The nation's leading organization of psychiatrists says the Pentagon has reneged on an agreement not to use psychiatrists in interrogations of detainees at Guantanamo and other detention sites.
In a letter to Defense Secretary Robert Gates, Dr. Nada L. Stotland, president of the American Psychiatric Association, says, "The use of psychiatrists to aid in interrogations is a serious violation of medical ethics and should be discontinued."
A Pentagon spokeswoman said the Pentagon's rules on the use of psychiatrists, psychologists and other "behavioral science consultants" does not violate professional ethical guidelines set out by the APA and other organizations.
Psychologists and psychiatrists have been involved in the interrogation of detainees for years. Their participation has generated strong feelings among mental health professionals, lawyers and ethicists.
The controversy is coming to a head. Last week, the American Psychological Association also weighed in on the issue, announcing the results of an unprecedented referendum on the issue: Nearly 60 percent of voting members said psychologists should not serve at detention centers at all. The only exceptions are psychologists who work directly for a detainee or a humanitarian agency.
The issue is whether it's ethically proper for mental health professionals, who vow to do no harm, to be instruments of interrogation.
Neither professional group can tell the Pentagon what to do. And the only direct power the associations have over psychiatrists and psychologists lies in being able to kick them out if they violate policies. But professionals' livelihoods could be in jeopardy if state licensure boards were to find they violated ethical rules.
The American Psychiatric Association's policy stems from a visit Dr. Steven Sharfstein made to Guantanamo in October 2005, when he was president of the group.
Sharfstein says he was disturbed to see what mental health professionals actually did there. He says they were advising interrogators as detainees were being questioned.
"They had headsets and microphones, and would be talking to (interrogators) as the interrogators were talking to the detainees," Sharfstein says. "I just had lots of problems with the whole process."
When he got home, Sharfstein resolved to get his association to oppose psychiatrists' participation in interrogations. After a contentious debate, the association adopted that policy in 2006.
The association's current president, Stotland, says the group thought it had an understanding with the Pentagon back then that it would stop using psychiatrists in interrogations. Then she read the Sept. 11 edition of the New England Journal of Medicine.
It contained a report by ethicists Jonathan Marks and Gregg Bloche, who obtained Pentagon documents through the federal Freedom of Information Act. The documents showed that the Army has continued to train some psychiatrists as behavioral science consultants.
The researchers also obtained — and the New England Journal published — a 26-page Army policy memo that states, among other things, that behavioral consultants are expected to do psychological profiles of detainees and identify their vulnerabilities as interrogations proceed.
"It's not the role of psychiatrists to figure out people's weaknesses and try to prey on them," Stotland says.
She complained to Gates in the letter she sent Sept. 12. "Both the American Psychiatric Association and the American Medical Association have taken official positions opposing the participation of psychiatrists in interrogation," she wrote. "We understood that the U.S. military had acknowledged those policies. Has the military's position changed?"
In an interview with NPR, Stotland says the controversy is not "just about a rule."
"This is about the soul of a psychiatrist, which is to be dedicated to helping people and healing people," she says. "And in order to do that, we need to get and we need to deserve their trust."
Gates has not yet replied, but a Pentagon spokesman says a response will be forthcoming.
Military officials say people have misconceptions about the way interrogations are currently done.
Col. Elspeth Cameron Ritchie, a psychiatrist with the Army, says that at the beginning of the war on terror, there was misunderstanding of "what the rules were" for interrogations. "We don't try to defend (that)," she says.
But abusive interrogations are in the past, military officials say.
"Interrogations are not abusive," says Dr. Jack Smith, who works in the Office of the Assistant Secretary of Defense for Health Affairs. "Anyone reading what's been published in magazines and even some medical journals would begin to feel that, by definition, interrogation is abuse. And I think that is not correct."
Pentagon officials say the presence of psychologists and psychiatrists prevent what they call "behavioral drift" — the erosion of ethical norms that they say can spiral into a situation like Abu Ghraib, the prison in Iraq where detainees were abused by some U.S. troops.
Ritchie says the Army did not consider the psychiatric association's 2006 policy statement to be an ethical guideline.
"We appreciate their position, and we've listened to it and discussed it intensively," she says. "But it is important to remember that information obtained from interrogation has been used, for example, to discover weapons caches in Iraq, and therefore has saved the lives of both Americans and Iraqis."
The new challenges to the participation of psychologists and psychiatrists in military interrogations may have consequences.
"If they took these position statements seriously, they would have to stop using psychologists and psychiatrists as advisers on individual interrogations," says Marks, a Pennsylvania State University lawyer-ethicist who co-wrote the New England Journal article.
"They would have to go back to the drawing board and seriously consider how they're going to conduct interrogations," Marks adds.
In fact, military officials are going back to the drawing board. The Army's 2006 policy memo on the role of "behavioral consultants" expires Oct. 20. Ritchie says work has begun on a new policy. She says it will take the current controversy into account.