- Email: [email protected]
A comparative model of the psychological effects on the victims of state and anti-state terrorism
/ntem8tiond Journal of Lew end Psychiatrf. Printed in the U.S.A. All rights reserved.
Vol. 12.281-293,
1999
Olao-2527/89 $3.00 + .oo Copyright 0 1990 Pergamon Press plc
A Comparative Model of the Psychological Effects on the Victims of State and Anti-State Terrorism Raymond R. Corrado* and Eric Tompkins*
An extensive body of research has accumulated on the psychological effects of terrorism on the victim. Most recently, case studies involving hostage victims of anti-state terrorism have provided important insights into the trauma associated with the victimization process during an incident and its aftermath. l In addition, the psychological impact of state or government sponsored terrorismz has been documented through case studies of concentration camp survivors, as well as victims of Third World state-terror. Despite these data, however, no attempt has been made to examine the differences and similarities between the two forms of terror3 in terms of the psychological effects on victims during and after the traumatic ordeal. Instead, much of the available literature centers on the victimization process involving anti-state hostage-taking incidents. Moreover, when state terrorism is examined, the emphasis is on concentration camp victims. Clearly, there are substantial limitations in the amount and type of research available, nevertheless, enough studies and sources exist (Flynn, 1987; Hatcher, 1987; Symonds, 1980) to develop a model for comparing and contrasting the psychological impact of both state and anti-state terrorism on its victims. The proposed model is based on assertions that certain psychological impacts and stages are common to state and anti-state terrorism regarding prolonged confined periods of detention, yet state-terrorism appears to produce more damaging mental disorders (such as chronic depression and posttraumatic stress disorders). Before elaborating this model, it is necessary first to discuss the available data base.
*School of Criminology, Simon Fraser University, Burnaby, British Columbia VSA lS6, Canada. I Anti-state terrorism is broadly defined to encompass any terrorist action that is in opposition to the state. Hence, this includes several sub-types: nationalist terrorists; ideological terrorists; insurgency terrorists; religious fanatics; as well as single issue fanatics. sFor the purpose of this paper, the term “state-terror” includes both official and unofficial activities of the state and its agents. For an excellent commentary on the pervasiveness and brutality of state-terrorism as compared to anti-state terrorism see: McMurtry, J. (1988, February/March). States of terror. The Cunudiun Forum, p. 6-8. sIndeed, there is a tendency in the literature to discuss the effects of state-terror and anti-state terror in synonomous terms. 281
282
RAYMOND
R. CORRADO
and ERIC TOMPKINS
Data Base
Four types of data sources were employed in developing the model outlined in Figure 1: clinical interviews with nonrandom but large samples of concentration camp survivors; individual case studies of victims of state terrorism; case studies of victims of violent crimes; and secondary analysis of all those previous types of data. The most extensive studies involve victims of state terrorism because a variety of research has occurred with survivors of World War II concentration camps. Most importantly is the theoretical work of Bettelheim (1979) and the descriptive studies of Krystal and Niederland (1968). The latter
STATE
STAGES
TERROR
ANTI-STATE
TERROR
1
I
1)
SHOCK
reslgnatibn
frozenfright
2) ACCEPTRNCE
acceptance of aggressors control over situatmn
mcreased
3) COPING
4)
,nferac;,on w,,h
aggressor palhologlcal transference
_
COPING STRATEGIES
-
transference
readmg. writmg. counting
OlSlNTERGRATlON OF CRPTORS CONTROL
chronic headaches
I[
I
POST TRAUMATIC STRESS
(guilt
reactton)
I
LJ INTERVAL
POSTCONCENTRATIONCAhR SYNDf%IM
Chronic depresslon wthdrawal
FIGURE terrorism.
1. A comparative
model
of the psychological
effects
on the victims
of state
and anti-state
VICTIMS OF TERRORISM
283
research involved diagnosis and treatment of concentration camp survivors over a 20 year period following World War II. A random sample of 149 case records was drawn by Krystal and Niederland in order to assess the distribution of mental disorders. Ostwald and Bittner (1968) examined records of 60 similar victims to assess psychological and related life-style adjustments. More recently the work of the Amnesty International Danish Medical Group (1979) has provided a valuable addition to the research into the psychological and physiological effects of systematic torture. The study they conducted was based on two culturally distinct groups of individuals: Chilean refugees (n =32), and former Greek political prisoners (n=35). The Chileans had allegedly been tortured from two weeks to two years prior to examination. The Greek exprisoners reported that they had been tortured from two to seven years prior to the study. Case studies usually not involving clinical interviews of victims of state terrorism also provided considerable insight into describing the victim experience. DesPres (1976), Lernoux (1982), and Padilla and Comas-Dias (1986) described experiences of survivors of Latin American state terrorist regimes in countries such as Argentina, Brazil and Chile. More extensive, contemporary autobiographical accounts also were available-most importantly the detailed and insightful recollections of former Argentinean newspaper editor Jocobo Timmerman (1981). Far fewer data sources were available for victims of anti-state terrorism. No accessible large sample studies were found; however, Symonds (1980) developed his model of psychological responses from case studies of 600 victims of violent crimes. In effect, data involving parallel violent experiences have been asserted by some researchers as appropriate to describing the anti-state victim experience. In addition to Symonds, Bard and Sangrey (1979) and Burgess and HolmStrom (1979) employed this parallel data primarily based on the rationale that many key experiences - most importantly, forced confinement and physical threats -are common to both “criminal” hostage incidents and terrorist hostage incidents. Case studies most often provided information concerning specific psychological manifestations such as the Stockholm Syndrome (Ochberg, 1978). Also, biographical accounts were available usually involving cases highlighted by the media as exemplified by Patricia Hearst (1982) and Jocobo Timmerman (1981). Another important source consisted of research on children subjected to a persistent environment of anti-state terrorism. Ayalon (1983), Fields (1977) and Harbison and Harbison (1980) all examined such chronic terrorist situations, most importantly, in Northern Ireland. Finally, two major models of anti-state terrorist victimization developed by Hatcher (1987) and Flynn (1987) relied entirely on secondary data sources, primarily the research of Symonds (1980) and Frederick (1980). All the above data sources are subject to standard validity concerns because they all lack rigorous research design elements, especially random selection procedures and control groups. As well, most accounts of the victim experience relied on memory often many years removed from actual events. Despite such validity limitations, the above data were employed because of the overwhelming convergence of information and the preliminary and tentative nature of the
284
RAYMOND
R. CORRADO
and ERIC TOMPKINS
model in Figure 1. In effect, generalizations concerning psychological sequelae among victims of terrorism were clearly evident. Figure 1 contains the outline of the psychological processes and outcomes that have been identified in the literature review as characterizing common victim experiences in the initial four stages for both state and anti-state terrorism. The distinctive psychological processes and outcomes as well are identified in this figure and they occur primarily in the final stages of the victim experience. And finally, the psychological repercussions evident after the termination of the victim experience are compared. While certain posttraumatic stress disorders are common, the more severe disorders are associated with state terrorism. In the following sections, the model in Figure 1 will be explicated in detail. Parallel Psychological Impacts of Anti-State and State-Terrorism Although the political objectives of anti-state and state-terrorism usually differ, the victimization process involving confinement initially involves similar elements. The victim is overwhelmed by a frightening and unpredictable force that threatens annihilation. The experience is intensely stressful and generates a feeling of extreme vulnerability. The complex psychological and physiological processes associated with such trauma have been described by Symonds (1980) who has developed a four-phase model of victim responses. The initial phase consists of shock, disbelief, and denial. Once the victim begins to acknowledge the extent of the violent threat, the second stage begins, which is characterized as “frozen fright” or “pseudocalm, detached behaviour.” Symonds’ third and fourth phases involve delayed responses and occur after the event has been terminated. In phase three, the victim experiences traumatic depression which is combined with feelings of selfrecrimination. In the final phase, victims are able to resolve the traumatic experience and resume a normal life-style. Flynn (1987) has expanded upon Symonds’ (1980) model-in particular the second “frozen fright” stage. During this period there is a “brief period of imminent reprieve,” where victims expect, unrealistically, that the authorities will soon rescue them. According to Flynn, there is a growing acceptance by the victims of their submissive and vulnerable position. In the final stage (which parallels Stage 3 in the model), victims increasingly become resigned and resort to a variety of coping strategies, including activities such as reading, writing, counting and reflecting on one’s life. Despite these coping activities, victims subjected to prolonged capture can become overwhelmed by despair and experience “traumatic psychological infantilism.” This condition is manifested in acts of appeasement, compliance and submission. Under extended periods of terror where the victims believe the terrorist has allowed them to live, pathological transference can also occur. Symonds maintains that this phenomenon consists of profound and persistent attitudinal and behavioral changes based on the relief the victim feels from the view of the terrorist as a “good guy.” This transference process will be further discussed below. A somewhat similar five-stage model has been developed by Hatcher (1987). As with Symonds (1980), the first stage involves victims denying reality and responding by selecting one of three alternatives: freeze, flee, or fright. During
VICTIMS OF TERRORISM
285
