Patterico’s Exclusive Interview with a Man Who Has Spoken to the Terrorists at Guantánamo (Part Three: Hunger Strikes, Suicides and Suicide Attempts, and the Detainees’ Mental Health)
[This is Part Three of my exclusive interview with "Stashiu," an Army nurse who worked at Guantánamo, and who spoke on a regular basis with detainees with psychological and/or behavioral problems. Part One can be accessed here. Part Two is available here.
Once again, these are his opinions and experiences, and are not meant to represent anything or anyone else, including the U.S. Army. Nearly everything has been officially released and those parts that are personal experience have been careful to respect operational security and confidentiality.
In today's entry, Stashiu talks about the hunger strikes at GTMO, and the suicide attempts -- both successful and unsuccessful. He gives insight into the mental health of the detainees.]
Anyone who has read about Guantánamo knows that detainees have often attempted suicide — and earlier this year, three of them succeeded.
Stashiu is able to shed considerable light on the issue of the detainees’ mental health. Based on his experience with the detainees, his opinion is that their suicides were likely an organized political act. Below, he explains the reasoning for his opinion.
Keeping Detainees Alive During Hunger Strikes
With his specialty in Psychiatric Nursing, Stashiu was involved in dealing with the detainees’ hunger strike:
Anyone identified as missing three consecutive meals was evaluated to ensure that it was a decision under their control. They were counseled as to the risks to their health and what the consequences of long-term malnutrition were (dumping syndrome, organ failure, death).
I helped write the SOP that was developed after the Forensic Psychiatrist visited. After that, the hunger strike was essentially under control as our guidance from command was essentially “you will not allow anyone to die from not eating.”
As unreasonable a goal as that may sound, we met it as humanely as anyone on Earth could have.
Feeding tubes were used, but reports have greatly exaggerated the conditions under which they were inserted:
The talk of ‘garden hoses inserted as feeding tubes without lubricant’ and such are all bunk. The Dobhoff tubes used were around the thickness of the little straw you’d get with your milk in elementary school, made of a rubbery material, and always inserted with lubrication.
Detainees Take Advantage of Concessions and Spread False Propaganda
I asked about the recent New York Times Magazine article about Guantánamo, which provided an in-depth look at the hunger strikes and suicide attempts. (I linked to and excerpted heavily from that article in this post.) The article, which was based on interviews with numerous people at Guantánamo, made several points, including these:
- The Colonel in charge made numerous concessions to the terrorists in terms of living conditions.
- Intelligence officials resisted the Colonel’s changes because they made interrogation more difficult, as the interrogators could not use promises of better living conditions as a carrot.
- The suicide attempts and three successful suicides were an organized event designed to create worldwide sympathy for the detainees’ plight — and the detainees who committed suicide did so in part by taking advantage of the Colonel’s measures to improve living conditions.
Of the article, Stashiu said:
The article is amazingly accurate and even-handed. The things that COL Bumgarner tried were good-faith efforts to make the best of the situation. Many of the detainees also made good-faith efforts to improve things, but I believe that any concessions were hijacked by the extremists and used against everyone else’s efforts. For example, the lights being dimmed, extra bedding, etc… were all used to facilitate the successful suicides. But, before those changes had not been at least tried, the extremists escalated the rhetoric against us saying, “See? They will not do anything to make things better!”
As the article explains, there were competing objectives among the detainees. Simply, we were in a Catch-22. If concessions were made, one group would say that they could get even more by continuing to cause problems. If concessions weren’t made, the reasoning was that they just weren’t applying enough pressure. There is a hardcore group of AQ there that will try to turn everything they can to their advantage. They circulate untrue stories of torture, poisoned food, desecrated Korans, and many other things. This keeps the tensions high and then they find a way to light the match.
(All emphasis in this post is mine.)
The article focused heavily on the considerable efforts of Colonel Bumgarner to humanize the camp in order to prevent disruptions. What did Stashiu think of Col. Bumgarner?
Colonel Bumgarner did a thankless job in the best way he could and I am proud to have worked with him. The only surprise in the article was that he used to be a quarterback because he’s built like a lineman. It’s only after you get to know the man that you realize how smart he is. Every day there was [a] new challenge as the AQ leaders probed for weaknesses. Without his efforts, many more of the detainees would have been dead by their own hands. Honestly, I was amazed that it took so long and that we kept everyone alive during our time there, sometimes by the skin of our teeth. . . . Some wouldn’t have survived but for the skill and dedication of the doctors who were determined to save them.
Working Hard to Prevent Detainee Deaths and Suicides
Was there a genuine effort to prevent suicides and deaths from hunger strikes?
“Not on my watch” was the biggest goal for most of us. Many of us felt that without major changes in policy the AQ leadership would eventually find a way. We just weren’t going to let it happen while we were there.
The rotation that replaced us was a fine group and would have done everything they could to protect the detainees. I believe the detainees just timed things to take advantage of the new rotation before they had learned all the tricks. The detainees tried when we came in and we had a very sharp learning curve. I believe that the timing of the attempted suicides, the attack on the guard force with the staged suicide [more on this below -- P], and the successful suicides [were] not an accident.
I believe that those men were ordered to die after months of planning. They knew when new personnel came in and waited until everything could come together. If the personnel rotation had happened a month or two later, I’m certain the suicides would have been a month or two later as well. It was one of the factors they waited for because our rotation was aware of most of their ruses.
