In the olden days, samurai warriors who disgraced the bushido (their code of conduct) fell on their swords in order to regain their honor. They could either do it of their own volition or be forced to at the behest of their fellow members or their leader. Fortunately, we no longer require death in order for erring people to cleanse their sins but perhaps it is time to revisit the consequences of failure toward our own bushido. For psychologists, that is our Code of Ethics.
One of the first things I learned in graduate school was ethics. Since the way in which mental health professionals conduct ourselves undergirds our very profession and the trust the general public has in us, it is of the utmost importance. While other healthcare professionals deal with the physical, we are the only ones dealing with people’s minds, emotions, and relationships. This can be heady stuff because these are the most important factors in people’s lives.
In addition, many of us operate with a severe disparity in power. People tell us their deepest and darkest secrets while we are relative mysteries. People come to us for help while we are supposed to provide answers. Our patients are in pain, so they look to us for guidance in observing strengths, patterns and possibilities and then they hope – many of them desperately – that we can lead them toward a path of healing. Not only is this a huge responsibility but it also comes with temptations to use undue influence or capitalize on vulnerability.
That is why the American Psychological Association (APA) developed a Code of Ethics that has a number of ethical rules that we are supposed to follow. And when I say a number, I mean a LOT. In fact, I wouldn’t be surprised if mental health professionals have the most numerous and detailed ethical rules of any profession. While there are a lot of ethical rules (and they change every so often), when in doubt we are supposed to follow our number one rule: non-maleficence which is Latin for “do no harm.” That is the one rule we all know, the one rule that supersedes all others. I believed that rule to be sacrosanct because, unlike many of the other ethical rules, this one has very little gray in it. Most of us can agree whether or not harm has been done.
That is why I was so upset when I heard that the torture inflicted on prisoners at Abu Ghraib and Guantanamo Bay was devised by psychologists. Apparently, shortly after 9/11, APA’s leadership tried to turn behavioral scientists into key players in U.S. counterterrorism and counterintelligence activities. Among other things, this led to psychologist Dr. John Leso being sent to Guantanamo to lead a new Behavioral Science Consultation Team (BSCT). This team designed and participated in abusive and torturous interrogations. While other mental healthcare professions refused to participate because of their ethical principles, APA not only seemed to find no problems with it but actively promoted and sought opportunities for psychologists within national security programs.
Once the psychological abuses came to light however, APA made a show of caring about it. They created a task force to address the controversy. Instead of following their own rules about independent review though, they stacked the task force with people who had conflicts of interest and allowed several high ranking members of APA and government agencies to participate in the process. As a result, it should come as no surprise that the task force concluded that it was ethical for psychologists to serve as consultants to interrogations and in related national security roles. APA did later issue formal resolutions condemning torture. They also promised to take decisive action against psychologists who committed ethical violations. But they haven’t.
A formal complaint was lodged against Dr. Leso and allowed to remain open for years. In an unprecedented move, the case was recently closed before the ethics committee was allowed to review and resolve the case. Because of the classified nature of the issue, the ethics office chose to rely upon information provided by unnamed individuals who had access to classified material. It was determined that Dr. Leso’s participation in the torture program was moderated by the fact that he did not volunteer for the assignment, he was an early-career psychologist and he reportedly expressed unease for his task. Oh, okay then. I think those justifications worked for the defendants at the Nuremberg trials too (they didn’t).
This is the problem: either we have a Code of Ethics that means something or we don’t. How can we possibly punish psychologists for record-keeping violations, dual roles or even consensual sex with patients (a strict no-no) if someone who engages in TORTURE is allowed to go free without any kind of censure? How can the public trust psychologists to act ethically if our biggest rule can be broken repeatedly for years without any consequences? How can we have confidence in our professional leadership if we know that they are willing to violate our principles? These are the reasons why samurai were required to fall on their swords. The public could not trust them to do the right thing if they weren’t willing to stand up (or fall down as it were) for their beliefs.
And that is why we need some sword falling by the people involved. When Dr. Leso, the other members of the BSCT and the APA leadership decided to break our biggest ethical principle, they hurt all psychologists. No other mental health professionals were involved. They all opted out leaving psychologists as the only profession that chose to dance with the devil. Many of us protested. A lot of members left APA and vowed not to return until they changed their policy. It did no good. Instead, APA’s leadership rushed forward to align with evil rather than serve the public trust. As such, if we are to regain our ethical standing, if we want people to know that we are committed to being good and positive influences, then swords need to be sharpened and used. Like the samurai of old, our good mental as a profession depends upon it.