the second stage, acceptance occurs and the victim is increasingly compliant and submissive. Stage three involves increased cooperative interaction between the victim and the perpetrator. The fourth stage is marked by fear and uncertainty associated with the disintegration of the perpetrator’s control, and is usually brought on by either the perpetrator or external factors.4 Hatcher’s final stage takes place once security is re-established and often includes a second wave of fear and anxiety. This is associated with what Symonds (1980) has labeled the “second injury” and can be a major factor in the subsequent psychological and physical reactions. According to Symonds, the second injury is linked to disorders such as anxiety, phobias, insomnia and depression. Although differences exist in the categorization of the different stages of the victimization process, five general stages have been extrapolated from the works of Symonds (1980), Flynn (1987), and Hatcher (1987) (see Figure 1). First, there is a period of intense trauma associated with the initial shock from being abducted. Second, there is a stage of resignation and acceptance. In the third stage, the victim resorts to various coping mechanisms such as transference. Stage four is characterized by renewed anxiety associated with disintegration of the captor’s control. And finally, stage five involves the various sequelae that develop after the termination of the terrorization experience. The model in Figure 1 is based on five stages, which includes the after effects, since it is important to emphasize the causal relationship between the physical acts of terror perpetrated on the victims and the psychological and physiological outcomes after the incident. Moreover, it is during the final stage (and to some extent stages three and four) that the more profound differences in the sequelae between the victims of state and anti-state terror develop. Significant differences in terms of process and victim experience take place in the third stage. An important coping strategy that is routinely discussed in the literature is referred to as transference. This involves the development of an emotional bond between the victim and perpetrator. However, the way in which transference is manifested varies depending on the type of terrorism experienced . Transference results from the shared conditions of stress and survival. With regard to anti-state terrorism, once the immediate trauma about being killed (during the initial contact period) has passed, a closeness and attachment can develop between victim and perpetrator. Both the captors and the hostages realize that their mutual survival depends on how the authorities decide to resolve the standoff. Specifically, it is obvious that if the police or military choose the assault option, death or serious injury will occur. In addition to this shared hope for survival, other dynamics emerge; such as exhaustion, hunger, boredom, and perhaps most importantly, a discussion of personal and other relevant information. If conditions are favorable, transference can develop into what is referred to as the Stockholm Syndrome (Ochberg, 1978). However, this syndrome appears to be specific to anti-state terrorism, therefore it will be discussed in more detail later in this paper. 4It is difficult to understand how this stage applies to state-terror incidents. Given the torture that is usually associated with state-terrorism, why would the victim have any apprehension released?
and brutality about being
266
RAYMOND
R. CORRADO
and ERIC TOMPKINS
The transference process is inhibited in state-terrorist abduction, especially because torture is often a routine terror tactic and the perpetrators and the authorities are by definition the same. There are, therefore, few shared conditions which can facilitate the development of empathetic relationships. Transference, however, does appear to be a factor in circumstances involving prolonged detention. In his research on survivors of concentration camps, Bettelheim (1979) observed that some victims developed a survival strategy that included identifying with their aggressors’ values and behaviors. In extreme cases, this led to victims becoming informers, Capos in Nazi concentration camps, and other types of “prisoner-officials.” In some cases, they were even more barbaric in their treatment of fellow prisoners than the guards (Krystal, 1968; see also Corrado, 1988). Interestingly, this condition seems to resemble the pathological transference that Symonds (1980) identified with hostage-taking incidents. In general, the transference process can serve “as a defense function mitigating fear and helplessness” (Simon & Blum, 1987, p. 194). It would appear that the most serious consequence of the victim having experienced transference is a guilt reaction for having behaved in such a way during the incident. A more significant problem that appears in victims of both state and antistate terrorism is referred to as “posttraumatic stress disorder” (see Spitzer, Sheehy, & Endicott, 1977). This appears to result from the high levels of stress and anxiety experienced during the incident. Some of the more common symptoms are: re-experience of the trauma; recurrent intrusive recollections; recurrent dreams and nightmares; acting out or feeling as if the traumatic event were recurring; social numbness or withdrawal; hyperalertness or hyperactive startle reaction; sleep disorders; guilt; memory impairment; avoidance of activities that arouse recollection of the event, and intensification of the symptoms by exposure to similar events (Andreasen, 1980; Kinzie, Frederickson, Fleck, & Karls, .1984). These develop as a result of a psychologically traumatic event(s) outside the range of “normal” human experience. In addition, Spitzer et al. (1980), in their chapter on the “Guiding Principles” for DSM-III, indicate that “the number of stressful events, their duration and the context in which they occur should be taken into account, including the degree to which the event is desired and is under the individual’s control” (p. 12). In effect, it appears that it is not the stress by itself that is damaging, but rather the individual’s inability to cope which is significant. This has important implications for victims of terror: . . . since the essence of terrorisation involves the negation of the victim’s capacity for willing his behavior, it must be seen as one of the most damaging stressors that can be inflicted on humans. (Flynn, 1987, p. 349)
As well as the above symptomatology, prolonged stress can lead to other psychological and physiological disorders. Five basic response systems have been identified: (a) the sympathetic nervous system, leading to hypertension, arrythmia, palpitation, fluid retention; (b) the parasympathetic nervous system, leading to gastrointestinal disorders such as colitis and ulcers; (c) the
VICTIMS OF TERRORISM
287
skeletal-muscular system, leading to muscular pain and tension headaches; (d) the endocrine system, responsible for the overall integration of skeletal-muscular, parasympathetic and sympathetic nervous systems; and (e) the immune system, responsible for the body’s infection-fighting mechanisms (Flynn, 1987). It is evident that any violent hostage experience or prolonged violent experience can induce stress, which can lead to systematic response stages and subsequent psychological responses, including various mental disorders. In the next section, response patterns associated with anti-state terrorism will be discussed. Effects of Anti-State Terror on the Individual An effect of anti-state terrorism that commonly arises out of a hostagetaking event is the Stockholm Syndrome. In many respects, this condition can be characterized as a more intense form of transference. However, it is not simply a matter of degree. As well as having the same characteristics of other forms of transference, the Stockholm Syndrome does focus on certain specific features: It can persist beyond the duration of the crisis; and the victim can feel continued extreme fear and distrust toward the authorities. Importantly, the Stockholm Syndrome is unlikely to develop if the terrorists are extremely abusive to their captives (Ochberg, 1978). As mentioned, it is common for the ex-hostage to experience feelings of responsibility and guilt about his/her behavior during the hostage-taking. As well as being attributed to the transference process, guilt feelings can also develop as a result of having survived the ordeal. In addition, a major part of this reaction is related to what Hatcher (1987) refers to as the John Wayne Syndrome; that is, the ex-hostage feels guilt for not having planned some heroic action and “acted as a stronger individual” (pp. 369-370). A variety of other reactions have been reported by ex-hostages. Among the more important ones: inability to concentrate; dramatic mood swings; startle reactions; intrusive images; and burn-out associated with an inability to deal with the event (Hatcher, 1987). Another important reaction to persistent anti-state terrorism involves the emotional state of young individuals (see Ayalon, 1983; Fields, 1977; Harbison & Harbison, 1980). While research has been limited, it appears that the duration and proximity of an assault, along with the extent of brutality either viewed or endured, can exacerbate stressful reactions among victims. Young victims usually have fewer means of self-defense and have less understanding or ability to predict the outcome of a terrorist experience. Along with the inevitable dehumanizing treatment, they are likely to feel hopeless, panicky, and subsequently engage in self-deceptive strategies to cope with the shock. Whether the typical initial shock has more serious emotional consequences may likely be determined by group dynamics and support networks. In other words, the individual’s perception of the strength and emotional support in a group of victims will influence the beliefs and the outcome of the individual’s situation. Along with the cognitive and emotional interaction, broad factors such as historical and cultural characteristics influence the group’s ability to cope with
288
RAYMOND
R. CORRADO
and ERIC TOMPKINS
