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In last month's Prospect, Michael Ignatieff wondered if torture, under some circumstances, may make us safer. The answer is a firm no.

Ignatieff personally rejects torture as a solution. None the less, he opens the door for those with fewer scruples, arguing that "moral prohibition comes at a price" and that those of us who oppose torture should "also be honest enough to admit that we may have a price to pay for our own convictions." The practical implications of this reasoning mean that his argument deserves a considered response.

Clearly, torture may sometimes persuade people to reveal information they would not otherwise have divulged. But that does not mean that permitting torture might keep us safe.

Ignatieff argues that an absolute ban on torture might prevent our intelligence services from gaining "timely access to information that may save lives." The "ticking-bomb" scenario, as it is usually known, can seem persuasive. If someone knows of a vast bomb primed to explode in the heart of central London, how could one not torture him, to save thousands of lives? Exposed to reality, however, the hypothetical is no longer so neat. It has damaging consequences for individuals and societies alike.

It is partly a question of the accuracy of statements made under torture. Take the case of the Peruvian student Magdalena Monteza, abducted as an alleged subversive. After being tortured and repeatedly raped by her captors, she admitted to being part of a revolutionary cell. In the film State of Fear, she describes her story: "I'd never had sex before. I was a virgin, 19 years old... I couldn't take the torture so I decided to sign. I confessed to things I never did... If they had sentenced me to death I wouldn't have cared." The Canadian-Briton Bill Sampson was repeatedly tortured in a Saudi jail. Under torture, he admitted to being part of a network responsible for bombings and murder, thus enabling the authorities to pretend that there is no homegrown terrorism in Saudi Arabia.

In the lead-up to the Iraq war in 2003, Colin Powell told a "first-hand" story of how Saddam Hussein supported biological and chemical weapons training for al Qaeda. The story, gained from an al Qaeda operative tortured in Egypt, later proved to be untrue. One CIA source was quoted: "This is the problem with using the waterboard [being held under water until you think you will die, known to the Latin American military as the submarino]. They get so desperate that they begin telling you what they think you want to hear."

Moral and practical arguments are inextricably intertwined. If some torture is justifiable in pursuit of the greater good, why not all torture? If the suspected terrorist is too hard a nut to crack, why not torture the man's wife or daughter? Is that not an acceptable price to pay to save lives?

The simple answer is no. Torture degrades the torturer and those who condone it; acceptance of torture undermines the very foundations-and thus the security-of our society. Rules do matter, even if some of our politicians seem reluctant to confront that truth. Iraq today is a country full of ticking bombs. On the face of it, this would seem to be an obvious case where more torture could help keep everyone safer. If you torture hundreds or thousands of alleged radicals, one might confess where or when the next bomb will be placed. In reality, the shameful use of torture has only helped plunge Iraq into ever deeper instability.

The US administration has not been shy about its abandonment of the rules, based partly on a version of Ignatieff's argument that "moral prohibition comes at a price." Cofer Black, CIA head of counter-terrorism, explained that, after 9/11, "the gloves came off." Those who committed abuses at Abu Ghraib and elsewhere acted as if moral scruples were trumped by what Ignatieff calls "accurate security information, even if collected by dubious means." In reality, the trampling of the rules has merely encouraged those who believe that mass murder of civilians can be justified, and may have helped give the terrorists fresh recruits. Popular co-operation and tips to the authorities, which security experts agree can play a crucial role in cracking a secretive conspiracy, are, by contrast, more difficult than ever.

The US army intelligence manual is clear: "The use of force is a poor technique, as it yields unreliable results, may damage subsequent collection efforts, and can induce the source to say whatever he thinks the interrogator wants to hear." This military common sense has been abandoned in the past few years in favour of the brutal, politically driven shortcut. Alberto Mora, until recently general counsel of the US Navy, argues: "Getting the information became the overriding objective. But there was a failure to look more broadly at the ramifications... When you put together the pieces, it's all so sad."

The British government has in past years played a key role in combating torture worldwide. And yet it refuses today to confront Washington's policies, which endanger us all. At home, too, Britain has tried to dodge its commitments-by asserting the right to use torture evidence in court proceedings (only a law lords' ruling forced the government to climb down), by negotiating flimsy agreements for sending people back to countries where they may be tortured, and by seeking to reverse the impact of European court judgments which emphasise that the ban on sending people back to the risk of torture is absolute.

William Hague talks of the "loss of moral authority" which comes from tolerating torture. This loss of moral authority has important implications. Ask Bill Sampson, ask Magdalena Montaleza. Ignatieff is right to reject torture: "We cannot torture, because of who we are." None the less, if we allow ourselves to be seduced by arguments that torture helps keep us safe, the prospects for the 21st century look bleak.

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In last month's Prospect, Michael Ignatieff wondered if torture, under some circumstances, may make us safer. The answer is a firm no. Ignatieff personally rejects torture as a solution.

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Larry Downing/Reuters

Updated | Top psychologists and senior officials at the American Psychological Association (APA) secretly collaborated with the Bush administration's interrogation programs, according to a damning, independent report by David H. Hoffman, a Chicago-based lawyer.

The 542-page report, which was obtained by The New York Times and published on its website for the first time on Friday, was commissioned last November by the APA's board to investigate allegations made in James Risen's 2014 book, Pay Any Price. In the book, Risen says senior APA officials clandestinely worked with high-ranking members of the CIA and Department of Defense to help justify the Bush administration's interrogation program.

The report, which seems to confirm findings in a separate report released earlier this year, is based on hundreds of interviews, an "immense volume" of internal APA documents and materials provided by former APA officials and association critics. Hoffman did not have access to classified material, and his report is unredacted. When reached by email, the APA, the largest professional body of psychologists in the U.S., which lobbies for funding and sets ethical standards for most American practitioners, pointed Newsweek to a statement and list of recommendations online.

It's long been known that health professionals played a key role in legitimizing and implementing the CIA's and Defense Department's interrogation programs. The Department of Justice mandated, in a series of now-notorious "torture memos," that doctors and psychologists monitor detainees' health during interrogations to ensure interrogators did not break the law by inflicting torture or abuse.

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Last December, the Senate Select Committee on Intelligence's Study of the CIA's Detention and Interrogation Program showed that the agency's "enhanced interrogation techniques" were designed and administered by psychologists James Mitchell and Bruce Jessen, both of whom were contractors. In another report from 2009, the Senate Armed Services Committee also found that Department of Defense psychologists at Guantanamo Bay helped interrogators break prisoners by identifying their mental vulnerabilities.

Yet Friday's report shows how the ties between the psychological profession and the American intelligence community went deeper than previously recognized. It finds that top officials at the APA, especially its ethics director Stephen Behnke, collaborated with figures at the Department of Defense to align the association's ethics policies with the needs of the Pentagon's interrogation program. Hoffman does not claim that APA officials knew the reality of the "enhanced interrogation program," but does find that "APA officials were colluding with DoD officials to create and maintain loose APA ethics policies that did not significantly constrain DoD." The APA has repeatedly denied any collusion with the administration.

"The most disturbing aspect of this whole episode is that it was run out of the APA's ethics office," says Steven Reisner, a psychologist and psychoanalyst who ran three times for the APA presidency and has long campaigned against the association's involvement in interrogations. "It's not just that they sold out APA's ethical standards to collude with the needs of the government," adds Reisner, who aided Hoffman's investigation. "What's unconscionable is the fact that this was done in support of torture and abuse."
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The American Medical Association and American Psychiatric Association, two other important professional associations, eventually barred their members from any involvement in interrogations. But the APA held fast, affirming psychologist participation at a key 2005 task force which, the report shows, was carefully managed by APA officials in conjunction with the administration. Later, senior APA officials "engaged in a pattern of secret collaboration with DoD officials" to stifle opposition to association policies from within the APA, according to Hoffman's report. Behnke also "regularly sought and received pre-clearance" for the association's public statements from a senior military psychologist at the Pentagon, according to the report. While working at the APA, the report says the Pentagon gave Behnke a secret contract to help train interrogators. He also coordinated a public relations campaign with the Pentagon to better sell psychologists' involvement in interrogations, and killed ethics complaints, the report shows.

"An especially disturbing aspect of this scandal is the way in which a supposedly independent civil society organization and profession were corrupted by involvement with the military and intelligence establishment," says Stephen Soldz, a professor at Boston Graduate School of Psychoanalysis, who assisted Hoffman's investigation. "This is not the way our democracy is supposed to work."

"This is the single greatest health professional ethics scandal of the 21st century," says Nathaniel Raymond, formerly the director of the campaign against torture at Physicians for Human Rights and currently the director of the Signal Program on Human Security and Technology at the Harvard Humanitarian Initiative of the Harvard Chan School of Public Health. "It represents the most egregious example of a health professional organization allowing the national security apparatus to determine its ethics," adds Raymond, who cooperated with Hoffman's investigation.

