June was flying by quickly as I assembled a biscuit team of two psychologists in addition to myself and two enlisted psych techs. This was not easy. At this point there was neither a training course for a psychologist to acquire expertise in this area nor much that one could read. So Colonel Banks and I identified two solid reserve clinical psychologists who were willing to put their lives on the line and come to this hellhole. One of the officers was a senior ranking psychologist within the Federal Bureau of Prisons. The other was well trained as a psychologist. I told Colonel Banks, “Just send me two good officers and I’ll do the rest.” He did exactly that. The enlisted techs who were selected had both worked for me previously; one at Walter Reed and the other at Gitmo. I trusted them to serve as my eyes and ears with the enlisted soldiers. Now that we were fully staffed we were able to be present at the intel center twenty-four hours a day and seven days a week. The orders from the general, myself, and the intel center director were crystal clear: if the biscuit was not present, there were to be no interrogations. The additional benefit of having a full staff allowed me to spend a great deal of time walking the compound and grasping just what in the hell had led to the abuses at Abu Ghraib and the looming level of despair that was ever-present.
One of the first things I noticed was that these soldiers, who probably arrived in excellent physical condition, were starting to look like couch potatoes. I learned a long, long time ago as a psychologist that one of the worst things for a patient who is depressed is to be inactive and lie on the sofa most of the day, just hiding away from the world. We had a lot of that going on at Abu Ghraib, or at least the combat-zone equivalent of lying on the sofa. Most of the soldiers at Abu Ghraib gained ten, fifteen, or twenty pounds during their deployment. Many of them were attempting to hide and use food as their elixir. I knew that activity is one of the keys to getting a depressed patient turned around in the right direction. We got busy with putting together a physical fitness program, and I requested more equipment for the gym.
There were plenty of examples of how things had gotten so bad at Abu Ghraib. In addition to the lousy oversight by superior officers, the prison population posed challenges that would have been daunting even back in the States, with all the best resources available and without the fear of mortars coming at you. One day in early July, I was asked to see a teenage Iraqi soldier, a boy, who had been arrested for firing an RPG (rocket-propelled grenade) at some soldiers. This kid was apparently suicidal. I went to see him and once again my heart dropped at the sight of such a young boy in our custody. I knew, though, that being held by the U.S. Army was not this child’s only problem.
His name was Abid, and though he was about fifteen years old, he could have passed for much older. He looked disheveled, smelled of feces, and wore tattered, torn clothes. He looked and smelled as bad as a sixty-year-old man living on the street in Washington, D.C. Through the aide of an Arabic interpreter, I learned that he had been kidnapped from his home by a local gang lord. Like most other teenage boys in his country, he was indoctrinated at a local mosque and believed that it was his duty to kill Americans and all other infidels. Also, he was angry because he felt that U.S. soldiers had wrongly captured his father and placed him in prison. The boy’s father, a truck driver, had lost his business and their home because he was locked up for eight months. It was apparent to me that Abid was very ill and the translator explained to me that the boy complained of a stomachache as well as wanting to kill himself. I called the camp physician to examine him. While we were waiting I chatted casually with the prisoner, with the aid of the interpreter, Harim. Eventually I got him laughing about how ugly his first girlfriend was.
“Hey, if you’re locked up here, at least you don’t have to see her in your hometown, right?” I waited for the translator, and then I saw a small grin creep across Abid’s face. He spoke softly to the translator, who then interpreted for me.
“He says he’s hoping the girl’s father will arrange for her to marry someone else while he is locked up,” Harim said. I looked at Abid and we both laughed out loud.
Seeing Abid laugh was some solace. In a way, even after my duty at Gitmo I was still sort of unprepared for this type of prisoner. Seeing a child in prison never seems right. But still, it’s not every day in the United States that you meet a teenager who was arrested for trying to blow the head off a policeman.
The living conditions were inhumane at Abu Ghraib, and it was particularly wrong for any youth to be housed in such filth. I needed to develop a rehabilitative plan for these young boys who were in our prison, to include their psychological, medical, academic, religious, and athletic needs. Our military was equally ill-prepared (medically, academically, in facilities/logistical planning, and in terms of mental health services) to manage the juvenile enemy combatant. No one was prepared for the large number of teenage terrorists we would encounter in Afghanistan and Iraq.
