In a war-crimes courtroom at Guantánamo Bay in January 2009, five men sat accused of plotting the Sept. 11 attacks. They were avowed enemies of the United States, who had admitted to grievous bloodshed. They had also been subjected to the most horrific of the government’s interrogation tactics.
During a courtroom break, one of the men, Ammar al-Baluchi, asked to speak with a doctor. Xavier Amador, a New York psychologist who was consulting for another defendant, met with him. As they talked, Mr. Baluchi’s eyes darted around the room, according to a summary of Dr. Amador’s notes obtained by The Times. Mr. Baluchi said he struggled to focus, described “terrifying anxiety” and reported difficulty sleeping.
Dr. Amador noted that Mr. Baluchi seemed to meet the criteria for PTSD, anxiety disorder and major depression. “No one can live like this,” Mr. Baluchi told him.
Mr. Baluchi, 39, was captured by Pakistani officers in April 2003. Though he was described as willing to talk, the C.I.A. moved him to a secret prison and immediately applied interrogation methods reserved for recalcitrant prisoners. In court documents and Mr. Baluchi’s handwritten letters, he described being naked and dehydrated, chained to the ceiling so only his toes touched the floor. He endured ice-water dousing and said he was beaten until he saw flashes of light and lost consciousness. He recalls punches from his guards whenever he drifted asleep.
Today, his lawyer said, Mr. Baluchi associates sleep with imminent pain. “Not only did they not let me sleep,” Mr. Baluchi wrote in a letter provided by the lawyer, “they trained me to keep myself awake.”
Guantánamo physicians have prescribed Mr. Baluchi antidepressants, anti-anxiety drugs and sleeping pills, according to his lawyer, James G. Connell III, who sends him deodorants and colognes to keep flashbacks at bay. “The whole time he was in C.I.A. custody, you’re sitting there, smelling your own stink,” Mr. Connell said. “Now, whenever he catches a whiff of his own body odor, it sets him off.”
General Xenakis, who is consulting on the case, found that Mr. Baluchi had PTSD and that he showed possible signs of a brain injury that may be linked to his beatings. He said Mr. Baluchi needed a brain scan, which the military opposes. The test would likely prompt more hearings, which could further complicate a trial.
“Having caused these problems in the first place, now the United States has to deal with them at the military commissions,” Mr. Connell said. “And that takes time.”
The compromised mental status of several other prisoners, like Mr. Baluchi, has affected the military proceedings against them.
Ramzi bin al-Shibh, who admits helping plan the Sept. 11 attacks, has said he believes the military is tormenting him with vibrations, smells and sounds at Guantánamo. Military doctors there have found him to be delusional, and records indicate that his symptoms began in C.I.A. custody, after brutal tactics and years of solitary confinement.
But Mr. bin al-Shibh refused to meet with doctors to assess his competency and insists he is sane, so the case continues.
Lawyers have similarly raised questions about Abd al-Nashiri’s psychological state. Accused in the U.S.S. Cole bombing, he was subjected to waterboarding, mock execution, rectal feeding and other techniques — some approved, some not — at C.I.A. sites. Even after internal warnings that Mr. Nashiri was about to go “over the edge psychologically,” the C.I.A. pressed forward.
Over the years, government doctors have diagnosed Mr. Nashiri with anxiety, major depression and PTSD. His lawyers do not dispute his competency to stand trial, though no such trial is imminent. His torture and mental decline, though, could make it harder for prosecutors to win a death sentence.
When the Walter Reed doctors evaluated Mr. Nashiri, “they concluded that he suffers from chronic, complex, untreated PTSD,” his lawyer told a military judge in 2014. “And they attributed it to his time in C.I.A. custody.”