Psychiatric Annals

Power in Psychiatry 

The Power Relationship Between Captor and Captive

Ellen Sherwood, PhD

Abstract

Power dynamics in psychotherapeutic relationships are largely implicit or unconscious. Therapist influence is subordinated as far as possible to the humane goals of helping the patient. Isolation of a patient from human contact or, when hospitalized, from the ward society, is prescribed rarely nowadays and only when the patient has been belligerent or destructive or when his or her own controls have failed. In the last few decades, seclusion as a means of restraint has been greatly diminished.

Likewise, deprivation and punishments of any type are categorically forbidden. The therapist can "set limits" and carry out necessary restraints to protect life and property, but he or she cannot do so with the goal to punish. Thus, any such form of restraint, if necessary, must be explained to the patient and thoroughly rationalized. Ward personnel are taught that the patient may have difficulty differentiating restraint from punishment, but persistent explanations plus obvious lack of anger or negative temper on the therapist's part may convince a patient eventually.

Interrogation is never in the service of obtaining information for the purpose of harming the patient. Indeed, the art of obtaining a history or of conducting a therapeutic interview involves interactions of great subtlety and sensitivity, which the mental health trainee takes considerable pains to master.

In contrast, captor-captive relationships are consciously and explicitly for the purpose of harming or hurting subjects. Power is used ruthlessly and inhumanely. Instead of raising the person's self-esteem and strengthening healthy defenses, the aim is to break down, to weaken the will, and to make the captive totally subordinate to the mastercaptor. In this sense, the therapistpatient and the captor-captive relationship are at extreme ends of the power use spectrum. As such, it is of interest to consider the latter phenomenon.

Through history, captors have taken captives for a variety of reasons in both war and peacetime. For those held captive, survival demands adapting to circumstances where environments and consequences of behavior are strictly and sometimes brutally controlled. The present consideration of the captor-captive power relationship summarizes captor tactics as well as captive coping strategies. Several captivity episodes exist that are comparable, thus providing an adequate data base, because captor and captive characteristics were similar across situations. In these situations, American military personnel were captured and imprisoned for varying but usually considerable lengths of time by Asian military captors over the course of three wars, World War II,1-3 the Korean War,46 and the Vietnam War,7'11 and one act of terrorism, the pirating by North Korea of the USS Pueblo. 12-'5 For a more detailed review of captivity stress, the reader may wish to consult an earlier paper.16

Hinkle and Wolff present a classic discussion of detention and interrogation tactics developed by Russian and Chinese Communist state police and used to varying extents by most captors.17 Of interest here are: 1) isolation and denial of access to avenues of communication, companionship, and uncertainty reducing information; 2) deprivation of food, sleep, and all aspects of an adequate, life-sustaining environment; 3) punishment in the form of indirect and direct physical/psychological abuse strategies; and 4) interrogation structured to evoke information and confessions.

ISOLATION

Two general types of isolating tactics are reported. First is physical separation from fellow prisoners via solitary confinement. Captives in solitary keep physically active by exercising and mentally active by reading, writing, and building things (when materials are available), fantasizing, developing elaborate plots and plans for future activities, counting and memorizing things, and setting target dates for release.

The second isolating tactic can be broadly categorized as psychological removal from previous sources of identification, support, and direction. This includes…

Power dynamics in psychotherapeutic relationships are largely implicit or unconscious. Therapist influence is subordinated as far as possible to the humane goals of helping the patient. Isolation of a patient from human contact or, when hospitalized, from the ward society, is prescribed rarely nowadays and only when the patient has been belligerent or destructive or when his or her own controls have failed. In the last few decades, seclusion as a means of restraint has been greatly diminished.

Likewise, deprivation and punishments of any type are categorically forbidden. The therapist can "set limits" and carry out necessary restraints to protect life and property, but he or she cannot do so with the goal to punish. Thus, any such form of restraint, if necessary, must be explained to the patient and thoroughly rationalized. Ward personnel are taught that the patient may have difficulty differentiating restraint from punishment, but persistent explanations plus obvious lack of anger or negative temper on the therapist's part may convince a patient eventually.

Interrogation is never in the service of obtaining information for the purpose of harming the patient. Indeed, the art of obtaining a history or of conducting a therapeutic interview involves interactions of great subtlety and sensitivity, which the mental health trainee takes considerable pains to master.