terrorist experiences. Finally, variables such as individual resourcefulness and tolerance also appear to affect victim responses (Ayalon, 1983). Hatcher (1987) has also researched the effects of terrorist incidents on young people. In a review of incidents involving 5- to 1I-year-olds, it was observed that child hostages go through the same stages as adult hostages, and in addition experience many of the same psychological and physical reactions. However, there appear to be a few important differences. After the event, some children seem to develop a preoccupation with death. It has been observed, for example, that death and violence appear more frequently in their play activities. In contrast to adults, though, there appear to be less gastrointestinal problems among child ex-hostages. These findings are tentative because the documented child hostage cases are quite small. In addition to the small sample size, the impact of chronic anti-state terrorism on young people is not easily measured. An extremely elaborate list of variables is required to even begin to understand the variation in psychological reactions (see Fields, 1977). Moreover, assertions that terrorist and counterterrorist activities of the last two decades in Northern Ireland have resulted in a “lost” generation of young people appear to be exaggerated. What the limited research to date indicates is that, despite major emotional disorders that some young people can experience, generally numerous mitigating influences can exist limiting the emotionally damaging effects of anti-state terrorism (Harbison & Harbison, 1980). Effects of State-Terror on the Individual State terrorism surpasses anti-state terrorism, both in scope and intensity of violence. The U.S. Department of State reports that between 1975 and 1985, there were approximately 5000 events and threats of events related to anti-state terrorism. However, during the same period, hundreds of thousands of people have been killed or tortured because of state-terrorism (Stohl, 1988). Although obtaining empirical evidence demonstrating that state-terrorism as a phenomenon is more pervasive is generally a straightforward process, determining whether or not the various sequelae arising out of a state-terror attack are more profound is much more problematic. In addition to the wide variation in the types of state-terrorist incidents, individual differences concerning psychological predisposition to traumatic events makes it difficult to establish general propositions. Nonetheless, inferences can be made on the basis of the available evidence. There is evidence that the degree of physical abuse and violence that is inflicted upon the victim is substantially greater in the case of a state-terrorist incident; torture is an integral and routine tactic, while, in comparison, systematic torture is considerably less common to the anti-state terrorist victim experience. The pervasiveness and brutality of torture is best illustrated through victim testimony. Lernoux (1982) quotes an Argentinean woman who was tortured by soldiers during the 1970s as part of the military government’s policy of state terrorism: They started to give me electric shocks on my breasts, the side of my body, and under my arms, all the time asking me questions. I was
VICTIMS OF TERRORISM
299
given electric shocks in the vagina and a pillow was placed over my mouth to stop me screaming. Someone they called the “colonel” came and said they were going to increase the voltage until I talked. They kept throwing water over my body and applying electric shocks all over. (p. 8) Lernoux mentions a barbaric device invented by the Brazilian military police known as the “dragon chair” (p. 174). Once the victim is strapped in, he or she is given electric shocks while a dentist drill shatters his or her teeth. Afterwards, if the victim is male, he is held upside down while his testicles are crushed. Not all torture involves acts of overt violence. Padilla and Comas-Dias (1986) point out that in Chile the use of psychological torture has been increasingly used. They note that victims are: . . . deprived of sleep and placed in solitary confinement. Their clothing and personal privileges are taken away from them. Their senses are disoriented by the continuous wearing of a blindfold and overloaded by the constant, loud playing of a radio. They are given false information about confessions of close friends and family members; often they are forced to listen to these loved ones scream in pain as they too are tortured and sexually abused. (p. 62)
Intimidation and fear also are enhanced by an open display of power through such methods as revealing a detailed knowledge of the victim’s personal and work habits. Given the extent of brutality and emotional suffering of victims of state terrorism, it is not unexpected that severe emotional and psychological disorders frequently develop. Wren (1986) is an article on the Toronto Torture Treatment Centre describes the lingering impact of torture among refugees from Latin America to Africa: once the physical bruises have gone, the scars that remain as a result of torture are physically “no different from scars from other causes . . . It is the meaning of that scar, the memories attached to it that matter.” (New York Times Magazine, p. 21) Physicians at this centre described specific case experiences in the following manner : . . . a child from Uganda screams when she is taken to church because the hymns and flowers evoke the funeral of her murdered father. An Afghan women weeps hysterically at the memories of repeated rape by her jailers. For some, the scars never heal. There have even been suicides, like Raul Rivadeneira, a Chilean who hung [sic] himself on the eve of his deportation hearing in 1984, evidently because he could not bear to recount his torture yet again. (p. 35)
Greater systematic and conclusive evidence of the more frequent and profound impact of state terrorism is found in documentation and case studies of concentration camp victims. For concentration camp victims the first phase of the experience is crucial for survival (DesPres, 1976). Survivors report that unless adjustment is made
290
RAYMOND
R. CORRADO
and ERIC TOMPKINS
quickly to the oppressive brutality of camp life, the result was usually immediate death (Smith, 1980; Timmerman, 1981; Utting, 1977). According to Bettelheim (1979), victims who were unable to cope during the initial three-week adjustment period often became severely depressed, withdrawn and apathetic. This condition is often referred to as the “musulman” stage and invariably precedes death. Bettelheim (1979) identifies three broad categories of reactions during the post-concentration camp period. The first category is comprised of individuals with persistent mental disorders which precluded effective functioning, both socially and at work. The second category consists of persons who experienced no lasting psychological effects; while the third involves individuals who engaged in a lifelong struggle to deal with the emotional effects. Research on the third category was undertaken in a clinical study by Ostwald and Bittner (1968). They reviewed records of 60 former Nazi concentration camp victims in attempts to assess their life adjustment and psychological adjustment. They mentioned that although socio-economic life adjustment of the victims appeared to be good, posttraumatic stress disorder symptoms, such as depression, anxiety, resentfulness, and somatic complaints, were not uncommon. Other case studies of concentration camp survivors have revealed serious ongoing psychological sequelae, even though symptoms did not always develop immediately. In Krystal and Niederland’s (1968) review of the evolution of this pattern, he discovered that upon liberation, the victim often experiences a feeling of triumph mixed with optimism for the future. The feeling that he or she will soon be reunited with family members is common, despite the fact that most or all of them may have perished in the holocaust. After a symptom-free period, ranging from a few months to a few years, a “post-concentration camp syndrome” develops. Symptoms include a pervasive depressive mood, morose behavior, tendency to withdraw, and apathy. These symptoms were described as severe and persistent. Krystal and Niederland (1968) concluded that 97% were suffering from chronic anxiety. This state was precipitated by situations that recalled the traumatic experience and renewed the fear of persecution. All of these victims experienced sleep disturbances, while one-third had developed disturbances of cognition and memory. The majority of survivors as well experienced chronic depression of one form or another. Two of the most persistent disorders involved a masochistic character trait (79%) and survivor guilt (92%). Niederland (1968) maintained that survivor guilt was critical to understanding depression: The guilt is felt as a constant depressive which follows them; it is sometimes a personalized, active force, expressing itself clinically in terms of a constant fear and vigilance, with paranoic reactions. As a persecutory component, for instance, the patients have to go to the other side of the street when they see a policeman. They cannot walk by a policeman, perceiving him as an enemy who might capture them. . . . The depressive component makes itself visible in the complete withdrawal, apathy, brooding seclusion, state of depres-
VICTIMS OF TERRORISM
sion, and especially the permanent these people. (p. 68)
291
feeling of loss and sadness in
In contrast to the above evidence, chronic depression and its various manifestations does not appear to be a common outcome of anti-state terror. Although victims of an anti-state terrorist hostage-taking do experience depressive moods, there is little clinical evidence similar to the frequency of chronic depression found in survivors of concentration camps. Another study of the outcome pattern of state terrorism was undertaken by the Amnesty International Danish Medical Group (1979). In a clinical study of Greek and Chilean victims of torture, the group found that 78% of the combined group displayed serious mental disturbances. The most common methods of torture that the victims reported were: the “falange” (beatings on the soles of the feet); electrical torture to the genitals; beatings to the genitals; severe beatings to the head; being burnt with cigarettes; being deprived of sleep; kept standing for long periods of time; having nails torn out. The researchers found that the method of torture that was inflicted was often related to the type of sequelae that later developed. For example, they observed that direct cranial trauma was related to chronic headaches, loss of memory, and an inability to concentrate. As well, victims that experienced beatings to the genitals invariably suffered from sexual disturbances. The most common symptoms were anxiety, irritability, and depression. It was hypothesized that direct cranial trauma combined with basic psycho-physical stress could result in organic lesions. More recently, Sack, Angell, Kinzie, & Rath, (1986) conducted a study of 40 Cambodian refugees (students and their families) who had survived two to four years of either concentration camp or forced labor under the Pol Pot regime. They all met the DSM-III5 criteria for posttraumatic stress disorder. Their symptoms included sleeplessness, difficulty concentrating, nightmares and recurrent intrusive thoughts, recurrent recollections of their traumatic experiences, guilt, avoidance, hyperactive startle reactions, and emotional numbness. They routinely watched the execution of family and friends. As well, in the process of being placed in either concentration or labor camps, families were separated. The camps in which they were forced to stay were overcrowded and unsanitary. Each day they would suffer more brutalities, humiliation, malnutrition, and sleep deprivation. Another dimension of state terrorism involves victims who “disappear.” These victim are often abducted without warning and taken into detention where they are tortured and executed. Rarely are the “disappeared” ever found alive (Amnesty International, 1983). This practice of enforced disappearances is a sinister form of terrorism. The experience of being arbitrarily isolated from the rest of society is particularly traumatizing: Their only mental bearings are within their own minds or within the walls of their place of detention. If death is not the final outcome and they are released, from the nightmare, the victims may suffer from sNote that this has now been revised and is referred to as DSM-III-R.
