As part of our report, we posted a listserv of internal e-mails between staff of the American Psychological Association and members of its Psychological Ethics and National Security task force. (Read the entire listserv here.) That listserv offers a rare look into a process that led to the adoption of an influential and controversial policy for the world’s largest professional organization of psychologists, which represents the profession of psychology in the United States. It also provides a window into a heated discussion among medical professionals grappling with their ethical obligations and their possible complicity in torture.

The task force was set up after news reports suggested that psychologists and other health professionals had been complicit with abuse of detainees in Iraq, Afghanistan and Guantánamo Bay, for example by sharing information about psychological vulnerabilities with interrogators. The group’s charge was to examine the ethical dimensions of psychologists’ involvement in “national security investigations” and consider whether the APA should develop policies to guide psychologists involved in those activities. The task force produced a 12-page report stating that the APA’s ethics code prohibited torture, obligated psychologists to report any instances to appropriate authorities, and banned psychologists from using healthcare information in ways that could harm detainees.

But it also gave psychologists an ethical blessing to continue consulting in national security-related interrogations. An organization of psychiatrists, in contrast, decided its physician members should not participate. In response, the Department of Defense changed its guidance to state that psychologists, but no longer psychiatrists, should participate in so-called Behavioral Science Consultation Teams or “BSCTs” (pronounced “biscuits”), which assist interrogators in prisons in Iraq, Afghanistan and in Guantánamo Bay, Cuba.

After the report was issued, the APA task force itself became a target for criticism, when it was revealed that some members had consulted on interrogations at Guantánamo and Abu Ghraib, trained other psychologists to do so, or worked within chains of command that authorized the very practices the task force was established to consider (six of the nine voting members were members of or had consulted for the military or intelligence agencies).

The e-mail traffic on the APA task force listserv forms a dense but riveting narrative. Task-force member Mike Gelles, then-chief psychologist for the Naval Criminal Investigative Service, who had opposed plans for the abusive interrogation of Mohammed al-Khatani, kicked off the substantive discussion on April 23, 2005, the day after the listserv was created. He forwarded a message he had written to APA ethics head Stephen Behnke.

“DOD [the Department of Defense] is trying to update current policy on interrogation,” Gelles wrote. “I think based on the GTMO [Guantánamo Bay] experience putting mental [h]ealth care professionals in the role of having to consult on interrogations when their training and role is to treat patients puts them in an untenable position.”

Col. Louie M. Banks, also a task-force member, pointed out that psychologists who support interrogations do not provide mental healthcare to detainees, “thereby preventing ‘doubling’ of their roles.” Banks was the leading psychologist for the Army’s Special Operations Command as well as the “Survival, Evasion, Resistance, Escape” (SERE) program. SERE exposes U.S. soldiers to a controlled program of harsh treatment in order to help them develop the ability to resist interrogations if they are captured by enemies that torture. SERE techniques, including waterboarding, were famously “reverse-engineered” and used by U.S. personnel during interrogations on detainees in the Bush administration’s global war on terror, a process Salon and other publications showed was led by psychologists.

“It is my opinion that when psychologists are involved in supporting interrogation and detainee operations, these operations are much more likely to be safe, legal, ethical, and effective,” Banks, who was in charge of training and overseeing BSCT psychologists, wrote on May 19, 2005. “I am very confident that my psychologists provide a very effective safety mechanism during these operations. I also believe that we provide a significant assist in making the process more productive, based on our knowledge of human behavior.”

Three days later, Jean Maria Arrigo, a specialist in the ethics of intelligence gathering, posed what seemed like a central question. “Should the APA declare the contribution of psychologists to coercive interrogation incompatible with the ethical obligations of the profession?” she asked. Those ethics include “beneficence” and “nonmaleficence” — the duty to bring benefit to patients and not to harm them.

The answer from her colleagues, it seemed, was no. None of Arrigo’s fellow task-force members wrote back to say yes. Some took issue with the question itself. “This question is worded in the affirmative that DOD/Military psychologists have done something illegal, morally wrong and/or unethical,” Col. Larry James, who had worked as a BSCT in Guantánamo and Abu Ghraib, wrote on May 23. “Like Morgan Banks, I am very proud of the fact, it was psychologists who fixed the problems and not caused it.”

The 10-member task force met in Washington, D.C., from June 24-26, 2005, two months after the listserv was initiated, and parted in apparent harmony. “I hope to continue our friendship and collaboration,” Banks wrote the day the meeting ended. The task-force report was drafted quickly by ethics head Behnke, presented to the APA board the day after the meeting, and adopted as official APA policy with only minor changes. The 11-page report reaffirmed the APA’s position that there was no role for psychologists to be involved in “torture or other cruel, inhuman, or degrading treatment,” but that it was “consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national security-related purposes.”

