Forensic psychiatry, to most, is the exercise of deconstructing tragedy and the tragic. Yet the practice itself reveals urgency well beyond the jails, hospitals, and modest rooms where tales of misery pour forth. The lessons of my professional experience in Guantanamo Bay bear an important challenge to our nation and to people of all faiths -- if we dare to look at those locked up.
Under heavy political pressure, the United States has reconsidered the basis of confinement and has released hundreds of detainees from Guantanamo in recent years. Sensitivity to America's image among human rights organizations propelled compliant optimism by the American government that many detainees would no longer be a belligerence risk if restored to freedom.
Relying upon the detainee's own self-advocacy in interviews, America has transferred many to other countries for transitional custody or outright release. But the near-catastrophe of Umar Abdulmutallab's Christmas 2009 airline underwear bombing attempt and the defiant Guantanamo alumni leadership who directed him have raised warnings to the world to rethink risk assessment and risk prevention.
Against the backdrop of these competing forces, the United States Department of Defense asked me as a veteran of highly sensitive forensic psychiatric assessments to appraise the risk of one such Guantanamo detainee, Omar Khadr. Mr. Khadr, by his own statements in 2002 and most recently in October 2010, admitted to throwing a grenade that killed Sfc. Christopher Speer as he inspected the scene of a recently completed battle. Khadr was 15 at the time that he killed Speer.
When I interviewed Khadr last June in my capacity as a forensic psychiatrist, he was an English-speaking, socially agile 23-year-old with the kind of easy smile that so similarly warms those who encounter the Dalai Lama and Bin Laden alike. Anticipating his eventual release, the military commission asked me to go beyond the natural tendency of advocates and adversaries to see what they want to see in Omar the man.
Forensic psychiatry is no stranger to risk assessment. Since the United States Supreme Court decision in Estelle vs. Smith (1981) established the enduring role of psychiatry expertise in death penalty cases, psychiatry and psychology have significantly refined risk assessment. Forced to endow its approaches with the rigor of scientific method, psychiatry has deconstructed our clinical presumptions. The very question itself has matured to niches of particular context. Future dangerousness of violence in the community involves a different approach from assessing risk of violence in maximum security; those approaches differ from assessing risk of sex offense, of non-violent criminality, of domestic violence, stalking, even future contact offense in a child pornography consumer. Assessing future risk of dangerous Jihadist activity necessarily recognizes that an approach may borrow from clinical understandings about criminal and violent recidivism, but has to stay true to context (actual ideological violence or otherwise facilitating violence) in order to gain relevance.