Content note: This article contains descriptions of suicidal thoughts and attempts

“Hardship is the only language that is used here. Anybody who is able to die will be able to achieve happiness for himself, he has no other hope except that.” These were the words of Adnan Latif, formerly incarcerated at the Guantánamo Bay detention camp, to his attorney two years before he committed suicide in 2012.

Like many other incarcerated people languishing behind Guantánamo’s walls, Latif had been pushed to the edge after being cleared for release three times. Last year, Sharqawi Al-Hajj, who is incarcerated at Guantánamo, told his attorney at the Center for Constitutional Rights, Pardiss Kebriaei, that he was suicidal. Despite many clear attempts to kill himself, the judge not only denied a motion to get him an independent medical examiner, he argued that Al-Hajj, who had slit his wrists with pieces of glass, was not trying hard enough to kill himself. While both stories highlight the injustice at Guantánamo, they also reveal a disturbing truth about the role of state violence in creating and exacerbating mental illness behind bars. Both stories, as important as they are, will predictably receive no attention during Mental Health Awareness Month.

Unfortunately, in both Mental Health Awareness Month and Mental Health Awareness Week (which takes place in December), mental health is treated as an individual problem—devoid of any context as to why some mental illness emerges. Even more absent is the role of the state. What happens when state violence is squarely responsible for the lack of mental health and/or the development of mental illness? This connection is typically minimized whether pertaining to Guantánamo or any other U.S. prison. The only form of culpability that the state might absorb is for treatment they can admit exacerbated an existing condition, not one that led to a particular condition in the first place.

Last year, in the wake of the Jeffery Epstein scandal, conversations about the lack of interventions for prison suicide often focused on staff shortages and a lack of oversight in prisons, rather than examinations into why incarcerated people would take their own lives. Moreover, the fact that there have been at least 7,000 suicides in prisons between 2000 and 2014 was an afterthought to Epstein’s death and not a problem worth addressing on its own. Regardless of who dies by suicide, the carceral state only seems to respond to prison suicides to mitigate public relations disasters. Little to no attention is paid to circumstances that led to an incarcerated person’s death in the first place, especially when it concerns their treatment in prison and how that treatment may have contributed to their death.

While the rate of suicides of incarcerated people has gone up in the last five years, this hasn’t necessarily shifted the calculus between physically preventing suicide or understanding mental illness and the roots of suicidal ideation. Many incarcerated people arrived at Guantánamo having already experienced unspeakable acts of violence at the hands of the CIA. The torture tactics were designed by two psychologists to produce a state of “learned helplessness,” including sleep deprivation, playing loud music, and rectal feeding. Coming away unscathed from these forms of abuse would have been almost impossible. Far from ending at the CIA black sites, the practice of torture has continued at Guantánamo. Being indefinitely detained in addition to being tortured creates conditions which put incarcerated people at risk of developing mental illnesses. Nevertheless, the prison offers mental health services that often treat the mental health status of incarcerated people as if it has nothing to do with their detention at the prison.

Moreover, the offer of mental health services is a problem from the get-go because of the widespread distrust incarcerated people have of providers. Former incarcerated person Lotfi Bin Ali, recalling his own suspicions, said that “if you complain about your weak point to a doctor, they told that to the interrogators.”

In the case of Guantánamo, some doctors have played a role in the government’s torture apparatus; others are employed by the same government that ordered incarcerated peoples’ torture in the first place. Even if that’s not the case, there is the argument that the consequences of having psychologists attend to the incarcerated people risks providing “ethical cover to an illegal detention site where detainees are still being tortured with painful forced feedings, solitary confinement, and the hopelessness induced by indefinite detention without charges.”

Psychiatrists working with people incarcerated at Guantánamo have been instructed not to ask them about the torture they have experienced nor entertain any mention of it, even if their patients bring it up themselves. In addition, the incarcerated person’s files pertaining to their psychological trauma history are not included in their medical records. In 2011, an article in The Guardian reported that 100 incarcerated people were diagnosed with psychiatric conditions with many more attempting suicide. Health notes included comments such as “detainee has multiple psychiatric diagnoses and is very manipulative” and “detainee suffers from borderline personality disorder, with a long history of manipulative behaviour with multiple suicidal threats and gestures and hospital admissions.” In 2006, three suicides at Guantánamo were described by some as “an act of asymmetric warfare waged against us.” These are only a few of many instances that exemplify what happens when incarcerated people are treated, in the words of Capt. Albert Shimkus, who was once Guantánamo’s hospital commander, as “enemy combatants.”

These examples illustrate the compounded violence that is Guantánamo and the fact that incarcerated people have been constructed as the “worst of the worst.” The cumulative negative construction of those incarcerated has precluded the possibility of care that is not fixated on their demonization. Thus, even when they present with serious mental illness—including illness directly tied to and triggered by the treatment of the state—their criminalization trumps the possibility of getting adequate care, much less acknowledging the state’s responsibility.

This leads to the question of what role could or should mental health services play in a place that has been described “as a system designed to break people down.” In other words, is there any condition under which mental health service provision wouldn’t be paradoxical to the situation that incarcerated people are in? What does mental health even mean in this context and how can it be preserved under conditions of isolation, deprivation, and general brutality?

The violence of Guantánamo continues to this day as does the suffering of the people detained there. Considering this continuing violence, Mental Health Awareness Month offers us an opportunity to uplift the stories of those who have been victimized by the state and whose stories are left untold and/or forgotten. Maybe we can heed Latif’s words to his lawyer: “With all my pains, I say goodbye to you and the cry of death should be enough for you.” But when will it be enough for us?

Dr. Maha Hilal is an expert in institutionalized Islamophobia in the War on Terror. She is currently co-director of Justice for Muslims Collective in the DMV, a council member of the School of the Americas Watch, and an organizer with Witness Against Torture. She has written numerous op-eds for publications such Al Jazeera, Newsweek, Vox, and Middle East Eye.

Dr. Maha Hilal is an expert on institutionalized Islamophobia in the War on Terror. She is currently a co-director for Justice for Muslims Collective, an organizer with Witness Against Torture, and a...