That led to an unexpected flood of public criticism. “APA members who have been in touch with me have expressed major disappointment,” task-force member Nina Thomas, a psychoanalyst who had worked with war victims, wrote on July 8, 2005. She shared excerpts of an e-mail from another listserv that criticized the task-force report for offering psychologists “much wiggle room” to “do whatever they see as indicated by concerns of national security.”

Tensions rose. “I do not think that we should now begin to second-guess ourselves,” Olivia Moorehead-Slaughter, the task-force chairperson, wrote on July 9, 2005.

A July 28, 2005, New York Times article showing that lawyers had stood up against harsh interrogation techniques led Thomas to lament, “reading it made me all the more sad that Mike Wessells, Jean Maria and I were not more successful at arguing our case for a more stringent standard for holding psychologists to account.”

Moorehead-Slaughter reminded her colleagues that the group had discussed including human rights standards in their report, but had concluded that “including such standards in the document would likely (perhaps definitely) put the document at odds with United States law and military regulations,” she wrote on July 29, 2005. “[T]he military would simply have ignored the document — thus, the community that we would most want to reach would have been prevented from using the report.”

Thomas wrote back to disagree. “(I)t has been the military’s own lawyers, indeed their highest ranking lawyers who have argued for the importance of using international human rights standards as the benchmark.” [Emphasis in original.]

Koocher, the incoming APA president, supported the task force’s decision to leave international standards out of their document. “I have zero interest in entangling APA with the nebulous, toothless, contradictory, and obfuscatory treaties that comprise ‘international law,’” he wrote on July 30. “Rather, I prefer to see APA take principled stands on policy issued where psychology has some scientific basis for doing so.”

The U.S. military apparently appreciated the report. Banks wrote on Aug. 12 to say that he, James and another psychologist had found it “a solid anchor” in an eight-hour meeting with the Army’s surgeon general that hammered out “the doctrinal guidelines and training model for psychologists” who support interrogations.

In January 2006, Moorehead-Slaughter discussed the group’s next assignment from the APA, the preparation of a book of case examples and commentary to demonstrate how the report’s statements should be applied.

Jean Maria Arrigo thought that the cases would reveal that the pressures of the prison environment rather than a psychologist’s own moral principles would govern his or her actions during interrogations. “I think the model of the morally autonomous psychologist in the U.S. detention center … will fade as soon as realistic cases are examined,” she wrote on Feb. 12, 2006.

“I must confess that I do not know what ‘morally autonomous’ means,” task-force member Capt. Bryce LeFever, a Navy special forces psychologist who had consulted on interrogation techniques in Afghanistan in 2002, replied.

“The ability to make moral decisions independently,” Arrigo responded.

“Moral behavior is never ‘autonomous.’ It is always connected to the community,” LeFever countered. “If there were, in the immediate environment, pressures on me to behave contrary to my sworn codes — I can do my utmost to resist those and behave morally. This takes courage. Some call it moral courage.”

The prospect that the group would be able to produce a casebook began to look unlikely. “All of my examples and commentary are classified, and cannot be shared outside of the DoD community,” Banks wrote on Jan. 25, 2006.

The beginning of the end of the listserv was signaled by a message from Mike Wessels, a task-force member who specialized in the psychological effects of armed conflict on children, on Jan. 15, 2006. “Out of ethical concerns, I have decided to step down from the PENS Task Force because continuing work with the Task Force tacitly legitimates the wider silence and inaction of the APA on the crucial issues at hand,” Wessels wrote. He had hoped for “a ringing condemnation of psychologists’ participation not only in torture but in all forms of cruel, inhumane and degrading treatment of detainees, including the use or support of tactics such as sleep deprivation.”

In February, Koocher, the new APA president, announced that the task force had ceased to exist when he took office on Jan. 1. This made Wessels’ resignation moot. Shortly thereafter, the listserv went silent.

The new information re-opens a number of questions that have tugged at the conscience of a whole profession since the Sept. 11 attacks. Is it possible for psychologists to uphold the ethical tenets of their profession while working within a system of interrogation that violates those tenets? If not, then should the psychologists, however well-meaning, be held to account for their possible role in torture? Does it matter if they raised objections to the system of interrogation but cooperated with it anyway?

The moral dilemma is encapsulated in the experiences of a psychiatrist and psychologist who worked at the U.S. military prison at Guantánamo Bay, Cuba. According to the Senate report, in an Oct. 2, 2002, memo they prepared a list of harsh interrogation techniques that ended up influencing interrogation policy not only at Guantánamo, but also in Afghanistan and Iraq. In the same memo, they warned that these methods were likely to result in inaccurate tips and could harm detainees. Those warnings disappeared as the memo moved up the chain of command.

