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Interviewing victims - A better way
by Frank Ochberg, M.D.
Interviewing victims of crimes or natural disasters is an essential part of the job of the journalist. Reporting the human cost of such events is even more important than counting up the property loss. But, we are told, in some cases, reporters add to the stress of the victims of trauma. In the rush to get the story and meet the next deadline, reporters sometimes ignore the feelings of people who have already suffered greatly.
We are not alone in this failing. Police officers, ambulance attendants, emergency room personnel, and even doctors have been accused of the same thing: adding to the suffering of victims of trauma. There are few among us who have not wondered if there might not be a better way to gather the information needed to report the human consequences of unhappy events.
Research into the effect of traumatic events on the victims of those events have turned up a number of valuable social lessons. We are learning how to prepare ourselves for such events, how to treat those who have endured such events. And, of particular interest to journalists, how to mitigate the effects of the trauma. In other words, there are ways we can become a part of the solution rather than continue to be part of the problem.
The victim of violent crime suffers from injury and injustice. To serve that victim with professional skill, journalists and those who work in the fields of law enforcement, criminal justice, social service, health, and mental health must understand the variety of wounds, physical and psychological, that victims bear. We must recognize the stigma attached to victims in our society, the isolation, ostracism, and humiliation they often feel, regardless of their innocence. We must know that, despite billions spent on courts, corrections, police, probation and parole, the victim is relatively neglected, with few programs directed toward his or her needs. In fact, our systems of justice frequently require the participation of victims, re-victimize the victim, and offer no compensation for lost wages and personal inconvenience. Professor Martin Symonds, a psychiatrist and deputy chief of the New York City Police Department, coined the term "second injury" to describe the wound that a victim suffers when treated insensitively by individuals and institutions in the aftermath of victimization. The second injury may, indeed, be more traumatic than the first.
Why has the victim been so neglected? There are many reasons. Crime is defined as an offense against the state, and has been since the eleventh century, when the feudal concept of "the king's peace" replaced the tribal practice of compensating the kin of injured parties. Courts serve the king rather than the clan, and the rise of nations signaled a decline in the rights of victims. Increasingly burdensome procedures forced government institutions to expend more and more effort on administering justice, crowding the court dockets, and squeezing the victim into a passive witness role. To avoid participating in a system that offers little gain and requires considerable risk, most victims refuse to report crimes. This contributes to victim neglect.
Furthermore, our society places great emphasis on achieving, prevailing and winning. Victims are losers, and loser status evokes more scorn than sympathy. Victims are therefore neglected by family and friends. And many people, including the victim, find it difficult to believe that bad things happen to good people. They assume or imagine some contribution by the victim to the crime. If the victim is somehow to blame, he or she deserves the injury and requires less concern. Finally, we avoid victims out of fear - it could very well happen to us (perhaps it has) and we would rather not have to visualize and feel the victim's pain, outrage, and impotent anger.
Medical doctors are not taught to recognize and treat victims of crime any differently than victims of accidents. Until recently, psychiatrists and psychologists had no special classification to aid in diagnosis and care for crime victims. Incest was believed by Sigmund Freud to be a universal taboo, and more often the hysterical fabrication of a neurotic woman than the true reporting of a sexual assault. Now we recognize that girls seldom lie about father-daughter incest, and estimates of incest cases in the United States number 15,000,000.
For several reasons, we are beginning to understand victimization and give the victim a better opportunity to heal with dignity and respect. I believe this is due to a combination of historic events in the last decade. The end of the Vietnam War allowed the voices of the veterans to be heard clearly. Many suffered victimization syndromes. They were traumatized and felt like losers. Further, the rise of political terrorism has caused us to collaborate across professions and across nations. We have discovered the "Stockholm Syndrome" and other patterns of victim reaction. And the women's movement has forced male-dominated professions to recognize the rape trauma syndrome, as well as to re-evaluate father-daughter incest and to shelter battered women without stigmatizing them as mentally ill.