292
RAYMOND
R. CORRADO
and ERIC TOMPKINS
the consequences of this form of dehumanization for a long time. (Independent Commission on International and Humanitarian Issues, 1986, p. 20) Disappearances also subject the friends and family of the victim to slow mental torture. Efforts to determine the victim’s whereabouts and state of health invariably end in frustration and failure. Their anguish is further compounded by not knowing whether they too are threatened and can expect the same fate. In a Chilean study of 203 children of parents that had disapbeared, physical and psychological testing revealed that 78% exhibited symptoms of withdrawal and 70% showed signs of depression (Allodi, 1980). Other symptoms were intense and generalized fear, sleep disturbances, and increased dependence on adults. This section has focused on the stress and trauma associated with state-terror during the incident, as well as the psychological after effects. Based on the various case studies and documented reports, it would be reasonable to assume that the sequelae resulting from state-terror far exceeds that of anti-state terror. Summary and Conclusions This paper has examined and compared the psychological impact of both state and anti-state terrorism on the victim. In this regard, three dimensions to this issue were discussed: (a) the effects that are common to anti-state terror and state-terror; (b) the effects that are unique to anti-state terror; and (c) the psychological effects and sequelae specifically associated with state-terror. Given the paucity of empirical research together with the complexity of the subject matter, definitive statements are difficult to advance. Despite this, however, a number of tentative conclusions can be made. With respect to psychological reactions during the incident, many similarities seem to hold for victims of a hostage-taking, concentration camps, and torture. That is, the incident begins with a period of initial shock accompanied by extreme fear and anxiety. This is followed by a phase characterized by outward acceptance of the perpetrator’s control while inside the victim is experiencing extreme fright. Gradually, a period of adaptation sets in, whereby the victim may resort to a number of coping strategies. Although similarities continue after the incident-the posttraumatic stress syndrome, for example - the intensity and duration of psychological sequelae appear to be much greater in victims of state-terror. Given the extreme brutality that invariably accompanies state-terror, this is not surprising. While the methods of anti-state terrorists may take a number of different forms, usually their resources and techniques are limited in comparison to stateterror. It is only more recently in the Middle East that anti-state terrorists more routinely are engaging in long-term detention and torture of victims. On the other hand, regimes that employ state-terror have a wide range of violent techniques at their disposal, most importantly concentration camps. It appears that prolonged physical and emotional violence combined with little hope of relief or escape is critical to understanding why victims of state terrorism are more likely to suffer more serious mental disorders than victims of anti-state terrorism.
VICTIMS OF TERRORISM
293
References Allodi, F. (1980). The psychiatric effects in children and families of victims of political persecution and torture. Danish Medical Bulletin, 27, 229-231. Amnesty International. (1983). Political killings by governments. London: Amnesty lnternational Publications. Amnesty International Danish Medical Group. (1979). Evidence of torture. London: Amnesty lnternational Publications. Andreason, N. C. (1980). Posttraumatic stress disorder. In H. I. Kaplan, A. M. Freedman, & B.J. Sadock (Eds.), Comprehensive textbook ofpsychiatry (3rd ed.). Baltimore, MD: Williams and Wilkins Co. Ayalon, 0. (1983). Coping with terrorism: The Israeli case, In D. Meichenbaum & M. E. Jarenko (Eds.), Stress reduction andprevention (pp. 293-339). New York: Plenum Press. Bard, M. & Sangrey, D. (1979). The crime victims book. New York: Basic Books. Bettelheim, B. (1979). Surviving and other essays. New York: Alfred A. Knopf. Burgess, A., & Holmstrom, L. (1976). Coping behavior of the rape victim. American Journal of Psychiatry, I3(4), 413-417. Corrado, R. (1988). Victims of extreme state terrorism. In E. Fattah (Ed.), Theplight ofthe victim in modern society. London: MacMillan Press Ltd. DesPres, T. (1976). The survivor. New York: Oxford University Press. Fields, R. (1977). Society under siege. Philadelphia: Temple University Press. Flynn, E. (1987). Victims of terrorism: Dimensions of the victim experience. In P. Wilkinson & A. M. Stewart (Eds.), Contemporary research on terrorism (pp. 337-357). Aberdeen: The University Press. Frederick, C. J. (1980). Effects of natural vs. human induced violence upon victims. Evaluation and Change, 71-75. Harbison, J., & Harbison, J. (1980). A society under stress. Somerset, England: Open Books. Hatcher, C. (1987). A conceptual framework in victimology: The adult and child hostage experience. In P. Wilkinson & A. M. Stewart (Eds.), Contemporary research on terrorism (pp. 357-376). Aberdeen: University Press. Hearst, P. (1982). Every secret thing. Garden City, NY: Doubleday. Independent Commission on International Humanitarian Issues. (1986). Disappeared: Technique of terror. New Jersey: Zed Books Ltd. Kinzie, J. D., Fredrickson, R. H., Fleck, R. B. J., Karls, W. (1984). Posttraumatic stress disorder among survivors of Cambodian concentration camps. American Journal of Psychiatry, 141(S), 645-650. Krystal, H., & Niederland, W. G. (1968). Clinical observations on the survivor syndrome. In H. Krystal (Ed.), Massivepsychic trauma (pp. 327-348). New York: International University Press. Lernoux, P. (1982). Cry of thepeople. New York: Penguin Books. Niederland, W. G. (1968). An interpretation of the psychological stresses and defences in concentration camp life and the late aftereffects. In Henry Krystal (Ed.), Massive psychic trauma (pp. 60-70). New York: International University Press. Ochberg, F. (1978). The victim of terrorism: Psychiatric considerations. Terrorism, l(2), 147-168. Ostwald, P. 8c Bittner, E. (1968). Life adjustment after severe persecution. American Journal of Psychiatry, 124(10), 87-94. Padilla, A. & Comas-Dias, L. (1986). State of fear. Psychology Today, 60-65. Sack, W. H., Angell, R., Kinzie, J. D., & Rath, B., (1986). The psychiatric effects of massive trauma on Cambodian children: 11. The family the home and the school. Journal of the American Academy ofChi/d Psychiatry, 25(3), 377-383. Simon, R. I., & Blum, R. A. (1987). After the terrorist incident: Psychotherapeutic treatment of former hostages. American Journal of Psychotherapy, 2, 194-200. Smith, G. I. (1980) Ghosts of Kampala. London: Weidenfeld and Nicolson. Spitzer, R. L., Sheehy, M., & Endicott, J. (1977). DSM-III: Guiding principles. In V. M. Rakoff, H. C. Stance& & H. B. Kedward (Eds.), Psychiatric diagnosis. New York: Brunner/Mazel. Stohl, M. (1988). Introduction: Myths and realities of political terrorism. In M. Stohl (Ed.), The politics of terrorism. (3rd ed., pp. l-23). New York: Marcel Dekker Inc. Symonds, M. (1980). The second injury to victims and acute responses of victims to terror. Evaluation and Change, 36-38. Timmerman, J. (1981). Prisoner without a name, cell without a number. New York: Alfred A. Knopf. Utting, G. (1977, July 15). Uganda prison from the inside. Vancouver Sun. Wren, C. S. (1986, August 17). Salvaging lives after torture. The New York Times Magazine.
