Monday, July 30, 2007
Psychologists: The shocking link between prescriptive authority and torture
During the 2007 legislative session Hawaii psychologists came as close as they ever have to attaining prescriptive authority--which has been a national as well as Hawaii battle for many years. The legislature passed a bill which was vetoed by the governor. Whew! How close can you get?
Hawaii may have been a pawn in a huge quid pro quo between the military and psychologists. Details of a strong linkage between the CIA, the military and psychologists is just coming out now.
During the session I was troubled by several things, but could not put them together. Thanks to a Vanity Fair article just out--The War on Terror: Rorschach and Awe and today's Democracy Now! program, the link I was searching for is now complete. And I hope legislators will read about the push for prescriptive authority, the American Psychological Association's refusal to ban complicity in military torture, and the participation of psychologists themselves in acts of torture.
It seems that some of the same people pushing for prescriptive authority are the ones involved in interrogation and torture. Prescriptive authority may be a quid pro quo.
Previous Disappeared News articles related to the psychologist bill:
March 13, 2006: Disappearing Doctors: Hawaii looks for quick but questionable fixes
April 5, 2007: Bad, bad day for sunshine at the Legislature
April 9, 2007: No reply from Senate President Hanabusa on resurrection of psychologist bill
June 6, 2007: Hawaii and Guantanamo -- combat zones for psychologists' wars
Many things troubled me about the prescriptive authority bill. A few:
- Particularly for older folks, psychologists haven't a clue about how psychoactive drugs interact with geriatric medications and side effects, and nothing in their proposed training would prepare them to treat the special needs of senior citizens
- One testifier claimed that in 10,000 psychologist prescriptions there was not a single problem (rough paraphrase) which is ridiculous but was never challenged
- The claims that the DOD program was successful and that Hawaii's program was essentially the same (it isn't)
- My belief that while prescriptive authority would enrich Hawaii psychologist it would put the nail in the coffin for a solution to our problem of attracting psychiatrists to rural areas (psychiatry is one of several medical specialties in short supply on the Neighbor Islands)
- How it was pushed by a legislative insider, a hired gun
- The bill imposed a restricted formulary, assuring that anyone treated by prescribing psychologists would be receiving second-class treatment
At the same time, I was aware that the American Psychiatric Association banned psychiatrists from participating in any program of torture, but the American Psychological Association refused to do the same. I smelled a link between the two issues but could not find anything. If there was one, it would cast a dark shadow on the motives and ethics of those pushing for prescriptive authority for psychologists in Hawaii and elsewhere.
Now the link has been discovered. And it's a good reason for Hawaii to swear off any future participation in this program if we have any concern that the United States is becoming a nation known for torturing innocent civilians in violation of international human rights covenants that our country is party to. According to the article, "psychologists weren't merely complicit in America's aggressive new interrogation regime. Psychologists, working in secrecy, had actually designed the tactics and trained interrogators in them while on contract to the C.I.A."
More from the Vanity Fair article by investigative reporter Katherine Eban:
Both army leaders and military psychologists say that psychologists help to make interrogations "safe, legal and effective." But last fall, a psychologist named Jean Maria Arrigo came to see me with a disturbing claim about the American Psychological Association, her profession's 148,000-member trade group. Arrigo had sat on a specially convened A.P.A. task force that, in July 2005, had ruled that psychologists could assist in military interrogations, despite angry objections from many in the profession. The task force also determined that, in cases where international human-rights law conflicts with U.S. law, psychologists could defer to the much looser U.S. standards—what Arrigo called the "Rumsfeld definition" of humane treatment.
Arrigo and several others with her, including a representative from Physicians for Human Rights, had come to believe that the task force had been rigged—stacked with military members (6 of the 10 had ties to the armed services), monitored by observers with undisclosed conflicts of interest, and programmed to reach preordained conclusions.
One theory was that the A.P.A. had given its stamp of approval to military interrogations as part of a quid pro quo. In exchange, they suspected, the Pentagon was working to allow psychologists—who, unlike psychiatrists, are not medical doctors—to prescribe medication, dramatically increasing their income. (The military has championed modern-day psychology since World War II, and continues to be one of the largest single employers of psychologists through its network of veterans' hospitals. It also funded a prescription-drug training program for military psychologists in the early 90s.)
Amy Goodman interviewed Brad Olson, Assistant Research Professor at Northwestern University and a founding member of the Coalition for an Ethical APA:
AMY GOODMAN: Why is the APA so closely tied to the military and military intelligence? What is the history of this relationship?
BRAD OLSON: Well, I mean, the history certainly goes way, way back. I mean, certainly in -- you know, some people might question the morality of any wars, but certainly some people would argue that World War II, that psychologists really were -- really created some effective means and techniques to do some positive things, although that -- there's also a great history of that being very sordid and sinister and harmful, which is exactly why we need to stick to our ethics code. But, I mean, now it’s a question, why -- where are the ties? I mean, some people argue that this has a lot to do with our competition with psychiatry, psychologists' competition with psychiatrists.
AMY GOODMAN: And now that the APA has refused, has said that they won't be involved with military interrogations -- that’s the American Psychiatric Association -- the APA can take over and play a greater role?