Sufficient clinical observations have allowed the American Psychiatric Association to define Post-Traumatic Stress Disorder in its diagnostic manual. Moreover, the Task Force on Victimization of the American Psychiatric Association believes that victims of violent crime suffer a particular, severe form of Post-Traumatic Stress Disorder. Major mental health organizations are currently studying victimization, including the American Psychiatric Association, the American Psychological Association, and the World Federation of Mental Health. President Reagan's Task Force on Victims of Crime reported unequivocally on the outrage of victim neglect, and the steps necessary for all concerned sectors of our society if we are to stop victimizing victims and being an era of true justice.
Victim DefinedThere are many forms of crime victimization and considerable variation in victim reactions. From a clinical point of view, a victim is someone who has been deliberately harmed by another person, has been lowered in dominance, and has suffered. The suffering may include pain, rage, depression, loss of mental or physical capacity, and shame to the point of humiliation and self-imposed isolation.
Acute victimization describes a single episode, usually sudden,
unanticipated and shocking.
Chronic victimization describes repeated trauma, seen usually in domestic situations where one family member dominates and preys on another. Incest and spouse abuse are common examples. And for some people, such as the poor, the elderly, and the disadvantaged, victimization becomes a tragic way of life. Forced by economic necessity to live in high-crime areas, they absorb repeated trauma. The chronic victim usually shows less visible rage and suffers from a desolate state of resignation.
Group victims are relatively rare, but not uncommon in military combat, POW camps, and terrorist and hostage situations. These victims may benefit from therapy sessions facilitated by a skilled intervenor.
Although one victim told me, "Once a hostage, always a hostage," I believe that victim status is a transient, normal and stressful state of being that begins with the traumatic event and lasts until survivor status is achieved. There is no sharp dividing line between these conditions, but people who have been victimized can usually describe a turning point, when they felt more whole than fragmented, more hopeful than hopeless, more healed than wounded. Victim status includes several usual symptoms and may include some relatively uncommon conditions. Before discussing these, it is wise to re-emphasize that a Post-Traumatic Stress Disorder is common among victims of violent crime, and this is no cause for alarm or embarrassment or blame. The news reporter, police officer, nurse, friend or relative who recognizes this will not be insensitively impatient, will not say, "Stop feeling sorry for yourself," and will not pester a victim with clichˇs calculated to evoke self blame.
Victims may have difficult recalling the first few moments of victimization. During a traumatic event, denial operates as a coping mechanism, shielding the individual from a rational appraisal of danger, and allowing an automatic set of adaptive reflexes to operate. The autonomic nervous system is activated, causing adrenalin to flow, the heart rate to increase, pupils to dilate, and blood to rush from the gut to the large muscles. Trained individuals find their powers of concentration increase at times of crisis and danger. But by definition, the victim is the loser in a struggle and no amount of mental or physical ability can alter that fact. When the reality of victimization breaks through, the victim is aware of physiological changes, injuries, and loss. This may follow a protracted or a brief period of frozen fright.
At first, the victim literally does not know what is happening. Then he or she may deny reality, unconsciously acting to survive through struggle or total resignation. When the victim says, "No, no, no, this isn't happening," he or she already knows that it is. Frozen fright keeps the body inert, while the mind thaws and begins to rationalize. Frequently the follow-up thought focuses on self-blame: "I was so stupid!" The assailant has fled, the damage has been done. But rather than take whatever steps are needed for health, safety, or recompense, the mind ruminates, rationalizes, tries to undo, and explain at once. Events are replayed. "If only I had done this, not that . . ." is said or thought a hundred different ways.
Feelings of disgust and defilement may emerge, even in crimes that are not explicitly sexual. Personal space and dignity have been invaded. The desire to wash, change clothes, restore a sense of self is understandably stronger than the desire to preserve evidence. Shame is intensified by disgust and becomes self-loathing.
