July 1st, 2013

“Enduring” trauma: long-term effects unknown

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PHOTO BY Tom Croke
James F. Campbell, Ph.D.,notes that individuals who are abducted often experience personality changes. Campbell is associate dean of student life at Brown University.

Imagine being held captive for just one hour. Now compound that intense fear and terror by 10 years, as in the case of the three recently rescued women in Cleveland. The general public becomes overwhelmed with radio, television, online and newspaper coverage of such events and may come to believe they are common. In truth, these are rare instances and understanding the long-term effects of captivity, brutality and isolation may derive from other traumatic situations, such as being a prisoner of war, living in a cult or a household wracked with domestic violence.

When abducted, these women in Cleveland were 13, 17 and 22. Held in captivity for 10 years, their ages at the time, as well as the duration of their captivity, may negatively impact their emotional growth, according to Barbara Greenberg, Ph.D., who has a private practice in Fairfield County, Conn. “Because their captivity was so long, these young women didn’t have time to grow up and develop the skills necessary to function as young adults,” she says. “They are emerging with the skills they had when they were abducted. They did not have the opportunity to develop emotional maturity.”

Additionally, the fact that they only had each other for company for a decade may make it difficult to be separated now that they have been rescued. “Only they can validate one another after sharing these experiences. No one else understands what they went through,” Greenberg says. She suggests that meeting with each other occasionally may help them work toward recovery.

And now that the women have been reunited with their families, both sides face readjustment challenges. “The young women are re-entering the family as different people. They are a stranger to the family and have to get to know them again,” Greenberg says. “And even though you would think the families would be relieved, they have adapted in some ways and have to readjust. Everyone is fraught with emotions – joy, stress, anger, confusion.”

James F. Campbell, Ph.D., associate dean of student life in the graduate school at Brown University, explains that an experience such as the one these women endured tends to cause personality changes. “Over time, you lose your sense of self and your personality,” he says. For the victims of these crimes, the unpredictability of the act, as well as the duration, can be excruciating, he adds.

Another psychologically damaging factor is the captor’s use of domination. “[Perpetrators] control your sense of reality. They may tell you that nobody is looking for you, that they’ve forgotten you, instilling a sense of hopelessness and helplessness. They reinforce this with brutality interspersed with acts of kindness,” says Campbell. Immediately after being rescued, a victim may believe she is worthless, unloved and deserving of her abduction.

After living in a situation in which victims have no control, any attempts to foster recovery must be undertaken slowly and carefully, Campbell says. “Gradually, give them more control, but don’t overwhelm them. You also need to help create a narrative about what happened to allow healing to occur.” With time, the psychologist can help the victim recover a sense of hope and acceptance that she is loved and can love, that she can experience tenderness without being suspicious. “But this could take years,” he adds.

The widespread media attention that follows incidents like the Cleveland kidnapping can complicate recovery, according to Campbell. “Victims should be getting information as they’re ready for it, not through random news broadcasts. As much as possible, they should be shielded from that,” he says. “Survivors should not be exposed to media and interviews.”

Not only is psychological damage a concern after a situation like this, but physical harm is also a serious possibility. Alan E. Kazdin, Ph.D., ABPP, John M. Musser Professor of Psychology & Child Psychiatry, department of psychology at Yale University, says that “enduring stress” impacts both mind and body. “Enduring stress reduces the ability to ward off inflammation, which is implicated in many diseases. It also makes the body less able to ward off infection,” he says. “When a child is older, the risk for dying younger as adults is higher.” These individuals die from heart disease, cancer, chronic respiratory disease and other very serious problems.

Although trauma-based cognitive behavioral therapy has been called the “gold standard” of treatment, Kazdin notes that psychotherapy may be the last line of attack. “Not every exposure to trauma shows a negative effect so you need to do a systematic assessment and ongoing monitoring,” he says. In fact, sometimes there is a delayed reaction to a traumatic experience. “Make no assumptions. No labeling should be done. These victims are at great risk, but not everyone responds the same way,” he says, noting that people are resilient and treatment should be based on individual reaction.

Margaret Blaustein, Ph.D., director of training and education at the Trauma Center at the Justice Research Institute in Brookline, Mass. points out that few people specialize in this area, as it’s not a common experience. However, in many ways there are parallels between long-term captivity and severe domestic violence situations where living in a chronic state of terror and hyper arousal influences the way the body and brain reacts, she notes.

A person who lives in a chronically violent environment has no other idea of how life should be. “For the child growing up in a chronically abusive home, this is the way life is,” Blaustein says, adding that victims learn how to adapt in a way to manage their experiences. However, when victims are removed from a traumatic situation, that coping strategy no longer works or makes sense. “Some part of a [victim] accesses safety in the world she already knows. But you lose sight of everything you know when suddenly placed in a different situation,” she says.

Blaustein emphasizes that any intervention should pay attention to how the victim recovers and handles chronic stress. “You have to address developmental pathways that are significantly shaped and influenced by early adverse experiences,” she says. “You need to decrease the danger response while supporting the development of all competencies in navigating the rest of life, while building safety in a care system.”

By Phyllis Hanlon

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