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Ethically Treating PTSD Resulting from Terrorism and other Traumas
3 CEUs Ethically Treating PTSD Resulting from Terrorism and other Traumas

Section 12
Time and Inflicting Pain
by Thomas Strentz

Question 12 | Test | Table of Contents | PTSD CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

Time and Inflicting Pain
In the early development of a hostage incident certain stages of hostage reactions occur with regularity. In my experience, the vast majority of hostages share this sequence of emotional events: denial, delusion of reprieve, busy work, and taking stock. The alliance that forms between the hostages and the subject comes later. Anna Freud distinguished denial, which is a reaction to external danger, from repression in which the ego is struggling with basically internal instinctual stimuli. Denial is a primitive but effective psychological defense mechanism. There are times when the mind is so overloaded with trauma it cannot handle the situation. To survive, the mind reacts as if the traumatic incident is not happening. Former hostages have reported responding: “Oh no,” “No, not me,” “This must be a dream,” or “This is not happening.”

Denial is but one stage of coping with the impossible turn of events. Each victim who copes effectively has a strong will to survive. One may deal with stress by believing he is dreaming, that he will soon wake up and it will be over. Some deal with this stress by withdrawing through sleep; I have interviewed hostages who have slept for over forty-eight hours while captive. Some have fainted, although this is rare.

Some of the denial and repression of fear of the hostages and the transfer of these feelings of fear to the police has a realistic basis. Research has shown that most hostages die or are injured during the police or military assault phase, although this is not to say that the police killed them.

Frequently hostages gradually accept their situation, but find a safety valve in the thought that their fate is not fixed. They view their situation as temporary and are sure that the police will come to their rescue. This gradual change from denial to delusions of reprieve reflects a growing acceptance of the facts. Although the victim accepts that he is a hostage, he believes that freedom will come soon.

If freedom does not immediately relieve the stress, many hostages begin to engage in “busy work,” work they feel comfortable doing. Some knit, some methodically count and record windows or other hostages, and some reflect upon their past lives. I have never interviewed a former hostage who has not taken stock of his life and vowed to change for the better, thus attempting to take advantage of a second chance at life.

Time is a factor in development of the Stockholm Syndrome, and its passage can produce a positive or negative bond, depending on the interaction of the subjects and hostages. If the hostage-takers do not abuse their victims, hours spent together will most likely produce “positive” results. Time alone will not do so, but it may be the catalyst in non-abusive situations.

Reactions of the Hostage-Taker
As time passes and positive contact between the hostage and hostage-taker begins, the Stockholm Syndrome also begins to take its effects upon the subjects. This was evident at Entebbe in July 1976. During this incident there were major variations in the quality of interaction between the hostage-takers and the hostages. These ranged from relatively friendly conversations to sadistic taunting. During the final assault, one of the male terrorists, who had engaged in conversations with the hostages from Air France Flight 139, elected at the moment of attack to shoot at the Israeli commandos rather than to execute the hostages. The same process was probably at work in the decision of the South Moluccan terrorists not to execute Gerard Vaders. After Vaders had told his fellow hostage, Prins, about the problems he was currently having in his marital relationship and with his daughter, the Moluccans could no longer see him as a faceless symbol to be executed. He was now a human being who might be spared. Tragically, the Moluccans selected another passenger, Bierling, and led him away to be executed before they had the opportunity to know him.

Inflicting Pain
Most people cannot inflict pain on another unless their victim remains dehumanized. When the subject and his hostages are locked together in a vault, a building, a train, or an airplane, a process of humanization apparently does take place. When a person, a hostage, can build empathy while maintaining dignity, he or she can lessen the aggression of a captor. The exception to this is the subject who can be characterized as having an antisocial personality. As Fred Carrasco demonstrated in August 1974, such hostage-takers experience little guilt and have an ability to abuse and even kill their captives if they feel this will be in their own interests. Fortunately, extreme cases of this type are in a minority, and in most situations the Stockholm Syndrome is a two-way street. With the passage of time and the occurrence of positive experiences, the victim's chances of survival increase. However, isolation of the victim precludes the formation of the positive bond.

In some hostage situations the victims either have been locked in another room or have been in the same room, hooded or tied, gagged and forced to face the wall and away from the subject. This type of interaction occurred frequently during the Hanafi Muslim siege in Washington, D.C., in March 1977. Consciously or unconsciously, the subject has dehumanized his hostage, thereby making it easier to kill him. As long as the hostage is isolated, time is not a factor. The Stockholm Syndrome will not be a force that may save the victim’s life.

Hostage-Captor Interaction
In interviewing victims of the Hanafi Muslim siege, I observed that even though some of the hostages responded positively toward their captors, they did not necessarily evidence Stockholm Syndrome reactions toward all of the subjects. It was learned, as might be expected, that most of the victims reacted positively toward those subjects who had treated them, in the words of the victim, “fairly.” Those hostages who gave glowing accounts of the gentlemanly conduct of some subjects did not generalize to all subjects. They evidenced dislike, even hatred, toward one hostage-taker whom they called “an animal.”

A hypothetical question was posed to determine the depth of these victims’ feelings toward their captors. Each former hostage was asked what he would do in a the following situation: A person immediately recognizable as a law enforcement officer, armed with a shoulder weapon, orders him to lie down. At the same instant one of his former captors orders him to stand up. When asked what he would do, the response varied according to the identity of the captor giving the “order.” If a captor who had treated him fairly were yelling “stand up,” he would stand up. Conversely, if he thought it was the command of the subject who had verbally abused him, he would obey the law enforcement officer. This would indicate that the strength of the syndrome is considerable. Even in the face of an armed officer of the law, the former hostage would offer himself as a human shield for his captor. As absurd or illogical as this may seem to those who are not familiar with the Stockholm Syndrome, such behavior has been observed by law enforcement officers throughout the world and on many different occasions.

Personal Reflection Exercise #6
The preceding section contained information as to how time and inflicting pain affects PTSD. Write two case study examples regarding possible applications of these principles.

Peer-Reviewed Journal Article References:
Larsen, S. E., Fleming, C. J. E., & Resick, P. A. (2019). Residual symptoms following empirically supported treatment for PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 207–215.

McGuire, A. P., Frankfurt, S. B., Anderson, L. M., & Connolly, K. M. (2020). Pre- to posttreatment changes in trauma-cued negative emotion mediate improvement in posttraumatic stress disorder, depression, and impulsivity. Traumatology, 26(4), 455–462.

Robison, M. K., Miller, A. L., & Unsworth, N. (2018). Individual differences in working memory capacity and filtering. Journal of Experimental Psychology: Human Perception and Performance, 44(7), 1038–1053. 

QUESTION 12: How can a hostage lessen the aggression of a captor? To select and enter your answer go to Test.
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