A mortified victim needs reassurance, but may seek to avoid all human contact and react impassively to questions and to expressions of concern. Crying, retching, shivering and screaming are understandable and automatic reactions in states of extreme duress. Expressions of rage, hatred, and vengeance are later manifestations or are ways of avoiding recognition of deep hurt and humiliation. Rape victims will often experience a phase of despair and a phase of bitter anger. One cannot predict that the other will follow.
In addition top these feelings, which are particularly true of victims, the traumatized individual can be expected to have recurrent, intrusive recollections of the event, in dreams and when awake. These people may fear that the images will obliterate their ability to concentrate. Concentration often is impaired and may cause some deficits at work or in household responsibilities. To avoid negative feelings, the traumatized individual may unconsciously and automatically void all feelings, entering a state known as psychic numbing. And it is common to have startle reactions (being easily frightened by sudden noises or movements), to have attacks of anxiety, and to phobically avoid reminders of the crime scene.
An unusual reaction, known as the Stockholm Syndrome, occurs relatively frequently among hostages and may account for some paradoxical responses in rape victims. The assailant demonstrated lethal power, immobilizes and infantilizes the victim, but does not kill. A primitive survival instinct takes over. The victim does not identify with the aggressor, but experiences a strange, positive attachment which may, in fact, be described as love. I believe the feeling is not love, but is the infantile precursor or love - a form of deep gratitude for life which we vaguely recall from early childhood when our parents removed the hunger, the wetness, the immobility that characterized our complete dependence as infants. The Stockholm Syndrome was recognized long ago, but was first introduced in the medical literature after the events in a Swedish bank vault, when Kristin, the victim, fell in love with Olsson, her captor.
What are the implications for each of us who come in contact with victims on a regular basis? Knowing how victims may feel does not mean we know how a given victim does feel. But it never hurts to say:
Symonds believes that these three simple statements are the cornerstone of decent interaction with victims. On the other hand, saying, "I know how you must feel" is often perceived as patronizing and wrong, even when coming from a fellow victim.
Predicting some possible victim reactions is useful. I often explain to victims
what other victims have experienced, particularly the feelings of self-blame, the
fears and the concentration difficulties. This reduces fear and shame, by
showing how normal the reaction is, and restores a sense of control. The unusual
and frightening emotional state is, in some measure, predictable. And it will
run its course.
Victims need practical help in addition to compassionate understanding. Giving practical, useful information in a straightforward manner is important:
The timing and sequencing of information giving is important as well. For example, where there is no immediate danger of re-victimization, it may be unwise to concentrate on security advice. This feeds the victim's propensity for self-blame by implying negligence in crime prevention. But a revisit to a victim of a house break-in, with security advice that is requested and valued, will do much to enhance the psychological recovery process, while reducing risk and improving community relations.
Victims should not be treated as mental patients or assumed to require psychiatric services. In fact, few credentialed professionals have training or experience with victims. Journalists are advised to develop a roster of reliable professionals who are known to the police department and who are interesting in helping victims. The American Psychiatric Association, the American Psychological Association, and the National Organization of Victim Assistance can help locate skilled professionals. Nonprofessional crisis intervenors have often learned through practical experience, night and day, to serve the psychological needs of victims and their families. Rape crisis centers, hot lines and shelter are often of great assistance, but are not of uniform quality. The self-help organizations have given great solace to mothers of murdered children, victims of drunk drivers, and others afflicted in traumatic victimization.
When symptoms are severe and incapacitating, such as hallucinations, depression with suicidal thoughts, alcohol or drug abuse, professional counseling is advisable. When physical changes occur - weight loss, abdominal pain, bloody stools, palpitations, shortness of breath - medical evaluation is indicated. And symptoms enduring beyond six months warrant professional attention.
News people are not expected to function in the role of the physician, but a good journalist is a good social worker, a good crisis intervenor, and a good advertisement for a compassionate community. Sensitivity to the needs of victims is a critical aspect of professionalism in the field of criminal justice. Justice is hollow when victims are neglected; democracy thrives when its citizens are respected at times of crisis and need.
This article first appeared in Police and the Community by Louis Radelet, Macmillan Pubishing Company, 1986.