Psychiatrist Maj. Paul Burney, psychologist John Leso and a psychiatric technician had been sent to Guantánamo in June 2002 with a combat stress control company. The three had expected to help U.S. soldiers cope with their extremely stressful deployments, but were “hijacked and immediately in processed into Joint Task Force 170, the military intelligence command on the island,” Burney told Senate investigators.

The three were instructed to form a Behavioral Science Consultation Team (BSCT) and help ramp up intelligence collection at Guantánamo. But they lacked training in how to support interrogations, and there was no standard operating procedure in place to guide their work. “Nobody really knew what we were supposed to do,” Burney told Senate investigators.

Burney did not respond to two phone calls and an e-mail message, and Leso — whose name is blacked out in the Senate committee’s final report, but is present in supporting documents released by the committee in December 2008 — did not respond to a phone message. ProPublica did, however, speak with Leso’s former boss at Walter Reed Army Medical Center, Col. Larry C. James, who was then psychology chief at the medical center.

In 2004, James would serve as an Army psychiatrist at Abu Ghraib, dispatched there to study what had produced its prisoner treatment scandal; he wrote a 2008 book about his experiences called “Fixing Hell.” James told ProPublica that Leso contacted him from Guantánamo in June 2002, not long after arriving, upset about what he was being asked to do and seeking guidance. After Leso contacted him seeking help, James sought his own guidance from Col. Louie “Morgan” Banks, chief of the Psychological Applications Directorate at the U.S. Army’s Special Operations Command. James said he turned to Banks because he had pioneered a specialty within the Department of Defense that was akin to how civilian psychologists assist police in solving crimes, and he was one of the few military psychologists with high-level security clearance.

By the time James turned to Banks, Banks was already deeply involved in supporting post-9/11 combat operations. He spent the winter of 2001 at Bagram airbase in Afghanistan at a time when some of the earliest interrogations were occurring.

The Senate report says that when James contacted him in 2002, Banks was the chief psychologist for the SERE program, which uses tough but carefully controlled interrogation techniques — including slapping students, pushing them into walls, forcing them to hold uncomfortable positions, and, in some schools at that time, waterboarding — to train American personnel to resist interrogations that violate the laws of war. Banks’ job had been to use his psychological expertise to prepare soldiers to deal with torture, but some psychologists, with the encouragement of the Bush administration, were already using that type of expertise to help inform interrogation techniques.

In December 2001, the Department of Defense General Counsel’s Office had asked SERE’s overseer, the Joint Personnel Recovery Agency (JPRA), for information on detainee “exploitation.” Two psychologists, retired Air Force SERE psychologist Dr. James Mitchell and then-senior JPRA SERE psychologist Dr. John “Bruce” Jessen, led the effort to put the JPRA’s expertise to use in intelligence gathering, according to interviews by the Senate committee and news reports, including Salon. (Mitchell and Jessen declined our request to speak with them.)

In a climate of post-9/11 fear, as hundreds of prisoners from a culture poorly understood by Americans were detained, the Senate report makes clear that the two psychologists and some JPRA officers saw both a need and an opportunity to promote their expertise. In early 2002, the JPRA, which had “no training or experience in intelligence collection,” the Senate report said, ran “crash” courses on interrogations for intelligence personnel rotating into the field, likely including CIA interrogators.

According to a JPRA memo describing the courses, which reads like a sales pitch for the agency (“JPRA has arguably developed into the DoD’s experts on exploitation”) and was released in part by the Senate committee, the courses trained interrogators to use the SERE school techniques. The memo stated that SERE techniques including physical (e.g., slapping, repeatedly pushing subjects into a wall, waterboarding, shaking and manhandling) and psychological (e.g., isolation, sensory deprivation, “disruption of sleep and biorhythms”) pressures “may be very effective in inducing learned helplessness and breaking the [Afghan] detainees’ willingness to resist.”

On July 15, 2002, after James had contacted Banks for guidance vis-à-vis the military’s interrogation program at Guantánamo, Banks let the behavioral science team at Guantánamo know by e-mail that the JPRA was willing to modify its interrogation training sessions for the BSCT team. (Though other individuals associated with SERE had already become involved in the Bush administration’s interrogation program, we do not know what practices Banks had been involved in prior to this e-mail.) The BSCT and several Guantánamo interrogators flew to Fort Bragg for a four-day session in mid-September 2002 co-hosted by Banks.

Days after the team returned to Guantánamo, senior lawyers for the Bush administration and the CIA visited the prison. BSCT psychiatrist Burney told the Army investigator general in 2006, four years later, that he believed there was “a lot of pressure to use more coercive techniques” because prisoners were resisting interrogators and “we were not being successful at establishing a link between Al Qaeda and Iraq.”