The report indicates that CIA officials, including the head of the agency's office of medical services, objected to the involvement of psychologists in the "enhanced interrogation program" on ethical grounds. But prominent psychologists outside the CIA, including two former APA presidents, stifled their protests. One, Joseph Matarazzo, wrote a memo concluding that sleep deprivation did not constitute torture. He later went on to own a stake in Mitchell, Jessen & Associates, a private company set up by the architects of the interrogation program.

The report also offers details missing from the Senate's report on torture, showing how Mitchell, who created the CIA's enhanced interrogation techniques, was introduced to the agency's counterterrorism center by Kirk Hubbard, a former senior official in the operational assessment division at Langley. Having brought Mitchell to the CIA, Hubbard later went on to work at Mitchell and Jessen's private company.

Mark Fallon, a former federal agent and chair of the research committee of President Barack Obama's High-Value Detainee Interrogation Group, which conducts interrogations of high-value terror suspects and sponsors research into interrogation techniques, is particularly troubled by what he calls this conflict of interest. "It would seem further investigation is required," Fallon says. "Government officials act on behalf of the people and are accountable to the people. We also have legal obligations internationally for accountability."

Several senior APA officials mentioned in the report are still working at the association. Behnke has reportedly left his position, and the association appears to be on the verge of crisis. Raymond believes it is "highly likely" more will lose their jobs as a consequence of Hoffman's findings, and that the "wave of accountability" could spread to Bush and Obama administration officials, even though, so far, no high-ranking official has been fired or prosecuted for involvement in prisoner abuse. The APA board has reportedly received the report and is expected to act on its findings shortly.
Correction: A previous version of this story mistakenly reported that former APA president Joseph Matarazzo went on to work at Mitchell, Jessen & Associates. He owned a stake in the company, but did not work there. A previous version of this story also mistakenly reported that Kirk Hubbard was the head of the operational assessment division at Langley. He was a former senior official in that division.

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Leading Psychologists Secretly Aided U.S. Torture Program

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Updated | Top psychologists and senior officials at the American Psychological Association (APA) secretly collaborated with the Bush administration's interrogation programs, according to a damning, independent report by David H. Hoffman, a Chicago-based lawyer.

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After the September 11, 2001 attacks on the United States, the US government authorized the use of so-called "enhanced interrogation techniques" on terrorism suspects in US custody. For years US officials, pointing to Department of Justice memorandums authorizing these techniques, denied that they constituted torture. But many clearly do: International bodies and US courts have repeatedly found that "waterboarding" and other forms of mock execution by asphyxiation constitute torture and are war crimes,[1] Other authorized techniques, including stress positions, hooding during questioning, deprivation of light and auditory stimuli, and use of detainees' individual phobias (such as fear of dogs) to induce stress, violate the protections afforded all persons in custody - whether combatants or civilians - under the laws of armed conflict and international human rights law, and can amount to torture or "cruel, inhuman, or degrading treatment."[2] Accordingly, the United Nations Committee against Torture and the UN Special Rapporteur on Torture have clearly stated that these techniques are torture.[3]

US President Barack Obama has acknowledged that the US used torture as part of the CIA's post 9/11 interrogation program, and has said that waterboarding constitutes torture.[4] However, many current and former US officials still argue that the "enhanced interrogation techniques" were not torture.[5] The recent release of the summary of the Senate Intelligence Committee's report on the CIA's detention and interrogation program has heightened debate around this issue.

The claims of those who argue these techniques did not constitute torture are contradicted by past US statements criticizing other countries for using those same techniques. Below are some examples of such statements, drawn from the US Department of State's annual Human Rights Reports.

The State Department's 2003-2007 Human Rights Reports on Sri Lanka classified "near-drowning" as among "methods of torture." In the reports on Tunisia from 1996 to 2004, "submersion of the head in water" is classified as "torture."[6]

The United States government has officially acknowledged waterboarding only three detainees: Khalid Sheikh Mohammed, Abu Zubaydah, and Abd al-Rahim al-Nashiri. Mohammed was waterboarded 183 times, Zubaydah 83 times, and al-Nashiri twice.[7]

In Human Rights Watch's 2012 report Delivered into Enemy Hands, detainee Mohammed Shoroeiya described being repeatedly waterboarded during interrogations in Afghanistan. Another detainee cited in the same report, Sharif, said he was subjected to a similar method of water suffocation where he was made to lie down in a plastic sheet filled with icy water while wearing a hood as jugs of freezing water were poured over his nose and mouth. Their accounts contradict statements about the practice from senior US officials, such as former CIA Director Michael Hayden, who testified to the Senate that the CIA waterboarded only three individuals.

Human Rights Watch's 2011 report Getting Away with Torture details the numerous times US courts found that waterboarding, or variations of it, constitutes torture and is a war crime. Examples include a congressional inquiry of the early 1900s US occupation of the Philippines that led to the court martialing of several US soldiers, and several US military commissions in the World War II Pacific Theater which found that variants of waterboarding constituted torture.

Stress Positions, Forced Standing, Forced Nudity

The State Department's 2006 Human Rights Report on Jordan deemed subjecting detainees to "forced standing in painful positions for prolonged periods" as torture.[8] In its 2000, 2001 and 2002 reports on Iran, "suspension for long periods in contorted positions" is described as torture.[9] In the 2002 report on Sri Lanka, "suspension by the wrists or feet in contorted positions" and remaining in "unnatural positions for extended periods" are described as "methods of torture."[10] In the 2005 report on North Korea, "being forced to kneel or sit immobilized for long periods, being hung by one's wrists, being forced to stand up and sit down to the point of collapse" is classified as a method of torture. The 2005 Egypt reports cited the stripping and blindfolding of prisoners among the "principal methods of torture."[11]

According to a report by the International Committee of the Red Cross, some detainees in US custody were subjected to "[p]rolonged stress standing position, naked, held with the arms extended and chained above the head ... for periods from two or three days continuously, and for up to two or three months intermittently, during which period toilet access was sometimes denied resulting in allegations from four detainees that they had to defecate and urinate over themselves." Many of the detainees also described being subjected to extended periods of nudity, ranging from several weeks to several months.

In Human Rights Watch's Delivered into Enemy Hands, five former detainees in CIA custody described being chained to walls naked - sometimes while diapered - in pitch black, windowless cells, for weeks or months; restrained in painful stress positions for long periods; and forced into cramped spaces.

As Human Rights Watch detailed in Getting Away with Torture, stress positions were among a number of interrogation and detention techniques authorized for use by the Bush administration.

Threats of Harm to Person, Family

In the 2006 report on Turkey,"threats to detainees or family members," and "mock executions" are classified as torture. In the 2006 report on Jordan, "threats of extreme violence or sexual or physical abuse of family members" are deemed as torture. In the 2002 report on Iraq, "threats to rape or otherwise harm family members and relatives" is considered torture.

According to a 2009 CIA Inspector General's report, during interrogations a CIA debriefer put an unloaded semi-automatic handgun to detainee Abd al-Rahim al-Nashiri's head, and also turned a power drill on and off to frighten him while he was naked and hooded. Interrogators also made threats against Nashiri's family, telling him, "We can get your mother in here," and, "We can get your family in here." In the ICRC report Nashiri also alleges that interrogators threatened to sodomize him and rape his family.

The CIA report also states that interrogators told Khalid Sheikh Mohammed: "We're going to kill your children."

Sleep Deprivation, Use of Loud Music

In the 2005 and 2006 reports on Indonesia, Iran, Jordan, Libya, Saudi Arabia and Turkey, sleep deprivation was classified as torture.[12] In the 2002 State Department report on Pakistan, denial of sleep is described as a "common torture method."[13] The 2002 report on Turkey lists "loud music" as a "torture method."

In Human Rights Watch's Delivered into Enemy Hands , detainees Mohammed Ahmed Mohammed al-Shoroeiya and Khalid al-Sharif stated that they were denied sleep by continuous, deafeningly loud Western music played from speakers right next to their ears.

The ICRC report details various methods used against detainees for sleep deprivation, from the continuous blaring of loud music or hissing noises to long interrogations and stress positions.[14] Abu Zubaydah, also known to have been held by the CIA, claimed that sometimes as he was falling asleep guards would splash water in his face to keep him awake.[15]

Prolonged Solitary Confinement, Confinement in Small Space

In the 2005 and 2006 reports on Jordan, "extended solitary confinement" is classified as "torture."[16] The 2002 report on Iraq described "extended solitary confinement in dark and extremely small compartments" as torture. In the 2005 report on North Korea, "being forced to kneel or sit immobilized for long periods, being hung by one's wrists, being forced to stand up and sit down to the point of collapse" is classified as a method of torture. In the 2002 report on China, "prolonged periods of solitary confinement" and "incommunicado detention" are listed as torture.

The ICRC report describes how detainees were kept in prolonged solitary confinement and incommunicado detention (with no access to family or attorneys) for periods ranging from 16 months to as long as four-and-a-half years.

In Delivered into Enemy Hands , detainees describe being held in very small cells for prolonged periods of solitary confinement and incommunicado detention through much of their imprisonment.

