Before the United States permitted a terrifying way of interrogating prisoners, government lawyers and intelligence officials assured themselves of one crucial outcome. They knew that the methods inflicted on terrorism suspects would be painful, shocking and far beyond what the country had ever accepted. But none of it, they concluded, would cause long lasting psychological harm.
Fifteen years later, it is clear they were wrong.
Today in Slovakia, Hussein al-Marfadi describes permanent headaches and disturbed sleep, plagued by memories of dogs inside a blackened jail. In Kazakhstan, Lutfi bin Ali is haunted by nightmares of suffocating at the bottom of a well. In Libya, the radio from a passing car spurs rage in Majid Mokhtar Sasy al-Maghrebi, reminding him of the C.I.A. prison where earsplitting music was just one assault to his senses.
And then there is the despair of men who say they are no longer themselves. “I am living this kind of depression,” said Younous Chekkouri, a Moroccan, who fears going outside because he sees faces in crowds as Guantánamo Bay guards. “I’m not normal anymore.”
After enduring agonizing treatment in secret C.I.A. prisons around the world or coercive practices at the military detention camp at Guantánamo Bay, Cuba, dozens of detainees developed persistent mental health problems, according to previously undisclosed medical records, government documents and interviews with former prisoners and military and civilian doctors. Some emerged with the same symptoms as American prisoners of war who were brutalized decades earlier by some of the world’s cruelest regimes.
Those subjected to the tactics included victims of mistaken identity or flimsy evidence that the United States later disavowed. Others were foot soldiers for the Taliban or Al Qaeda who were later deemed to pose little threat.
Some were hardened terrorists, including those accused of plotting the Sept. 11 attacks or the 2000 bombing of the American destroyer Cole. In several cases, their mental status has complicated the nation’s long effort to bring them to justice.
Americans have long debated the legacy of post-Sept. 11 interrogation methods, asking whether they amounted to torture or succeeded in extracting intelligence. But even as President Obama continues transferring people from Guantánamo and Donald J. Trump, the Republican presidential nominee, promises to bring back techniques, now banned, such as waterboarding, the human toll has gone largely uncalculated.
At least half of the 39 people who went through the C.I.A.’s “enhanced interrogation” program, which included depriving them of sleep, dousing them with ice water, slamming them into walls and locking them in coffin-like boxes, have since shown psychiatric problems, The New York Times found. Some have been diagnosed with post-traumatic stress disorder, paranoia, depression or psychosis.
Hundreds more detainees moved through C.I.A. “black sites” or Guantánamo, where the military inflicted sensory deprivation, isolation, menacing with dogs and other tactics on men who now show serious damage. Nearly all have been released.
“There is no question that these tactics were entirely inconsistent with our values as Americans, and their consequences present lasting challenges for us as a country and for the individuals involved,” said Ben Rhodes, the deputy national security adviser.
The United States government has never studied the long-term psychological effects of the extraordinary interrogation practices it embraced. A Defense Department spokeswoman, asked about long-term mental harm, responded that prisoners were treated humanely and had access to excellent care. A C.I.A. spokesman declined to comment.
This article is based on a broad sampling of cases and an examination of hundreds of documents, including court records, military commission transcripts and medical assessments. The Times interviewed more than 100 people, including former detainees in a dozen countries. A full accounting is all but impossible because many former prisoners never had access to outside doctors or lawyers, and any records about their interrogation treatment and health status remain classified.
Researchers caution that it can be difficult to determine cause and effect with mental illness. Some prisoners of the C.I.A. and the military had underlying psychological problems that may have made them more susceptible to long-term difficulties; others appeared to have been remarkably resilient. Incarceration, particularly the indefinite detention without charges that the United States devised, is inherently stressful. Still, outside medical consultants and former government officials said they saw a pattern connecting the harsh practices to psychiatric issues.
Those treating prisoners at Guantánamo for mental health issues typically did not ask their patients what had happened during their questioning. Some physicians, though, saw evidence of mental harm almost immediately.
“My staff was dealing with the consequences of the interrogations without knowing what was going on,” said Albert J. Shimkus, a retired Navy captain who served as the commanding officer of the Guantánamo hospital in the prison’s early years. Back then, still reeling from the Sept. 11 attacks, the government was desperate to stave off more.
But Captain Shimkus now regrets not making more inquiries. “There was a conflict,” he said, “between our medical duty to our patients and our duty to the mission, as soldiers.”
After prisoners were released from American custody, some found neither help nor relief. Mohammed Abdullah Saleh al-Asad, a businessman in Tanzania, and others were snatched, interrogated and imprisoned, then sent home without explanation. They returned to their families deeply scarred from interrogations, isolation and the shame of sexual taunts, forced nudity, aggressive body cavity searches and being kept in diapers.
Mr. Asad, who died in May, was held for more than a year in several secret C.I.A. prisons. “Sometimes, between husband and wife, he would admit to how awful he felt,” his widow, Zahra Mohamed, wrote in a statement prepared for the African Commission on Human and Peoples’ Rights. “He was humiliated, and that feeling never went away.”
‘A Human Mop’
In a cold room once used for interrogations at Guantánamo, Stephen N. Xenakis, a former military psychiatrist, faced a onetime Qaeda child soldier, Omar Khadr. It was December 2008, and this evaluation had been two years in the making.