I worked closely with the camp physician and leadership to form the nucleus for a rehab team. We put in an order to improve the facilities with air-conditioning, and we made plans for adding recreational and educational activities. General Miller brokered a deal with the Iraqi minister of education to provide us with Iraqi tutors for the teenagers, and that helped us make tremendous progress with their rehabilitation.
I thought a lot about Abid while I was in Iraq. He could appear cheerful, kind, and engaging as long as you didn’t talk about why he wanted to kill Americans. That was when you realized you didn’t really want this kid hanging around your neighborhood. Whenever anyone asked him about shooting at soldiers, building weapons and IEDs, or bombmaking factories, he would sit up in his chair and the pupils of his brown eyes would dilate. He went from likable teenager to homicidal terrorist in an instant, like you had flipped a switch. He would begin each sentence with “It says in the Koran,” but he could never tell the Arabic translator where in the Koran it said so. He couldn’t read a lick! This was a common strategy of the Iraqi and Afghani leaders: deny people the ability to read. Illiteracy enslaved them in that they would have to rely on the Koran’s interpretation from the gang lord or the tribal leaders. They couldn’t read it for themselves and realize those people were feeding them a lot of bullshit to suit their own agenda. I learned that this was why so many schools in Afghanistan had minefields around them—to keep the children out of schools, to keep them dumb, to keep them useful.
The translator Harim would sometimes try to enlighten the young man about how he had been led astray by people who lied to him about the Koran. One afternoon he told Abid, “Islam is a peaceful religion. A good Muslim never hurts anybody with his hands or his mouth.”
“Kill all nonbelievers!” Abid shouted in response, full of intense rage. It was almost like the mental rigidity of many delusional patients I had seen over the years. I couldn’t help but ask myself on many occasions, Is Abid crazy? Can this be more than just a wrongheaded dedication to his cause? Is he thinking this way because of a delusional disorder?
These were questions our country was not prepared to answer, and even more so as they related to juvenile enemy combatants. The closest we had ever come to waging war against an enemy with a similar mind-set was when we fought the Japanese in World War II. The kamikaze suicide bombers would sign up for missions that required them to crash their planes into U.S. ships. We had never seen this prior to World War II—and the very idea of young people sacrificed by their leaders, and willing to be sacrificed, freaked us out at the time. The thought of such unstoppable fanaticism probably unnerved American servicemen even more than the actual damage wrought by the suicide attacks. That was terrorism. This time around in the global war on terrorism, we were unnerved by the idea of these teenage terrorists coming at us in such large numbers. Like the Japanese suicide bombers, the JECs are rarely talked out of their mind-set of “kill all nonbelievers.” In some regions, 10 to 20 percent of the Muslim fighters are teenagers. As the global war on terrorism spreads, we will have to dissect and analyze th
is issue. If we are to be effective in this war, we will have to ask, “Is this part of a mental delusion?”
The question has to be asked and the problem of teenage terrorists and their possible mental disorder has to be addressed. The first suicide bomber who walks into Madison Square Garden or Union Station may very well be a twelve- or thirteen-year-old with a backpack filled with C-4 explosives. I’m sure Abid would have been willing to do it.
Abid and the other JECs were constantly on my mind through June and July as I struggled to figure out how we should handle them, how I could care for their psychological needs as a doctor while fulfilling my duty to my country as a U.S. soldier. That was the type of question that often troubled me as I settled into operations in Abu Ghraib. I could never get away from the human suffering in this place. The screams and desperate faces of those young boys, and the smells of their filthy cages, came to me in my sleep, and they still do. And to this day, when I least expect it, I see the image of that young female interrogator being psychologically tortured by the terrorist in the late night of my first twenty-four-hour period at Abu Ghraib. Sometimes I can clearly see her face and hear her gasping for air as though she were standing right next to me. If I could pick the one thing that was perhaps the most broken about Abu Ghraib, it would be those sailors, soldiers, and marines abandoned when night fell upon them. Rarely would there be any officers or senior enlisted soldiers providing oversight, supervision, or guidance to interrogators in the late-night hours. I knew that it would be an uphill battle to convince many of the supervising interrogators to come out of their cement buildings, stand over the shoulders of these young interrogators, and provide 100 percent supervision at all times.