Getting Away with Torture describes the CIA's secret detention program as entailing "prolonged incommunicado detention."

[5] Jose Rodriguez, former chief of the Central Intelligence Agency's clandestine operations, recently said of the CIA's enhanced interrogation program for example, that "it worked because it was not torture ("Watching 'Zero Dark Thirty' with the CIA: Separating Fact from Fiction," Moderated Discussion at American Enterprise Institute Transcript, January 29, 2013, http://www.aei.org/wp-content/uploads/2013/01/-event-transcript_111915959376.pdf

(accessed December 5, 2014); Senate Intelligence Committee Vice-Chairman Saxby Chambliss has disputed the use of the term "torture" to describe the CIA's enhanced interrogation program and said that waterboarding is "not torture, (Sandy Fitzgerald, "Saxby Chambliss: Senate Probe of CIA Interrogations "a Mistake,'" Newsmax August 3, 2014, http://www.newsmax.com/Newsfront/Chambliss-hacking-probe-CIA/2014/08/03/id/586557/ (accessed December 5, 2014); Former US President George W. Bush has also said that "enhanced interrogation techniques" authorized by the Justice Department were legal and that waterboarding is not torture (see "Waterboarding is Torture, Downing Street Confirms," The Guardian, November 9, 2010, http://www.theguardian.com/world/2010/nov/09/george-bush-memoirs-waterboarding (accessed December 5, 2014).

[7] Testimony of Michael Hayden in front of the Senate Select Committee on Intelligence, February 5, 2008, http://www.intelligence.senate.gov/pdfs/110824.pdf, p. 71-72. CIA Office of the Inspector General, "Special Review: Counterterrorism Detention and Interrogation Activities (September 2001 - October 2003)," May 7, 2004, declassified in August 2009, http://graphics8.nytimes.com/packages/pdf/politics/20090825-DETAIN/2004CIAIG.pdf (accessed July 2, 2012), ("CIA OIG report"), p. 90-91.

[14] ICRC, Regional Delegation for United States and Canada, "ICRC Report on the Treatment of Fourteen "High Value Detainees" in CIA Custody," p. 9, 29.

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After the September 11, 2001 attacks on the United States, the US government authorized the use of so-called "enhanced interrogation techniques" on terrorism suspects in US custody. For years US officials, pointing to Department of Justice memorandums authorizing these techniques, denied that they constituted torture.

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READ MORE: Not-so-magnificent 7: Nations named & shamed in CIA torture report
According to the Senate committee's findings released on Tuesday, the "enhanced interrogation techniques," or EITs, used against foreign prisoners within the walls of covert, overseas prisons ultimately prove to be largely ineffective. John Brennan, the current director of the CIA, challenged those claims with a lengthy rebuttal on Thursday.

Nevertheless, the executive summary made public this week after four years of research (and at a cost of some $40 million) continues to raise serious questions about the CIA's use of torture in the wake of the September 11 terrorist attacks. Now, as the CIA, Senate, and seemingly everyone in Washington, DC debates the committee's findings, below is but a mere sampling of some of the more shocking details described within the document.

Frozen to death

Gul Rahman, an alleged Afghan militant, was arrested six weeks after the 9/11 attacks and brought to a CIA-run prison north of Kabul, known as the Salt Pit (or COBALT, in this week's report). Rahman's stay wasn't a long one, however, on account of him dying less than a month later, from what the Senate committee suspects to have been hypothermia.

Sometime that November, a low-level CIA officer at COBALT ordered that Rahman be stripped naked, except for a sweatshirt, and " shackled to the wall of his cell in a position that required the detainee to rest on the bare concrete floor," according to the Senate committee. So soon after 9/11, though, CIA headquarters had yet to approve any interrogation tactics whatsoever at that time. Rahman's name was kept secret for seven years after he died, and the bulk of what the world knows about his passing was largely unknown until this week. The junior officer who insisted Rahman spend the night naked on a cold, concrete floor, meanwhile, was recommended to receive a " cash award" of $2,500 for his " consistently superior work " just four months later, the Senate report acknowledges.

Rectal feeding

At least five CIA detainees were subjected to " rectal rehydration," or rectal feeding, the Senate report reads, in order to keep prisoners alive who allegedly otherwise refused to eat. Yet according to the committee's findings, investigators failed to discover any " documented medical necessity" for doing as much. What the Senate did discover, however, is that the CIA's chief of interrogations at the COBALT facility characterized the tactic as being among the methods used to exhibit the agents' " total control" over detainees; another officer described the technique as being helpful to " clear a person's head," and CIA medical staff even called it a means of behavioral control, according to the report.

According to another excerpt, Saudi detainee Abd al-Rahim al-Nashiri was placed " in a forward-facing position (Trendlenberg) with head lower than torso," then rectally " fed." Another prison, the report reveals, was given a " lunch tray" of hummus, pasta with sauce, nuts, and raisins, which was " pureed " and anally infused.

"[W]hat I infer is that you get a tube up as far as you can, then open the IV wide. No need to squeeze the bag - let gravity do the work," one officer wrote of the process.

When the CIA responded to the Senate panel's inquiries about the practice ahead of the report's publication, the agency called rectal rehydration a " well acknowledged medical technique." At least one detainee, however, was subsequently diagnosed with chronic hemorrhoids, an anal fissure, and symptomatic rectal prolapse after being rectally fed. The CIA also said that doing as much to a detainee was necessary in instances where prisoners became uncooperative, but the Senate panel found that records suggested such was done to inmates regardless of whether they were willing to cooperate.

Insects

While not exactly a revelation - reports concerning the CIA's use of insects on detainees as a means of torture were unearthed half a decade ago - the executive summary released touches on how interrogators sought to exploit one detainee's severe entomophobia, or fear of insects, in order to elicit information. According to the Senate panel's findings, the Department of Justice's Office of Legal Counsel (DOJ OLC) issued a memorandum in August 2002 advising that placing Abu Zubaydah, a suspected Saudi militant, in a " confinement box" with insects " would not violate prohibitions against torture." That method of interrogation was proposed one month earlier by a contractor, codenamed SWIGERT in the report, who had derived it from a United States military manual but personally lacked any real-world experience with interrogations prior to orchestrating the torture program.

Details about the CIA's desire to use insects on detainees first surfaced in 2009, when a declassified DOJ memo revealed that the agency wanted to place Zubaydah in a small confinement box with a bug because " he appear[ed] to have a fear of insects." Interrogators would then tell Zubaydah that the insect's sting " would produce death or severe pain." Ultimately, however, a 2005 memo noted that the technique was removed from the list of authorized interrogation tactics.

As for Zubaydah, today he remains imprisoned 12 years later at the Guantanamo Bay detention center, despite having never been charged with a crime.

Sleep deprivation

Russian scientists experimented with sleep deprivation as far back as the nineteenth century, and American prisoners caught during the Korean War were subjected to the practice more than 60 years ago. Yet while the extent of how the CIA used the technique to try and gain intelligence from suspected terrorists has been well documented in the past, this week's report contains examples of particular, previously unpublished incidents in which detainees were deprived of sleep for upwards of five straight days.

" Sleep deprivation involved keeping detainees awake for up to 180 hours, usually standing or in stress positions, at times with their hands shackled above their heads," the Senate report reads in part. " At least five detainees experienced disturbing hallucinations during prolonged sleep deprivation and, in at least two of those cases, the CIA nonetheless continued the sleep deprivation. "

In one instance, the CIA subjected a detainee, Abu Hudhaifa, to "ice water baths and 66 hours of standing sleep deprivation," then released him because it was realized that, according to the report, " he was likely not the person he was believed to be." Another inmate, Arsala Khan, reportedly suffered from " disturbing hallucinations" after being kept awake for 56 hours, at which point the CIA determined that he did not appear to be "involved in...current plans or activities against US personnel or facilities."

According to the Senate report, alleged 9/11 mastermind Khalid Sheikh Mohammed once endured a period of sleep deprivation, most of it in the standing position, for seven and a half days, or approximately 180 hours, in 2003.

Although CIA headquarters did approve the use of sleep deprivation on detainees while the so-called "black sites" were in operation, the report found that often prisoners were forced to stay awake for days past the officially allowable amount. When the White House weighed in about torture tactics in July 2003, according to the report, the CIA began considering sleep deprivation beyond 72 hours as an "EIT," and not a "standard" interrogation technique.

" To avoid using an 'enhanced' interrogation technique, CIA officers subjected Khallad bin Attash to 70 hours of standing sleep deprivation, two hours less than the maximum," the Senate panel found. " After allowing him four hours of sleep, bin Attash was subjected to an additional 23 hours of standing sleep deprivation, followed immediately by 20 hours of seated sleep deprivation." Another inmate was kept awake for 46.5 hours, 24 hours and 48 hours, " with a combined three hours of sleep between sessions," according to the report. Yet another, Abu Ja'far Al-Iraqi, was kept awake for 102 hours at one point.

