The decision by the Attorney General (in fact The President) to move the Sheikh’s trial out of a military court in Guantanamo Bay to a Federal Court in Manhattan has far-reaching implications.
While I am only qualified to give an opinion on the mental health implications, there are at least three other aspects that will also impact on the public health:
- The question of whether it raises the risk to the city of a future attack.
- The role that the media will play in its presentation of the relevant trial material.
- The risk of the government acting-out out some unconscious agenda to a forum of victims.
As I develop the discussion on mental health from a “trauma perspective” I will refer to the above-mentioned items when relevant.
While 90% of those surveyed after the attacks on the Twin Towers and Pentagon suffered from some acute stress in the weeks following the attack, only a small percentage still showed PTSD after six-months (Schlenger JAMA 2002).
That means that only a small minority of New York residents currently suffer from the triad of PTSD symptoms resulting from the 9/11 attacks: trauma recollections; heightened levels of startle and arousal; and phobic avoidance of trauma-triggers.
Those most likely to have residual symptoms of trauma include immediate eye-witnesses, emergency on-site rescue personnel, and individuals who experienced a personal loss as a result of the terrorist attack.
One has to therefore consider the effects of trauma reactivation on two groups: a significant minority of individuals whose wounds are still very raw; and the rest of the community, who have come to some form of psychological “closure”.
There is another factor that will affect the public’s response to the trial: Communities tend to have a collective structure, and most primate groups will rally around a victim who has been attacked.
While we may heuristically distinguish between one group of the population that still suffers from trauma-related symptoms, and the remaining group without current symptoms, the psychologically healthier group might coalesce, to some extent, by cross-identifying with those who have been more damaged.
But at a physiological level, victims with current trauma symptoms have been shown, via psychometric tests as well as various biological probes, to be more prone to experience symptom-relapse when confronted with trauma-reminders.
When it comes to the public health challenge of managing and “containing” the painful symptoms that victims experience when they are re-exposed to their perpetrator, there has been a significant shift by trauma experts over the past ten years in their philosophy about the best therapeutic approach.
The “Old School” of Cognitive Behavior Therapists believed that frequent re-exposure to the trauma-trigger resulted in a gradual lessening of symptoms over time.
For instance, in the case of a rape victim, assigning the victim the task of recording the trauma narrative, and then listening to it repeatedly, would, according to this theory, eventually cause relief of symptoms through a process known as “habituation”.
However, as a result of the work of Marylene Cloitre and others, many victims were identified who required some form of preparation before trauma re-exposure (J. of Consulting and Clinical Psychology 2002). They found many victims who were unable to manage the intense feelings elicited by trauma re-exposure, unless they first were taught a variety of coping strategies. These include learning how to “stay calm and mindful in the present” and finding ways to “self-soothe”.
The immediate stress-reaction to trauma is characterized by heightened sensory-perceptual function and is part of the body’s survival system. Subsequent exposure to specific trauma reminders will also elicit a cascade of fear-driven symptoms and behaviors.
Cloitre recommends that therapists establish a clinical profile of the victim’s unique stress reactions in order to provide appropriate strategies as a preparation for subsequent exposure to trauma-triggers.
Verbal characterization of the trauma-event and its synthesis into a coherent narrative is the final step required in the healing process.
The trauma narrative is what transforms the immediate vivid sensory experience into an abstract representation. This creates a distance between the apprehension of past trauma-recollections and the sense of safety in the present.
It is in the context of this safe “holding environment” that the victim is able to organize a coherent trauma-narrative.
The narrative should preferably satisfy the victim’s need for compensation and justice, even at a symbolic level, to allow full psychological closure.
An example of a landmark trial that provided a therapeutic narrative occurred when Mossad agents captured Adolf Eichmann in Argentina and brought him to Israel.
He was exposed to an open public trial protected by bullet-proof glass.
For thousands of holocaust survivors, his conviction and subsequent execution re-awakened the notion that justice still existed in a universe that no longer made sense.
This was an instance in history when a government was resolved to satisfy the collective need of the public it served.
In contrast, the public has been left wondering about the motives regarding the Administration’s decision to move the trial of America’s most dangerous terrorist away from a military court in Guantanamo to a civil court in New York.
I believe that the overwhelming attacks on two countries following the 9/11 attacks sent a message to most citizens that the enemy had been confronted and the threat level significantly reduced.
Many opinion-polls now indicate a public perception of battle-weariness.
There is no indication that New Yorkers currently feel any great appetite to revisit the crime-scene of 9/11 by hosting the trial of the suspected mastermind of this egregious act.
But there still are wounds, and these are going to be opened up, by dint of this decision.
The thought of warehousing Khalid in New York not only reactivates traumatic memories in some; it also makes people feel more prone to another attack.
In order to help victims maintain their sense of safety, one should keep them as far away from the perpetrator as possible.
While one may be comforted by the fact that the self-confessed terrorist is incarcerated, we have no measure of his outreach capabilities or potential to constellate a network of sympathizers.
My opinion is that the trial will both increase the public’s sense of threat, as well as raise the actual threat level.
For the tens of thousands of individuals who lost beloved family members or friends, confronting one of the ringleaders will also unleash other emotions, including bereavement and anger.
I mentioned one crucial aspect of trauma-recovery, namely, the need to establish the victim’s emotional and physival safety. Another vital component for recovery is to provide a narrative for the victim which is coherent.
There are many legal consequences arising from the change in the trial format that work to the advantage of the alleged terrorist.
In the case of the Khalid Sheikh Mohammed, the government also runs the risk of contaminating the prosecution of the perpetrator with a completely different agenda, namely its embarrassment about Guantanamo.
New Yorkers may discover that they have been selected as a stage to purge a previous Administration, following a pattern of political decisions that appear driven by a desperate need to transform the “Persona” of America from an imperialist superpower to a benevolent one.
The most un-therapeutic dynamic that could play-out would be anything remotely resembling the “O.J.Simpson Trial”, where the country`s best attorneys out-maneuvered the D.A to the extent that the LAPD appeared to be on trial rather than the defendant.
That type of narrative would not sit well in this context.
In a previous article I cited the freeing of convicted Pan-Am 103 bomber al Megrahi earlier this year by the Scottish Justice Secretary.