Shortly after the administration lawyers visited Gitmo, the camp’s director of intelligence asked the BSCT to draft an interrogation policy that could be sent up the chain of command. According to the Senate report, Burney and “the BSCT psychologist,” Leso, wrote their memo listing interrogation techniques in a single evening, devising some techniques and incorporating others that they had learned from their Fort Bragg training.

The Oct. 2, 2002, memo, which the Senate report quoted from but didn’t publish, mentioned manipulating the detention environment to create dependence and disorientation and promote intelligence gathering. Resistant detainees might be allowed only four hours of sleep per night, subjected to noise as a psychological pressure tactic, and deprived of sheets and blankets, with access to Qurans controlled by interrogators, the authors suggested.

Three categories of interrogation techniques were delineated. Category I included incentives and “mildly adverse approaches.” Category II, meant for “high-priority” detainees suspected of having significant information that could impact American security, included stress positions (which may have been used earlier at Guantánamo), long periods of isolation, 12-hour food deprivation, back-to-back 20-hour interrogations once per week, removal of religious and other comfort items, forced grooming, handcuffing and hooding during questioning. The final group, Category III, was reserved for high-priority detainees who were showing advanced resistance. According to the Senate report:

“Category III techniques included the daily use of 20 hour interrogations; the use of strict isolation without the right of visitation by treating medical professionals or the International Committee of the Red Cross (ICRC); the use of food restriction for 24 hours once a week; the use of scenarios designed to convince the detainee he might experience a painful or fatal outcome; non-injurious physical consequences; removal of clothing; and exposure to cold weather or water until such time as the detainee began to shiver.”

Years later, Burney and Leso told the Armed Services Committee’s investigators they were uncomfortable with what they were asked to produce. In fact, the memo they drafted in 2002 included clear warnings: “Physical and/or emotional harm from the above techniques may emerge months or even years after their use,” they said, stressing that the most effective interrogation strategy is based on building rapport. “Interrogation techniques that rely on physical or adverse consequences are likely to garner inaccurate information and create an increased level of resistance.”

Burney sent Banks the memo. He responded “great job” to the BSCT by e-mail on Oct. 2, 2002, the same day the memo was dated, but he too expressed unease about using physical pressures in interrogations:

“The use of physical pressures brings with it a large number of potential negative side effects … When individuals are gradually exposed to increasing levels of discomfort, it is more common for them to resist harder … If individuals are put under enough discomfort, i.e. pain, they will eventually do whatever it takes to stop the pain … it usually decreases the reliability of the information … Because of the danger involved, very few SERE instructors are allowed to actually use physical pressures … everything that is occurring [in SERE school] is very carefully monitored and paced … Even with all these safeguards, injuries and accidents do happen. The risk with real detainees is increased exponentially … My strong recommendation is that you do not use physical pressures … [If GTMO does decide to use them] you are taking a substantial risk, with very limited potential benefit.”

The excerpt of Banks’ e-mail in the Senate report does not show him objecting to the use of psychological — as opposed to physical — pressures in interrogations. Also, whether or not Banks shared his reservations about the interrogation techniques with anyone outside the BSCT is unclear. Repeated attempts were made to reach Col. Banks directly by phone and e-mail, and via three separate military public affairs offices. A Special Operations Command public affairs officer took questions for Banks, but then, after giving the psychologist time to review them, responded that “it would not be appropriate for Col Banks to make any additional comments at this time.”

That same day as the memo and Banks’ e-mail response, Oct. 2, Burney and Leso also provided a description of “SERE Psych Training” to senior Guantánamo officials and the chief counsel to the CIA’s counterterrorist center, according to notes from the meeting made public by the Senate committee. They also raised doubts about the efficacy of some of the interrogation techniques. “Fear-based strategies” would be unreliable compared with “proven” friendly and rapport-building approaches, the BSCT team said.

“Psychological stressors,” however, seemed to be another matter. In the minutes of the meeting, which paraphrased comments made by participants, Burney and Leso called strategies including sleep deprivation, withholding food, and isolation “extremely effective,” and said it was “vital” to disrupt normal camp operations through the creation of “controlled chaos.”

CIA lawyer Jonathan Fredman, the minutes say, described other SERE techniques, including “wet towel treatment” that can make a person “feel like you’re drowning” and the “very effective” use of phobias, including insects, snakes and claustrophobia. He argued that the techniques described in the BSCT memo were legal and that the international Torture Convention was written vaguely. “It is basically subject to perception. If the detainee dies you’re doing it wrong.” (An updated version of this story on ProPublica’s web site includes a response from Fredman, who disputes the accuracy of the minutes from the meeting.)

