My experience: psychologist Dr Sarah Whittaker shares how she supports former hostages

British psychologist, Dr Sarah Whittaker, is on our network of mental health experts working with many of those we support at Hostage International. 

The article below was originally published in faz.net.

Dr. Sarah Whittaker is a clinical psychologist with internationally recognised expertise in treating people who have survived hostage-taking, torture and other extreme trauma. Based near London, she has worked with more than 30 former hostages who were held and tortured by groups and regimes such as the Taliban, Al-Qaeda, Syrian intelligence services and state actors in Iran, China, Russia and the United Arab Emirates. She has worked in Iraq, Jordan, the Democratic Republic of Congo and northern Sri Lanka, among other places. Most of her cases are referred by Hostage International. This charity provides comprehensive assistance to hostages and their families during and after a kidnapping or arbitrary detention. It provides important information, advice and expertise, including on political, legal, media and financial issues, which can become very complex during and after a hostage-taking. Whittaker has also served as an expert witness in war crimes investigations and treats victims of sexual violence, war journalists and military personnel.

You deal with survivors of torture, sexual violence, and combat. Why have you specialized on this?

I think my path into trauma psychology started in my childhood, after my brother had a serious car accident. I was about ten and he was in his early twenties. He suffered a high spinal cord injury and became tetraplegic, paralysis of the four limbs. He was in hospital for a long time and then came back to live in the family home. It was a traumatic and painful experience.

How did you cope?

I had to learn to be comfortable in the presence of this ongoing suffering, the suffering of my brother and the entire family. Which I did. At the same time, there was a part of me that felt overwhelmed with helplessness. I think a subconscious motivation began to defend against that feeling by creating a part of my identity that can respond to the suffering of others in a meaningful way. I think that’s where my journey into trauma psychology began. But I certainly never had my eyes set on hostage trauma.

How did that happen?

For my specialist twelve-month placement at the end of my training I managed to get a placement in an NHS service that worked with migrants. There were a lot of people who had experiences of torture.

You remember your first torture case?

My first torture case was kidnapped by the Taliban in Afghanistan. He was an Afghani. And he was a doctor. The Taliban forced him by ways of physical brutality to treat Taliban fighters. What I remember the most about that case was thinking: „Wow, you are an ordinary person. You’re just like me.“ That really stuck out for me because up until that point I had this perception that torture happens to people that aren’t like me.

What other „normal“ clients do you get? Soldiers or people working for NGOs or government employees?

Individuals I work with may have been taken hostage during humanitarian missions or people who are working internationally in many different and ordinary roles; or were travelling; some people are simply just citizens who have been detained by the state. I’ve also worked with military personnel who are taken as prisoners of war.

Psychologist Sarah Whittaker in her home office near LondonFoto Dan Wilton

You deal with complex trauma reactions. What is meant by that?

Many will be familiar with the classic post-traumatic stress, PTSD, symptoms, like nightmares and flashbacks. But I think some of the more complex reactions that we see in hostage-taking trauma are the psychological reactions from torture methods that have dehumanized. You could describe it as a psychological death. You no longer feel like yourself, even though the body is still surviving. These methods of torture are completely emptying you out of everything that evidences to you that you are a human being. Every human thing is taken from you. When you are denied the ability to make even the most basic choices – like when to eat, what to wear, when to use the toilet or wash, how to move your body; detained in these sensory depriving or inhumane conditions; your sense of self begins to erode, you start to feel like you no longer exist in a recognizable way. So you get this psychological reaction of dehumanization. And then with that comes detachment from reality.

What are the consequences?