Threats to Family

At times, CIA officers evoked the families of detainees in order to try and break them down during interrogations, according to the report. Al-Nashiri, whose rectal feeding is described above, was told "[w]e could get your mother in here" and "[ w]e can bring your family in here," CIA records reveal; according to the report, CIA officers implied during one interrogation that Al-Nashiri's mother would be brought to the same prison and raped in front of him. KSM, the alleged 9/11 mastermind, was told the CIA was going to kill his children if any terror plots occurred in the US while he was in custody.

At least three detainees were threatened with harm to their families, the Senate Intelligence Committee found, " to include threats to harm the children of a detainee, threats to sexually abuse the mother of a detainee and a threat to 'cut [a detainee's] mother's throat.'" With respect to KSM, detention site personnel hung a picture of his sons in his cell as a way to "[heighten] his imagination concerning where they are, who has them, [and] what is in store for them," CIA officials said.

Prolonged Standing

As noted above, often detainees forced to endure long bouts of sleep deprivation were forced to stay awake by being tethered to walls with their arms shackled above their heads. Such a pose was used often against detainees even when prohibiting prisoners of sleep wasn't the aim, however, and many victims exhibited injuries, according to the report, while being forced to stand for sometimes days on end.

Throughout much of 2003, the committee found, " CIA officers (including personnel not trained in interrogation) could, at their discretion, strip a detainee naked, shackle him in the standing position for up to 72 hours and douse the detainee repeatedly with cold water - without approval from CIA headquarters." In one instance cited in the report, a CIA official said of a detainee, "' as far as we could determine,' had been chained to the wall in a standing position for 17 days. "

Another detainee, Basliir Nasri Ali al-Marwalah, told jailers at Guantanamo Bay upon his arrival there from a CIA black site that he had been " tortured" by agents at COBALT who forced him to stand naked for five days straight once. On occasion, detainees long-subjected to standing would be relieved when their injuries, often edema, became significant enough. In the case of Abu Hazim and Abd al-Karim, CIA documents reveal the detainees would be " seated, secured to a cell wall, with intermittent disruptions of normal sleeping patterns" when they could no longer stand. Another, Abu Ja'far al-Iraqi, " experienced swelling in his lower legs requiring blood thinner and ace bandages," according to report, after being forced to stand for 54 hours. " After the swelling subsided, he was provided with more blood thinner and was returned to the standing position," the Senate found.

No Accountability

The Senate committee's report and subsequent remarks made this week by lawmakers have indicated that no CIA officials have ever been reprimanded or held accountable whatsoever for interrogating detainees with torturous tactics.

" CIA officers and CIA contractors who were found to have violated CIA policies or performed poorly were rarely held accountable or removed from positions of responsibility," a portion of the report reads. " CIA managers who were aware of failings and shortcomings in the program but did not intervene, or who failed to provide proper leadership and management, were also not held to account," reads another excerpt and, on two occasions, " accountability recommendations were overruled by senior CIA leadership," including the instance in which Gul Rahman froze to death on the cold concrete COBALT prison floor.

" As detailed in the study, there was no accountability for personnel responsible for the extended detention of individuals determined by the CIA to have been wrongly detained," reads another portion.

To this day, the only CIA official who participated in the torture program believed to have been punished is John Kirakou, a former employee currently serving prison time after going public in 2007 about the interrogation tactics.

" In truth, this is my punishment for blowing the whistle on the CIA's illegal torture program and for telling the public that torture was official US government policy," Kiriakou said in a letter last May sent from a Pennsylvania prison.

Meanwhile, this week's Senate report revealed that the two psychologists who developed the torture program on behalf of the CIA have since made more than $81 million for their contributions and to this day remain eligible for government-paid legal counsel should they ever been called into court for their role.

George W. Bush, the American president who held office during the torture program, defended the interrogations ahead of the report's release this week, calling the CIA officials connected to it " patriots." His vice president, Dick Cheney, has since called the report " full of crap," a " terrible piece of work" and " deeply flawed."

"I think what needed to be done was done," Cheney told CNN on Wednesday this week."I think we were perfectly justified in doing it. And I'd do it again in a minute."

"I certainly agree that there were times when CIA officers exceeded the policy guidance that was given and the authorized techniques that were approved and determined to be lawful," CIA Director Brennan said Wednesday this week; he too acknowledged that no employees have ever been reprimanded.

Truths of Waterboarding

It's no secret that the CIA employed the simulated-drowning tactic known as waterboarding to try and get information out of suspected terrorists detained overseas. With the release of this week's report, however, details are emerging about lengthy interrogation sessions in which prisoners were subjected to "the water board," as agents often called it, well beyond what was officially allowed.

"The waterboarding technique was physically harmful, inducing convulsions and vomiting," the Senate panel found. In the case of Abu Zubaydah, for instance, the terror suspect became " completely unresponsive, with bubbles rising through his open, full mouth" when interrogators tried to give the inmate the impression that he was drowning to death. Interrogators then relied on medical officials to revive the man, at which point he expelled " copious amounts of liquid." Despite nearly killing the man, the Senate probe found that the event " was referenced in emails, but was not documented or otherwise noted in CIA cables."

Zubaydah, who today resides at Gitmo, was waterboarded two-to-four times a day, the Senate found, which often " resulted in immediate fluid intake and involuntary leg, chest and arm spasms" and "hysterical pleas."

In 2003, a CIA email uncovered by the Senate revealed exactly how prison officials at the "DETENTION SITE BLUE" facility planned to use the water board extensively on KSM the day he arrived at the secret jail:
"[T]he team here apparently looks to use the water board in two different contexts. One is as a tool of regression and control in which it is used up front and aggressively. The second is to vet information on an as needed basis. Given the various pressures from home vs what is happening on the ground, I think the team's expectation is that [KSM] will [be] getting treatment somewhere in between. I don't think they believe that it will be possible to entirely avoid the water board given the high and immediate threat to US and allied interests. It is an interesting dynamic because they are well aware of the toll it will take on the team vs. the detainee. The requirements coming from home are really unbelievable in terms of breadth and detail."
According to the committee's report, KSM arrived at COBALT sometime in March 2003 and, by the last week of the month, had been waterboarded 183 times. Meanwhile, the report reads, guidelines circulated among medical personnel at the detention site said the tactic should be used only 20 times a week.

"On March 10, 2003, KSM was subjected to the first of his 15 separate waterboarding sessions. The first waterboarding session, which lasted 30 minutes (10 more than anticipated in the Office of Legal Counsel's August 1, 2002, opinion), was followed by the use of a horizontal stress position that had not previously been approved by CIA headquarters. The chief of Base, worried about the legal implications, prohibited the on-site medical officer from reporting on the interrogation directly to OMS [CIA's Office of Medical Services] outside of official CIA cable, " reads part of the report.

"Prior to the third waterboard session of that calendar day, the onsite medical officer raised concerns that the waterboard session-which would be the fourth in 14 hours-would exceed the limits included in draft guidelines that had been distributed the previous afternoon," which said up to three session in a 24-hour span was acceptable. By then, though, KSM had already been waterboarded more than 65 times over the course of four sessions in a single day.

"During the waterboarding sessions that day, the application of the interrogation technique further evolved, with the interrogators now using their hands to maintain a one-inch deep 'pool' of water over KSM's nose and mouth in an effort to make it impossible for KSM to ingest all the water being poured," the panel found.

Mistaken Identities and Lost Detainees

According to the information contained in this week's report, the CIA either lost detainees or outright lied about who was being held at black sites during the Bush administration. Although the CIA said in both public and classified settings that " fewer than one hundred " prisoners were held at those facilities, the Senate committee found that, in actuality, at least 119 individuals were detained by the intelligence agency.

" Internal CIA documents indicate that inadequate record keeping made it impossible for the CIA to determine how many individuals it had detained," the report reads.

In one instance cited in the executive summary, a 2003 CIA document found the agency was " holding a number of detainees about whom" it knew "very little."

During the span that those sites were in operation, the Senate committee found that 26 of the 119 detainees - 22 percent - were held by the CIA despite not meeting the standards for detention. Additionally, at least four instances occurred where individuals did not meet the standards for detention relied on by US officials, so prisoners were instead confined at facilities in foreign nations at the behest of the CIA.

Misleading the White House

"The CIA represented to the White House, the National Security Council, the Department of Justice, the CIA Office of Inspector General, the Congress and the public that the best measure of effectiveness of the CIA's enhanced interrogation techniques was examples of specific terrorist plots 'thwarted' and specific terrorists captured as a result of the use of the techniques," reads a portion of the Senate report. Nevertheless, the committee's probe determined that such claims were inaccurate, and that the CIA lied about the effectiveness of the torture tactics for years.

"The suggestion that all CIA detainees provided information that resulted in intelligence reporting is not supported by CIA records," the committee found, going as far later in the report to call the CIA's representations concerning the effectiveness of interrogations "inaccurate and unsupported by CIA records."

Responding to the report this week, Director Brennan said he admits that it's " unknowable" whether the use of enhanced interrogation techniques, or EITs, solely elicited information from detainees, adding, " But for someone to say that there was no intelligence of value, of use, that came from those detainees once they were subjected to EITs, I think that...lacks any foundation at all."

