

A lot has been written about the panic among national security officials in the summer of 2002, when the possibility of an anniversary attack by Al Qaeda seemed very real. It was at that point that DOJ's Office of Legal Counsel produced the first torture memos, and the torture program began. (Later, OLC's director Stephen Bradbury would appeal to post-9/11 panic to excuse the excesses of several legal opinions from that time period.)

But the APA "ethics" forum was not in the summer of 2002. It took place in July 2004, mere weeks after the Abu Ghraib revelations and the leak of the original torture memo. In other words, just at a moment of national soul-searching about torture, the APA's ethics director was guiding a conversation about "the risk ... that mental health professionals will stay away from this work, out of a concern of exposing themselves to legal and ethical liability" (p. 200). Instead of asking whether to put the brakes on psychologist participation, the aim was to explore "how APA ... can serve as a resource for psychologists and mental health professionals who participate in these investigations" (p. 198). Even in the wake of Abu Ghraib, APA still hoped to be an enabler.

The Ethics Director and the Presidents

The Report portrays Behnke, the APA's ethics director, as the impresario of the organization's campaign to depict itself as a human rights champion, while quietly permitting its members to engage in coercive interrogations and shielding them from ethics complaints. The APA presidency is a one-year position; Behnke was the institutional memory. His triple status as psychologist, lawyer, and ethics expert positioned him to write interrogation-friendly rules that only looked like real prohibitions:

[T]he key APA official who drafted the report (the APA Ethics Director) intentionally crafted ethics guidelines that were high-level and non-specific so as to not restrict the flexibility of DoD in this regard, and proposed key language that was either drafted by DoD officials or was carefully constructed not to conflict with DoD policies or policy goals (p. 12).

One key maneuver was to build permissive U.S. legal definitions into ethics prohibitions. Another was to fend off requests for concrete guidance by promising that the rules and the APA's ethics report (the so-called PENS report) would soon be followed by a casebook, which in fact would never be written. Behnke was also instrumental in ensuring that the PENS Task Force would be stacked with DOD-friendly members; and he played a large role in APA's media strategy, described by Hoffman this way:

[the APA would] emphasize that PENS said that psychologists could not engage in torture or cruel, inhuman or degrading treatment and claim PENS as a strong, pro-human-rights document. The principal purpose of PENS--to state that psychologists could in fact engage in interrogations consistent with the Ethics Code--was relegated to the sidelines.... And of course, the principal motivation for Behnke and other APA officials in drafting PENS the way they did--pleasing DoD--remained fully concealed (pp. 320-21).

But Behnke did not act alone, and the Hoffman Report features a bewilderingly large cast of characters. Notably, some APA presidents and past presidents were fully on board with the agenda. In 2002, former president Joseph Matarrazo approached one psychologist who would later serve on the PENS Task Force and said, "In this environment, things are different, and the CIA is going to need some help. Things may get harsh. We may need to take the gloves off" (p. 160); Matarrazo also advised a CIA psychologist that sleep deprivation by itself is not torture.

The 2005 president, Ronald Levant, features prominently in the Hoffman Report. And Gerald Koocher, 2006 APA president, played a larger and more disturbing role on several issues. One was the processing of ethics complaints against psychologists involved in enhanced interrogations.

In an email exchange ..., Koocher pointedly suggested that APA would never be able to obtain any "hard data" about whether psychologists were committing abuses at Guantanamo Bay, and therefore as a matter of strategy, APA should simply continue to issue public statements saying it was "concerned" and would look into the matter as soon as such hard data became available (knowing that it never would). Behnke responded that he agreed.... Koocher responded, "Right! We should probably simply [r]epeat same until 'evidence' of anything becomes public in 2055" (p. 216).

Another important issue that confronted the APA is whether its ethics standards should incorporate international law, including Common Article 3 of the Geneva Conventions, the Convention Against Torture, and human rights standards. DoD members of the PENS committee vehemently opposed it (see pp. 174-77 of the Hoffman Report). Koocher's reaction, in an email to a private listserv, was blistering. "I have zero interest in entangling APA with the nebulous, toothless, contradictory, and obfuscatory treaties that comprise 'international law'" (p. 326). (In another email, Koocher confessed to being addicted to the TV show 24, "in which non-psychologist terrorist hunter Jack Bauer routinely inflicts painful injury on suspects as he attempts to stop a terrorist caused nuclear disaster.")

Koocher's low point was his effort to silence the most vocally dissenting PENS committee members, Jean Maria Arrigo. After she appeared on Democracy Now! he publicly dismissed her objections as symptoms of her own "troubled upbringing" and the trauma of her father's purported suicide (pp. 25, 267, 342-43). The Hoffman Report comments:

Koocher was incorrect in his letter when he stated that Arrigo's father had committed suicide. Arrigo's father was alive during the time of PENS. Koocher has insisted that Arrigo lied during the meeting about this fact, and Arrigo has insisted she never stated her father was deceased or that he committed suicide.

Our interviews on this issue strongly support Arrigo's position (p. 343).

Among his other credentials, Koocher is the founder and editor of the journal Ethics and Behavior.