Two days after the memo, Banks’ e-mail and the meeting, on Oct. 4, 2002, the Senate report notes, Burney again wrote to Banks: “persons here at this operation are still interested in pursuing the potential use of more aversive interrogation techniques.” Burney asked Banks whether he knew where they could go to get additional training.

Banks answered by e-mail, and again expressed reservations about the direction of interrogation training: “I do not envy you. I suspect I know where this is coming from. The answer is no, I do not know of anyone who could provide that training … The training that SERE instructors receive is designed to simulate that of a foreign power, and to do so in a manner that encourages resistance among the students. I do not believe that training interrogators to use what SERE instructors use would be particularly productive.”

But again, there is no evidence that Banks raised these concerns to higher authorities, or in any forum besides an e-mail message to the BSCT. He also traveled to Guantánamo on several occasions to provide assistance to interrogators, according to the Senate report and Banks’ interview with New Yorker reporter Jane Mayer, but the exact nature of his involvement is unclear.

What is clear is that JPRA continued to train interrogators, and the Senate report shows that many of the harsh physical and psychological techniques in the BSCT team’s hastily written memo went on to be adopted by interrogators not only at Guantánamo, but also in Afghanistan and Iraq. They migrated to Abu Ghraib prison, where Larry James would later be stationed. An official request for Defense Secretary Donald Rumsfeld to give blanket approval of counter-resistance strategies at Guantánamo was based on the BSCT memo, but included none of its caveats. A legal memo accompanying the request, which was made public by the Senate committee, stated, in direct contradiction to Burney and Leso’s warnings, “there is no evidence that prolonged mental harm would result from the use of these [Category II] strategies.” Rumsfeld subsequently approved all of the Category II techniques and one Category III technique.

The Gitmo BSCT team’s experiences also showed that even when behavioral health professionals were on hand to consult on interrogations, abuses occurred. From late November to mid-January, Joint Task Force Guantánamo interrogated Mohammed al-Khatani, a high-value detainee suspected of involvement in the Sept. 11, 2001, attacks. According to the BSCT psychiatrist’s statement to the Senate committee, Al-Khatani was “made [to] believe he was sent to a hostile country which advocated torture” and that he “might be killed if he did not cooperate with questioning.”

Psychiatrist Burney told the committee he was present for parts of the interrogation, which included “stripping, forced grooming, invasion of space by a female interrogator, treating Khatani like an animal, using a military working dog, and forcing him to pray to an idol shrine,” according to a memo by an unknown author. That memo, excerpted in the Senate report, was sent in January 2003 from a BSCT psychiatrist at Guantánamo to Banks, who therefore knew what had taken place. Other sources show that Al-Khatani was doused with water, forced to stand for hours, deprived of sleep, and prevented from praying by shackling his hands to a chair. The convening authority for the U.S. military commissions, Susan Crawford, later refused to approve charges against him because his treatment “met the legal definition of torture.”

Psychologist Leso also witnessed parts of the interrogations and was “devastated to have been a part of this,” according to the book later written by Col. Larry James, Leso’s former boss at Walter Reed. James replaced Leso as the BSCT psychologist in January 2003. “He had no command authority,” James wrote of Leso, “meaning he felt as though he had no legal right to tell anyone what to do or not do … He told me he felt that he had received increasing pressure to teach interrogators procedures and tactics that were a challenge to his ethics as a psychologist and moral fiber as a human being.” James confirmed this information in an interview with ProPublica.

One psychologist, Michael Gelles, a civilian employee of the Naval Criminal Investigative Service working with a Criminal Investigation Task Force (CITF) for Guantánamo, had criticized the plans for Al-Khatani’s interrogation before they were even implemented. Gelles had served for years as a consultant for both civilian and military interrogators, and the techniques being proposed struck him as both inappropriate and ineffective. “It wasn’t what Americans did,” Gelles told ProPublica. “Why would you prescribe something that doesn’t work? It wasn’t the right prescription for what we wanted to do … to get accurate and reliable information.”

In a Nov. 22, 2002, memo excerpted in the Senate report, Gelles warned that if the plans for interrogating Al-Khatani were implemented, he would “have trouble not finding myself from a professional perspective, being forced into an adversary position through cross examination in a military tribunal as an expert in interrogation.” Both the CITF and the FBI objected to the al-Khatani interrogation plan, questioned its legality, and offered Joint Task Force Guantánamo Cmdr. Maj. Gen. Geoffrey Miller an alternative plan based on building rapport, which had long been used successfully by law enforcement personnel. After their repeated objections were ignored, the two agencies refused to participate in al-Khatani’s interrogation.