We all hold this belief that the world is meant to have some logic and fairness. Hostage-taking and torture violently breaks that. The level of physical and psychological violence experienced by many hostages is such an overwhelming betrayal of humanity that can’t be processed in the moment. And there are these huge moments of shock and disbelief over how another person could willfully harm you to such an extent. You can’t integrate that into reality. The mind and body detach from reality to create distance. It’s a survival skill to get from one day to the next. This dehumanization detachment reaction causes deep psychological wounds that can linger long after captivity. Hostages can struggle to reconnect with who they were before or they feel empty or like they’re playing a role, not truly living. They can feel very detached to what happened to them. They know that they were taken hostage and tortured, but they have a sense of: „Did this really happen to me? I know it did, but I can’t feel it.“

Are there different intensities of that?

The level of severity might depend on different factors: How long you were taken hostage for? Were you kept in isolation or were you able to connect with other prisoners? What types of torture were you subjected to? Psychological, physical, a mixture of both? Who you were you before? What is available after the captivity: Are you coming back into a safe environment? One of the other things is this experience of guilt that a lot of hostages have.

What kind of guilt?

There can be guilt to who they became or choices that they had to make to survive. Part of the hostage experience can be the trauma that you are put in a situation that forces you to take on behaviors that you don’t recognize as being part of your identity or go against your belief system and values. People have to make hard choices to survive. And when they come home there can be a lot of guilt and self-hatred for that. Some people are forced to harm other hostages or prisoners. And it’s horrifying and distressing for people to have experienced that there’s a part of them that exists that is capable and willing to act in these ways for the sake of the self. Some people have guilt over false confessions and the giving up of names. Some hostages needed to use self-harm to cope or made suicide attempts. There can be a lot of guilt over this.

How often do you come across the so called “Stockholm Syndrome”. That hostages try to become friends with the hostage takers?

I don’t see it a lot in how Stockholm syndrome is presented, like in TV or in films. What I see more of is strategies to get the interrogator or the people that are holding you captive to see you as a human. Because there’s a sense that, if this person sees me as a human, they might treat me with a bit more dignity. Then there’s also a process where the desire to be interrogated can become quite strong. Because you can have weeks and weeks of being interrogated – and then it suddenly stops. That can be extremely traumatic. People often describe to me that despite the fact of how distressing interrogations were, when they stopped and they were held in total isolation for prolonged periods of time the desire to be interrogated was really strong

How do you treat a person that has experienced dehumanization?

We go back together into their darkest moments. We don’t deny the experience but at the same time we also want to look for the moments where darkness and light met, those moments when you noticed the sound of birdsong and how that filled you with a sense of life. Or the moments of resistance and how that communicated your internal sense of worth and strength.

Do they have to explain in detail what they lived through?

We try to find memories that represent the moments when you felt most dehumanized. And that could be the moment that you were denied to go to the toilet or something that happened during interrogation. And we travel back together. I’ll go with them. But not just through the mind, through the body as well, so how does your body remember it. You’re helping someone in a safe way to re-live those moments of dehumanization, to process that and stay regulated. At the same time, looking for or introducing moments in this scene that you didn’t notice at the time that evidence to you that you are a human being.

How do you deal with the feeling of guilt?

We go back into the trauma together to understand how their choices were made. We go step by step taking in all the available information that they had at the time – and what they were believing at the time and what their body was telling them. And sometimes we swap roles. So I’ll take on the role of the hostage, and I’ll have them watch me through their imagination making the same choice and ask them to make judgment on that. Often, people go into that work thinking there was a better choice to make that would have had a more positive outcome. But the reality is that there were no good choices available for them in that moment. Also, you must allow people to hold on to some of that guilt. Because this indicates to them they have a moral compass. It allows them to lament over what they were forced to do. This might be where some other therapeutic approaches can get it wrong because they aim for people to completely let go of their guilt. But, we have to learn to embrace what we would rather dismiss and deny, which is the reality that we’re all capable of doing harm when we are put in these unique positions of survival.

Do you keep diaries?

Yes, I do. I’ve moved away from traditional trauma therapies which are very protocol and clinically driven. I’ve learned that you can’t always work in that way. It requires a lot more creativity. You must try things and see what works. So I’ve started to try ways of working that seem to be successful and making note of those and themes that come out across cases.