In contrast, captor-captive relationships are consciously and explicitly for the purpose of harming or hurting subjects. Power is used ruthlessly and inhumanely. Instead of raising the person's self-esteem and strengthening healthy defenses, the aim is to break down, to weaken the will, and to make the captive totally subordinate to the mastercaptor. In this sense, the therapistpatient and the captor-captive relationship are at extreme ends of the power use spectrum. As such, it is of interest to consider the latter phenomenon.

Through history, captors have taken captives for a variety of reasons in both war and peacetime. For those held captive, survival demands adapting to circumstances where environments and consequences of behavior are strictly and sometimes brutally controlled. The present consideration of the captor-captive power relationship summarizes captor tactics as well as captive coping strategies. Several captivity episodes exist that are comparable, thus providing an adequate data base, because captor and captive characteristics were similar across situations. In these situations, American military personnel were captured and imprisoned for varying but usually considerable lengths of time by Asian military captors over the course of three wars, World War II,1-3 the Korean War,46 and the Vietnam War,7'11 and one act of terrorism, the pirating by North Korea of the USS Pueblo. 12-'5 For a more detailed review of captivity stress, the reader may wish to consult an earlier paper.16

Hinkle and Wolff present a classic discussion of detention and interrogation tactics developed by Russian and Chinese Communist state police and used to varying extents by most captors.17 Of interest here are: 1) isolation and denial of access to avenues of communication, companionship, and uncertainty reducing information; 2) deprivation of food, sleep, and all aspects of an adequate, life-sustaining environment; 3) punishment in the form of indirect and direct physical/psychological abuse strategies; and 4) interrogation structured to evoke information and confessions.

ISOLATION

Two general types of isolating tactics are reported. First is physical separation from fellow prisoners via solitary confinement. Captives in solitary keep physically active by exercising and mentally active by reading, writing, and building things (when materials are available), fantasizing, developing elaborate plots and plans for future activities, counting and memorizing things, and setting target dates for release.

The second isolating tactic can be broadly categorized as psychological removal from previous sources of identification, support, and direction. This includes segregating officers and emerging, natural leaders. Ties with family are weakened by withholding or censoring mail. Ties with country are weakened by reporting false captor military victories, American defeats and atrocities, and authorities' lack of concern for captives or intent to punish them after release for cooperating with the enemy.

Isolated captives consciously strive to retain their precaptivity identities as Americans, soldiers, husbands, and fathers. Officers seize opportunities to smuggle out messages reestablishing command, lines of authority, and routine. Captives, deprived of leadership, set up both task-oriented groups developed to insure compliance with acceptable forms of behavior, and social groups, designed to provide company and mutual support. Some groups undertake missions, Such as recording data about captors, thus introducing an element of mastery into the situation and reducing feelings of helplessness. Captives cope with prohibitions and restrictions on exchange of information by smuggling news, developing secret codes and elaborate, idiomatic language systems, often incorporating humor to keep up spirits.

DEPRIVATION

All captor groups considered here deprived captives, at one time or another and with varying degrees of severity, of most aspects of a lifesustaining environment including food, water, adequate clothing, shelter and hygiene facilities, sleep, medical care, and access to avenues of constructive physical and mental activity. Sometimes resources were available but withheld by captors and other times resources were unavailable, even to captors.

Some captives cope with severe deprivation by complying with captors' demands in exchange for needed resources. Although understandable, this strategy is problematic because it leads to loss of self respect. Many cope by forcing themselves to rise above the situation, sharing food and other meager resources with others. Food is a favorite topic of discussion and fantasy. Most captives find the typically over-crowded living environments stressful and cope by learning to work out interpersonal problems and conflicts. Close and gratifying relationships sometimes develop. Captives cope with lack of doctors and medicine by treating each other with whatever resources are available.

ABUSE

Two general categories of captor abuse can be developed for the sake of convenience: psychological abuse, usually in the form of threats of torture and death, and physical abuse involving actual beatings and other types of punishment and torture. Captors may use abuse contingent either on captives producing undesired behavior or refusing to engage in desired behavior, or they may use abuse noncontingently. Severe degrees of deprivation are abusive and already weakened captives, when physically abused, are more vulnerable to serious injury and death.

Little beyond physical and emotional insensitivity protects captives from the pain of abuse. Conscious or unconscious supressions of thoughts and all feelings can become so extreme that captivés sometimes experience hysterical blindness, deafness, and generally reduced capacities to feel anything. Sometimes these types of defensive reactions spread throughout the captive group. Other coping strategies include protesting to captors, engaging in fantasies of exaggerated retaliation, and striking back at captors ina disguised way. Captives who suffer extreme abuse cope by developing suicide plans.