BRAD OLSON: You know, that’s one possibility. Other people argue --
AMY GOODMAN: What about the use of --
BRAD OLSON: -- that there’s this issue of psychopharmacology. Should psychologists -- I mean, that’s the main distinction between psychologists and psychiatrists, or one of them, and that’s that psychiatrists can prescribe. So, there is a big movement within psychology, so to make it so that psychologists have prescriptive authority. And Walter Reed, the Department of Defense, set up the pilot program that essentially put -- that gave psychologists the foot in the door to start prescribing. And, in fact, some of these psychologists are the very -- the “Biscuit” psychologists are the ones who are -- have been part of this prescriptive authority program. But there’s all sorts of different reasons, and some people argue that it has to do with appropriations and funding for research and just all sorts of possible connections.
AMY GOODMAN: Explain, Katherine Eban, who the “Biscuits” are. And this is very interesting, this idea that the military might be the path through which psychologists can be able to prescribe drugs.
KATHERINE EBAN: The “Biscuits” -- it’s an acronym for the Behavioral Science Consultation Team.
AMY GOODMAN: BSCT.
KATHERINE EBAN: BSCT. And what happened at Guantanamo -- I mean, the “Biscuits” have been a focus of the ire of some psychologists who oppose involvement in interrogation by their profession. But initially the BSCT teams were a tool of those who were pursuing rapport-based interrogation methods.
I describe Colonel Brittain Mallow, who was initially in charge of trying to investigate who at Guantanamo should be prosecuted or not. And he foresaw -- he has an advanced degree in Middle East studies -- he foresaw that there would be a tremendous cultural divide. So his group, the Criminal Investigative Task Force, reached out to Dr. Michael Gelles, who is a psychologist who was also a member of the APA task force, the PENS task force, and he set up a group of psychologists who would act as cultural advisors and advise on ways to bridge the cultural divide and employ rapport-building techniques in interrogations.
Well, what happened was, as Mitchell and Jessen's tactics were promulgated throughout the system, it was like a sort of gravy train. It was the new hot idea to bring psychologists into the interrogation booth. So the head of the Joint Task Force Guantanamo, which was the main arm of the Defense Department to extract intelligence from detainees, said, “I want my own psychologists, so I’m going to go set up my own BSCT team, and I’m going to pull psychologists who are involved in clinical care at Guantanamo and put them into these behavioral science consultation teams.” So, basically, something that started out as a good idea to advance rapport-building methods in interrogations turned into a tool to use coercive tactics.
Prescriptive authority requires legislation at the state level. 48 states do not allow psychologists to prescribe. Hawaii looked like a ripe target. With a critical shortage of rural medical specialists and no sign that solutions such as increasing insurance company reimbursements in rural areas would soon be implemented, granting psychologists prescriptive authority looked like a cheap way out. Nevermind that children and senior citizens would lose big time due to their special needs.
If Hawaii caved in, another state might follow, and then another. We would become part of the larger plan, the quid pro quo.
Now we know more about the military and psychologists. We don't have to buy into their plans.
this is one of the most far-fetched conspiracy fantasies i have ever read. i am a health professional in hawaii ---------- and the department of defense was not related in ANY WAY even as lobbyist for the promotion of prescriptive authority for psychologists.
rather, if you held any sort of professional medical degree you would realize the argument was about EDUCATION - psychiatrists have a curriculum that includes are far more intense pharmacology study.
in the specific instance of hawaii's hope to grant prescriptive authority to psychologists, the bill included language that psychologists could NOT be given prescriptive authority until 4 years of psychiatric pharmacology, or equivalent, was obtained.
hawaii's most rural islands in are incredibly underserved for its community's need. on kauai, 70,000 people are here, with an average of 43% diagnosed depressive issues, there are currently seven psychiatrists and NONE NONE NONE of those seven are currently taking new patients.
this means that a person with a diagnosed depression or other psychiatric issue (schizophrenia, bipolar,psychosis - serious issues) have NO access to a health professional who can manage their necessary medications. MOST, 90%+, of family practice and internists will NOT manage the care of more serious psychiatric disorders. they are not trained in this speciality and do not feel comfortable with handling the care of a patient that needs this type of intense psychiatric care.
the same would be true of any specialists' care: FP and Internal Medicine doctors will generally refer out patients who need endocrinology, neurological, boint and joint, cancer care, etc.
IN THE CASE OF THIS SPECIFIC BILL: the intent was to provide psychologists with prescriptive authority in order to serve the population of individuals with more complicated mental concerns. psychologists are properly trained to diagnose such illnesses, but cannot prescribe a medicine for a patient. therefore, once a patient as been diagnosed as psychotic, for example, the psychologist has no choice but refer the patient to a psychiatrist. and the issue with that is - THERE ARE NO PSYCHIATRISTS ON THIS ISLAND WHO ARE ACCEPTING NEW PATIENTS. therefore they do not get the proper medical care they need.
while it is possible to fly to a neigboring island such as oahu, it is not that simple. over 70% of the population on rural islands have no insurance whatsoever, or at most, are participants in the state's QUEST program which does not cover interisland flights for referrals, much less psychitric care.
get your head out of the sand and learn the FACTS before you whip together such foolishness.
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