For Longtime Captives, a Complex Road Home

September 1, 2009
By BENEDICT CAREY
http://www.nytimes.com/2009/09/01/health/01psych.html?ref=global-home

Jaycee Dugard has suffered sexual abuse, neglect and emotional manipulation to an extent hard to imagine, according to the charges in the case involving her abduction. But therapists say the biggest challenge facing Ms. Dugard, who was found last week after 18 years in captivity, may be switching families.

“Her captor was her primary relationship, and the father of her two children, and at some level separation may be difficult for all of them,” said Douglas F. Goldsmith, executive director of the Children’s Center in Salt Lake City. Dr. Goldsmith added that any therapy “has to be mindful that there are three victims, not one, and that they will be entering a new life together.”

About two-thirds of children who are kidnapped or abused suffer lingering mental problems, most often symptoms of post-traumatic stress and depression.

Recent studies have found that about 80 percent of victims do show significant improvement in mood after three to four months of trauma-focused weekly therapy. Still, given the information available so far, experts say Ms. Dugard and her two children face an unusually complex task.

Her stepfather, Carl Probyn, says she has already told her mother of feeling guilt that she bonded with the man who kidnapped her when she was 11. She and her children will have to learn to connect with and trust her first family, the one from which she was taken in 1991.

“The way I think about this case is that it is an extreme version of a phenomenon that is really not that uncommon: a child engaged in an abusive relationship when young and, not knowing any better, coming to accept it as their life, adapting as best they can,” said Lucy Berliner, director of the trauma program at Harborview Medical Center in Seattle. “Certainly every case is different, but we now have some proven interventions we can use.”

Therapists say Ms. Dugard’s transition to a new life is likely to take some time, probably years. Elisabeth Fritzl, the Austrian woman held in a dungeon by her father for 24 years, has reportedly undergone extensive therapy and still struggles mentally, 16 months after she was freed.

And Shawn Hornbeck, abducted in Missouri at age 11 in 2002 and held captive for four years, told reporters nearly two years after being freed that he was still learning to cope with the emotional effects.

By contrast, Elizabeth Smart, the young woman in Utah who was kidnapped at age 14 in 2002 and held for nine months, is now reportedly doing well, a student at Brigham Young University. When she was reunited with her family, she told CNN last week, “we just spent time as a family, which was like — it was the best thing I could have done.”

The main challenge in all such cases, experts say, is breaking the bond with the captor and abuser. David Wolfe, a professor of psychology and psychiatry at the University of Toronto, has studied victims and some perpetrators of long-term abusive relationships.

In these cases, as in many kidnappings, perpetrators work hard to win the trust of their victims. “It’s a common element,” Dr. Wolfe said. “The child is frightened, and the perpetrator works to gain or regain the child’s confidence, to come across as a really good person: ‘I’m not going to hurt you, everything’s going to be O.K.’ and so on.

“So the child never knows when to fight or run,” he continued. “Do I wait and it’ll get worse? Or do I believe him and I won’t be hurt?”

Humans are wired to form social bonds, and such scraps of kindness can deepen even a relationship built on manipulation and abuse. Some victims have profoundly ambivalent feelings toward abusive captors, psychologists say, and tend to do better when they acknowledge their mixed feelings. Thinking of the perpetrator as a monster feels unfair; on the other hand, it would be wrong to call him merely misguided.

Once victims have shaken the influence of a perpetrator and re-established trust with loved ones, they can better learn through therapy how to ease the impact of their ordeal, said John A. Fairbank, a professor of psychiatry and biobehavioral sciences at Duke and co-director of the U.C.L.A.-Duke University National Center for Child Traumatic Stress.

The most rigorously tested therapy is called trauma-focused cognitive behavioral therapy. In weekly sessions over three to four months, people learn how to examine and refute suspect assumptions about their ordeal. One of the most common of these is “I can’t trust anyone anymore.” Another is “It’s my fault I didn’t resist more.”

“Of course it is not their fault, and we communicate that,” said Dr. Berliner, the Seattle therapist. “But at the same time, in many cases they did go along, they did make decisions not to fight or run, and we help people examine why they made those decisions — to understand that judging themselves harshly in retrospect might not be fair to the child they were in that moment.”

Typically, people in trauma-focused therapy also learn methods to regulate the strength of their emotions. These methods include simple breathing and relaxation techniques, as well as mindfulness, an exercise in allowing an emotion to take hold and pass without acting on it.

Finally, victims often work with the therapist to build a narrative, oral or written, of the entire ordeal, then file it as a chapter of their lives rather than the entire story. If appropriate, they may also “relive” the experience multiple times until its emotional power wanes. This approach is not for everyone — it seems to make some people more distraught — but experts say it can be helpful in some patients.

So far, Jaycee Dugard seems to be doing just as her fellow abductee Ms. Smart advised: staying with family, keeping herself and her children away from public scrutiny. Those are good instincts, therapists say.

“It’s not like resilience is out of the question in a case like this,” said Dr. Judith A. Cohen, medical director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “In a lot of kidnapping cases, people do remarkably well, and this woman has already shown amazing survival skills.

“That she managed to survive for so long suggests that she might do well in the years to come.”

Police Find Bone Fragment

SAN FRANCISCO — Law enforcement officials in the Bay Area community of Antioch said Monday that a bone fragment had been found in the search of a house neighboring the property of Phillip Garrido, the man charged with abducting Ms. Dugard. But a spokesman for the county sheriff said it was not clear if the fragment was human.

Searchers have been looking for evidence not only in the Dugard case but also in a string of murders in the area. The authorities suspect that Mr. Garrido had access to the neighbor’s property, and may have lived there, in 2006.