There's " no evidence that terror attacks were stopped, terrorists captured or lives saved through use of EITs, " Sen. Dianne Feinstein (D-California), the chair of the committee that conducted the four-year investigation into the torture program, tweeted in response.

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10 most shocking facts we found in CIA torture report

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READ MORE: Not-so-magnificent 7: Nations named & shamed in CIA torture report According to the Senate committee's findings released on Tuesday, the "enhanced interrogation techniques," or EITs, used against foreign prisoners within the walls of covert, overseas prisons ultimately prove to be largely ineffective.

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President Donald Trump declared Wednesday he believes torture works as his administration readied a sweeping review of how America conducts the war on terror. It includes possible resumption of banned interrogation methods and reopening CIA-run "black site" prisons outside the United States.

In an interview with ABC News, Trump said he would wage war against Islamic State militants with the singular goal of keeping the U.S. safe. Asked specifically about the simulated drowning technique known as waterboarding, Trump cited the extremist group's atrocities against Christians and others and said: "We have to fight fire with fire."

Trump said he would consult with new Defense Secretary James Mattis and CIA Director Mike Pompeo before authorizing any new policy. But he said he had asked top intelligence officials in the past day: "Does torture work?"

"And the answer was yes, absolutely," Trump said.

He added that he wants to do "everything within the bounds of what you're allowed to do legally."

A clip of Trump's interview was released after The Associated Press and other news outlets obtained copies of a draft executive order being circulated within his administration.

Beyond reviewing interrogation techniques and facilities, the draft order would instruct the Pentagon to send newly captured "enemy combatants" to Guantanamo Bay, Cuba, instead of closing the detention facility as President Barack Obama had wanted. Altogether, the possible changes could mark a dramatic return to how the Bush administration waged its campaign against al-Qaida and other extremist groups.

Trump spokesman Sean Spicer, questioned about the draft order, said it was "not a White House document" but would not comment further.

House Speaker Paul Ryan told MSNBC the draft order was not written by the Trump administration. "My understanding is this was written by somebody who worked on the transition before. ... This is not something the Trump administration is planning on, working on," Ryan said.

The draft says U.S. laws should be obeyed at all times and explicitly rejects "torture." But its reconsideration of the harsh techniques banned by Obama and Congress raises questions about the definition of the word and is sure to inflame passions in the U.S. and abroad.

After the Sept. 11, 2001, attacks, President George W. Bush authorized a covert program that led to dozens of detainees being held in secret locations overseas and to interrogation tactics that included sleep deprivation, slapping and slamming against walls, confinement in small boxes, prolonged isolation and even death threats. Three detainees faced waterboarding. Many developed psychological problems.

While some former government leaders insist the program was effective in obtaining critical intelligence, many others say the abuses weakened America's moral standing in the world, hurt morale among intelligence officers and proved ineffective before Obama shut it down.

The AP obtained the draft order from a U.S. official, who said it had been distributed by the White House for consultations before Trump signs it. The official wasn't authorized to speak publicly on the matter and demanded anonymity.

The Pentagon didn't immediately comment and Spicer, Trump's press secretary, said, "I have no idea where it came from." But reports of the upcoming order quickly sparked alarm among Republicans and Democrats.

"The president can sign whatever executive orders he likes. But the law is the law," said Republican Sen. John McCain, tortured himself as a prisoner during the Vietnam War. "We are not bringing back torture in the United States of America."

On the campaign trail, Trump spoke emphatically about toughening the U.S. approach to fighting the Islamic State group. He said he would authorize waterboarding and a "hell of a lot worse." After winning the election, however, he appeared to backtrack, pointedly citing Mattis' advice that torture is ineffective.

Pompeo, Trump's CIA director, said in his confirmation hearing that he would abide by all laws. But he also said he'd consult with CIA and other government experts on whether current restrictions were an "impediment to gathering vital intelligence to protect the country or whether any rewrite of the Army Field Manual is needed."

Specifically, Trump's draft order calls for reinstating an executive order - "to the extent permitted" by current law - that President Bush signed in 2007 and Obama later revoked.

Trump's draft would reverse two other executive orders of Obama's. One called for closing Guantanamo Bay. The other ordered the CIA to shut any detention facility it operated and prohibited the U.S. from using any interrogation technique not listed in the Army Field Manual, demanding treatment in compliance with the Geneva Conventions, including timely access for the International Red Cross to all detainees.

Among the interrogation techniques banned by the manual were forced nakedness, hooding, beatings, sexual humiliation, threatening with dogs, mock executions, electric shocks, burning and waterboarding.

Any changes would face steep legal and legislative hurdles.

McCain, the Senate Armed Services Committee's chairman, may be the most formidable opponent in Congress, but he is not the only one.

"It is wrong and I hope he will rethink it," House Democratic Leader Nancy Pelosi said.

On Guantanamo, the draft order says detention facilities "are a critical tool in the fight against international jihadist terrorist groups who are engaged in armed conflict with the United States, its allies and its coalition partners." About 40 detainees remain in Guantanamo.

The document says "over 30 percent of detainees" who've been released have returned to armed conflict, with at least a dozen conducting attacks "against U.S. personnel or allied forces in Afghanistan." Six Americans, including a civilian aid worker, died as a result of those attacks.

U.S. intelligence agencies say 17.6 percent of detainees released from Guantanamo are confirmed to have re-engaged in conflict. An additional 12.4 percent are "suspected" of re-engaging.

Trump pledged on the campaign trail to "load it up with some bad dudes."

But it's unclear who the new detainees would be. As American ground troops have stepped back this decade from the front lines in Iraq and Afghanistan, captures of high-level detainees have become much rarer, and Obama tried to direct them through the U.S. justice system.

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Trump says torture works, US will review policies in war on terror

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President Donald Trump declared Wednesday he believes torture works as his administration readied a sweeping review of how America conducts the war on terror. It includes possible resumption of banned interrogation methods and reopening CIA-run black site prisons outside the United States.

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The CIA has declassified documents about the brutal interrogation techniques it used on terrorist suspects following the 9/11 attacks.

Among the 50 guidelines, disclosed in response to a Freedom of Information request by the American Civil Liberties Union (ACLU), are revelations that medical personnel acknowledged that leaving detainees in boxes only just large enough for their bodies to fit in was not "particularly effective".

Abu Zubaydah, who was detained in 2002, spent a total 266 hours, more than 11 days, within such a box, according to one report. A different document concludes Mr Zubaydah would probably have cooperated with interrogators without such "aggressive" torture.

The report adds: "The CIA interrogators told Abu Zubaydah that the only way he would leave the facility was in the coffin-shaped confinement box."

Precise specifications by The Office of Medical Staff (OMS) detail how to enforce sleep deprivation, limit the caloric intake of food, and the correct positions required for waterboarding.

In a 2004 document called Description of Physical Pressures, a number of physical and psychological techniques are discussed, including a facial slap, use of diapers, "insects," and "mock burial."

"One possibility is to threaten to place stinging insects into the cramped confinement box with the detainee but instead place harmless insects," the document notes, going on to explain a mock burial as "a cramped confinement box that resembles a coffin. The box has hidden air holes to prevent suffocation."

Khalid el-Masri, a German detainee whom the CIA held in 2004 by mistake, lost 50lb (22.6kg) during five months of captivity, according to a different declassified document.

The documents, some of which have redacted content, strictly discourage employees from using "speculative language as to the legality of given activities", noting that it is "not helpful".

One CIA official bluntly wrote in an email, released as part of the request, that the interrogation program was a "train (wreck) waiting to happen and I intend to get the hell off the train before it happens."

According to a 2006 memo, President George W Bush voiced concerns about the interrogation practices.

The then Director of the Central Intelligence Agency, Porter Goss, had said Mr Bush "was concerned about the image of a detainee, chained to the ceiling, clothed in a diaper and forced to go to the bathroom on themselves."

It continues: "[The techniques] incorporate physical or psychological pressure beyond standard techniques" but that require medical personnel "shall suspend the interrogation if they determine that significant and prolonged physical or mental injury, pain, or suffering is likely to result if the interrogation is not suspended."

A significant amount of the information contained in the documents has previously been made public, partly during a Senate investigation in 2014.

Jameel Jaffer, ACLU deputy legal director, said in a statement: "These newly declassified records add new detail to the public record of the CIA's torture program and underscore the cruelty of the methods the agency used in its secret, overseas black sites."

A spokesperson for the CIA said: "The events of 9/11 will be forever seared into the memories of all Americans who bore witness to the single greatest tragedy to befall our homeland in recent history.

"The documents released today reflect differing views formed roughly a decade ago within CIA about the Agency's performance prior to 9/11."

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Sleep deprivation, starvation and waterboarding: What torture looks like after 9/11

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The CIA has declassified documents about the brutal interrogation techniques it used on terrorist suspects following the 9/11 attacks. Among the 50 guidelines, disclosed in response to a Freedom of Information request by the American Civil Liberties Union (ACLU), are revelations that medical personnel acknowledged that leaving detainees in boxes only just large enough for their bodies to fit in was not "particularly effective".