A log of that interrogation was made public on June 12, 2005, by Time magazine. The log records the themes and approaches used by interrogators and Al-Khatani’s emotional and verbal responses to them, an experiment-like design that bioethicist Steven Miles, in an interview, called an “outside of the park violation” of the Nuremberg Code on research ethics, which was established in response to the Nazis’ infamous experimentation on humans. (The newly released edition of Miles’ book “Oath Betrayed” discusses this aspect of the al-Khatani interrogation.)

The interrogation log included several references to “MAJ L (BSCT)” — Leso — revealing that he was present. On one day the log indicated he advised interrogators to put al-Khatani in a swivel chair to “keep him awake and stop him from fixing his eyes on one spot.”

Weeks after Time published the log, a 10-member task force convened by the American Psychological Association met to explore the ethical aspects of psychologists’ involvement in national security work and interrogations. Banks, James and Gelles were tapped by the APA president and board as members.

By then, many stories had emerged about prisoner abuse by U.S. personnel, and the role of psychologists and physicians was under scrutiny and attack. The task force’s deliberations were conducted in secret, but its e-mail listserv was obtained by ProPublica. Writing to his colleagues on the listserv, Banks said that psychologists were the only professionals left supporting interrogations. “The Army’s psychiatry consultant has stated that she is opposed to psychiatrists performing this function,” he wrote in an e-mail on May 18, 2005.

Banks, who by that time was training and overseeing all army psychologists involved in interrogation support, held a different view, as did James. When a civilian task force member wrote to the listserv to question whether contributing to coercive interrogations was incompatible with the ethics of psychology, which require professionals to promote well-being and avoid harm, James bristled at the suggestion that “DOD/Military psychologists have done something illegal, morally wrong and/or unethical. Like Morgan Banks, I am very proud of the fact, it was psychologists who fixed the problems and not caused it. This is a factual statement! the fact of the matter is that since Jan 2003, where ever we have had psychologists no abuses have been reported,” James wrote on May 23, 2005.

Of course, abuses did occur after that time, and while they may not have been publicly “reported” by early 2005, they have been now. When asked about this, James told ProPublica, “You’re always going to have a guard who’s going to do something stupid.” He argued that abuse at Guantánamo ended when those who served there started realizing — thanks to improved camp leadership and the efforts of psychologists such as himself and John Leso — that rapport-building strategies were more effective than abuse, regardless of what the rules allowed.

But as more information about the still-murky happenings at detention sites has emerged, it seems clear that while psychologists may have helped rein in uncontrolled sadism of the likes depicted in the Abu Ghraib photos, extremely distressing psychological pressure techniques, now banned, continued to be employed with the former administration’s legal permission for years. “Maybe [psychologists] curtailed some abuses, but they also continued to participate in the interrogations,” said Maj. David Frakt, a lead defense counsel in the military commissions for Guantánamo. Frakt cites evidence that his client, Mohammad Jawad, who was a teenager when he was detained in Afghanistan and accused of throwing a grenade at U.S. forces, was subjected to prolonged isolation in late 2003 and later endured a sleep-deprivation program known as the “frequent flyer” program in which he was moved from cell to cell with all his belongings 112 times in a 14-day period — on average every three hours. He later attempted suicide. One camp official testifying at a hearing for Jawad said the program was standard procedure and was “fully vetted” by mental health and medical personnel, Frakt said.

Frakt has asked the military for evidence that anyone, including medical personnel, complained about the program, and has received none. “One of the things that disappointed me was how few people raised objections,” he said. The abuses ended, he said, for the most part in June of 2006, when the U.S. Supreme Court stated that the detainees had to be treated humanely in accordance with the minimum standards provided for by the international laws of war.

Another example that defies James’ characterization is the officially planned and vetted interrogation of Mohamadou Walid Slahi, which was proposed in January 2003 and implemented at Guantánamo in July of that year shortly after James’ departure. Slahi’s interrogation, which involved stress positions, sensory deprivation and threats to his family, was so abusive that when a military prosecutor assigned to Slahi’s case heard about the techniques used, he refused to take part in his prosecution. Records show that a psychologist was made aware by interrogators that Slahi was “hearing voices.”

Whether that psychologist took steps to halt the interrogation techniques is unknown. In contrast, James’ book is filled with examples of how he used his knowledge of human psychology to convince young, inexperienced interrogators — themselves living in hot, horrific conditions at Guantánamo and Abu Ghraib — to stop shouting at and demeaning detainees and instead focus on building rapport with them. Both Banks, in a recent academic article he co-authored, and James still argue that the now-formalized BSCT teams play “a critical and vital role in keeping interrogations safe, legal, ethical and effective.” Gelles also feels that psychologists with the proper training can provide value to national security-related investigations, just as they do across America in civil law enforcement.

