When the CIA began what it called an "increased pressure phase" with captured terrorism suspect Abu Zubaida in the summer of 2002, its first step was to limit the detainee's human contact to just two people. One was the CIA interrogator, the other a psychologist.
During the extraordinary weeks that followed, it was the psychologist who apparently played the more critical role. According to newly released Justice Department documents, the psychologist provided ideas, practical advice and even legal justification for interrogation methods that would break Abu Zubaida, physically and mentally. Extreme sleep deprivation, waterboarding, the use of insects to provoke fear -- all were deemed acceptable, in part because the psychologist said so.
"No severe mental pain or suffering would have been inflicted," a Justice Department lawyer said in a 2002 memo explaining why waterboarding, or simulated drowning, should not be considered torture.
The role of health professionals as described in the documents has prompted a renewed outcry from ethicists who say the conduct of psychologists and supervising physicians violated basic standards of their professions.
Their names are among the few details censored in the long-concealed Bush administration memos released Thursday, but the documents show a steady stream of psychologists, physicians and other health officials who both kept detainees alive and actively participated in designing the interrogation program and monitoring its implementation. Their presence also enabled the government to argue that the interrogations did not include torture.
Most of the psychologists were contract employees of the CIA, according to intelligence officials familiar with the program.
"The health professionals involved in the CIA program broke the law and shame the bedrock ethical traditions of medicine and psychology," said Frank Donaghue, chief executive of Physicians for Human Rights, an international advocacy group made up of physicians opposed to torture. "All psychologists and physicians found to be involved in the torture of detainees must lose their license and never be allowed to practice again."
The CIA declined to comment yesterday on the role played by health professionals in the agency's self-described "enhanced interrogation program," which operated from 2002 to 2006 in various secret prisons overseas.
"The fact remains that CIA's detention and interrogation effort was authorized and approved by our government," CIA Director Leon Panetta said Thursday in a statement to employees. The Obama administration and its top intelligence leaders have banned harsh interrogations while also strongly opposing investigations or penalties for employees who were following their government's orders.
The CIA dispatched personnel from its office of medical services to each secret prison and evaluated medical professionals involved in interrogations "to make sure they could stand up, psychologically handle it," according to a former CIA official.
The alleged actions of medical professionals in the secret prisons are viewed as particularly troubling by an array of groups, including the American Medical Association and the International Committee of the Red Cross.
AMA policies state that physicians "must not be present when torture is used or threatened." The guidelines allow doctors to treat detainees only "if doing so is in their [detainees'] best interest" and not merely to monitor their health "so that torture can begin or continue."
The American Psychological Association has condemned any participation by its members in interrogations involving torture, but critics of the organization faulted it for failing to censure members involved in harsh interrogations.
The ICRC, which conducted the first independent interviews of CIA detainees in 2006, said the prisoners were told they would not be killed during interrogations, though one was warned that he would be brought to "the verge of death and back again," according to a confidential ICRC report leaked to the New York Review of Books last month.
"The interrogation process is contrary to international law and the participation of health personnel in such a process is contrary to international standards of medical ethics," the ICRC report concluded.
The newly released Justice Department memos place medical officials at the scene of the earliest CIA interrogations. At least one psychologist was present -- and others were frequently consulted -- during the interrogation of Abu Zubaida, the nom de guerre of Zayn al-Abidin Muhammed Hussein, a Palestinian who was captured by CIA and Pakistani intelligence officers in March 2002, the Justice documents state.
An Aug. 1, 2002, memo said the CIA relied on its "on-site psychologists" for help in designing an interrogation program for Abu Zubaida and ultimately came up with a list of 10 methods drawn from a U.S. military training program known as Survival, Evasion, Resistance and Escape, or SERE. That program, used to help prepare pilots to endure torture in the event they are captured, is loosely based on techniques that were used by the Communist Chinese to torture American prisoners of war.
The role played by psychologists in adapting SERE methods for interrogation has been described in books and news articles, including some in The Washington Post. Author Jane Mayer and journalist Katherine Eban separately identified as key figures James Mitchell and Bruce Jessen, two psychologists in Washington state who worked as CIA contractors after 2001 and had extensive experience in SERE training. Mitchell, reached by telephone, declined to comment, and Jessen could not be reached yesterday.
The CIA psychologists had personal experience with SERE and helped convince CIA officials that harsh tactics would coerce confessions from Abu Zubaida without inflicting permanent harm. Waterboarding was touted as particularly useful because it was "reported to be almost 100 percent effective in producing cooperation," the memo said.
The agency then used a psychological assessment of Abu Zubaida to find his vulnerable points. One of them, it turns out, was a severe aversion to bugs.
"He appears to have a fear of insects," states the memo, which describes a plan to place a caterpillar or similar creature inside a tiny wooden crate in which Abu Zubaida was confined. CIA officials say the plan was never carried out.
Former intelligence officials contend that Abu Zubaida was found to have played a less important role in al-Qaeda than initially believed and that under harsh interrogation he provided little useful information about the organization's plans.
The memos acknowledge that the presence of medical professionals posed an ethical dilemma. But they contend that the CIA's use of doctors in interrogations was morally distinct from the practices of other countries that the United States has accused of committing torture. One memo notes that doctors who observed interrogations were empowered to stop them "if in their professional judgment the detainee may suffer severe physical or mental pain or suffering." In one instance, the CIA chose not to subject a detainee to waterboarding due to a "medical contraindication," according to a May 10, 2005, memo.
Yet some doctors and ethicists insist that any participation by physicians was tantamount to complicity in torture.
"I don't think we had any idea doctors were involved to this extent, and it will shock most physicians," said George Annas, a professor of health law, bioethics and human rights at Boston University.
Annas said the use of doctors to monitor prisoners subjected to torture is "totally unethical" and has been condemned by the American and World Medical Associations, among other professional bodies.
"In terms of ethics, it's not even a close call," he said.
Steven H. Miles, a professor of medicine at the University of Minnesota and author of "Oath Betrayed: America's Torture Doctors," said the actions described in the memos were the "kind of stuff that doctors have been tried, convicted and imprisoned for in other countries -- and that's what should happen here."
But Michael Gross, a professor at the University of Haifa in Israel and the author of "Bioethics and Armed Conflict: Moral Dilemmas of Medicine and Warfare," said that if physicians think particular harsh interrogation techniques do not constitute torture, there is no reason they should not participate.
"Physicians are faced with a hard dilemma," he said. "They have professional obligations to do no harm, but they also have a duty as a citizen to provide expertise to their government when the national security is at stake. In a national security crisis, I believe our duties as citizens take precedence."
Staff writers R. Jeffrey Smith and Dana Priest and staff researcher Julie Tate contributed to this report.