I eventually asked myself why a supervisor would not want to come and work with their subordinates or provide the necessary oversight. There were really only two or three answers I could come up with. Perhaps fear, desperation, and hopelessness hung over the sand of Abu Ghraib like an early morning fog on a fall day. There was no respite from fear for the troops at this place. Most of us, when we experienced fear, could find a safe haven, a sanctuary—a psychological safe place. The fear doesn’t just go on and on and on. Abu Ghraib lacked the usual things most American boys and girls grew to expect and experience in their lives back home—physical and emotional safety. I could see it in their eyes. As a child my mother’s calm voice soothed me. “Son, it’s gonna be okay. You’ll feel better in the morning,” she would say. No one here had their mothers to reassure them, but soldiers need the same thing from their commanders, the adult, military equivalent of hearing that someone is in control and watching over them and making sure everything will be fine. These soldiers lacked the comfort of their leaders telling them it would be okay. Rather, the leaders would commonly express or show their sense of hopelessness and that things would get worse.
Toward the end of July it became clear to me that this was the answer. Many of the leaders at Abu Ghraib simply did not want to be there. They were angry and depressed, and not hiding it well. It was like a festering cancer. So my goal was to lead by example and sleep only perhaps three or four hours and spend the rest of my time at the intel center. I wanted those soldiers to see a colonel walking around all the time, to see me there at all times of the day and night, with a good word for them and a good attitude. This was the second of the eleven steps I had formulated for fixing this place—be an active, positive influence at all times.
I thought that leading by example would be what the doctor ordered. It worked. Over time it became the norm to see other officers and senior enlisted soldiers walking the halls, being there for the junior soldiers and even having a little fun. It made a difference for those soldiers.
7
I’m in a Zoo
Early August 2004
The 115th Field Hospital out of Fort Polk, Louisiana, was deployed to Abu Ghraib in mid to late July 2004. With it came surgeons, family practice specialists, a preventive medicine team, a full lab, and a sorely needed mental health team. I convinced the leadership that the mission required half of the mental health team to remain in Abu Ghraib and the other half to deploy south to the other prison, Camp Bucca, the newest detention center in southern Iraq. An inpatient psychiatric facility was built at Abu Ghraib for the detainees, coupled with outpatient services for the Army staff and prisoners.
We ended up with a psychiatrist, a psychologist, psych techs, and psych nurses to run the mental health services for the detainees as well as the soldiers. Likewise, we also got a psychiatrist, a social worker, psych nurses, and psych techs to staff a mental health clinic at Camp Bucca. We built a twelve- to sixteen-bed psych hospital at Abu Ghraib for the detainees and had more advanced mental health services for the Iraqis than anywhere else in the country. The standard procedure in Iraq—among the Iraqis themselves, not American soldiers—was to either beat a mentally ill patient, torture him, tie him up, or just drug the shit out of the guy so he couldn’t cause any trouble. Finally, my staff and I had brought the mental health care standards of the American Correctional Health Services Association, the group that sets standards for health care in American prisons, to the prisoners at Abu Ghraib and Camp Bucca. Much of the good work in this area was done by a psychologist by the name of Captain Pat Bradleson, as well as the psychiatrist Major Martin Shorts.