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How it impacted the people who were tortured.

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How it impacted the people who were tortured.

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Before the United States permitted a terrifying way of interrogating prisoners, government lawyers and intelligence officials assured themselves of one crucial outcome. They knew that the methods inflicted on terrorism suspects would be painful, shocking and far beyond what the country had ever accepted. But none of it, they concluded, would cause long lasting psychological harm.

Fifteen years later, it is clear they were wrong.

Today in Slovakia, Hussein al-Marfadi describes permanent headaches and disturbed sleep, plagued by memories of dogs inside a blackened jail. In Kazakhstan, Lutfi bin Ali is haunted by nightmares of suffocating at the bottom of a well. In Libya, the radio from a passing car spurs rage in Majid Mokhtar Sasy al-Maghrebi, reminding him of the C.I.A. prison where earsplitting music was just one assault to his senses.

And then there is the despair of men who say they are no longer themselves. "I am living this kind of depression," said Younous Chekkouri, a Moroccan, who fears going outside because he sees faces in crowds as Guantánamo Bay guards. "I'm not normal anymore."

After enduring agonizing treatment in secret C.I.A. prisons around the world or coercive practices at the military detention camp at Guantánamo Bay, Cuba, dozens of detainees developed persistent mental health problems, according to previously undisclosed medical records, government documents and interviews with former prisoners and military and civilian doctors. Some emerged with the same symptoms as American prisoners of war who were brutalized decades earlier by some of the world's cruelest regimes.

Those subjected to the tactics included victims of mistaken identity or flimsy evidence that the United States later disavowed. Others were foot soldiers for the Taliban or Al Qaeda who were later deemed to pose little threat. Some were hardened terrorists, including those accused of plotting the Sept. 11 attacks or the 2000 bombing of the American destroyer Cole. In several cases, their mental status has complicated the nation's long effort to bring them to justice.

Americans have long debated the legacy of post-Sept. 11 interrogation methods, asking whether they amounted to torture or succeeded in extracting intelligence. But even as President Obama continues transferring people from Guantánamo and Donald J. Trump, the Republican presidential nominee, promises to bring back techniques, now banned, such as waterboarding, the human toll has gone largely uncalculated.

At least half of the 39 people who went through the C.I.A.'s "enhanced interrogation" program, which included depriving them of sleep, dousing them with ice water, slamming them into walls and locking them in coffin-like boxes, have since shown psychiatric problems, The New York Times found. Some have been diagnosed with post-traumatic stress disorder, paranoia, depression or psychosis.

Hundreds more detainees moved through C.I.A. "black sites" or Guantánamo, where the military inflicted sensory deprivation, isolation, menacing with dogs and other tactics on men who now show serious damage. Nearly all have been released.

"There is no question that these tactics were entirely inconsistent with our values as Americans, and their consequences present lasting challenges for us as a country and for the individuals involved," said Ben Rhodes, the deputy national security adviser.

The United States government has never studied the long-term psychological effects of the extraordinary interrogation practices it embraced. A Defense Department spokeswoman, asked about long-term mental harm, responded that prisoners were treated humanely and had access to excellent care. A C.I.A. spokesman declined to comment.

This article is based on a broad sampling of cases and an examination of hundreds of documents, including court records, military commission transcripts and medical assessments. The Times interviewed more than 100 people, including former detainees in a dozen countries. A full accounting is all but impossible because many former prisoners never had access to outside doctors or lawyers, and any records about their interrogation treatment and health status remain classified.

Researchers caution that it can be difficult to determine cause and effect with mental illness. Some prisoners of the C.I.A. and the military had underlying psychological problems that may have made them more susceptible to long-term difficulties; others appeared to have been remarkably resilient. Incarceration, particularly the indefinite detention without charges that the United States devised, is inherently stressful. Still, outside medical consultants and former government officials said they saw a pattern connecting the harsh practices to psychiatric issues.

Those treating prisoners at Guantánamo for mental health issues typically did not ask their patients what had happened during their questioning. Some physicians, though, saw evidence of mental harm almost immediately.

"My staff was dealing with the consequences of the interrogations without knowing what was going on," said Albert J. Shimkus, a retired Navy captain who served as the commanding officer of the Guantánamo hospital in the prison's early years. Back then, still reeling from the Sept. 11 attacks, the government was desperate to stave off more.

But Captain Shimkus now regrets not making more inquiries. "There was a conflict," he said, "between our medical duty to our patients and our duty to the mission, as soldiers."

After prisoners were released from American custody, some found neither help nor relief. Mohammed Abdullah Saleh al-Asad, a businessman in Tanzania, and others were snatched, interrogated and imprisoned, then sent home without explanation. They returned to their families deeply scarred from interrogations, isolation and the shame of sexual taunts, forced nudity, aggressive body cavity searches and being kept in diapers.

Mr. Asad, who died in May, was held for more than a year in several secret C.I.A. prisons. "Sometimes, between husband and wife, he would admit to how awful he felt," his widow, Zahra Mohamed, wrote in a statement prepared for the African Commission on Human and Peoples' Rights. "He was humiliated, and that feeling never went away."

'A Human Mop'

In a cold room once used for interrogations at Guantánamo, Stephen N. Xenakis, a former military psychiatrist, faced a onetime Qaeda child soldier, Omar Khadr. It was December 2008, and this evaluation had been two years in the making.

The doctor, a retired brigadier general who had overseen several military hospitals, had not sought the assignment. The son of an Air Force combat veteran, he debated even accepting it. "I'm still a soldier," General Xenakis recalls thinking. Was this good for the country? When he finally agreed, he told Mr. Khadr's lawyers that they were paying for an independent medical opinion, not a hired gun.

Mr. Khadr, a Canadian citizen, had been wounded and captured in a firefight at age 15 at a suspected terrorist compound in Afghanistan, where he said he had been sent to translate for foreign fighters by his father, a Qaeda member. Years later, he would plead guilty to war crimes, including throwing a grenade that killed an Army medic. At the time, though, he was the youngest prisoner at Guantánamo.

He told his lawyers that the American soldiers had kept him from sleeping, spit in his face and threatened him with rape. In one meeting with the psychiatrist, Mr. Khadr, then 22, began to sweat and fan himself, despite the air-conditioned chill. He tugged his shirt off, and General Xenakis realized that he was witnessing an anxiety attack.

When it happened again, Mr. Khadr explained that he had once urinated during an interrogation and soldiers had dragged him through the mess. "This is the room where they used me as a human mop," he said.

General Xenakis had seen such anxiety before, decades earlier, as a young psychiatrist at Letterman Army Medical Center in California. It was often the first stop for American prisoners of war after they left Vietnam. The doctor recalled the men, who had endured horrific abuses, suffering panic attacks, headaches and psychotic episodes.

That session with Mr. Khadr was the beginning of General Xenakis's immersion into the treatment of detainees. He has reviewed medical and interrogation records of about 50 current and former prisoners and examined about 15 of the detainees, more than any other outside psychiatrist, colleagues say.

General Xenakis found that Mr. Khadr had post-traumatic stress disorder, a conclusion the military contested. Many of General Xenakis's diagnoses in other cases remain classified or sealed by court order, but he said he consistently found links between harsh American interrogation methods and psychiatric disorders.

Back home in Virginia, General Xenakis delved into research on the effects of abusive practices. He found decades of papers on the issue - science that had not been considered when the government began crafting new interrogation policies after Sept. 11.

At the end of the Vietnam War, military doctors noticed that former prisoners of war developed psychiatric disorders far more often than other soldiers, an observation also made of former P.O.W.s from World War II and the Korean War. The data could not be explained by imprisonment alone, researchers found. Former soldiers who suffered torture or mistreatment were more likely than others to develop long-term problems.

By the mid-1980s, the Veterans Administration had linked such treatment to memory loss, an exaggerated startle reflex, horrific nightmares, headaches and an inability to concentrate. Studies noted similar symptoms among torture survivors in South Africa, Turkey and Chile. Such research helped lay the groundwork for how American doctors now treat combat veterans.

"In hindsight, that should have come to the fore" in the post-Sept. 11 interrogation debate, said John Rizzo, the C.I.A.'s top lawyer at the time. "I don't think the long-term effects were ever explored in any real depth."

Instead, the government relied on data from a training program to resist enemy interrogators, called SERE, for Survival, Evasion, Resistance and Escape. The military concluded there was little evidence that disrupted sleep, near-starvation, nudity and extreme temperatures harmed military trainees in controlled scenarios.

Two veteran SERE psychologists, James Mitchell and Bruce Jessen, worked with the C.I.A. and the Pentagon to help develop interrogation tactics. They based their strategies in part on the theory of " learned helplessness," a phrase coined by the American psychologist Martin E. P. Seligman in the late 1960s. He gave electric shocks to dogs and discovered that they stopped resisting once they learned they could not stop the shocks. If the United States could make men helpless, the thinking went, they would give up their secrets.

