A sign displays the portrait of Warren Hill during a protest advocating for alternatives to the death penalty in Atlanta, Georgia, Monday, July 15, 2013. (AP Photo/Jaime Henry-White)   On July 18, one day before he was scheduled to die, Warren Hill, a mentally disabled prisoner on Georgia’s death row, was spared from the execution chamber when a Fulton County Superior Court judge granted him a temporary reprieve.

It was not the first time that Hill, who has been diagnosed as having an IQ of 70, had faced imminent death. One year earlier, on July 23, 2012, Hill ate his last meal and said his final goodbyes as he prepared for an execution that was halted ninety minutes before he was supposed to die by lethal injection. Seven months after that, Hill came within thirty minutes of execution—he was sedated and strapped to the gurney—when a stay was granted. And on July 15 of this year, he was granted another temporary stay with less than four hours to spare, only for a new date to be set, for four days later. All told, in just under a year, Hill has come within hours of execution four times.

Hill, who had already been serving a life sentence for killing his girlfriend in 1986, was sentenced to death for the 1990 deadly prison beating of a fellow inmate, Joseph Handspike.

It is not uncommon for prisoners on death row to face multiple execution dates and last-minute stays as attorneys try to keep them alive. Some might consider Hill lucky for surviving so many execution dates. But human rights experts believe that repeated trips to the death chamber, followed by last-minute reprieves, amount to psychological torture. Although the death penalty has long been upheld despite the Eighth Amendment ban on “cruel and unusual punishment,” Brian Evans, head of Amnesty International USA’s Death Penalty Abolition Campaign, compares the psychological impact of an eleventh-hour stay of execution to a mock execution, in which someone is falsely led to believe he or she is about to be killed. “Mock executions are a form of torture under international law,” Evans told The Nation. “A last-minute stay isn’t quite as deliberate, but for the person on the gurney it’s the same effect.”

Richard Dieter, executive director of the Death Penalty Information Center (DPIC), agrees, calling it “akin to a form of torture where people are told they’re going to die again and again and then spared.” He adds, “Warren Hill has been in a tight situation where it’s constantly unknown whether he’s going to be alive or dead twenty-four hours later. This seriously needs to be looked at as a cruel form of punishment.”

Brian Kammer, Hill’s attorney and director of the Georgia Resource Center, told The Nation that the past year has been “extremely traumatic and stressful” for Hill and his family. “Warren has been anxious and frightened. I can hear the tension in his voice,” he says. “In a sane world you wouldn’t put anyone through this kind of misery and insanity, particularly in this case, where all experts agree Warren is mentally retarded.”

According to Kammer, Hill’s mental limitations make the uncertainty of his fate even more difficult to bear because “he has fewer coping skills to handle the stress of being taken out of [a] regular cell and put into a death watch cell.” Then there’s “the anticipation of being killed. That’s hard for anyone to handle. It’s even more cruel for someone who’s mentally disabled.”

Stuart Grassian, a psychiatrist and former Harvard Medical School professor, confirms that the terror of imminent execution is intensified for persons with mental retardation. Grassian has evaluated several death row inmates, including Earl Washington, a mentally disabled Virginia man who was wrongfully convicted of rape and murder and came within nine days of being killed in the electric chair. Washington later testified that from his cell he could hear the electric chair being tested as his execution date approached, a memory that gave him nightmares years after his release. “People with mental retardation struggle with the ability to think abstractly. They have very powerful feelings but because they have fewer cognitive strengths they are less able to manage those feelings than others are,” says Grassian

Technically, a 2002 ruling by the US Supreme Court, Atkins v. Virginia, placed a categorical ban on executing the mentally disabled. But how the ruling would be implemented was left to the discretion of the states. Georgia imposed the strictest standard in the country for exempting an inmate from execution on these grounds, requiring that prisoners prove they are intellectually disabled “beyond a reasonable doubt”—a standard clinical experts say is virtually impossible to meet.

Though researchers have yet to thoroughly study the mental trauma directly associated with repeated execution dates, it is a growing topic of interest in the human rights community and contributes to what psychologists and lawyers call “Death Row Syndrome,” a term that refers to the psychological damage caused by years and sometimes decades of living on death row. Death row prisoners wait an average of fifteen years before execution, according to the Bureau of Justice Statistics. This time is marked by extended periods of solitary confinement and sensory deprivation so damaging to the human mind that many international courts have condemned these conditions alone as torture.

Life on death row can be so agonizing that many prisoners opt for a quicker execution by voluntarily waiving all appeals. A 2005 study by John Blume of Cornell Law School found that 106 out of 822 executions in the modern era of capital punishment to date involved death row inmates who “volunteered” to die.

More recently, in a 2011 position paper exploring the link between the death row experience and torture, the Center for Constitutional Rights unequivocally defined “the intense strain of repeatedly coming within hours or days of execution” as torture. “Did anyone who closely followed Troy Davis’s execution, and his temporary reprieve from the Supreme Court, doubt that the hours leading up to his execution, the hope and then betrayal, amounted to torture?” the authors asked. “Is there any significant difference between mock executions, long recognized as torture by the international community, and Mr. Davis’s last-minute brush with death in 2008?”

Last-minute stays and reprieves are also traumatic for the families of death row prisoners, who face the prospect of repeated, uncertain goodbyes with loved ones. Dieter calls them “the forgotten victims.”

“They are not aided or helped by the prosecution’s office or victims’ aid groups. They’re often looked down upon as though the guilt somehow transfers onto them,” he says. “They have to be outcasts while dealing with their loved one being killed.”

Troy Anthony Davis faced a total of four scheduled execution dates before he was put to death. Though each stay was a temporary victory for Davis and his supporters, the constant uncertainty tormented his family. Soon after the Supreme Court denied Davis’s final appeal in early 2011, his mother passed away of natural causes, despite receiving a clean bill of health from her doctor a day earlier. Martina Davis-Correia, Davis’s late sister, wrote, “I don’t think she could take another execution date. I believe she died of a broken heart.” On September 21, 2011, Georgia finally succeeded in murdering Davis, but not before his execution was postponed one last time by the Supreme Court only to be lifted four hours later. Soon after his death, Martina, who spent years battling cancer, died as well.

Today, Warren Hill’s attorney says his client’s family is “emotionally exhausted.”

“They’re trying to be strong for him, but this is incredibly difficult for them too,” says Kammer. For now, the Atkins ruling and Hill’s challenge of Georgia’s new secrecy law—which blocks the public from learning the source of its lethal injection drugs—are the only obstacles standing in the way of Georgia’s steadfast desire to end Warren Hill’s life.

“I’ve rarely observed a case where we go through three executions and have a client come out alive in all three,” says Kammer. “But it’s not over until it’s over, which means he’s either executed or commuted to a sentence less than death.” In the meantime, Hill is trapped in legal limbo, forced to live with the impending but always uncertain threat of execution.