All three men communicated those views to their colleagues on the APA task force in 2005. James credited Leso and Burney’s then-secret Guantánamo memo — which had set out the list of harsh interrogation techniques that the Senate report said was later adopted throughout the world — with “clearly defin[ing] what can and cannot be done,” James wrote to the listserv on July 29, 2005. “[B]y the time I arrived at GITMO in January 2003 this memorandum was on official DOD letterhead, signed by the secretary of defense.” Like James, Banks and Gelles, six of the ten task-force members were members of or had consulted for the military or CIA. They had real-life experience in the questions they were considering, but some of their jobs would logically have limited them from helping the APA develop an opinion that went against DoD policy.

“We were hearing from members that they needed guidance,” APA spokesperson Rhea Farberman said in an interview. “That was really our original goal. We wanted to give real world guidance. That had a lot to do with the makeup of the task force.”

The task force found it to be “consistent with the APA Ethics Code” for psychologists to consult with interrogators in the interests of national security. While noting that psychologists do not participate in torture and have a responsibility to report it, and should be committed to the APA ethics code whenever they “encounter conflicts between ethics and law,” the task force decided that “if the conflict cannot be resolved … psychologists may adhere to the requirements of the law,” apparently left psychologists free to adhere to the U.S. legal determinations of the time, regardless of their relationship to international treaties such as the Geneva Conventions. “I have long had a sense of frustration with ‘international law,’” then-incoming APA president wrote to the task-force listserv on July 30, 2005. “I have zero interest in entangling APA with the toothless, contradictory and obfuscatory treaties that comprise ‘international law.’ Rather, I prefer to see APA take principled stands on policy isssues where psychology has some scientific basis for doing so.”

The board of the APA, the largest membership organization for psychologists, who are employed in great numbers by the Department of Defense, quickly adopted the task force’s report as the organization’s official policy.

Then came the backlash. Last year, members of the APA successfully petitioned for a vote on whether to ban psychologists from working in detention settings where international law or the U.S. Constitution are violated. The membership passed the proposal.

Some psychologists have filed complaints with the APA and state licensing boards against colleagues who were involved in abusive interrogations. Two years ago, psychologist Trudy Bond filed an APA ethics complaint against John Leso, arguing that “Dr. Leso’s very presence at any point of [al-Khatani's] interrogation” violates numerous professional ethical standards and both national and international laws. She has also filed state licensing board complaints against James and other psychologists. “When professional organizations do not hold members accountable for acts that are in violation of international law, in my opinion it makes a mockery of the professional organization,” she told ProPublica.

To her knowledge, none of her complaints have been investigated. She recently took the Louisiana State Board of Examiners to court for dismissing her complaint against James. The Louisiana board, in a court filing, wrote: “the truth of the allegations contained in said complaint [against James] are denied for a lack of sufficient information.”

Most of the organizations Bond has approached have claimed that they are unable to investigate because so little information about the true role of health professionals supporting interrogations has been released. Do the allegations that health professionals participated in abuses have grounds, or are they inaccurate or circumstantial, as James insists? To that question, the organization Physicians for Human Rights has an answer: Allow a nonpartisan U.S. government commission to investigate and clarify what health professionals did and didn’t do. However determined, perhaps the truth would finally help heal the disputes that continue to roil the psychological and medical communities.

At 9 p.m. on Saturday, two hours after Gustav’s first squall drenched New Orleans, she and other first responders had already spent days helping the city brace for a long, ugly fight with the storm.

The city’s mandatory evacuation program had ended hours earlier, but Saussy was receiving reports that several dozen of the city’s sick and elderly were still stranded in their homes. They and their families were calling 911, insisting they had registered for the city’s special-needs transport program, but that help had never arrived. The program was officially over, but Saussy and her EMS teams pledged to keep it going.

“We’re not going to leave people,” she said. “We’ve seen what it looks like when people drown.”

Ambulances picked up those residents and took them to New Orleans Union Passenger Terminal, the city’s designated evacuation point. “We got a lot more coming,” Saussy told an emergency medical technician there.

Of all the ghosts of Katrina, perhaps the most haunting was the specter of vulnerable residents suffering and dying at home and in hospitals and nursing homes before help arrived. Hospitals became furnaces as they lost power in the summer heat, surrounded by water and cut off from communications. Few times in American civilian history have health workers faced such horrific conditions and wrenching choices over whom to save first when rescue boats and helicopters were slow to arrive.

Hospital administrators swore their facilities would be better prepared for the next storm. Among them was Robert Lynch, CEO of Tulane University Hospital.

Hours before Gustav’s predicted arrival, I watched Lynch, dressed down in khakis and a Tulane shirt, give a pep talk to a roomful of grave-looking nurses and support staff. “I can’t tell you how much I appreciate your effort to be here,” he told them.

