Coping with Tangible and Intangible Traumatic Losses in Prisoners of War
Neria, Yuval, The Israel Journal of Psychiatry and Related Sciences
Abstract: The study of trauma and loss has been biased towards a pathogenic perspective with relatively few investigations assessing resilience. The present paper demonstrates the role of coping, pre-captivity traumatic loss and social support at homecoming in the short and the long-term impact of tangible and intangible traumatic losses of war captivity. Two case descriptions of former prisoners of war suggest that the utilization of active coping enabled good adjustment. On the other hand, emotion-focused, passive coping strategies, pre-captivity unresolved loss, and perceived negative social support at homecoming lead to an enduring and painful psychological toll. The theoretical and clinical implications of coping with traumatic loss are discussed.
Loss is a salient feature of the war experience. Bodily losses of limb, sense and function stemming from physical injury, disappearance, death or severe injury of friends and commanders are well known tangible losses. However, intangible losses are no less real (1). Persons who are exposed to the imminent threat of their own mortality and that of others, to the uncertainties and confusions of the battlefield, and to the testing of their own character may come away feeling less safe and secure and with less faith in themselves and others than they previously possessed.
However, soldiers who become captives are subjected to even greater losses. While some of these are amplifications of the battlefield losses, others derive from the nature and meaning of being taken and held as a prisoner of war. For example, while the soldier's combat wounds are often treated carefully by army physicians, the POW's war wounds may go untreated, thereby exacerbating losses in health or in function. Indeed, the POW may suffer additional physical impairment, through systematic torture, causal brutality and by the unhealthy and unhygienic conditions of his internment.
But more notably, as suggested by Herman (2) and Neria and colleagues (1), what distinguishes captivity from combat are a series of pervasive intangible losses stemming from elements inherent in the experience. These losses include (1) Loss of autonomy: Due to isolation from their entire social network and to the ongoing control of their jailers, the POWs may lose their inner autonomy and ability to take initiative and gradually become dependent on them. (2) Loss of former ideals and values: The POWs are on their own in the face of intentionally-- inflicted suffering which brings home the darker brutalities of human nature. It is difficult for POWs who live with those brutalities to retain much optimism or faith in human nature or to emerge from their captivity with their former ideals and innocence intact. (3) Loss of former social roles: In captivity the POWs are stripped of their military identity, rendered unable to defend their unit and country, and subjected to their captors' persistent efforts to isolate them from one another. They become anonymous figures, cut off from the roles and commitments by which they defined themselves and which gave them strength and sustenance. (4) Loss of dignity and self-esteem: These losses begin immediately upon capture, which the victims may interpret as a personal failure and are amplified with the POWs' forced dependency, systematic humiliation (whether through verbal insults or physical indignities, such as being stripped naked, raped, compelled to perform bodily functions in public) and enforced helplessness at the hands of their jailers. These experiences may lead to a deep and searing sense of shame, augmented by the inclination of their own society to suspect POWs of somehow having fallen short in their duty to home and country. (5) Loss of essential aspects of prior identity: Captivity is "designed to destroy the victim's sense of the self in relation to others" (2, p. 92), and prolonged and repeated traumatic exposure damages crucial elements of the individual's self structure. …