Saturday, May 11, 2013

Emotional Recovery Seen Possible for Victims of Prolonged Abuse

From The New York Times, an article on how the young women rescued from the house in Ohio can possibly heal from their trauma. One thing they fail to mention in this article is that the single greatest predictor of how someone recovers from this kind of traumatic experience is determined by the quality of their attachment relationship with their primary caregiver as infants and toddlers. Secure attachment allows much quicker and complete healing, insecure attachment generates more intense PTSD and prolongs the healing process.

Elizabeth Smart, who was abducted at age 14.

Emotional Recovery Seen Possible for Victims of Prolonged Abuse

Published: May 9, 2013

Day after day, it was his voice they heard, his face they saw.

He was their tormentor and their deliverer, the one who — at his whim — could violate their minds and bodies, the keeper of the keys and the source of food and water. His dominion was a ramshackle house with boarded up windows. His control was absolute.

For the women he is accused of kidnapping and holding prisoner for a decade in a home on Seymour Avenue in Cleveland, their captor was for all intents and purposes their world.

Therapists experienced in the treatment of trauma survivors said on Thursday that how the three women — Amanda Berry, now 27, Gina DeJesus, 23, and Michelle Knight, 32 — interpreted that relationship and the small ways that they struggled to preserve their selfhood in the face of physical and psychological intimidation will be critical to their recovery.

The women were finally freed on Monday after two neighbors responded to Ms. Berry’s call for help by kicking in the front door. Ms. Berry’s 6-year-old daughter, who was born during the ordeal, also came out of the house. Ariel Castro, who the police say imprisoned the women and initially kept them tied with chains and rope in the basement and sexually assaulted them repeatedly, has been charged with four counts of kidnapping and three counts of rape.

David A. Wolfe, a senior scientist and psychologist at the Center for Addiction and Mental Health at the University of Toronto, said that in situations of long-term sexual abuse and threat to life, victims inevitably develop complicated and ambivalent emotions toward their abuser in order to survive.

“You turn the devil into something you can handle,” he said, adding that the first thing he would want to know from someone who survived such an ordeal would be “What was your feeling about this person during the captivity?”

Dr. Wolfe and other therapists noted that all traumatic experiences are different and that many details of the women’s ordeal have not been made public; some experts argued that for the women’s sake, they should not be.

But they said many people can and do rebound from even the most extreme abuse, aided by the support of family and friends, the use of specifically tailored therapies and the privacy, safety and time to digest and come to terms with their experience. It is important, some therapists said, that the women not be turned into a spectacle, their identities as individuals diminished to “kidnap victims.”

“We know that resilience exists and that recovery is possible,” said Dr. Judith A. Cohen, medical director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “For people who believe that it’s inevitable that a horrific experience like this would leave lasting scars, the evidence does not necessarily support that.”

That does not mean that the women, who with the exception of Ms. Knight have been reunited with their families, have an easy road ahead. Studies have found that about two-thirds of children who are kidnapped or abused have lingering psychological disturbances, including depression and the symptoms of post-traumatic stress disorder. The toll of prolonged abuse is physical as well as psychological, as the body tries to cope with constant fear.

“Your brain is being flooded with stress hormones,” Dr. Wolfe said, “just like you’ve been sitting in a cage with an animal for a long time.”

Yet about 80 percent of abuse victims who receive trauma-focused weekly therapy show significant improvement after three to four months, studies find — the authorities in Cleveland are arranging for the women to receive trauma therapy, according to a person with knowledge of the situation. Some survivors of lengthy captivities can have continuing problems, especially if they were already experiencing emotional difficulties before their abduction, and so, are more vulnerable. Others — like Elizabeth Smart, who was abducted from her bedroom in 2002 at the age of 14, and Jaycee Lee Dugard, who spent 18 years as a prisoner after being kidnapped in 1991 and had two children by her abductor — have apparently done well, going on to write books about their experiences and work on behalf of other abuse victims.

Terri L. Weaver, a professor of psychology at St. Louis University who has been a consultant in long-term kidnapping cases, said that the presence of the other captives in the Seymour Avenue house may possibly have helped each woman cope.

“My hope would be that they could have provided some degree of support with one another,” Dr. Weaver said, “and that may have aided in their ability to emotionally, and perhaps even physically, cope with the situation.” In fact, the person familiar with the investigation said the victims felt they were like sisters now because of what they went through.

Ms. Berry’s young daughter, Dr. Weaver said, who, like the child in Emma Donoghue’s 2010 novel “Room,” was born into captivity, has an equally good chance of surmounting the adversity of her early life.

“There are all types of children in this world that were conceived in violent and traumatic circumstances who come to an understanding of those circumstances and go on to have very happy lives,” Dr. Weaver said.

Like cases of domestic violence, Dr. Weaver and other therapists said, the stories of women who remain with their captors for years sometimes give rise to misconceptions — like the idea that the women could have escaped. But such notions vastly underestimate the psychological and physical control exerted by perpetrators, and often arise from people’s desire to believe that they themselves would not fall victim to a similar fate.

“Rape in conjunction with life-threatening force is very powerful,” Dr. Weaver said, “and it’s repeatedly used by men against women.”

Dr. Cohen put it more sharply: “It’s very easy to sit in your living room and second-guess from the safety of your couch why somebody didn’t act a certain way. But when your life is under constant threat, you think and act and feel quite differently.”

Steven Yaccino contributed reporting from Cleveland.

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