I assume that there are many hostage-takings we never hear about in public.

It is difficult to put a figure on it. Hostage taking by terrorist groups will always get more coverage. In state-taking hostage cases it varies and is often dependent on if the family want to go public. I have worked with who people would be recognize in the media. Their stories have been high-profile hostage-taking cases. But I have an equal number of people who haven’t been in the media. One of the less recognized traumas is when a hostage has this forced exposure in the public eye. So when the hostage comes home, they have this new public identity that they’ve not consented to. In cases where detention has been high-profile and involved a prisoner swap or there’s been a ransom payment, individuals can become symbols of larger political narratives. I’ve worked with people where this has invited intense public scrutiny and, at times, misplaced blame. And it can be incredibly painful for hostages to have strangers questioning their actions, like „why were you even in that country“. And I’ve worked with people who have had death threats and rape threats, because their release was dependent on the home government paying a ransom to a terrorist organization. To go public can be a double-edged sword. It can be restorative to know people were protesting for your freedom. On the other side the media can cause harm.

One of your clients told me he felt so comfortable with you, because you knew what he was talking about. You did not treat him like a one-in-a-lifetime-case…

There are a lot of brilliant trauma psychologists out there. But traditionally, therapy often maintains a very strict boundary between psychologist and client, with the psychologist remaining largely anonymous and asking lots of questions. If this is the psychologist’s first experience of working with a hostage, the hostage can feel like a subject that is being studied. Many of the hostages that I’ve worked with that have tried therapy before described it as feeling like an interrogation even though this is completely unintentional by the psychologist. I think there is a gap in understanding the context of hostage-taking and interrogation and not knowing that those who have been interrogated and isolated are extremely sensitive to the dynamics of relationships. I really focus on building a relationship that feels equal. When I can and if it is appropriate I spend time outside the therapy to get to know them and their family and they get to know me.

You´ve come across horrible stories about torture. What have you learned about modern torture?

Physical torture is a significant part of some hostages’ experience. What is less understood is psychological torture or non-touch torture methods. These methods are designed to destroy a person’s sense of self and to distort reality. These are the methods that are particularly used in state hostage-taking contexts, where states use their judiciary to detain foreign citizens as a tool for political leverage. Psychological techniques are used when the state wants to force a confession or extract information. And it’s a way to create extreme suffering, which is the currency that states use in political leverage without needing to use physical violence that would leave visible evidence of torture. Psychological torture is used because it’s clean, silent, invisible. You might think about extreme sleep deprivation, social isolation, solitary confinement for days/weeks/months, sensory overload or deprivation, complete loss of autonomy, so not being able to use the toilet when you want to, no access to washing facilities, acts of humiliation, and then strategies used during interrogation, gaslighting, repetitions, and threats, especially against loved ones. Psychological torture is often described by hostages as more difficult to cope with, more damaging, and harder to recover from. And that’s not to underplay the impact that physical torture causes. Many hostages are tormented by the nightmares and the flashbacks to physical acts of torture. But, there is something about psychological torture, that it’s insidious and it’s utterly corrosive and so wounding. And in some ways, it’s harder to name, to understand and to process, which makes healing much more complicated.

Why?

Physical brutality is horrific, but has clear boundaries, a clear end, it stops when the pain stops. But psychological torture, in particular isolation, doesn’t have this clear boundary. The pain isn’t contained to the moment of the act. It’s like a virus that is infecting how you experience your whole sense of self, both your individual identity and what makes you human. Your existence becomes the trauma and the pain. You can’t escape from yourself. And this leads much more to an existential wound. When you’re isolated for a long period of time, it starts to attack your sense of existence, you start to feel unreal and like you are vanishing.

Is that kind of torture only conducted by governments, state-run agencies? Or do you also find that with Hamas or other terrorist groups?

It’s one of the most common methods that people report who have been held by state hostage-taking contexts. But is also experienced by people that have been held by terrorist organizations.

