Prisoners of Hussein
POWs in the past have suffered posttraumatic stress disorder (PTSD), a group of disabling symptoms such as inability to concentrate, extreme vigilance, and exaggerated fearfulness.
It's too soon to know about the Iraq prisoners, says Terrence Keane, a PTSD expert at the Department of Veteran's Affairs Medical Center in Boston, because the conditions of captivity are uncertain. "We don't know if it was simply a matter of them being held, in which case psychologically we'd expect them to be doing fine. But if there were interrogations, threats, beatings or torture, keeping them awake or depriving them of food, it would a take more concerted effort to assist in recovery."
PTSD was listed as a psychological disease in 1980, largely because American veterans of the war in Vietnam had suffered flashbacks, inability to sleep or concentrate, and unexplained terrors long after their return. The diagnosis was later expanded to cover survivors of rape, natural disaster, factory explosion and other terrors.
The disorder can have lifetime impact, according to the National Center for PTSD: "The traumatic event remains, sometimes for decades or a lifetime, a dominating psychological experience that retains its power to evoke panic, terror, dread, grief or despair."
Hallmarks of PTSD include:
Posttraumatic stress disorder appears at high rates among some U.S. veterans. The U.S. National Vietnam Veterans Readjustment Survey, for example, found PTSD symptoms among 31 percent of men, and 27 percent of women. An additional 22 percent of men and 21 percent of women had partial PTSD at some point, so more than half of U.S. veterans of the war in Vietnam -- a total of about 1,700,000 people -- have experienced "clinically serious stress reaction symptoms," according to the National Center for PTSD.
The numbers were even more dramatic for American POWs from World War II and the Korean War. According to research published in 1997 (see "Posttraumatic Stress Disorder...." in the bibliography), 84 percent of U.S. prisoners held by Japan had PTSD symptoms at one time or another, and 59 percent were still suffering in the 1990s.
Such numbers make PTSD look like a normal, not abnormal, response to the experience of combat and being a POW, says Brian Engdahl, a counseling psychologist at the Department of Veterans Affairs Medical Center in Minneapolis. Engdahl says he explains to veterans "that this is your mind and body's way of reacting to a life-threatening experience, that they are very permanent, painful memories that you will carry with you for rest of your life."
However, he argues that these reactions had an adaptive value in evolution. "Hypervigilance, the startle response, and avoidance of situations that appear related to the threat all helped our species survive, and they are still that way because they are 'wired,' to remember these things permanently, and be on guard against similar situation permanently."
POWs of Iraq
A second factor, he adds, is less intuitive. Shorter captivity may not be better. Among people held in the same conditions, POWs "suffer more if they are released before they are able to accommodate to the experience. There is a transition period [after capture] when they are afraid, and then they begin to accommodate, begin to cope."
During this period, which may last 24 to 48 hours, he says, POWs figure out "what happened, why I'm here, what I need to do to get away, how can I survive this." After that point, Figley says, the trauma goes down, and "they are more likely to fare well after release."
Training for captivity
The Uniform Code of Military Justice, which governs the behavior of captured U.S. soldiers, has another purpose -- preventing the Stockholm Syndrome -- in which captives identify with their captors. In almost any social situation, Figley says, "There's a natural instinct to join mentally in the values and habits of those around you." Famously, after heiress Patty Hearst was kidnapped by a group of radicals in 1974, she joined them in a bank robbery. "We want to make sure [soldiers] don't cross the line, don't compromise the mission," says Figley.
A second group of resistance techniques consists of "'going to the movies' in your mind," says Figley. "They think through various movies and scenes from their lives, recalling a novel or running a route for exercise. ... it has a soothing effect, induces endorphins, you sigh and breath better... If you can keep your mind occupied and take mental breaks from the agony, that maintains hope."
So who prospers?
What happens after captivity also makes a difference, says Keane, who treats and studies PTSD in Boston. "The military is very sophisticated about issues of psychological trauma, about the pace of debriefing, about use of psychologists and psychiatrists, in the care that people receive in the short run.
Building on what has been learned since the war in Vietnam, Keane says, "clinicians are more frankly aware of the long-term effects of trauma, so the jubilation of return is coupled with concern about providing the right treatment, at the right time."
To deal with the symptoms, Keane suggests controlling the stimulus. "We try to help them manage the information. You don't need to buy the paper. You can tune the radio to a classical music station, try to be aware when the news comes on."
Like a moth to a flame, he says, however, people with PTSD "are drawn to it, but repelled by it, have this sense they have to watch it, and then get distressed." The pictures and thoughts of war, he says, "may instigate nightmares." Even anniversaries can trigger PTSD symptoms.
What are the psychological effects of being a civilian prisoner?
©2003, University of Wisconsin, Board of Regents.