Vol. 12.281-293,
1999
Olao-2527/89 $3.00 + .oo Copyright 0 1990 Pergamon Press plc
A Comparative Model of the Psychological Effects on the Victims of State and Anti-State Terrorism Raymond R. Corrado* and Eric Tompkins*
An extensive body of research has accumulated on the psychological effects of terrorism on the victim. Most recently, case studies involving hostage victims of anti-state terrorism have provided important insights into the trauma associated with the victimization process during an incident and its aftermath. l In addition, the psychological impact of state or government sponsored terrorismz has been documented through case studies of concentration camp survivors, as well as victims of Third World state-terror. Despite these data, however, no attempt has been made to examine the differences and similarities between the two forms of terror3 in terms of the psychological effects on victims during and after the traumatic ordeal. Instead, much of the available literature centers on the victimization process involving anti-state hostage-taking incidents. Moreover, when state terrorism is examined, the emphasis is on concentration camp victims. Clearly, there are substantial limitations in the amount and type of research available, nevertheless, enough studies and sources exist (Flynn, 1987; Hatcher, 1987; Symonds, 1980) to develop a model for comparing and contrasting the psychological impact of both state and anti-state terrorism on its victims. The proposed model is based on assertions that certain psychological impacts and stages are common to state and anti-state terrorism regarding prolonged confined periods of detention, yet state-terrorism appears to produce more damaging mental disorders (such as chronic depression and posttraumatic stress disorders). Before elaborating this model, it is necessary first to discuss the available data base.
*School of Criminology, Simon Fraser University, Burnaby, British Columbia VSA lS6, Canada. I Anti-state terrorism is broadly defined to encompass any terrorist action that is in opposition to the state. Hence, this includes several sub-types: nationalist terrorists; ideological terrorists; insurgency terrorists; religious fanatics; as well as single issue fanatics. sFor the purpose of this paper, the term “state-terror” includes both official and unofficial activities of the state and its agents. For an excellent commentary on the pervasiveness and brutality of state-terrorism as compared to anti-state terrorism see: McMurtry, J. (1988, February/March). States of terror. The Cunudiun Forum, p. 6-8. sIndeed, there is a tendency in the literature to discuss the effects of state-terror and anti-state terror in synonomous terms. 281
282
RAYMOND
R. CORRADO
and ERIC TOMPKINS
Data Base
Four types of data sources were employed in developing the model outlined in Figure 1: clinical interviews with nonrandom but large samples of concentration camp survivors; individual case studies of victims of state terrorism; case studies of victims of violent crimes; and secondary analysis of all those previous types of data. The most extensive studies involve victims of state terrorism because a variety of research has occurred with survivors of World War II concentration camps. Most importantly is the theoretical work of Bettelheim (1979) and the descriptive studies of Krystal and Niederland (1968). The latter
STATE
STAGES
TERROR
ANTI-STATE
TERROR
1
I
1)
SHOCK
reslgnatibn
frozenfright
2) ACCEPTRNCE
acceptance of aggressors control over situatmn
mcreased
3) COPING
4)
,nferac;,on w,,h
aggressor palhologlcal transference
_
COPING STRATEGIES
-
transference
readmg. writmg. counting
OlSlNTERGRATlON OF CRPTORS CONTROL
chronic headaches
I[
I
POST TRAUMATIC STRESS
(guilt
reactton)
I
LJ INTERVAL
POSTCONCENTRATIONCAhR SYNDf%IM
Chronic depresslon wthdrawal
FIGURE terrorism.
1. A comparative
model
of the psychological
effects
on the victims
of state
and anti-state
VICTIMS OF TERRORISM
283
research involved diagnosis and treatment of concentration camp survivors over a 20 year period following World War II. A random sample of 149 case records was drawn by Krystal and Niederland in order to assess the distribution of mental disorders. Ostwald and Bittner (1968) examined records of 60 similar victims to assess psychological and related life-style adjustments. More recently the work of the Amnesty International Danish Medical Group (1979) has provided a valuable addition to the research into the psychological and physiological effects of systematic torture. The study they conducted was based on two culturally distinct groups of individuals: Chilean refugees (n =32), and former Greek political prisoners (n=35). The Chileans had allegedly been tortured from two weeks to two years prior to examination. The Greek exprisoners reported that they had been tortured from two to seven years prior to the study. Case studies usually not involving clinical interviews of victims of state terrorism also provided considerable insight into describing the victim experience. DesPres (1976), Lernoux (1982), and Padilla and Comas-Dias (1986) described experiences of survivors of Latin American state terrorist regimes in countries such as Argentina, Brazil and Chile. More extensive, contemporary autobiographical accounts also were available-most importantly the detailed and insightful recollections of former Argentinean newspaper editor Jocobo Timmerman (1981). Far fewer data sources were available for victims of anti-state terrorism. No accessible large sample studies were found; however, Symonds (1980) developed his model of psychological responses from case studies of 600 victims of violent crimes. In effect, data involving parallel violent experiences have been asserted by some researchers as appropriate to describing the anti-state victim experience. In addition to Symonds, Bard and Sangrey (1979) and Burgess and HolmStrom (1979) employed this parallel data primarily based on the rationale that many key experiences - most importantly, forced confinement and physical threats -are common to both “criminal” hostage incidents and terrorist hostage incidents. Case studies most often provided information concerning specific psychological manifestations such as the Stockholm Syndrome (Ochberg, 1978). Also, biographical accounts were available usually involving cases highlighted by the media as exemplified by Patricia Hearst (1982) and Jocobo Timmerman (1981). Another important source consisted of research on children subjected to a persistent environment of anti-state terrorism. Ayalon (1983), Fields (1977) and Harbison and Harbison (1980) all examined such chronic terrorist situations, most importantly, in Northern Ireland. Finally, two major models of anti-state terrorist victimization developed by Hatcher (1987) and Flynn (1987) relied entirely on secondary data sources, primarily the research of Symonds (1980) and Frederick (1980). All the above data sources are subject to standard validity concerns because they all lack rigorous research design elements, especially random selection procedures and control groups. As well, most accounts of the victim experience relied on memory often many years removed from actual events. Despite such validity limitations, the above data were employed because of the overwhelming convergence of information and the preliminary and tentative nature of the
284
RAYMOND
R. CORRADO
and ERIC TOMPKINS
model in Figure 1. In effect, generalizations concerning psychological sequelae among victims of terrorism were clearly evident. Figure 1 contains the outline of the psychological processes and outcomes that have been identified in the literature review as characterizing common victim experiences in the initial four stages for both state and anti-state terrorism. The distinctive psychological processes and outcomes as well are identified in this figure and they occur primarily in the final stages of the victim experience. And finally, the psychological repercussions evident after the termination of the victim experience are compared. While certain posttraumatic stress disorders are common, the more severe disorders are associated with state terrorism. In the following sections, the model in Figure 1 will be explicated in detail. Parallel Psychological Impacts of Anti-State and State-Terrorism Although the political objectives of anti-state and state-terrorism usually differ, the victimization process involving confinement initially involves similar elements. The victim is overwhelmed by a frightening and unpredictable force that threatens annihilation. The experience is intensely stressful and generates a feeling of extreme vulnerability. The complex psychological and physiological processes associated with such trauma have been described by Symonds (1980) who has developed a four-phase model of victim responses. The initial phase consists of shock, disbelief, and denial. Once the victim begins to acknowledge the extent of the violent threat, the second stage begins, which is characterized as “frozen fright” or “pseudocalm, detached behaviour.” Symonds’ third and fourth phases involve delayed responses and occur after the event has been terminated. In phase three, the victim experiences traumatic depression which is combined with feelings of selfrecrimination. In the final phase, victims are able to resolve the traumatic experience and resume a normal life-style. Flynn (1987) has expanded upon Symonds’ (1980) model-in particular the second “frozen fright” stage. During this period there is a “brief period of imminent reprieve,” where victims expect, unrealistically, that the authorities will soon rescue them. According to Flynn, there is a growing acceptance by the victims of their submissive and vulnerable position. In the final stage (which parallels Stage 3 in the model), victims increasingly become resigned and resort to a variety of coping strategies, including activities such as reading, writing, counting and reflecting on one’s life. Despite these coping activities, victims subjected to prolonged capture can become overwhelmed by despair and experience “traumatic psychological infantilism.” This condition is manifested in acts of appeasement, compliance and submission. Under extended periods of terror where the victims believe the terrorist has allowed them to live, pathological transference can also occur. Symonds maintains that this phenomenon consists of profound and persistent attitudinal and behavioral changes based on the relief the victim feels from the view of the terrorist as a “good guy.” This transference process will be further discussed below. A somewhat similar five-stage model has been developed by Hatcher (1987). As with Symonds (1980), the first stage involves victims denying reality and responding by selecting one of three alternatives: freeze, flee, or fright. During
VICTIMS OF TERRORISM
285