In the end, Justice Department lawyers concluded that the methods did not constitute torture, which is illegal under American and international law. In a series of memos, they wrote that no evidence existed that "significant psychological harm of significant duration, e.g., lasting for months or even years" would result.

With fear of another terrorist attack, there was little incentive or time to find contrary evidence, Mr. Rizzo said. "The government wanted a solution," he recalled. "It wanted a path to get these guys to talk."

The question of what ultimately happened to Dr. Seligman's dogs never arose in the legal debate. They were strays, and once the studies were over, they were euthanized.

A Sense of Drowning

Mohamed Ben Soud cannot say for certain when the Americans began using ice water to torment him. The C.I.A. prison in Afghanistan, known as the Salt Pit, was perpetually dark, so the days passed imperceptibly.

The United States called the treatment "water dousing," but the term belies the grisly details. Mr. Ben Soud, in court documents and interviews, described being forced onto a plastic tarp while naked, his hands shackled above his head. Sometimes he was hooded. One C.I.A. official poured buckets of ice water on him as others lifted the tarp's corners, sending water splashing over him and causing a choking or drowning sensation. He said he endured the treatment multiple times.

Mr. Ben Soud was among the early captives in the C.I.A.'s network of prisons in Afghanistan, Thailand, Poland, Romania and Lithuania. Again and again, he said, he told the American interrogators that he was not their enemy. A Libyan, he said he had fled to Pakistan in 1991 and joined an armed Islamist movement aimed at toppling Col. Muammar el-Qaddafi's dictatorship. Pakistani and United States officials stormed his home and arrested him in 2003. Under interrogation, he said, he denied knowing or fighting with Osama bin Laden or two senior Qaeda operatives.

In 2004, the C.I.A. turned Mr. Ben Soud over to Libya, which imprisoned him until the United States helped topple the Qaddafi government seven years later. In interviews, he and other Libyans said they were treated better by Colonel Qaddafi's jailers than by the C.I.A.

Today, Mr. Ben Soud, 47, is a free man, but said he is in constant fear of tomorrow. He is racked with self-doubt and struggles to make simple decisions. His moods swing dramatically.

"'Dad, why did you suddenly get angry?' 'Why did you suddenly snap?'" Mr. Ben Soud said his children ask. "'Did we do anything that made you angry?'"

Explaining would mean saying that the Americans kept him shackled in painful contortions, or that they locked him in boxes - one the size of a coffin, the other even smaller, he said in a phone interview from his home in Misurata, Libya. They slammed him against the wall and chained him from the ceiling as the prison echoed with the sounds of rock music.

"How can you explain such things to children?" he asked.

Mr. Ben Soud, along with a second former C.I.A. prisoner and the estate of a third, is suing Dr. Mitchell and Dr. Jessen in federal court, accusing them of violating his rights by torturing him. In court documents, Dr. Mitchell and Dr. Jessen argue, among other things, that they played no role in the interrogations.

Mr. Ben Soud was one of the men identified in a 2014 Senate Intelligence Committee report as having been subjected to the C.I.A.'s "enhanced interrogation techniques." Condemning the methods as brutal and ineffective in extracting intelligence, the report noted that interrogators also used unapproved tactics such as mock executions, threats to harm prisoners' children or rape their family members, and "rectal feeding," which involved inserting liquid food supplements or purées into the rectum.

Senate investigators did not set out to study the psychological consequences of the harsh treatment, but their unclassified summary revealed several cases of men suffering hallucinations, depression, paranoia and other symptoms. The full 6,000-page classified report offers many more examples, said Daniel Jones, a former F.B.I. analyst who led the Senate investigation.

"The records we reviewed clearly indicate a connection between their treatment in C.I.A. custody and their mental state," Mr. Jones said in an interview.

At least 119 men moved through the C.I.A. jails, where the interrogations were designed to disrupt the senses and increase helplessness - factors that researchers decades earlier had said could make people more susceptible to psychological harm. Forced nudity, sensory deprivation and endless light or dark were considered routine.

Many of those men were later released without charges, unsure of why they were held. About one in four prisoners should never have been captured, or turned out to have been misidentified by the C.I.A., Senate investigators concluded. Khaled el-Masri, a German citizen, is the best known case.

Macedonian authorities arrested him while he was on vacation in December 2003 and turned him over to the C.I.A. Mr. Masri said officials beat him, stripped him, forced a suppository into him and flew him to a black site in Afghanistan. He was held for months, he said, in a concrete cell with no bed, and endured more beatings and interrogations.

Years later, Mr. Masri's nightmares are accompanied by a paralyzing tightness in his chest, he said. "I have been suffering from absent-mindedness, amnesia, inability to memorize, depression, helplessness, apathy, loss of interest in the future, slow thinking, and anxiety," Mr. Masri wrote in an email.

Ms. Mohamed, the widow of Mr. Asad, the Tanzanian businessman, said he returned home paranoid and anxious.

"He used to forget things that he never would have forgotten before," she wrote recently. "For example, he would talk with someone on the phone and later forget to whom he had been talking."

Mr. Asad believed the C.I.A. seized him because he once rented space in a building he owned to Al Haramain Foundation, a Saudi charity later linked to financing terrorism. Interrogators questioned him repeatedly about the charity, he said in legal papers, then released him with no explanation.

"Mohammed's personality changed after his detention," his wife wrote. "Something tiny would happen and he would blow up - he would be so angry - I had never ever seen him like this before. At these times, he would come close to crying, and he would withdraw to be alone."

'Still Living in Gitmo'

Today at Guantánamo Bay, the Caribbean landscape is reclaiming the relics of the American detention system. Weeds overtake fences in abandoned areas of the prison complex. Guard towers sit empty. It is eerily quiet.

President Obama banned coercive questioning on his second day in office and his administration has whittled the prison population to 61, down from nearly 700 at its peak. Interrogations ended long ago. Except for the so-called high-value detainees, kept in a building hidden in the hills, most of the remaining prisoners share a concrete jail called Camp 6.

Asked about their psychological well-being, Rear Adm. Peter J. Clarke, the commander at Guantánamo, said in an interview: "What I observe are detainees who are well adjusted, and I see no indications of ill effects of anything that may have happened in the past."

In the early years of Guantánamo, interrogators used variations on some of the C.I.A.'s tactics. The result was a combination of psychological and physical pressure that the International Committee of the Red Cross found was "tantamount to torture."

Capt. Richard Quattrone of the Navy, who left his post as the prison's chief medical officer in September, said his staff mostly dealt with detainees' anxiety over whether they would be released. "I've talked to some of my predecessors," he said in an interview, "and from what they say, it's vastly different today."

About 20 detainees are cleared for release. Another 10 are being prosecuted or have already been convicted in military commissions. The fate of the remaining men, including some of the high-value prisoners, is unclear. For now they are considered too dangerous to release, but have not been charged.

For some men who have been released, Guantánamo is not easily left behind. Mr. Chekkouri, a Moroccan living in Afghanistan in 2001, was held for years as a suspected member of a group linked to Al Qaeda. He said he was beaten repeatedly at a United States military jail in Kandahar and forced to watch soldiers do the same to his younger brother.

Mr. Chekkouri is a Sufi, a member of a mystical Islamic sect that has been oppressed by Al Qaeda and others. At Guantánamo, he was kept in isolation.

When he asserted his innocence, he said, interrogators threatened to turn him over to the Moroccan authorities, who have a history of torture. The Americans warned that his family in Morocco could be jailed and abused, he said, and showed him execution photos. Interrogators repeatedly made him believe his transfer was imminent, he said. "It's time to say goodbye," interrogation files cited in court documents say. "Morocco wants you back."

After he was released last year, the United States gave him a letter saying it no longer stood by information that he was a member of a Qaeda-linked group in Morocco. Despite diplomatic assurances that he would face no charges, Morocco jailed him for several months late last year and he continues to fight allegations that he thought were behind him.

Now, he is under a psychiatrist's care and takes antidepressants and anti-anxiety drugs. He complains of flashbacks, persistent nightmares and panic attacks. He also suffers an embarrassing inability to urinate until it becomes painful. It started, he said, when he was left chained for hours during interrogations and soiled himself. His doctors say there is nothing they can treat.

"They tell me everything is normal," he said. "Your brain is playing games. It is something mental. You're still living in Gitmo. It's fear."

Mr. Chekkouri saw psychiatrists at Guantánamo, but he said he did not trust them. He and others believed the doctors shared information about medical problems with interrogators. In one case, a psychiatrist prescribed the antipsychotic medication olanzapine to a prisoner. He then suggested that interrogators exploit a side effect, food cravings, according to another military doctor who later reviewed the records.

Normally, such information would be confidential, but Guantánamo's dual missions of caring for prisoners and extracting information created conflicts. Over time, the military created two mental health teams. One, led by psychiatrists, was there to heal. The other, called the Behavioral Science Consultation Team, was led by psychologists with a very different mission.