A Clean Bill of Health
I noted that, according to the article, the three men who killed themselves had recently been given a psyche evaluation and came up with a clean bill of health. I asked Stashiu whether he had participated in their evaluations. He said:
The article mentions that all three were also hunger-strikers and we “teamed” everyone on hunger-strike (the psychiatrist, psychologist, myself, or one of my staff would talk to them directly… then we would all sit down together weekly to review each hunger-striker as a team.) The eval directly prior to their suicides would have been done after I left.
The Riot in Camp 4
In a prime example of the detainees taking advantage of concessions granted to them, there was a major riot just after Stashiu’s time at Guantánamo — in Camp 4, which is the open area for more compliant detainees. Guantánamo is like a prison facility with different levels of security: a more lenient setting for compliant inmates, and a more secure setting for the disruptive ones. Camp 4 was the lenient setting for the most cooperative detainees. There, they are free to congregate, and engage in recreational activities such as soccer.
The riot was described in this piece by James Taranto, which Stashiu confirmed was accurate, to the extent of his knowledge (again, he was not present for the riot). After some suicide attempts, the detention group commander ordered a shakedown of all the cells, looking for pills that the detainees could take to commit suicide. According to Taranto:
Early in the evening, the search reached Camp 4, the least restrictive of the detention areas. Unlike in the other camps, detainees in Camp 4 are not confined to individual cells but bunk communally and congregate in fenced yards. This is where the detainees live who are most compliant with camp rules. But on that day in May, their cooperation came to an end.
A guard noticed a detainee who appeared to be trying to hang himself. “The detainee had put a sheet in the ceiling around the lights and built what looked like a noose and was putting his head toward that noose,” Adm. Harris says. “The quick-reaction force rushed into that [cell] block to save the life of the individual they thought was trying to kill himself. When they got in there, the detainees had slickened the floor with feces, urine and soapy water,” making it hard for the guards to keep their footing.
“They proceeded to attack the guard force. . . . The attack was obviously planned. They managed to get a guard down on the ground. They attacked him with broken light fixtures, with fan blades and with [security] cameras that they had torn off to use as bludgeoning weapons. In that process the NCOIC [noncommissioned officer in charge] made the call–a gutsy call–to fire less-than-lethal rounds at the detainees. . . . All that took about three to five minutes. . . . The disturbance was quelled. No one was seriously injured, either the guards or the detainees.
Stashiu told me that it sounded like the guards had handled the incident “perfectly.” But it was a reminder that almost any detainee was capable of fanaticism and violence — even the ones in the low-security unit of Camp 4.
Few Terrorists Are Mentally Ill
The New York Times editorial board has claimed that the suicides occurred because the detainees were driven to despair by their conditions. I asked Stashiu to what extent the detainees’ feelings of depression were centered around the idea that they had no idea when (if ever) they’d get out. Did they talk about this? Did they complain about how they just wanted a trial, and that sort of thing?
Some did and it makes sense. There were detainees with situational depression that was authentic, just as you can see situational depression in prisons. We did not talk at length about this though, as I mentioned, there were some topics that just had no therapeutic benefit to them. This was one of them and we would redirect the conversation because we had no answers for them and expressing sympathy for their situation would not only have been inappropriate, it would have been seen as weakness and exploited.
However, Stashiu is clear that very few of these folks are truly mentally ill. As mentioned in a previous post, Stashiu told me that the majority of the detainees had been seen by Behavioral Health, and fewer were on “psychiatric service,” which meant that Stashiu and his staff regularly spoke to them and worked with them through their psychological and behavioral issues. But that didn’t mean that they were truly mentally ill. Rather, Stashiu confirmed reports previously published in the media that:
[t]he incidence of true mental illness was exactly the same as stateside correctional facilities, between 16 and 17 percent.
In phone conversations, I quizzed Stashiu about the “between 16 and 17 percent” number. In essence, he said that this number correlated roughly with Axis I of the DSM IV-TR, which (in rough layman’s terms) represents mental illnesses that are beyond the patient’s control. He said that roughly 80 percent of the detainees met the criteria for a psychological disorder under the DSM IV-TR, but the vast majority of those (perhaps 63 to 64 percent) fell within Axis II, which (again in rough layman’s terms) represents behavioral disorders that are controllable. If you have “antisocial personality disorder” or “narcissistic personality disorder” then you fall within Axis II. Your disorder may well be severe, but most laymen would recognize your problem as a learned reaction to environmental stimuli — in other words, something that you have control over.
Of the detainees who had mental illness, almost all respond well to medications with only occasional admissions to the psychiatric facility. People with Axis II diagnoses are notoriously difficult to treat because medications are only minimally effective. These people must learn more adaptive coping skills and change is hard for most people.
Bottom line: maybe 16 to 17 percent of detainees are truly mentally ill. But about 80 percent of them have problems coping with the stresses of life.
I suppose people could debate whether these problems pre-existed Gitmo, or were caused by the conditions of their detention. I asked Stashiu for his opinion on this. He said that conditions at the facility mirror those at stateside facilities. In his opinion, the causes of these mental health problems are a mixture of factors, just as in the United States.
But one thing is certain: the terrorists are not like you and me. For example, you and I would not smash a woman’s face into a door and shatter her facial bones.
But more about that tomorrow . . .
Tomorrow: The guards’ treatment of the detainees — and the detainees’ treatment of the guards. Bonus: you’ll finally learn who has been abusing Korans at Gitmo.