the second stage, acceptance occurs and the victim is increasingly compliant and submissive. Stage three involves increased cooperative interaction between the victim and the perpetrator. The fourth stage is marked by fear and uncertainty associated with the disintegration of the perpetrator’s control, and is usually brought on by either the perpetrator or external factors.4 Hatcher’s final stage takes place once security is re-established and often includes a second wave of fear and anxiety. This is associated with what Symonds (1980) has labeled the “second injury” and can be a major factor in the subsequent psychological and physical reactions. According to Symonds, the second injury is linked to disorders such as anxiety, phobias, insomnia and depression. Although differences exist in the categorization of the different stages of the victimization process, five general stages have been extrapolated from the works of Symonds (1980), Flynn (1987), and Hatcher (1987) (see Figure 1). First, there is a period of intense trauma associated with the initial shock from being abducted. Second, there is a stage of resignation and acceptance. In the third stage, the victim resorts to various coping mechanisms such as transference. Stage four is characterized by renewed anxiety associated with disintegration of the captor’s control. And finally, stage five involves the various sequelae that develop after the termination of the terrorization experience. The model in Figure 1 is based on five stages, which includes the after effects, since it is important to emphasize the causal relationship between the physical acts of terror perpetrated on the victims and the psychological and physiological outcomes after the incident. Moreover, it is during the final stage (and to some extent stages three and four) that the more profound differences in the sequelae between the victims of state and anti-state terror develop. Significant differences in terms of process and victim experience take place in the third stage. An important coping strategy that is routinely discussed in the literature is referred to as transference. This involves the development of an emotional bond between the victim and perpetrator. However, the way in which transference is manifested varies depending on the type of terrorism experienced . Transference results from the shared conditions of stress and survival. With regard to anti-state terrorism, once the immediate trauma about being killed (during the initial contact period) has passed, a closeness and attachment can develop between victim and perpetrator. Both the captors and the hostages realize that their mutual survival depends on how the authorities decide to resolve the standoff. Specifically, it is obvious that if the police or military choose the assault option, death or serious injury will occur. In addition to this shared hope for survival, other dynamics emerge; such as exhaustion, hunger, boredom, and perhaps most importantly, a discussion of personal and other relevant information. If conditions are favorable, transference can develop into what is referred to as the Stockholm Syndrome (Ochberg, 1978). However, this syndrome appears to be specific to anti-state terrorism, therefore it will be discussed in more detail later in this paper. 4It is difficult to understand how this stage applies to state-terror incidents. Given the torture that is usually associated with state-terrorism, why would the victim have any apprehension released?
and brutality about being
266
RAYMOND
R. CORRADO
and ERIC TOMPKINS
The transference process is inhibited in state-terrorist abduction, especially because torture is often a routine terror tactic and the perpetrators and the authorities are by definition the same. There are, therefore, few shared conditions which can facilitate the development of empathetic relationships. Transference, however, does appear to be a factor in circumstances involving prolonged detention. In his research on survivors of concentration camps, Bettelheim (1979) observed that some victims developed a survival strategy that included identifying with their aggressors’ values and behaviors. In extreme cases, this led to victims becoming informers, Capos in Nazi concentration camps, and other types of “prisoner-officials.” In some cases, they were even more barbaric in their treatment of fellow prisoners than the guards (Krystal, 1968; see also Corrado, 1988). Interestingly, this condition seems to resemble the pathological transference that Symonds (1980) identified with hostage-taking incidents. In general, the transference process can serve “as a defense function mitigating fear and helplessness” (Simon & Blum, 1987, p. 194). It would appear that the most serious consequence of the victim having experienced transference is a guilt reaction for having behaved in such a way during the incident. A more significant problem that appears in victims of both state and antistate terrorism is referred to as “posttraumatic stress disorder” (see Spitzer, Sheehy, & Endicott, 1977). This appears to result from the high levels of stress and anxiety experienced during the incident. Some of the more common symptoms are: re-experience of the trauma; recurrent intrusive recollections; recurrent dreams and nightmares; acting out or feeling as if the traumatic event were recurring; social numbness or withdrawal; hyperalertness or hyperactive startle reaction; sleep disorders; guilt; memory impairment; avoidance of activities that arouse recollection of the event, and intensification of the symptoms by exposure to similar events (Andreasen, 1980; Kinzie, Frederickson, Fleck, & Karls, .1984). These develop as a result of a psychologically traumatic event(s) outside the range of “normal” human experience. In addition, Spitzer et al. (1980), in their chapter on the “Guiding Principles” for DSM-III, indicate that “the number of stressful events, their duration and the context in which they occur should be taken into account, including the degree to which the event is desired and is under the individual’s control” (p. 12). In effect, it appears that it is not the stress by itself that is damaging, but rather the individual’s inability to cope which is significant. This has important implications for victims of terror: . . . since the essence of terrorisation involves the negation of the victim’s capacity for willing his behavior, it must be seen as one of the most damaging stressors that can be inflicted on humans. (Flynn, 1987, p. 349)
As well as the above symptomatology, prolonged stress can lead to other psychological and physiological disorders. Five basic response systems have been identified: (a) the sympathetic nervous system, leading to hypertension, arrythmia, palpitation, fluid retention; (b) the parasympathetic nervous system, leading to gastrointestinal disorders such as colitis and ulcers; (c) the
VICTIMS OF TERRORISM
287
skeletal-muscular system, leading to muscular pain and tension headaches; (d) the endocrine system, responsible for the overall integration of skeletal-muscular, parasympathetic and sympathetic nervous systems; and (e) the immune system, responsible for the body’s infection-fighting mechanisms (Flynn, 1987). It is evident that any violent hostage experience or prolonged violent experience can induce stress, which can lead to systematic response stages and subsequent psychological responses, including various mental disorders. In the next section, response patterns associated with anti-state terrorism will be discussed. Effects of Anti-State Terror on the Individual An effect of anti-state terrorism that commonly arises out of a hostagetaking event is the Stockholm Syndrome. In many respects, this condition can be characterized as a more intense form of transference. However, it is not simply a matter of degree. As well as having the same characteristics of other forms of transference, the Stockholm Syndrome does focus on certain specific features: It can persist beyond the duration of the crisis; and the victim can feel continued extreme fear and distrust toward the authorities. Importantly, the Stockholm Syndrome is unlikely to develop if the terrorists are extremely abusive to their captives (Ochberg, 1978). As mentioned, it is common for the ex-hostage to experience feelings of responsibility and guilt about his/her behavior during the hostage-taking. As well as being attributed to the transference process, guilt feelings can also develop as a result of having survived the ordeal. In addition, a major part of this reaction is related to what Hatcher (1987) refers to as the John Wayne Syndrome; that is, the ex-hostage feels guilt for not having planned some heroic action and “acted as a stronger individual” (pp. 369-370). A variety of other reactions have been reported by ex-hostages. Among the more important ones: inability to concentrate; dramatic mood swings; startle reactions; intrusive images; and burn-out associated with an inability to deal with the event (Hatcher, 1987). Another important reaction to persistent anti-state terrorism involves the emotional state of young individuals (see Ayalon, 1983; Fields, 1977; Harbison & Harbison, 1980). While research has been limited, it appears that the duration and proximity of an assault, along with the extent of brutality either viewed or endured, can exacerbate stressful reactions among victims. Young victims usually have fewer means of self-defense and have less understanding or ability to predict the outcome of a terrorist experience. Along with the inevitable dehumanizing treatment, they are likely to feel hopeless, panicky, and subsequently engage in self-deceptive strategies to cope with the shock. Whether the typical initial shock has more serious emotional consequences may likely be determined by group dynamics and support networks. In other words, the individual’s perception of the strength and emotional support in a group of victims will influence the beliefs and the outcome of the individual’s situation. Along with the cognitive and emotional interaction, broad factors such as historical and cultural characteristics influence the group’s ability to cope with
288
RAYMOND
R. CORRADO
and ERIC TOMPKINS
