Former APA President Paul Appelbaum, M.D., urges the Assembly to endorse
an APA position statement on psychiatric participation in detainee
interrogations, while Joseph Berger, M.D., of the Ontario District Branch
waits his turn to speak. See article below. David Hathcox
After an extended and often impassioned debate at its May meeting in
Toronto, the Assembly passed an APA position statement dealing with
psychiatrists' participation in interrogation of detainees held in either
military or civilian detention. The Board of Trustees endorsed the position
statement at its meeting later that day, so it is now official APA policy.
The statement also reiterates APA's position that psychiatrists"
should not participate in, or otherwise assist or facilitate, the
commission of torture of any person" and should report any instances of
torture they learn have occurred or are being planned (see page 10). There was
no disagreement among Board or Assembly members about this part of the
The Board had endorsed a statement addressing torture and interrogations at
its October 2005 meeting, but in November 2005 Assembly members approved a
statement whose wording differed on key points related to the interrogation
limits, with a majority of the Assembly favoring less-restrictive limits on
psychiatrists' involvement in interrogations. One major difference was that
the while the Board's statement said that psychiatrists should not take part
in "interrogation of persons held in custody by military or civilian
investigative or law-enforcement authorities....," the Assembly added
wording to ban participation only in "coercive"
The Board, however, reaffirmed its version in December 2005, prompting APA
President Steven Sharfstein, M.D., to appoint a small work group to develop
wording on which the two governing bodies were likely to agree.
The revised wording was presented to the Assembly in May. With 66.4 percent
of votes in favor, 30.2 percent opposed, and 3.4 percent abstaining, the
Assembly endorsed the statement with the following wording:
"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
One noncontroversial part of the statement emphasized that psychiatrists
should not disclose any part of a medical record "or any information
derived from the treatment relationship" to people conducting detainee
During the Assembly debate last month, several members, including Thomas
Grieger, M.D., representative of the Society of Uniformed Services
Psychiatrists (an APA district branch for members in the military), urged the
Assembly to delete part of a sentence that described what "direct
participation" in interrogations entails, including being present during
the interview and "advising authorities on the use of specific
techniques of interrogation." Grieger, who was a member of the work
group appointed by Sharfstein, was concerned that the wording provides
unnecessary restrictions on psychiatrists' ability to advise officials on
noncoercive interviewing techniques that could be effective in eliciting
information from certain detainees. Greiger told Psychiatric News
that he sees a legitimate role for psychiatrists in "suggesting
approaches to conducting interviews." Among the examples he cited were"
using a different interviewer, asking more open-ended questions, [and]
opening sessions with periods of rapport building." He likened such
activities to what forensic psychiatrists do and noted that their goal is
mainly to identify "other potentially dangerous individuals who are not
Barry Perlman, M.D., who has been the Area 2 representative to the
Assembly for the last four years, is the first recipient of the Ronald A.
Shellow Award. The award is named for a former speaker and longtime member of
the Assembly who died in 2004. Perlman was honored for his contributions to
the Assembly during his 18 years as a delegate. David Hathcox
Agreeing with Grieger was Joseph Berger, M.D., a representative of the
Ontario District Branch, who indicated that he has two daughters and six
grandchildren living in Israel, where the threat of terrorism in constant. He
insisted that he would want psychiatrists to be able "to do anything if
it prevents terrorists from killing innocent people."
Former APA President Paul Appelbaum, M.D., chair of the joint
Board-Assembly work group, pointed out that psychiatrists in forensic and
other roles often perform nonclinical tasks, but the difference between those
and interrogating detainees is that in the former instances the person being
questioned understands the psychiatrist's role, and the interaction is neither
coercive nor deceptive. The purpose of forensic evaluations is "to
assess the person's mental state."
"Interrogations, even when conducted legally, are inherently coercive
and deceptive," Appelbaum said in a memo to Assembly Speaker Joseph
Rubin. They are "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 the
interrogation is to pressure or trick the detainee into revealing information
the detainee does not want to disclose."
Evan Eyler, M.D., the Area 1 ECP representative, urged her colleagues to
support the revised wording, saying that while the wording may not seem ideal
to some members of the Assembly, APA should not delay even further in adopting
an official position on this critical topic. "I am most proud of APA
when it tackles difficult issues," Eyler stated.
In his address to the Assembly's opening session, Sharfstein stressed that"
our ethics as physicians require us to obtain consent" before
meeting with someone in a professional capacity. He added that "policing
functions belong to the state, not to physicians."
In other actions the Assembly voted to
Assembly member and SAMHSA senior medical advisor Anita Everett, M.D.
(center), stands with the four Iraqi psychiatrists she invited to attend the
Assembly and annual meeting in Toronto. They are (from left) Muhamed Lafta,
M.D., Maiia Abas, M.D., Ali Obeed, M.D., and Waeel Hikmit, M.D. David
The Assembly also heard a discussion by AMA Trustee Ronald Davis, M.D., of
issues on that organization's health care advocacy agenda, most of which
parallel those of APA. The AMA's top legislative priority, he said, is medical
liability reform. Also high on the agenda are reforming the Medicare physician
payment system so it reflects practice costs and inflation, expanding health
care coverage for the uninsured and increasing access to care, and
improvements in patient safety and quality of care. Davis is a candidate for
president-elect of the AMA.
A summary of actions from the May Assembly meeting is posted in the
Members Corner section of APA's Web site at<www.psych.org/members.index.cfm>
under "Assembly." ▪