On Sept. 3, 2003, after a teenager named Mohammed Jawad was seen talking to a poster on the wall, an interrogator called for a consultation with a BSCT (pronounced "Biscuit") psychologist. Mohammed's age at the time is in dispute. The military says it captured him at 17; his lawyer says he was more likely 14 or younger. However old, he was pleading for his mother.

When the psychologist arrived, the goal was not to ease the young man's distress, but to exploit it.

"The detainee comes across as a very immature, dependent individual, claiming to miss his mother and his young siblings, but his demeanor looks like it is a resistance technique," the psychologist wrote, according to notes seen by The Times. "He tries to look as if he is so sad that he is depressed. During today's interrogation, he appeared to be rather frightened, and it looks as if he could easily break."

The psychologist, who was not identified in the notes, recommended that Mr. Jawad be kept away from anyone who spoke his language. "Make him as uncomfortable as possible," the psychologist advised. "Work him as hard as possible."

The guards placed him in isolation for 30 days. They then subjected him to the "frequent flier program," a method of sleep deprivation. Guards yanked Mr. Jawad from cell to cell 112 times, waking him an average of every three hours, day and night, for two weeks straight, according to court records.

After being held for years, Mr. Jawad was charged in 2007 with throwing a grenade that wounded American soldiers. But the evidence collapsed. The military prosecutor, Lt. Col. Darrel Vandeveld, withdrew from the case and declared that there was no evidence to justify charges. "There is, however, reliable evidence that he was badly mistreated by U.S. authorities, both in Afghanistan and at Guantánamo, and he has suffered, and continues to suffer, great psychological harm," he wrote in a letter to the court.

Katherine Porterfield, a New York University psychologist, found Mr. Jawad to have PTSD after examining him in 2009. Seven years after his capture, she said, he suffered from flashbacks and anxiety attacks. A panel of military doctors disagreed. Medical records from Guantánamo include repeated notes such as "no psych issues at this time," or the prisoner "denied any psych problem."

The military dropped all charges against Mr. Jawad, who is now living in Pakistan. He declined to discuss his mental health. But in a series of text messages, he wrote: "They tortured us in jails, gave us severe physical and mental pain, bombarded our villages, cities, mosques, schools." He added, "Of course we have" flashbacks, panic attacks and nightmares.

Ignoring a Link

It has been difficult to determine the scale of mental health problems at Guantánamo, much less how many cases are linked to the treatment the prisoners endured. Most medical records remain classified. Anecdotal accounts, though, have emerged over the years.

Andy Davidson, a retired Navy captain who served as the chief psychologist treating prisoners at Guantánamo from July to October 2003, said most appeared to be in good health, but he still saw "an awful lot" of mental health issues there.

"There were definitely guys who had PTSD symptoms," he said in an interview. "There were definitely guys who had poor sleeping, nightmares. There were guys who were definitely shell shocked with a thousand-mile stare. There were guys who were depressed, avoidant."

One of the few official glimpses into the population came in a 2006 medical journal article. Two military psychologists and a psychiatrist at Guantánamo wrote that about 11 percent of detainees were then receiving mental health services, a rate lower than that in civilian jails or among former American prisoners of war. The authors acknowledged, however, that Guantánamo doctors faced significant challenges in diagnosing mental illness, most notably the difficulty in building trust. Many prisoners, including some with serious mental health conditions, refused evaluation and treatment, the study noted, which would have lowered the count.

Five years later, General Xenakis and Vincent Iacopino, the medical director for Physicians for Human Rights, published research about nine prisoners who exhibited psychological symptoms after undergoing interrogation tactics - a hose forced into a mouth, a head held in a toilet, death threats - by American jailers.

The two based their study on the medical records and interrogation files of the prisoners, all of whom had arrived at Guantánamo in its first year, had never been in C.I.A. custody, and were never charged with any crimes. In none of those cases, the study said, did Guantánamo doctors document any inquiries into whether the symptoms were tied to interrogation tactics.

Today in Tangier, Morocco, Ahmed Errachidi runs two restaurants, has a wife and five children and has been free for nearly a decade. The United States military once asserted that he trained at a Qaeda camp in early 2001, but the human rights group Reprieve later produced pay stubs showing that he had been working at the time as a cook in London.

Mr. Errachidi had a history of bipolar disorder before arriving at Guantánamo, and after being held in isolation there, he said, he suffered a psychotic breakdown. He told interrogators that he had been Bin Laden's superior officer and warned that a giant snowball would overtake the world.

Guantánamo still lurks around corners. Recently, at a market in Tangier, the clink of a chain caused a paralyzing flashback to the prison, where Mr. Errachidi was forced into painful stress positions, deprived of sleep and isolated. On chilly nights, when the blanket slips off, he is once again lying naked in a frigid cell, waiting for his next interrogation.

"All I can think of is when are they going to take me back," Mr. Errachidi said in an interview. He compared his treatment by the Americans to being mugged by a trusted friend. "It is very, very scary when you are tortured by someone who doesn't believe in torture," he said. "You lose faith in everything."

Guantánamo, particularly during its early years, operated on a system of rewards and punishments to exploit prisoners' vulnerabilities. That manipulation, taken to extremes, could have dangerous effects, as in the peculiar case of Tarek El Sawah.

An Egyptian who said he was a Taliban soldier, Mr. Sawah was captured while fleeing bombing in Afghanistan in 2001 and turned over to the United States. He arrived at Guantánamo in May 2002. Though his brother, Jamal, said he had no history of mental problems, Mr. Sawah began shrieking at night, terrified by hallucinations.

When he began defecating and urinating on himself, soldiers would hose him down in front of other detainees, a nearby prisoner stated in court documents. Mr. Sawah said he was given antipsychotic drugs, sometimes forcibly.

After his breakdown, interrogators found Mr. Sawah eager to talk. "'Bring me good things to eat,'" he told them. They delivered McDonald's hamburgers or Subway sandwiches, multiple servings at a time.

Mr. Sawah became a prized informant, though the value of what he offered is disputed, and he says he fabricated stories, including that he was a Qaeda member. He ballooned from about 215 pounds to well over 400 pounds, records show. When the interrogations ended and he was placed in a special hut for cooperators, the food kept coming. His jailers had to install a double-wide door for him.

Mr. Sawah called it a competition between the interrogators, who used food as an incentive, and the doctors, who told him to lose weight. He developed coronary artery disease, diabetes, breathing disorders and other health problems, court records show.

In 2013, General Xenakis examined him and, in a plea for better medical treatment, told a judge that "Mr. El Sawah's mental state has worsened and he appears apathetic with diminished will to live." The military responded that he was offered excellent medical care but refused it.

Today in Bosnia, Mr. Sawah, 58, complains of frequent headaches and begs a doctor for antidepressants. His mood fluctuates wildly. Though he has lost weight, his eating remains compulsive. Over dinner with a reporter after a daily Ramadan fast, he ate a steak, French fries, a plate of dates and figs, a bowl of chicken soup, spinach pie, slices of bread, the uneaten portion of another steak, another bowl of soup, two lemonades, a Coke and nearly an entire cheese plate, six or seven slices at a time.

"He's unbalanced," said his brother, who lives in New York. "He needs care. Mental care. Physical care."

Mr. Sawah does not blame American soldiers for his treatment. "They were afraid of me, afraid for their life," he said. "Guantánamo on both sides was just very scared people who want to live."

Complicating Trials

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."

Interrogation's Shadow

In Libya today, a former C.I.A. prisoner named Salih Hadeeyah al-Daeiki struggles to focus, and his memory fails him. He finds himself confusing the names of his children. Sometimes, he withdraws from his family to be alone.

A survivor of the C.I.A. interrogation in the Salt Pit, Mr. Daeiki says he was kept naked, humiliated and chained to the wall as loud music blared. Sleep is difficult now, but when it comes, his interrogators haunt him there.

"Something is strangling me or I'm falling from high," he said in an interview. "Or sometimes I see ghosts following me, chasing me."

Last year, a video surfaced showing Colonel Qaddafi's son, Saadi, being blindfolded and forced to listen to what sounded like the screams of other prisoners inside Al Hadba, a prison holding members of the former regime - Libya's own high-value detainees. Someone beat the soles of his feet with a stick.

As the scene unfolded, Mr. Daeiki appeared on the screen.

The beating was a mistake, he later acknowledged, but he did nothing to stop it. The goal was to collect intelligence to prevent bloodshed, he said.

He was an interrogator now.

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How U.S. Torture Left a Legacy of Damaged Minds

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Before the United States permitted a terrifying way of interrogating prisoners, government lawyers and intelligence officials assured themselves of one crucial outcome. They knew that the methods inflicted on terrorism suspects would be painful, shocking and far beyond what the country had ever accepted. But none of it, they concluded, would cause long lasting psychological harm.

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John Oliver did a piece on the CIA report on US torture after 9/11.

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Torture: Last Week Tonight with John Oliver (HBO)

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The US Senate Torture Report revealed horrifying details of America's interrogation program. Helen Mirren will fill you in. Connect with Last Week Tonight online...