Stockholm Syndrome
Photo courtesy sxc.hu
By Chris Farnady
There are many facets within mental health. Paramedics, while well versed in the diversity of these sub-categories, may not always have a well-defined understanding or appreciation for the complexity behind them. Stockholm Syndrome presents practitioners with this challenge. While many may have heard mention of this syndrome, its complexity and relationship with Post Traumatic Stress Disorder (PTSD) continues to be researched for better understanding.
Stockholm Syndrome has been described as one of the two great paradoxes in mental health (the second one being cooperative behaviour often displayed by abused children and adults to their domestic abusers) (Cantor & Price, 2007). Research has noted that both Stockholm Syndrome and PTSD characteristics have been displayed in victims of domestic abuse (Cantor & Price, 2007). A landmark paper authored by Judith Herman quoted that ‘… prolonged, repeated trauma can occur only where the victim is in a state of captivity, unable to flee and under the control of the perpetrator’ (Cantor & Price, 2007, p. 377). The results have been described as “complex PTSD”.
But what exactly is Stockholm Syndrome? Stockholm Syndrome is aptly named following a hostage-taking incident in Stockholm Sweden that began on August 23, 1973 and ended six days later on August 28. The syndrome is used to describe the paradoxical development of reciprocal positive feelings between hostages and their captors which enables the captives ability to cope with the traumatic experiences (Cantor & Price, 2007) as was the case in the Stockholm hostage-taking. Interesting facts about the incident include:
- For several months following the release, the hostages continued to see the police as the “enemy” and their captors as protectors who gave them life.
- One hostage later accused psychiatrists of trying to “brainwash” her so as to turn her against her captors
- Six months later, all four former hostages testified against their captors, which resulted in a ten year prison sentence for Jan-Erik Olsson; the orchestrator of the Stockholm incident. However, approximately a year following the incident; one of the former hostages visited Olsson after having experienced a “powerful impulse” to do so. She refused to disclose to anyone what they had discussed
- Two of the female hostages became engaged to the two captors
(Cantor & Price, 2007)
- There must be a perceived threat to one’s physical or physiological survival at the hands of an abuser(s)
- There must be perceived small kindnesses from the abuser to the victim
- There must be isolation from perspectives other than the abuser
- There must be the inescapability of the situation
(Cantor & Price, 2007)
The suggested and accepted explanations for the syndrome have included identification with the aggressor as well as introjection of the valued attributes of the captor. Victims tend to regress, identifying with their captors, as would an abused child with an abusive parent. As well, cognitive dissonance has been found to play a role; the victim reduces emotional discomfort that arises from the contradictory cognitions by way of bending the cognitions in order to accommodate the situation. This in essence, would equate to the “all husbands beat their wives” perspective (Cantor & Price, 2007).
Experimentally, Stockholm Syndrome has been tested from the perspective of interpersonal theory by using simulated captivity. The two interpersonal dimensions examined where: control (dominance-submission) and affiliation (friendliness-hostility). The outcome revealed that the less the so-called hostages perceived the so-called terrorists as dominant and the more they perceived them as friendly gave way to a better adjustment on the part of the ‘hostages’ (Cantor & Price, 2007). To add to this, there are also certain variables that may add to the propensity in the development of the Stockholm Syndrome. These may include age, sex, the relationship of the hostage(s) to the aggressors’ cause (this means that the less a “we-they” stance exists, the more the syndrome will appear) (Vecchi, 2009).
The likelihood of the syndrome taking effect is largely dependent on variables also. They have been noted to include:
- The absence of the gagging and/or hooding of the captive(s)
- Captives being permitted to make eye contact with their aggressors
- Infrequent rotation of “guards”
- Guards being permitted to converse with those being held captive
- Reduction in captive-aggressor language differences
- Reduction in prejudice or pre-existing stereotypes that may put psychological distance between the captive(s) and the aggressors
(Vecchi, 2009)
Paramedic practitioners should take note of the characteristics of Stockholm Syndrome and its parallels with complex PTSB, cases of domestic violence and/or cases of child abuse. These present a potentially immense hurdle in the effective management and treatment of individuals experiencing one of these circumstances, whether they have suffered physical wounds or the much deeper and troubling psychological wounds. In today’s society paramedics play a much larger role than simply one of conveyance to the emergency department. We are mobile medical and trauma specialists, obstetricians and pediatricians, as well as mental health professionals, whether we choose to recognize it or not. It is only through professional growth and development that we may positively benefit those we seek to treat by first understanding them and the circumstances they have experienced.
References
Cantor, C., & Price, J. (2007). Traumatic entrapment, appeasement and complex post-traumatic stress disorder: evolutionary perspectives of hostage reactions, domestic abuse and the Stockholm syndrome. Australian and New Zealand Journal of Psychiatry, 41, 377-384.
Vecchi, G. M. (2009). Conflict & Crisis Communication: Workplace and school violence, stockholm Syndrome and Abnormal Psychology. Annals of Behavioral Sciences, 30-39.
