Raj Persaud: Mental anguish likely to be most damaging

Severe psychiatric disorders such as post-traumatic stress disorder (PTSD) are reported in 88 per cent of survivors of captivity in circumstances such as Guantanamo Bay, according to researchers. Depression, anxiety, and alcohol and substance abuse are also frequently reported in such prisoners, even if no physical abuse or torture has been involved.

The research suggests it is the emotional effectsof captivity which will be most damaging in the long run. It will also be the most difficult to detect to the non-specialist eye, as there is no physical scar to show the world.

The newly released men are likely to experience a range of symptoms which come under the definition of PTSD. These include nightmares and other sleep disturbances, flashbacks, disorientation, depression, anxiety, hyper-arousal, difficulty in learning new skills, memory dysfunction, eating disorders, anger and lethargy. Victims will fear that they are "going crazy" so they must be reassured that PTSD is an understandable reaction to an abnormal situation.

The camp itself seems to have been designed for psychological torture. The US military states that, in addition to numerous hunger strikes, by the end of 2003 there had been at least 28 suicide attempts by the detainees.

According to reports, the detainees will have been deprived of food, water, sleep, and light. They will have been kept in isolation, wearing black hoods for hours at a time, and have been forced to stand or kneel in unnatural positions in extreme cold or heat. They will have been kept shackled and naked at times, and been hooked up to sensors during serial interrogations.

And they will no doubt have been informed of the ever-present possibility of the death penalty.

US officials maintain that this treatment of detainees does not violate international law or constitute torture. However, by the definition in the World Medical Association's "Declaration of Tokyo" (1975), torture is "the deliberate, systematic or wanton infliction of physical or mental suffering, to force another person to yield information, to make a confession, or for any other reason", which is clearly what the detainees have experienced. The United Nations has also denounced the US's "ticking bomb" justification of its means - that information needs to be obtained quickly to avert atrocities.

But it is well known these psychological torture tactics produce unreliable intelligence. Their real purpose is to destroy dissent and opposition in its victims and the population from which they come - the Muslim and Arab communities - by creating psychologically disabled survivors who shuffle out of detention as fearful reminders of what it might mean to oppose a regime.

Ironically, one of the negative consequences of trauma, especially torture, has been observed as increased aggression, so the US has most probably taken the innocent and transformed them into the potentially violent.

Dr Raj Persaud is Consultant Psychiatrist at the Maudsley Hospital in south London