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Ethically Treating PTSD Resulting from Terroism and other Traumas

Section 17
Use of Ego Defense Mechanisms
by Thomas Strentz

Question 16 | Answer Booklet | Table of Contents | Printable Page

Whether the incident is a bank robbery in Stockholm, Sweden, a hijacking of an American aircraft over western New York, a kidnapping in South America, or an attempted prison break in Texas, there are behavioral similarities despite geographic and motivational differences. In each situation a relationship, a healthy relationship (healthy because those involved were alive to talk about it), seems to develop within and between people caught in circumstances beyond their control and not of their making, a relationship that reflects the use of ego defense mechanisms by the hostage. This relationship seems to help victims cope with excessive stress and at the same time enables them to survive - a little worse for wear, but alive. The Stockholm Syndrome is not a magical relationship of blanket affection for the subject. This bond, although strong, does have its limits. It has logical limits. If a person is nice to another, a positive feeling toward him develops even if he is an armed robber, the hijacker of an aircraft, a kidnapper, or a prisoner attempting to escape.

The victim’s need to survive is stronger than his impulse to hate the person who has created his dilemma. It is his ability to survive and to cope that has enabled man to advance to the top of the evolutionary ladder. His ego is functioning and has functioned well, performing its primary task of enabling the self to remain alive. At an unconscious level the ego has activated the proper defense mechanisms in the correct sequence - denial, regression, identification, or introjection to achieve survival. The Stockholm Syndrome is merely another example of the ability of the healthy ego to cope and adjust to difficult stress brought about by a traumatic situation.

The application for law enforcement is clear, although it does involve a trade-off. The priority in dealing with hostage situations is the survival of all participants. This means the survival of the hostage, the crowd that has gathered, the police officers, and the subject. To accomplish this end, various police procedures have been instituted. Inner and outer perimeters are well-recognized procedures designed to keep crowds at a safe distance. Police training, discipline, and proper equipment save officers’ lives. The development of the Stockholm Syndrome may save the life of the captor as well as the hostage. The life of the captor is usually preserved, because it is highly unlikely that police will used deadly force unless the subject makes a precipitous move. The life of the hostage may also be saved by Stockholm Syndrome; the experience of positive contact, thus setting the stage for regression, identification, or introjection on the part of all those involved in the siege. The subject is less likely to injure a hostage he has come to know and, on occasion, to love.

How to Foster the Stockholm Syndrome
It is suggested that the Stockholm Syndrome can be fostered while negotiating with the subject by asking him to allow the hostage to talk on the telephone, by asking him to check on the health of the hostage, or by discussing with him the family responsibilities of the hostages.
Any action the negotiator can take to emphasize the hostages’ human qualities to the subject should be considered by the negotiator.

The police negotiator must pay a personal price for this induced relationship. Hostages will curse him as they did in Stockholm in August 1973. They will call the police cowards and actively side with the subject in trying to achieve a solution to their plight, a solution not necessarily in their own best interests or in the best interest of the community.

Unfortunately, it may not end there. Victims of the Stockholm Syndrome may remain hostile toward the police after the siege has ended. The “original” victims in Stockholm still visit their abductors, and one former hostage has been engaged to Olofsson. Some American victims visit their former captors in jail. Others, such as some of the hostages in the Croatian skyjacking of TWA Flight 355 in 1976, have begun legal defense funds for some of their jailed captors. A hostile hostage is the price that law enforcement must pay for a living hostage. Anti-law enforcement feelings are not new to the police. But this may be the first time it has been suggested that law enforcement seek to encourage hostility, hostility from people whose lives law enforcement has mustered its resources to save. However, a human life is an irreplaceable treasure and worth some hostility. A poor or hostile witness for the prosecution is a small price to pay for this life.

Personal Reflection Exercise #7
The preceding section contained information as to how time and inflicting pain affects PTSD. Write two case study examples regarding possible application of these principles.

QUESTION 16: How can the Stockholm Syndrome be fostered? To select and enter your answer go to Answer Booklet.

Selected Readings Bibliography/Authors/Instructors

If you would like additional information on this topic,
below are OPTIONAL books to consider buying for your personal library...

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Abu-Ras, Wahiba; Abu-Bader, Soleman H. Risk Factors for Depression and Posttraumatic Stress Disorder (PTSD): The Case of Arab and Muslim Americans Post-9/11. Journal of Immigrant & Refugee Studies. Dec. 2009. Vol. 7. Issue 4. p 393- 419

Bemecker, Samantha L. Helping Clients Help Themselves: Managing Ethical Concerns When Offering Guided Self-Help Interventions in Psychotherapy Practice. Professional Psychology: Research & Practice. Apr2014, Vol. 45 Issue 2, p111-119.

Bergner, Raymond M. PhD, Pathological Self-Criticism Assessment and Treatment. Plenum Press, New York, 1999.

Bishop, Melanie; Rosenstein, David; Bakelaar, Susanne; Seedat, Soraya. An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder. Annals of General Psychiatry. 2014, Vol. 13 Issue 1, p1-24.

Congressional Budget Office, The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans, Congres of the United States Congressional Budget Office, February 2012, p1-52.

Deits, Bob PhD. Life After Loss. Fisher Books, Tucson, 1998.

Drožđek, Boris; Kamperman, Astrid M.; Tol, Wietse A.; Knipscheer, Jeroen W.; Kleber, Rolf J. Seven-Year Follow-Up Study of Symptoms in Asylum Seekers and Refugees With PTSD Treated With Trauma-Focused Groups Journal of Clinical Psychology. Apr2014, Vol. 70 Issue 4, p376-387.