INTERROGATION

Interrogation usually occurs within a short time after capture, but might recur at any time in captivity or go on continuously. Captors interrogate for the purpose of obtaining tactical or military information, confessions of criminal guilt, and autobiographies. Immediate post-capture interrogations can be brutal. Continued interrogations are associated with indoctrination programs or renewed campaigns by captors to extract desired information.

Most captives cooperate during interrogations when sufficiently abused or when forced to tell the truth by relentless demands to justify discrepant information. Moderate resistance allows captives to retain some self-esteem while preventing serious injury or death. Destructive effects on captives' self-esteem of cooperation during interrogations is mitigated when officers adopt and communicate an attitude that anyone can be broken if punished enough. Captives cope with shame and guilt about public confessions by incorporating into them expressions designed to communicate duress and lack of sincerity to American audiences but to escape detection by captors.

CONCLUSION

The captor-captive influence process can be summarized using the concepts of debility, dread, and dependency.18 Captor influence tactics induce in captives a state of debility resulting from starvation, fatigue, disease, and pain. Dread is induced by unrelenting uncertainty and threat of death, pain, and nonrelease. Captors control all resources for alleviating debility and dread, so captives develop a dependency on captors for relief. They cope by learning the set of responses required for bringing about a less punishing state of being. Damage to self-esteem is lessened through conscious efforts to retain pre-capti vity identity, group support, and covert action against captors - all of which provide captives with some sense of control in this unilateral power relationship.

REFERENCES

1. Nardini J: Psychiatric concepts of prisoner of war confinement. Milit Med 1962; 127:299-307.

2. Nardini J: Survival factors in American prisoners of war of the Japanese. Am J Psychiatry 1952; 109:241-248.

3. WoIfS, Ripley H: Reactions among allied prisoners of war subjected to three years of imprisonment and torture by the lapancse. Am J Psychiatry 1947; 104: 180-193.

4. Segal H: Initial psychiatric findings of recently repatriated POWs. AmJ Psychiatry 1954; 111:358-163.

5. Lifton R: Home by ship: Reaction patterns of American POWs repatriated from North Korea. Am J Psychiatry 1954; 110:732-738.

6. Schein E: The Chinese indoctrination program for prisoners of war. Psychiatry 1956; 19:149-172.

7. Anderson R: Operation homecoming: Psychological observations of repatriated Vietnam prisoners of war. Psychiatry 1975; 38:65-74.

8. Richlin M, Rahe R, Shale I, et al: Fiveyear medical follow-up of Vietnam POWs: Preliminary results. US Navy Medicine 1980; 71:19-26.

9. Berg W, Richlin M: Injuries and illnesses of Vietnam war POWs. IV. Comparisons of captivity effects in North and South Vietnam. Aititi Med 1977; !42:678-680.

10. Ursano R: The Vietnam Era Prisoner of War: Precaptivity Personality and the Development of Psychiatric Illness. Bethesda, Maryland, USUHS. 1977.

11. Sledge W, Boydston J, Rahe A: Self-concept changes related to war captivity. Arch Gen Psychiatry 1980; 37:430-443.

12. Bücher L : Bucher: My Story. Garden City, New Jersey, Doubleday, 1970.

13. Spaulding R, Ford C: The Pueblo incident: Psychological reactions to the stresses of imprisonment and repatriation. Am J Psychiatry 1972; 129:17-26.

14. Ford C, Spaulding R: The Pueblo incident: A comparison of factors related to coping with extreme stress. Arch Gen Psychiatry 1973; 29:340-344.

15. Spaulding R: The Pueblo incident: Medical problems reported during captivity and physical findings at the time of the crew's release. Milit Med 1977; 142:681-684.

16. Rahe R, Genender-Sherwood E: Adaptation to and recovery from captivity stress. Milit Med 1983; 148:577-585.

17. Hinkie L. Wolff H : Communist interrogation and indoctrination of "enemies of the state." Archives of Neurology and Psychiatry 1956; 76:115-174.

18. Farber I, Harlow H, West L: Brainwashing, conditioning, and DDD (debility, dependency, and dread). Sociometry 1957; 20:271-285.

10.3928/0048-5713-19861101-10

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