Notably, the Hoffman report reveals that “deceptively crafted and permissive ethics policies facilitated the active involvement of psychologists in abusive and torturous interrogations of prisoners at Guantanamo and other secret CIA ‘black sites.’”The report also shows “how easy it was for the APA officials to jettison the ‘do no harm’ moral rule to conform to the Department of Defense (DOD) interrogation practices.” 

What the APA does next is critical not just to psychology as a profession trusted by the public, but also to the mental health profession as a whole. I am a philosopher, not a psychologist, but for a brief time I was a public member of the APA’s Ethics Committee. I believe now (and believed then) that the APA must affirm its commitment to respect human rights and human dignity. It should also inform its members that violation of human rights and dignity will not be tolerated, and that sanctions will be applied. This proposition does not rest on instinct, emotion, fear, personal gain, risk/benefit assessment, or public relations, but on the recognition that all humans possess intrinsic and incomparable worth and dignity that is unconditional and nonnegotiable.

A look back at the roots of psychology is helpful for understanding, at least partially, why the psychological association waited so long to ban its members from participating in torture, as well as for recommending how the psychological association can repair professional and public trust.

In the Hippocratic moral tradition, the” do no harm” ethics rule is at the core of medical practice and the foundation of medical ethics. It is also the main reason why the American Psychiatric Association has long told its members they should not be involved in torture, or in cruel, inhuman and degrading treatment of detainees. In Hippocratic moral philosophy, there could be no ethically justifiable deliberation over whether to engage in abusive interrogations of human detainees. The “do no harm” rule applies to all humans. Unlike physician-psychiatrists, psychologists do not traditionally pledge allegiance to Hippocratic moral ideals. Psychology, once a branch of philosophy, has long sought to be distinct from philosophy and become an independent scientific discipline in its own right.

Tension developed between psychologists who thought that philosophy was necessary to attach human values to their work, and those who wanted nothing to do with philosophy. This tension was felt early on, at the very first meeting of psychologists who, in 1892, founded the APA. The proposed solution was either to create a separate “section” in the association to accommodate the “philosophically inclined psychologists” or to eject them from the association altogether. (The conflict was practically, but not philosophically, resolved when philosophers created their own association). By the beginning of the 20^thcentury psychology began operating as an independent scientific discipline, adopting various models for understanding the brain-mind function, and devising various experimental approaches to test, explore, analyze, and measure mental processes that might inform human behaviors.

Independence from philosophy, although beneficial to modern psychologists, also has a cost. Humans are unlike any other animals. Their singularity resides in the indivisible union of the body and the mind, or the “thinking soul.” Animal models, may be useful for testing various biological and physiological hypotheses, but are almost useless to give values to facts. For this, philosophy is necessary. To paraphrase Immanuel Kant, facts without meanings are empty, and meanings without values are blind.

The Hoffman report highlights the ongoing and unresolved dispute about whether CIA contract-psychologists should have applied to prisoners the concept of “learned helplessness” derived from experiments on dogs. “Learned helplessness” is a phenomenon which demonstrates that manipulation of dogs’ environment can cause dogs to give up trying to adjust to environmental changes and to protect themselves from assaults, and thus to become completely helpless. Applying this technique to CIA-held prisoners ended up to treating humans no better than dogs.

Humans are “special” animals because they alone possess dignity, which is the foundation of human rights and at the core of medical ethics. Notably, as a matter of both ethics and international law, humans cannot be treated like animals, in an “inhuman,” undignified, degrading and cruel manner. Moral rules based on human rights principles are necessary to prevent dehumanizing human beings. Had the psychologists attached values (other than scientific) to raw facts they would have recognized that putting humans in “helpless” condition for any reason is unethical and a violation of human rights and human dignity. As French physician-philosopher Georges Canguilhem noted decades ago, a moral philosophy having at its core respect for human dignity is what psychology needs.

At the very least, in addition to repudiating human rights violations, the APA leadership should apologize publically to the victims of its misguided and pernicious ethics policies and ask for forgiveness for the harm it caused.  The apology, in the form of public admission of wrongdoings, can set the stage for changes in the APA’s culture.  At this crossroads, if the APA adopts a philosophy based on universally accepted human rights principles and enforces a dignity-based ethics, it can put psychology back on the right track. But if it still chooses to pay lip service to medical ethics and human dignity, as it has done since 9/11, it will further damage the profession and be unworthy of the public trust.

Evelyne Shuster is the former hospital ethicist at the Philadelphia Veterans Affairs Medical Center and founder and first chair of the Philadelphia VA Institutional Ethics Committee.

Posted by Susan Gilbert at 09/28/2015 11:56:44 AM |