Freedman, Lawrence Zelic PhD. Perspectives on Terrorism. Scholarly Resources, Inc., Wilmington, 1997.

Helge, Ph.D., Doris. Transforming Pain Into Power. Shimoda Publishing, Bellingham, 1999.

Henderson, Kathryn L. Mandated Reporting of Child Abuse: Considerations and Guidelines for Mental Health Counselors. Journal of Mental Health Counseling. Oct2013, Vol. 35 Issue 4, p296-309.

Kaitz, Marsha; Levy, Mindy; Ebstein, Richard; Faraone, Stephen V.; Mankuta, David. The intergenerational effects of trauma from terror: A real possibility. Infant Mental Health Journal. April 2009. Vol. 30. Issue 2. p 158- 170

Kangas, Julie L.; Calvert, James D. Ethical Issues in Mental Health Background Checks for Firearm Ownership. Professional Psychology: Research & Practice. Feb2014, Vol. 45 Issue 1, p76-83.

Kip, Kevin E.; Rosenzweig, Laney; Hernandez, Diego F.; Shuman, Amy; Sullivan, Kelly L.; Long, Christopher J.; Taylor, James; McGhee, Stephen; Girling, Sue Ann; Wittenberg, Trudy; Sahebzamani, Frances M.; Lengacher, Cécile A.; Kadel, Rajendra; Diamond, David M. Randomized Controlled Trial of Accelerated Resolution Therapy (ART) for Symptoms of Combat-Related Post-Traumatic Stress Disorder (PTSD). Military Medicine. Dec2013, Vol. 178 Issue 12, p1298-1309.

Kressel, Neil J. PhD, Mass Hate The Global Rise of Genocide and Terror. Plenum Press, New York, 2000.

Litt, Lisa. Clinical Decision Making in the Treatment of Complex PTSD and Substance Misuse. Journal of Clinical Psychology. May2013, Vol. 69 Issue 5, p534-542.

Loewenberg, F. M., & Dolgoff, R. & Harrington, D. Ethical decisions for social work practice. Itasca, Illinois: F.E. Peacock., 2000.

Matsakis, Ph.D., Aphrodite. Trust After Trauma. New Harbinger Publications, Oakland, 1998.

Mitchell, J.T.(1998) MA. When disaster strikes....the critical incident stress debriefing process. Journal of Emergency Medical Services, 8. (1), 36-39.

Mitchell, J.T. PhD, and Everly, G.S.(1997). Scientific evidence for CISM. Journal of Emergency Medical Services, 22, 87-93

Moe, Cathrine; Kvig, Erling I; Brinchmann, Beate; Brinchmann, Berit S. Working behind the scenes’ An ethical view of mental health nursing and first-episode psychosis. Nursing Ethics. Aug2013, Vol. 20 Issue 5, p517-527.

Nickerson, Angela; Liddell, Belinda J.; Maccallum, Fiona; Steel, Zachary; Silove, Derrick; Bryant, Richard A. Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry. 2014, Vol. 14 Issue 1, p1-19.

O'Hare, Thomas; Sherrer, Margaret V.  Lifetime Traumatic Events and High-Risk Behaviors as Predictors of PTSD Symptoms in People with Severe Mental Illnesses. Social Work Research. Dec. 12. Vol. 33. Issue 4. p 209-219

Pennebaker, Ph.D., James W. Opening Up The Healing Power of Confiding in Others. W. Morrow and Company, Inc., New York, 1999.

Reamer, F. G. The social work ethics audit: A risk-management strategy. Social Work, 2000, 45(4), 355-366.

Reamer, Frederic G., Social Work Ethics Casebook: Cases and Commentary. Washington, DC: NASW Press, 2009

Reamer, Frederic G., Social Work Malpractice and Liability: Strategies for Prevention, 2nd ed. (New York: Columbia University Press, 2003)

Reamer, Frederic G., Social Work Values and Ethics, 3rd ed. (New York: Columbia University Press, 2006)

Reamer, Frederic G., Ethical Standards in Social Work: A Review of the NASW Code of Ethics, 2nd ed. (Washington, DC: NASW Press, 2006)

Reamer, Frederic G., The Social Work Ethics Audit: A Risk-management Tool (Washington, DC: NASW Press, 2001)

Reamer, Frederic G., Tangled Relationships: Managing Boundaries in the Human Services (New York: Columbia University Press, 2001)

Reamer, Frederic G., Ethics Education in Social Work (Alexandria, VA: Council on Social Work Education, 2001)

Rothstein, Mark A., Tarasoff Duties after Newtown, Journal of Law, Medicine & Ethics. Spring2014, Vol. 42 Issue 1, p104-109.

Rubin, Barry PhD. Terrorism and Politics. St. Martin’s Press, New York, 1997.

Simon, Jeffrey D PhD,. The Terrorist Trap. Indiana University Press, 1998.

Somer, Prof., Dr. Tarik. International Terrorism and the Drug Connection. Ankara University Press, Ankara, 2002.

Stamm, Ph.D., B. Hudnall. Secondary Traumatic Stress. Sidran Press, Lutherville, 1999.
White, Jonathan R. PhD, Terrorism: an Introduction. Brooks/Cole Publishing Company, Pacific Grove, 2003.

Whittaker, David J. PhD, The Terrorism Reader. Routledge, New York, 2001.

Wieviorka, Michel PhD. The Making of Terrorism. The University of Chicago Press, Chicago, 1997.

Wilkinson, Paul PhD. Terrorism and Political Violence Volume 11. Frank Cass & Co. Ltd., 1999.

Coordinating Author/Instructor: Tracy Appleton, LCSW, MEd

The article above contains foundational information. Articles below contain optional updates.
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