In Syria they used torture methods that sounded medieval. Like the „German chair“, where they overstretch the spine of victims or that people were first squeezed in tires and then beaten up with batons.

The hostages I work with who have experienced that level of physical brutality are mostly people who have been held by terrorist organizations.

What have learned about people who torture? Who are they?

I learn less about the people but more around the function of it. In state hostage-taking it’s for political leverage. How much can we demonstrate that this person is suffering and that they really need to come home? And torture as a function for extracting information and false confessions. I have not worked with perpetrators of torture.

Do people that experience torture and hostage-taking ever have the chance to overcome such a trauma?

Lots of people can and do have what I call symptom reduction, reducing the number of nightmares and flashbacks and kind of resolving these feelings of shame and guilt. But there are things that can’t be fully undone. Their experiences can fundamentally alter how they understand themselves and the world around them. You can’t unsee what’s been revealed, like the fragility of being human, the ease of which a person’s rights or dignity or even existence can be erased. So recovery is about learning how to live with what you know.

How long is a normal therapy?

Unfortunately, most of the time the therapy length depends on funding rather than on the need of the client. The reality is you can’t undo months of torture in twelve hours of therapy. Hostage International for instance will fund a limited number of therapy sessions for people. And then I might be working with people who have the means to pay privately. I will never work with somebody and then stop before it feels safe to, so I have a pro bono caseload that people will move onto when there’s no funding available. I have a number of people on my caseload who I’ve been working for two, three years.

You hear all these horrible stories; how can you carry that burden? How do you avoid getting emotionally too involved?

For me, it’s not the stories that haunt me. They remind me how fragile life is. But it can also give more color to it. The impact isn’t so much in the mind but within the body. My body, I think, contains and remembers the stories of what it was like to be separated from your child and never know when you’re going to see them again, to be deprived of light, to be restricted in movement, the humiliation of not being able to use the bathroom, and the powerlessness, and the fear of physical brutality. I feel it in the body. That’s what the impact is for me. So what’s important is that I give my body lots of evidence of the opposite of that. I deliberately take time every day to experience life, like the sun on my face. Like how does this feel to hold my child at night. Like purposely taking a longer shower, just because I can. So rather than it being a disturbing career that haunts me, it brings so much color and groundness to my life.

But has your work changed the way you look upon the world or on human beings?

I think I’ve come to accept that evil and good co-exists. Or cruelty and compassion, they coexist and always will be part of the human condition. But I guess what sustains me is the work that is happening quietly, that’s often in the margins between individuals. There’s an extraordinary amount of care and courage and quiet humanity in those spaces. My clients themselves are often the ones who remind me of that. Even after what they’ve been through, their endurance, their capacity for connection and for love, their defiance is deeply humbling. That’s what I place my faith on, those real everyday moments with people rather than abstract ideas about humanity.

A lot of best-selling books and successful movies deal with crimes and violence of all sorts. How do you react to entertainment like that?

Yes, it’s funny, because I don’t recognize any trauma reactions in myself from the work that I do. But one of the things that I can’t do is watch particular types of traumas on TV. Any films or series where there is physical violence or a separation between parent and child – I really can’t watch it. And I wonder if that’s because the separation between fiction and non-fiction is just not there for me. I know this stuff happens. So I find it quite unbearable to watch it on TV.

After all these years, what keeps you carrying on?

I guess, the people. Every single person I work with is so extraordinary and they teach me so much. Their stories of suffering and triumph, loss and love, despair and hope. And I feel very lucky to be with people that offer that wisdom each day.

Quelle: Frankfurter Allgemeine QuarterlyArtikelrechte erwerben

By Rainer Schmidt

Verantwortlicher Redakteur Frankfurter Allgemeine Quarterly.

Thank you to the publisher for agreeing to allow us to re-publish this article on our website. You can read the original article here. However, we could not re-post with the original images published due to our strict policy in that we do not include images of weapons on our website.  

The images in this blog are courtesy of ©Dan Wilton. 

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