Captivity and Posttraumatic Stress Disorder

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In reaction to the mistreatment of prisoners of war during the nineteenth century, beginning in 1864 a series of international meetings known as the Geneva Convention was held. The result was a set of rules regarding the humane treatment of prisoners of war, as well as the sick, the wounded, and those who died in battle. Despite some improvements as a result of the Geneva Convention and the rules for the treatment of prisoners of war that were defined at the Second Hague Conference of 1907, the conditions under which prisoners existed continued to be atrocious in many instances. During World War II for example, American soldiers captured by the Japanese were subjected to inhuman treatment and forced to survive on a near-starvation diet. In many ways, however, American soldiers who were taken prisoner by the Viet Cong or North Vietnamese during the Vietnam War suffered an even worse fate. Reminiscent of the treatment of inmates in concentration camps during World War 11, prisoners in Vietnam were malnourished, treated like animals, and made to perform unpatriotic or immoral acts. They suffered not only from physical disorders such as diarrhea, serious infections, and malnutrition but also from anxiety, depression, headaches, insomnia, irritability, nightmares, and other psychological disturbances.

The camp's conditions beggar description. At any time there were about 11 men who lived in a bamboo hut, sleeping on one crowded bamboo bed about 16 feet across. The basic diet was three small cups of red, rotten, vermin-infested rice a day. Within the first year the average prisoner lost 40 to 50 percent of his body weight, and acquired running sores and atrophied muscles. There were two prominent killers: malnutrition and helplessness. (Seligman, 1992, p. 166)

The physical and psychological changes in one prisoner caused by the loss of any hope of release from captivity and his resulting feelings of helplessness were described by a survivor of a Viet Cong prison camp:

Finally it dawned on him that he had been deceived—that he had already served his captors' purpose, and he wasn't going to be released. He stopped working and showed signs of severe depression: he refused food and lay on his bed in a fetal position, sucking his thumb. His fellow prisoners tried to bring him around. They hugged him, babied him, and when this didn't work, tried to bring him out of his stupor with their fists. He defecated and urinated in the bed. After a few weeks, it was apparent that [he] was moribund: although otherwise his gross physical shape was still better than most of the others, he was dusky and cyanotic. In the early hours of a November morning he lay dying ... (Seligman, 1992, p. 168)

Depending on the length of imprisonment and the harshness of the treatment, prisoners of war who survive the experience of captivity generally manifest a variety of debilitating conditions: lowered resistance to disease and frustration, greater dependence on alcohol and drugs, and general emotional instability (Hunter, 1978; O'Connell, 1976; Wilbur, 1973). Even among Vietnam veterans who had not been imprisoned, the frequency of depression, marital problems, and divorce was more common than among individuals of the same age who did not go to war (Hunter, 1981). For months and even years after their return, many of these veterans continued to have anxiety attacks, nightmares, insomnia, relationship problems, substance-abuse problems, and "flashbacks" (reexperiencing a stressful event) related to their stressful experiences of combat and captivity. These symptoms, referred to collectively as posttraumatic stress disorder (PTSD) have also been observed in civilians who have suffered through earthquakes, airplane clashes, shipwrecks, and other highly stressful events.

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