This was not the only APA attack on critics. Stephen Soldz and Steven Reizner are psychologists who for the past decade have spearheaded the national effort to remove psychologists from abusive national security interrogations. In comments they delivered last summer to the APA's Board about the Hoffman Report, they highlighted "the vicious personal attacks upon PENS Task Force member and national hero Jean Maria Arrigo," but added:

Other critics have been banned from state psychological association listservs; been attacked by an APA president in the official Monitor on Psychology as "opportunistic commentators masquerading as scholars;" been threatened with possible libel suits and ethics complaints; been disinvited from speaking to and writing for state psychological associations; been surreptitiously recorded by APA staff when having a private conversation with reporters; had venues where they were speaking criticized and even implicitly threatened with loss of accreditation; and called "clowns" in a national psychological newspaper by an individual given numerous awards by APA and its divisions and who is often in APA governance. ... These actions were all undertaken against those who sought to uncover the collusion that was denied by Association leadership, including this Board and the current CEO only a few months ago.

What Went Wrong?

Given the large cast of characters, it would be facile to suppose the APA's massive institutional failure was the handiwork of a few bad apples. Facile, and very likely unfair. I've heard Behnke, for instance, described as morally aware, idealistic, and fully cognizant of the post-Nuremberg literature on the cooptation of health professionals--at least before he was hired at the APA in 2000. (In the wake of the Hoffman Report, Behnke has resigned.) And while some might slap their heads to learn that Koocher founded an ethics journal (my own first reaction was "nfw!"), nobody takes on such editorial burdens without a genuine concern about ethics.

Can the descent of the organization be explained by individual conflicts of interest? The Hoffman Report, and media coverage, highlights conflicts involving Matarrazo, Behnke, and an APA Practice Directorate chief. With due respect, I think this is a minor issue. It is inconceivable that things would have gone differently at APA if those conflicts of interest didn't exist. The individual conflicts of interest are revealing, to be sure: the fact that no one in the APA appeared to be concerned about them speaks volumes about how uncritical the officials had become about the organization's relationship with DoD. But the conflicts came as a result of compromised ethics--they were not its cause. To repeat: individual sin is real, but it is not the most important problem with the APA. That problem is institutional. As Soldz and Reizner emphasize:

This years-long collusion was accompanied by false statements from every Board and every elected President over the last decade denying the existence of the collusion described in such detail by Mr. Hoffman.

At the heart of the problem is an institutional conflict of interest, which the Hoffman Report describes succinctly: "In some ways, DoD is like a rich, powerful uncle to APA, helping it in important ways throughout APA's life" (p. 72). A large APA constituency works, directly or indirectly, for DoD. And DoD has conferred benefits on APA members, most notably by granting APA members prescription-writing privileges within DoD and in other locales, crucial in competing with psychiatrists. The Hoffman Report doubts the prescription privilege was a key financial issue in 2005 (see p. 69). But the bare fact that DoD had been the organization's patron at one crucial juncture meant that every top official in APA had a mandate to make sure the relationship was a smooth one.

This was less a function of APA seeking something concrete with regard to a specific contract or program (like prescription privileges), but more a function of APA knowing very concretely how willing and able DoD was to provide large-scale support to psychology as a profession--now and perhaps in the future in unknown ways (p. 69).

APA is a professional guild. Like all professional guilds, it exists to enhance the incomes and prestige of its members. It shouldn't surprise us to read this:

[then-APA President] Levant told Sidley that a goal of his trip to Guantanamo Bay in October 2005 ... was to give a good impression of psychology to DoD officials, which aided his long-term goal of expanding the scope of psychology (233).

Exactly.

There is nothing inherently wrong with a guild acting to advance the interests of its members--including by developing relationships with government agencies. The problem, however, was that the virtually uniform, unswerving devotion to this aspect of the organization's mission demagnetized the moral compass of virtually all APA officials--including those whose jobs were to ensure ethical conduct, even when it might mean fewer professional opportunities for the membership. This makes the moral clarity of psychologists like Arrigo, Soldz, Reizner, Steven Miles, Ken Pope, and others too numerous to name all the more remarkable.

Why This, Why Now?

The APA has issued a public apology:

The actions, policies and the lack of independence from government influence described in the Hoffman report represented a failure to live up to our core values. We profoundly regret, and apologize for, the behavior and the consequences that ensued. Our members, our profession and our organization expected, and deserved, better.

It promises to take action to right itself. Yet there is reason to be skeptical. The same document speaks of "deeply disturbing findings that reveal previously unknown and troubling instances of collusion."

Previously unknown to whom? Not to the APA itself--the whole point of the report is that countless officials, including the Presidents, were very self-conscious about what they were doing. Unknown to the current Board members? In fact, nearly everything in the Report that matters has been known for years. The role of psychologists in torture was reported by Jonathan Marks and my Georgetown colleague Gregg Bloche in 2005, and independently a few days later by Jane Mayer. Further light was shed by Mark Benjamin in 2006 and by Katherine Eban and Benjamin in 2007. Arrigo revealed the APA machinations in her 2007 appearance on Democracy Now! and Bloche exposed them in detail in The Hippocratic Myth (2011). By the time of Risen's 2014 Pay Any Price, APA Board members and officials must have been alone in their ignorance - alone in being shocked, deeply shocked to discover that gambling is going on in this establishment.

As recently as last fall, APA was still trying to "refute" Risen. The reforms it now promises are weaker than those recommended by Soldz and Reizner - and they don't begin to tackle the fundamental problem of how to get the organization out from under the sway of its rich, powerful uncle. As for the tragic way a decade's worth of leaders lost their moral compass - well, that is a question psychologists could shed some light on.