Lasting Scars

Mr. bin al-Shibh undergoes a routine examination during intake in Guantánamo. Doctors, relying on a government assessment prior to his arrival, note that he has had “some difficulties” in an unspecified place over the past 16 months. But they describe him as in generally good health. He says he is “fine.”

Mr. bin al-Shibh says he is unable to sleep “because of problems he had in the past at another facility.” He begins to complain that the guards are sending smells, noises and subtle vibrations into his cell to torment him. He also describes a chronic skin allergy that gives him painful pins-and-needles sensations. Military psychiatrists find that he has “adjustment disorder with depressed mood,” which means he has developed marked sadness and hopelessness in response to recent stress.

Complaints about odors, sounds and vibrations persist, to the point that doctors wonder whether a neurological disorder is causing hallucinations. Mr. bin al-Shibh tells doctors that, before arriving at Guantánamo, he had been hung from the ceiling, which he says causes tingling sensations in his arms and legs. Doctors note that lotions and medications have not helped. They fill out a form for “suspected detainee maltreatment.” They cross off the word “suspected” and write in “alleged.”

Mr. bin al-Shibh screams that it is too cold in his cell. But when guards raise the temperature a single degree, he responds that it is too hot. He continues to complain of “skin sensations,” prompting him to strip off his clothes or refuse blankets, exacerbating the temperature problems. Psychiatrists give a preliminary diagnosis of delusional disorder. He refuses psychiatric drugs, but doctors recommend that he “be involuntarily medicated with a long-acting antipsychotic medication.”

Doctors inject him with Haldol, Ativan and Benadryl, a cocktail of antipsychotic and anti-anxiety drugs. At one point, a psychiatrist tells him that he has a delusional disorder. Mr. bin al-Shibh calls him a liar and says the doctor is the one with the disorder. The Navy hospital’s bioethics committee votes to start him on involuntary, long-acting treatments of Haldol.

Doctors give Mr. bin al-Shibh another antipsychotic injection over his objections. He tells a psychiatrist: “I am not sick. You are sick.” Delusional disorder is now his primary diagnosis. His behavior improves, though skin problems persist, and he requests ointments and anti-itching medication. He agrees to take Zyprexa, another antipsychotic, but denies having problems.

Mr. bin al-Shibh screams at the guards and bangs on the camera in his cell, demanding that people stop shaking his bed when he is sleeping. When a psychiatrist tells him that these are the same delusions that led to his forced medication, Mr. bin al-Shibh curses at him, then looks sullen and says, “Give me the pill.” He screams that his leg shackles are too tight when he is unshackled.

Nearly a dozen psychiatrists affirm a diagnosis of delusional disorder over the years, though eventually Mr. bin al-Shibh refuses to take antipsychotic medication and doctors stop forcing it on him. He frequently refuses to meet with doctors. Complaints of bed shaking, sounds and vibrations persist. In 2013, he tells a military judge that the sounds get louder when he tries to concentrate.

Mr. bin al-Shibh testifies before a military commission, telling a judge that the guards have machines that can produce vibrations from anywhere. In C.I.A. prisons, he says, officers used vibrations and sounds as part of interrogations. “But now why do they keep doing these things?” he asks. Even when doctors give him special earplugs, he says, he can still hear the noises.

Mr. bin al-Shibh added: “You cannot sleep, you cannot read, you cannot pray, you cannot do anything. And they follow you everywhere you go.” Mr. bin al-Shibh has refused to meet with a panel of government psychiatrists to assess his competency to stand trial for the Sept. 11 attacks. He insists he is sane and competent, and the case is moving forward.