Pat had trained under me at Walter Reed for a year. He stood about five foot seven and was a slender 160 pounds with dark hair. He wore gold wire-framed glasses that were as thick as a Coke bottle. Pat looked more like a nerdy store clerk than a rough-and-tough military officer. Perhaps this may be why some in the military shunned him—he just didn’t look the part. His appearance, together with his slow-moving and deliberate style, would often get in his way at Walter Reed. But somehow he found his stride at Abu Ghraib and came out of his shell. A combat zone can make a soldier better or make him worse, and Pat grew as an officer, soldier, and man at Abu Ghraib. He developed the outpatient unit from the ground up for both the detainees and the military staff. Pat and I had many hilarious conversations and consultations about the camp’s two most difficult patients. One was a psychotic, loudmouthed Moroccan Jew who had a penchant for telling the Arab prisoners what to do and how to do it, and on occasion he would remind them all that they were not God’s chosen people. Needless to say, he got his ass kicked on a weekly basis. Undaunted, while in the midst of his schizophrenic stupor, he was determined to convert all of the Muslim fundamentalists and help them see the error of their ways. He was not successful. Pat and I would scratch our heads on many occasions, wondering how we could get this guy out of the camp alive and in one piece. He had lost his passport, had been divorced by his Moroccan wife, was flat-out crazy, and was Jewish in a place where that never helped ease your day.
Pat became a master at managing complicated patients like these with all of the cultural, medical, and State Department issues woven into it. He was able to help this patient who had neither a passport nor a birth certificate get home. His other cross to bear was a patient by the name of “Thumpy.” Thumpy was a suicide bomber who changed his mind in midstream. We didn’t know exactly how he abandoned the idea, but in the process he blew off several fingers, which somehow led to the nickname Thumpy. He was a walking personality disorder, just a chronic pain in the ass. He liked cutting on himself to ease his stress and, like the Moroccan Jewish guy, loved to confront the hardened killers in the detainee population. Well, like the Moroccan, he would also get his ass kicked on a regular basis. Pat was able to establish a rapport with this guy as well, which kept him stabilized and safe.
Major Shorts, the psychiatrist, was a former artillery officer prior to going to medical school. You could tell by his appearance and bearing that he was a no-bullshit military officer. This was what the mission needed, and Major Shorts excelled at developing the inpatient psych unit. From the moment I saw him in the hallway of our barracks building I knew he would organize the mental health team. We were now able to offer our soldie
rs at Abu Ghraib the same level of outpatient mental health services they would receive back home. At the same time, we brought on board enough well-trained mental health staff that our mental health department at Abu Ghraib could provide detainees with nearly all of the services delivered at any prison in the United States. Finally, soldiers and detainees were both covered.
But with more medical services came more newbies who assumed they knew how everything should be done. In August we saw more of those “terrorism experts” who had never actually looked in the eyes of a terrorist, but regardless of that minor detail, their PhDs or MDs made them the authorities on the subject. These experts tried to dismiss the idea that mental illness could help explain the terrorists’ actions, arguing that there was in fact a low rate of mental illness in the terrorist population. Mind you, on a daily basis I would see “Abdul” or “Hassad” either talk to a turd in his cell or try to eat it. Then he would throw what was left of it in the face of the guard or make decorative pottery out of it—with a purpose, and with pride. We had built the inpatient psychiatric facility at Abu Ghraib over the objections of those experts who said there was little need for it, and then, in order to prove to the medical planners how sane they were, the schizophrenics at Abu Ghraib set the inpatient psych unit on fire in early August, the day after we opened it. The same experts who had tried to tell me that these detainees were perfectly sane now asked me why the psych patients had set the new unit on fire. I responded with just one line: The voices told them to do it.
By this time I was settled into the routine of Abu Ghraib and I felt like we had achieved a major goal by establishing the necessary mental health infrastructure. I had never stopped trying to understand how the abuse came to be, but in August I felt I had more time to focus on that question. I decided to start small and work my way up to the top as a process of trying to find what went wrong and how all of the many problems combined to create the debacle at Abu Ghraib. I was on the lookout for the many small indignities that can beat down any soldier in the field after a while, and they weren’t hard to find. After chow one afternoon, I headed for the port-a-potty. I stopped short when I saw that it was literally overflowing with crap. Before I could open the door to the potty the smell just about knocked me over. I gagged, shut the door, and went to the next one. It was worse! There’s nothing like the smell of an overflowing port-a-potty on a 130-degree day. I found the sergeant major in the headquarters building to report the problem to him.
Fixing Hell Page 13