Mr. Khadr, a Canadian citizen, had been wounded and captured in a firefight at age 15 at a suspected terrorist compound in Afghanistan, where he said he had been sent to translate for foreign fighters by his father, a Qaeda member. Years later, he would plead guilty to war crimes, including throwing a grenade that killed an Army medic. At the time, though, he was the youngest prisoner at Guantánamo.
He told his lawyers that the American soldiers had kept him from sleeping, spit in his face and threatened him with rape.
When it happened again, Mr. Khadr explained that he had once urinated during an interrogation and soldiers had dragged him through the mess. “This is the room where they used me as a human mop,” he said.
A Sense of Drowning
Mohamed Ben Soud cannot say for certain when the Americans began using ice water to torment him. The C.I.A. prison in Afghanistan, known as the Salt Pit, was perpetually dark, so the days passed imperceptibly.
The United States called the treatment “water dousing,” but the term belies the grisly details. Mr. Ben Soud, in court documents and interviews, described being forced onto a plastic tarp while naked, his hands shackled above his head. Sometimes he was hooded. One C.I.A. official poured buckets of ice water on him as others lifted the tarp’s corners, sending water splashing over him and causing a choking or drowning sensation. He said he endured the treatment multiple times.
Mr. Ben Soud was among the early captives in the C.I.A.’s network of prisons in Afghanistan, Thailand, Poland, Romania and Lithuania. Again and again, he said, he told the American interrogators that he was not their enemy. A Libyan, he said he had fled to Pakistan in 1991 and joined an armed movement aimed at toppling Col. Muammar el-Qaddafi’s dictatorship. Pakistani and United States officials stormed his home and arrested him in 2003.
Under interrogation, he said, he denied knowing or fighting with Osama bin Laden or two senior Qaeda operatives.
Today, Mr. Ben Soud, 47, is a free man, but said he is in constant fear of tomorrow. He is racked with self-doubt and struggles to make simple decisions. His moods swing dramatically.
“‘Dad, why did you suddenly get angry?’ ‘Why did you suddenly snap?’” Mr. Ben Soud said his children ask. “‘Did we do anything that made you angry?’”
Explaining would mean saying that the Americans kept him shackled in painful contortions, or that they locked him in boxes — one the size of a coffin, the other even smaller, he said in a phone interview from his home in Misrata, Libya. They slammed him against the wall and chained him from the ceiling as the prison echoed with the sounds of rock music.
“How can you explain such things to children?” he asked.
Mr. Ben Soud, along with a second former C.I.A. prisoner and the estate of a third, is suing Dr. Mitchell and Dr. Jessen in federal court, accusing them of violating his rights by torturing him. In court documents, Dr. Mitchell and Dr. Jessen argue, among other things, that they played no role in the interrogations.
Mr. Ben Soud was one of the men identified in a 2014 Senate Intelligence Committee report as having been subjected to the C.I.A.’s “enhanced interrogation techniques.”
Mr. Chekkouri saw psychiatrists at Guantánamo, but he said he did not trust them. He and others believed the doctors shared information about medical problems with interrogators. In one case, a psychiatrist prescribed the antipsychotic medication olanzapine to a prisoner. He then suggested that interrogators exploit a side effect, food cravings, according to another military doctor who later reviewed the records.
Normally, such information would be confidential, but Guantánamo’s dual missions of caring for prisoners and extracting information created conflicts. Over time, the military created two mental health teams. One, led by psychiatrists, was there to heal. The other, called the Behavioral Science Consultation Team, was led by psychologists with a very different mission.
Ignoring a Link
It has been difficult to determine the scale of mental health problems at Guantánamo, much less how many cases are linked to the treatment the prisoners endured. Most medical records remain classified. Anecdotal accounts, though, have emerged over the years.
Andy Davidson, a retired Navy captain who served as the chief psychologist treating prisoners at Guantánamo from July to October 2003, said most appeared to be in good health, but he still saw “an awful lot” of mental health issues there.
“There were definitely guys who had PTSD symptoms,” he said in an interview. “There were definitely guys who had poor sleeping, nightmares. There were guys who were definitely shell shocked with a thousand-mile stare. There were guys who were depressed, avoidant.”
One of the few official glimpses into the population came in a 2006 medical journal article. Two military psychologists and a psychiatrist at Guantánamo wrote that about 11 percent of detainees were then receiving mental health services, a rate lower than that in civilian jails or among former American prisoners of war. The authors acknowledged, however, that Guantánamo doctors faced significant challenges in diagnosing mental illness, most notably the difficulty in building trust. Many prisoners, including some with serious mental health conditions, refused evaluation and treatment, the study noted, which would have lowered the count.
Five years later, General Xenakis and Vincent Iacopino, the medical director for Physicians for Human Rights, published research about nine prisoners who exhibited psychological symptoms after undergoing interrogation tactics — a hose forced into a mouth, a head held in a toilet, death threats — by American jailers.
The two based their study on the medical records and interrogation files of the prisoners, all of whom had arrived at Guantánamo in its first year, had never been in C.I.A. custody, and were never charged with any crimes.
The New York Times