terrorist experiences. Finally, variables such as individual resourcefulness and tolerance also appear to affect victim responses (Ayalon, 1983). Hatcher (1987) has also researched the effects of terrorist incidents on young people. In a review of incidents involving 5- to 1I-year-olds, it was observed that child hostages go through the same stages as adult hostages, and in addition experience many of the same psychological and physical reactions. However, there appear to be a few important differences. After the event, some children seem to develop a preoccupation with death. It has been observed, for example, that death and violence appear more frequently in their play activities. In contrast to adults, though, there appear to be less gastrointestinal problems among child ex-hostages. These findings are tentative because the documented child hostage cases are quite small. In addition to the small sample size, the impact of chronic anti-state terrorism on young people is not easily measured. An extremely elaborate list of variables is required to even begin to understand the variation in psychological reactions (see Fields, 1977). Moreover, assertions that terrorist and counterterrorist activities of the last two decades in Northern Ireland have resulted in a “lost” generation of young people appear to be exaggerated. What the limited research to date indicates is that, despite major emotional disorders that some young people can experience, generally numerous mitigating influences can exist limiting the emotionally damaging effects of anti-state terrorism (Harbison & Harbison, 1980). Effects of State-Terror on the Individual State terrorism surpasses anti-state terrorism, both in scope and intensity of violence. The U.S. Department of State reports that between 1975 and 1985, there were approximately 5000 events and threats of events related to anti-state terrorism. However, during the same period, hundreds of thousands of people have been killed or tortured because of state-terrorism (Stohl, 1988). Although obtaining empirical evidence demonstrating that state-terrorism as a phenomenon is more pervasive is generally a straightforward process, determining whether or not the various sequelae arising out of a state-terror attack are more profound is much more problematic. In addition to the wide variation in the types of state-terrorist incidents, individual differences concerning psychological predisposition to traumatic events makes it difficult to establish general propositions. Nonetheless, inferences can be made on the basis of the available evidence. There is evidence that the degree of physical abuse and violence that is inflicted upon the victim is substantially greater in the case of a state-terrorist incident; torture is an integral and routine tactic, while, in comparison, systematic torture is considerably less common to the anti-state terrorist victim experience. The pervasiveness and brutality of torture is best illustrated through victim testimony. Lernoux (1982) quotes an Argentinean woman who was tortured by soldiers during the 1970s as part of the military government’s policy of state terrorism: They started to give me electric shocks on my breasts, the side of my body, and under my arms, all the time asking me questions. I was
VICTIMS OF TERRORISM
299
given electric shocks in the vagina and a pillow was placed over my mouth to stop me screaming. Someone they called the “colonel” came and said they were going to increase the voltage until I talked. They kept throwing water over my body and applying electric shocks all over. (p. 8) Lernoux mentions a barbaric device invented by the Brazilian military police known as the “dragon chair” (p. 174). Once the victim is strapped in, he or she is given electric shocks while a dentist drill shatters his or her teeth. Afterwards, if the victim is male, he is held upside down while his testicles are crushed. Not all torture involves acts of overt violence. Padilla and Comas-Dias (1986) point out that in Chile the use of psychological torture has been increasingly used. They note that victims are: . . . deprived of sleep and placed in solitary confinement. Their clothing and personal privileges are taken away from them. Their senses are disoriented by the continuous wearing of a blindfold and overloaded by the constant, loud playing of a radio. They are given false information about confessions of close friends and family members; often they are forced to listen to these loved ones scream in pain as they too are tortured and sexually abused. (p. 62)
Intimidation and fear also are enhanced by an open display of power through such methods as revealing a detailed knowledge of the victim’s personal and work habits. Given the extent of brutality and emotional suffering of victims of state terrorism, it is not unexpected that severe emotional and psychological disorders frequently develop. Wren (1986) is an article on the Toronto Torture Treatment Centre describes the lingering impact of torture among refugees from Latin America to Africa: once the physical bruises have gone, the scars that remain as a result of torture are physically “no different from scars from other causes . . . It is the meaning of that scar, the memories attached to it that matter.” (New York Times Magazine, p. 21) Physicians at this centre described specific case experiences in the following manner : . . . a child from Uganda screams when she is taken to church because the hymns and flowers evoke the funeral of her murdered father. An Afghan women weeps hysterically at the memories of repeated rape by her jailers. For some, the scars never heal. There have even been suicides, like Raul Rivadeneira, a Chilean who hung [sic] himself on the eve of his deportation hearing in 1984, evidently because he could not bear to recount his torture yet again. (p. 35)
Greater systematic and conclusive evidence of the more frequent and profound impact of state terrorism is found in documentation and case studies of concentration camp victims. For concentration camp victims the first phase of the experience is crucial for survival (DesPres, 1976). Survivors report that unless adjustment is made
290
RAYMOND
R. CORRADO
and ERIC TOMPKINS
quickly to the oppressive brutality of camp life, the result was usually immediate death (Smith, 1980; Timmerman, 1981; Utting, 1977). According to Bettelheim (1979), victims who were unable to cope during the initial three-week adjustment period often became severely depressed, withdrawn and apathetic. This condition is often referred to as the “musulman” stage and invariably precedes death. Bettelheim (1979) identifies three broad categories of reactions during the post-concentration camp period. The first category is comprised of individuals with persistent mental disorders which precluded effective functioning, both socially and at work. The second category consists of persons who experienced no lasting psychological effects; while the third involves individuals who engaged in a lifelong struggle to deal with the emotional effects. Research on the third category was undertaken in a clinical study by Ostwald and Bittner (1968). They reviewed records of 60 former Nazi concentration camp victims in attempts to assess their life adjustment and psychological adjustment. They mentioned that although socio-economic life adjustment of the victims appeared to be good, posttraumatic stress disorder symptoms, such as depression, anxiety, resentfulness, and somatic complaints, were not uncommon. Other case studies of concentration camp survivors have revealed serious ongoing psychological sequelae, even though symptoms did not always develop immediately. In Krystal and Niederland’s (1968) review of the evolution of this pattern, he discovered that upon liberation, the victim often experiences a feeling of triumph mixed with optimism for the future. The feeling that he or she will soon be reunited with family members is common, despite the fact that most or all of them may have perished in the holocaust. After a symptom-free period, ranging from a few months to a few years, a “post-concentration camp syndrome” develops. Symptoms include a pervasive depressive mood, morose behavior, tendency to withdraw, and apathy. These symptoms were described as severe and persistent. Krystal and Niederland (1968) concluded that 97% were suffering from chronic anxiety. This state was precipitated by situations that recalled the traumatic experience and renewed the fear of persecution. All of these victims experienced sleep disturbances, while one-third had developed disturbances of cognition and memory. The majority of survivors as well experienced chronic depression of one form or another. Two of the most persistent disorders involved a masochistic character trait (79%) and survivor guilt (92%). Niederland (1968) maintained that survivor guilt was critical to understanding depression: The guilt is felt as a constant depressive which follows them; it is sometimes a personalized, active force, expressing itself clinically in terms of a constant fear and vigilance, with paranoic reactions. As a persecutory component, for instance, the patients have to go to the other side of the street when they see a policeman. They cannot walk by a policeman, perceiving him as an enemy who might capture them. . . . The depressive component makes itself visible in the complete withdrawal, apathy, brooding seclusion, state of depres-
VICTIMS OF TERRORISM
sion, and especially the permanent these people. (p. 68)
291
feeling of loss and sadness in
In contrast to the above evidence, chronic depression and its various manifestations does not appear to be a common outcome of anti-state terror. Although victims of an anti-state terrorist hostage-taking do experience depressive moods, there is little clinical evidence similar to the frequency of chronic depression found in survivors of concentration camps. Another study of the outcome pattern of state terrorism was undertaken by the Amnesty International Danish Medical Group (1979). In a clinical study of Greek and Chilean victims of torture, the group found that 78% of the combined group displayed serious mental disturbances. The most common methods of torture that the victims reported were: the “falange” (beatings on the soles of the feet); electrical torture to the genitals; beatings to the genitals; severe beatings to the head; being burnt with cigarettes; being deprived of sleep; kept standing for long periods of time; having nails torn out. The researchers found that the method of torture that was inflicted was often related to the type of sequelae that later developed. For example, they observed that direct cranial trauma was related to chronic headaches, loss of memory, and an inability to concentrate. As well, victims that experienced beatings to the genitals invariably suffered from sexual disturbances. The most common symptoms were anxiety, irritability, and depression. It was hypothesized that direct cranial trauma combined with basic psycho-physical stress could result in organic lesions. More recently, Sack, Angell, Kinzie, & Rath, (1986) conducted a study of 40 Cambodian refugees (students and their families) who had survived two to four years of either concentration camp or forced labor under the Pol Pot regime. They all met the DSM-III5 criteria for posttraumatic stress disorder. Their symptoms included sleeplessness, difficulty concentrating, nightmares and recurrent intrusive thoughts, recurrent recollections of their traumatic experiences, guilt, avoidance, hyperactive startle reactions, and emotional numbness. They routinely watched the execution of family and friends. As well, in the process of being placed in either concentration or labor camps, families were separated. The camps in which they were forced to stay were overcrowded and unsanitary. Each day they would suffer more brutalities, humiliation, malnutrition, and sleep deprivation. Another dimension of state terrorism involves victims who “disappear.” These victim are often abducted without warning and taken into detention where they are tortured and executed. Rarely are the “disappeared” ever found alive (Amnesty International, 1983). This practice of enforced disappearances is a sinister form of terrorism. The experience of being arbitrarily isolated from the rest of society is particularly traumatizing: Their only mental bearings are within their own minds or within the walls of their place of detention. If death is not the final outcome and they are released, from the nightmare, the victims may suffer from sNote that this has now been revised and is referred to as DSM-III-R.
