How torture is like a microwave for your mind

Shaker Aamer was released to the UK at the end of October, after 13 years detention by US authorities, without charge. The report of the US psychiatrist who assessed Aamer is available online. It directly quotes some of Aamer’s own descriptions of what he alleges happened to him. It is not an easy read.

Aamer claims that he endured years of physical and mental torture including sleep deprivation, isolated confinement, beatings, having water poured over him, being made to stand in stress positions and having guards swiftly change from nice to nasty and back again. Aamer describes one guard who allowed him to sit with him and eat hot food, then described in detail the sexual attacks he allegedly threatened to carry out on Aamer’s five-year-old daughter. It is the sudden kindnesses that Aamer describes as the worst thing: “It destroys you completely,” he says in the report. “You can’t tell apart good and bad.”

One part of the report lists the physical complaints that Aamer has. It is a substantial list, but it is often the less immediately obvious psychological effects which are just as profound, if not more devastating, for individuals surviving torture.

Aamer has been diagnosed with post traumatic stress disorder (PTSD), a cluster of symptoms commonly experienced by survivors of torture and war, often situations where personal and physical integrity is compromised and the individual thinks they are likely to die. Studies suggest that torture has a "dose-response effect", so the more torture that is experienced, the more likely a post-traumatic reaction. Aamer claimed he had endured 13 years of torture.

PTSD involves a triad of symptoms: avoidance, hyperarousal and re-experiencing.

Avoidance is just as it says on the tin: not wanting to remember or talk about what happened to you. The psychiatric report describes Aamer breaking off mid-interview, in the middle of describing severe maltreatment, distracting himself by loudly singing the Eurythmics song "Sweet dreams (are made of this)".

Hyperarousal means being on really high alert all the time, constantly looking out for danger, being jumpier than usual, or feeling very irritable.

Re-experiencing symptoms include intrusive memories, flashbacks and nightmares. Intrusive memories are thoughts or images of the trauma that pop into your head unwanted and unexpected. Flashbacks are when you feel like you are back in the trauma and it is happening to you again. Nightmares about what happened are another common symptom, often leaving the individual sleep-deprived and increasing the likelihood of being tired, snappy and sad.

Alongside the classic three categories of post traumatic symptoms are several associated feelings and experiences, including low mood, panic attacks, psychotic-like experiences such as paranoia, thoughts that what happened is your fault, and overwhelming shame.

The feeling of shame is one that isn’t talked about as much, but is perhaps one of the biggest barriers to individuals being able to seek the help they need. The best-evidenced treatments for PTSD are talking therapies, but to access these people need to be willing to talk to someone about the worst things that have ever happened to them. Imagine something you feel mildly ashamed of: something you’ve said or done that you wouldn’t want other people to know about. Now imagine that you have to stand up in a room full of your friends, family and work colleagues and tell them about it. That sense of shame, but magnified, is what people have to overcome to be able to tell their story.

Psychological therapies for PTSD have a good rate of effectiveness. They aim to help people to "reprocess" traumatic memories back into a coherent order where intrusive thoughts and flashbacks are less. Therapy helps someone to reappraise the meaning of their memories now that they are safe. Survivors of torture might be released to a place of safety but it can take time and work for them to actually feel this. The effects of trauma can make it seem like the danger travels with you.

When really traumatic things happen, our ideas about who we are, how safe the world is and how much we can trust others get turned upside down and inside out. Aamer talks about not being able to distinguish good from bad anymore during his interrogations. For people living with PTSD everything can feel dangerous, even their own thoughts. Aamer compared the process of torture’s effect on his mind to being cooked in a microwave: “they boil you from the inside to the outside until you explode.”

Aamer is the last British resident to be released from Guantanamo Bay, but 112 prisoners still remain.