Some of them, including Lynch, had watched three years ago when Lake Pontchartrain flooded the hospital’s generator, knocking out all the facility’s power. For days, staff labored in extreme heat until all the 1,600 people who had sheltered at the hospital were flown by helicopter off the top floor of its parking garage. Bed-bound patients were carried down staircases on mattresses.

This time, as the storm threatened, hospital officials discharged patients who were capable of going home and told staff to find other accommodations for their own family members and pets. That left only about 430 people to be evacuated from the main campus if the levees failed again. The Lakeside campus was down to just a few high-risk pregnant mothers and babies. Generators at the main campus had been raised high above the ground, and a larger fuel tank installed, along with flood gates and pumps.

And there was another difference. Many of the hospital’s critically ill patients and those who rely on electricity-powered technology, such as dialysis machines, were being evacuated to other cities that officials expected would be safer. Doctors used medical judgment when choosing whom to evacuate. The bottom line, Lynch said, was this: “Who would you pick if you had the choice of moving someone now — planned, controlled, with very good medical assets like a mobile ICU, versus going out like Katrina?”

Across southern Louisiana, doctors at other hospitals made similar choices about whom to evacuate. But even well-laid plans hit hitches. As Gustav’s predicted landfall grew closer, New Orleans Mayor Ray Nagin called it “the mother of all storms.” Hospitals decided at the last minute to evacuate even more patients.

Cindy Davidson, an administrator with the Metropolitan Hospital Council of New Orleans, helped coordinate an aerial evacuation using local, state and federal assets. On Sunday, 231 patients were on her list, many of them critically ill. Ambulances from as far away as Pennsylvania were ready at 6 a.m. to begin shuttling ICU patients to New Orleans Lakefront Airport. Then they waited. And waited. “It took a long time for the planes to actually come in,” Davidson said.

When the air evacuation teams arrived, many weren’t prepared to transport the most critically ill. “They kept asking, ‘Don’t you have some ambulatory patients?’” Davidson said. In the end, many of the sickest patients had to be transported by ground. At least three patients died awaiting evacuation at area airports, according to remarks by Louisiana Gov. Bobby Jindal. It was impossible to know whether the wait contributed to their outcomes. Davidson said that although careful plans had been established in recent years to evacuate individual regions of the state, “we never planned to evacuate the whole southern coast of Louisiana.”

Still, while the process was far from smooth, the accomplishment was considerable. “We got everyone out on our list and plus some,” she said.

Just after 10 p.m. on Sunday, EMS director Saussy was still at the Union Passenger Terminal in downtown New Orleans, struggling to get the city’s last special-needs residents out of town. It was raining again when an ambulance pulled up with an elderly couple. Other ambulances with more elderly and sick residents were on their way, and about two dozen relatively healthy people still waited inside the terminal.

Two U.S. Army National Guard officers warned Saussy that for safety reasons the evacuation vehicles needed to be on the road by 10:30 p.m. Just then, two empty yellow school buses drove up to the terminal.

“Hallelujah, hallelujah,” said Saussy, who had eaten almost nothing that day and had only two hours’ sleep that night. Passengers were guided to the buses as the wind picked up and rain began falling harder. Then the buses and several ambulances pulled out, heading toward Baton Rouge and presumed safety.

Saussy walked through the rain to her car and drove back to the emergency operations center at City Hall, where she hunkered down for the night with colleagues from FEMA and the National Guard, as well as state and city officials. Several asked how her night had gone. “We got everyone out,” she said again and again.

Hours later, Gustav’s eye hit the Louisiana coastline. Its winds whistled eerily through cities that had been battered so recently, pulling down young trees, street signs and traffic lights. It knocked out power in Baton Rouge, hit the town of Houma and took out a levee in Plaquemines Parish.

On Monday night, Davidson began hearing that hospitals in other parts of the state were on backup power, perhaps some of the same hospitals that had taken in the patients she had worked so hard to evacuate from New Orleans. “They’re going to have fuel issues in a day or two,” she said.

Tulane University Hospital’s Lakeside campus had lost electricity six hours after coming off the city grid, despite having three forms of backup power. The hospital had only a few patients by then, but one was a baby on a ventilator. Lynch oversaw the baby’s safe evacuation to the main campus. Things were functioning so smoothly there that a group of key maintenance workers had time to gather by a window overlooking the street, chatting and watching the hurricane shake tree branches.

Late Monday night, Lynch got a call from Louisiana Secretary of Health and Hospitals Alan Levine, warning of a new and unexpected medical crisis. Much of Baton Rouge, where many New Orleans patients had been transferred before the storm, was without power.

By this morning state officials were warning that more than 800 sick people might need to be moved from the affected hospitals. Could Tulane accept some of them?

Yes, Lynch said, this time it could.