292
RAYMOND
R. CORRADO
and ERIC TOMPKINS
the consequences of this form of dehumanization for a long time. (Independent Commission on International and Humanitarian Issues, 1986, p. 20) Disappearances also subject the friends and family of the victim to slow mental torture. Efforts to determine the victim’s whereabouts and state of health invariably end in frustration and failure. Their anguish is further compounded by not knowing whether they too are threatened and can expect the same fate. In a Chilean study of 203 children of parents that had disapbeared, physical and psychological testing revealed that 78% exhibited symptoms of withdrawal and 70% showed signs of depression (Allodi, 1980). Other symptoms were intense and generalized fear, sleep disturbances, and increased dependence on adults. This section has focused on the stress and trauma associated with state-terror during the incident, as well as the psychological after effects. Based on the various case studies and documented reports, it would be reasonable to assume that the sequelae resulting from state-terror far exceeds that of anti-state terror. Summary and Conclusions This paper has examined and compared the psychological impact of both state and anti-state terrorism on the victim. In this regard, three dimensions to this issue were discussed: (a) the effects that are common to anti-state terror and state-terror; (b) the effects that are unique to anti-state terror; and (c) the psychological effects and sequelae specifically associated with state-terror. Given the paucity of empirical research together with the complexity of the subject matter, definitive statements are difficult to advance. Despite this, however, a number of tentative conclusions can be made. With respect to psychological reactions during the incident, many similarities seem to hold for victims of a hostage-taking, concentration camps, and torture. That is, the incident begins with a period of initial shock accompanied by extreme fear and anxiety. This is followed by a phase characterized by outward acceptance of the perpetrator’s control while inside the victim is experiencing extreme fright. Gradually, a period of adaptation sets in, whereby the victim may resort to a number of coping strategies. Although similarities continue after the incident-the posttraumatic stress syndrome, for example - the intensity and duration of psychological sequelae appear to be much greater in victims of state-terror. Given the extreme brutality that invariably accompanies state-terror, this is not surprising. While the methods of anti-state terrorists may take a number of different forms, usually their resources and techniques are limited in comparison to stateterror. It is only more recently in the Middle East that anti-state terrorists more routinely are engaging in long-term detention and torture of victims. On the other hand, regimes that employ state-terror have a wide range of violent techniques at their disposal, most importantly concentration camps. It appears that prolonged physical and emotional violence combined with little hope of relief or escape is critical to understanding why victims of state terrorism are more likely to suffer more serious mental disorders than victims of anti-state terrorism.
VICTIMS OF TERRORISM
293
References Allodi, F. (1980). The psychiatric effects in children and families of victims of political persecution and torture. Danish Medical Bulletin, 27, 229-231. Amnesty International. (1983). Political killings by governments. London: Amnesty lnternational Publications. Amnesty International Danish Medical Group. (1979). Evidence of torture. London: Amnesty lnternational Publications. Andreason, N. C. (1980). Posttraumatic stress disorder. In H. I. Kaplan, A. M. Freedman, & B.J. Sadock (Eds.), Comprehensive textbook ofpsychiatry (3rd ed.). Baltimore, MD: Williams and Wilkins Co. Ayalon, 0. (1983). Coping with terrorism: The Israeli case, In D. Meichenbaum & M. E. Jarenko (Eds.), Stress reduction andprevention (pp. 293-339). New York: Plenum Press. Bard, M. & Sangrey, D. (1979). The crime victims book. New York: Basic Books. Bettelheim, B. (1979). Surviving and other essays. New York: Alfred A. Knopf. Burgess, A., & Holmstrom, L. (1976). Coping behavior of the rape victim. American Journal of Psychiatry, I3(4), 413-417. Corrado, R. (1988). Victims of extreme state terrorism. In E. Fattah (Ed.), Theplight ofthe victim in modern society. London: MacMillan Press Ltd. DesPres, T. (1976). The survivor. New York: Oxford University Press. Fields, R. (1977). Society under siege. Philadelphia: Temple University Press. Flynn, E. (1987). Victims of terrorism: Dimensions of the victim experience. In P. Wilkinson & A. M. Stewart (Eds.), Contemporary research on terrorism (pp. 337-357). Aberdeen: The University Press. Frederick, C. J. (1980). Effects of natural vs. human induced violence upon victims. Evaluation and Change, 71-75. Harbison, J., & Harbison, J. (1980). A society under stress. Somerset, England: Open Books. Hatcher, C. (1987). A conceptual framework in victimology: The adult and child hostage experience. In P. Wilkinson & A. M. Stewart (Eds.), Contemporary research on terrorism (pp. 357-376). Aberdeen: University Press. Hearst, P. (1982). Every secret thing. Garden City, NY: Doubleday. Independent Commission on International Humanitarian Issues. (1986). Disappeared: Technique of terror. New Jersey: Zed Books Ltd. Kinzie, J. D., Fredrickson, R. H., Fleck, R. B. J., Karls, W. (1984). Posttraumatic stress disorder among survivors of Cambodian concentration camps. American Journal of Psychiatry, 141(S), 645-650. Krystal, H., & Niederland, W. G. (1968). Clinical observations on the survivor syndrome. In H. Krystal (Ed.), Massivepsychic trauma (pp. 327-348). New York: International University Press. Lernoux, P. (1982). Cry of thepeople. New York: Penguin Books. Niederland, W. G. (1968). An interpretation of the psychological stresses and defences in concentration camp life and the late aftereffects. In Henry Krystal (Ed.), Massive psychic trauma (pp. 60-70). New York: International University Press. Ochberg, F. (1978). The victim of terrorism: Psychiatric considerations. Terrorism, l(2), 147-168. Ostwald, P. 8c Bittner, E. (1968). Life adjustment after severe persecution. American Journal of Psychiatry, 124(10), 87-94. Padilla, A. & Comas-Dias, L. (1986). State of fear. Psychology Today, 60-65. Sack, W. H., Angell, R., Kinzie, J. D., & Rath, B., (1986). The psychiatric effects of massive trauma on Cambodian children: 11. The family the home and the school. Journal of the American Academy ofChi/d Psychiatry, 25(3), 377-383. Simon, R. I., & Blum, R. A. (1987). After the terrorist incident: Psychotherapeutic treatment of former hostages. American Journal of Psychotherapy, 2, 194-200. Smith, G. I. (1980) Ghosts of Kampala. London: Weidenfeld and Nicolson. Spitzer, R. L., Sheehy, M., & Endicott, J. (1977). DSM-III: Guiding principles. In V. M. Rakoff, H. C. Stance& & H. B. Kedward (Eds.), Psychiatric diagnosis. New York: Brunner/Mazel. Stohl, M. (1988). Introduction: Myths and realities of political terrorism. In M. Stohl (Ed.), The politics of terrorism. (3rd ed., pp. l-23). New York: Marcel Dekker Inc. Symonds, M. (1980). The second injury to victims and acute responses of victims to terror. Evaluation and Change, 36-38. Timmerman, J. (1981). Prisoner without a name, cell without a number. New York: Alfred A. Knopf. Utting, G. (1977, July 15). Uganda prison from the inside. Vancouver Sun. Wren, C. S. (1986, August 17). Salvaging lives after torture. The New York Times Magazine.