Do inmates incarcerated at state mental hospitals develop STOCKHOLM SYNDROME?
The Stockholm Syndrome is a well-documented psychological reaction to being held captive by criminals or political terrorists. The original articulation of this syndrome, dating from a hostage situation in Stockholm in 1973, has been expanded in the ensuing decades to cover situations covering abused children, battered women, prisoners of war, cult members, incest victims, concentration camp prisoners, and other controlling or intimidating circumstances. The Syndrome itself has been characterized as an identification, sympathy, and even affection towards the captors by the captives. It has been described as a common psychological reaction to danger based upon the survival instinct. In extreme cases, the captives may even express hostility towards those who may be trying to help them escape from captivity.
But does it also apply to prisoners held in state mental institutions for forced treatment? This analysis seems to be missing from the literature and will be explored in this paper.
To examine this question, it’s necessary to compare the processes that prisoners in mental hospitals undergo and check for similarities with the conditions experienced by captives in the above groups.
The generalized conditions necessary for a person to develop symptoms of the Stockholm Syndrome have been summarized as:
1) A perceived threat of danger from violence to enforce the captivity;
2) Isolation from all other information input except from those of the captors;
3) The perceived inability to escape;
4) The perception of small kindnesses offered on the part of the captors.
The question for prisoners in mental hospitals, then, is whether or not the conditions they experience fall into these generalized categories. If so, the development of Stockholm Syndrome among some of the hospital population would be expected.
VIOLENCE USED TO ENFORCE CAPTIVITY
In the case of prisoners held against their will in the state mental hospitals, it is necessary to examine how they came to be held there in the first place. Most come to the mental hospital through the criminal justice system in one of four ways:
1) They have pled and been found to be Not Guilty by Reason of Insanity (NGI) in a criminal trial;
2) They have been found by the court to be incapable of standing trial due to mental disorder;
3) They have been examined by state psychiatrists and found to be a Mentally Disordered Offender (MDO) or Sexually Violent Predator (SVP) after being convicted of a crime and serving their prison sentence, or;
4) They have been sent by the prison authorities to the hospital for treatment because they have been unable to adapt to the environment of the prison while serving their prison sentence.
From the circumstances of their placement in the hospital, we can deduce that the original violence or threat of violence they have experienced is the prison system itself. The horrors of the prison system are well known and widespread, to the point of saturating the popular culture. The sadism, rape, beatings, and murder that occur within the prisons are common attributes of the system in the minds of most people. Through their personal experiences in the prison system, prisoners arriving at state mental hospitals have already experienced the violence or threat of violence that makes up the initial precondition necessary for the development of the Stockholm Syndrome. Even the NGI prisoners have experienced lengthy stays in the county jails, where conditions can be even worse than the state prisons, and it can reasonably be argued that the reason most of them chose to plead NGI was to avoid the violence of the prisons.
So most, if not all, of the prisoners in the state mental hospitals meet criteria one: They have been exposed to, or threatened with, violence – they have experienced a perceived and immediate ongoing threat to their physical and/or psychological survival. It is an ongoing threat because they can be removed back to prison should they be involved in any violent situation while incarcerated at the hospital.
ISOLATION FROM OUTSIDE PERSPECTIVES
In the case of the state mental hospitals, this is accomplished in a variety of ways:
1) Placement of the hospital in a location removed from population centers;
2) Limited visiting procedures;
3) Little or very poor communication between the hospital staff and the families of the prisoners, i.e., isolation of the families from the treatment process;
4) Mail and telephone limitations, monitoring and interference.
Studies have consistently shown that developing a reliable, informed network of friends and family is the single greatest factor leading to a prisoner gaining complete recovery and rehabilitation. However, state mental hospitals have given this finding only the barest of lip service. Although state mental hospitals have been under increasing pressure to allow at least one family member to participate in “treatment team” meetings and decisions regarding the prisoner’s care, this practice is almost never carried out. Most families remain unaware that this option is even open to them, and the hospital authorities do nothing to change that status. When family members do insist upon participation, despite the hardships of travel and expense, they are immediately removed if they express any disagreement with the treatment decisions mandated by the hospital staff. In reality, family is viewed as an impediment to treatment. Thus, though the hospital administrators hide behind the facade of “family involvement”, the facts are quite the opposite, and as a result the prisoner suffers the isolation desired by the state hospital staff, and family dissonance with the treatment decisions of the hospital is kept to a minimum, if not suppressed altogether.
In this manner, the second condition necessary for development of the Stockholm Syndrome is effectively accomplished by the mental health authorities.
PERCEIVED INABILITY TO ESCAPE
This perception is achieved both through the physical setting of the hospital and the legal system that supports the incarceration for treatment.
The state mental hospitals hardly resemble hospitals. Surrounded by electrified fences with barbed concertina wire on top, with barred windows and doors, metal detectors and armed guards, their appearance is that of a prison. Escape is unthinkable.
In addition, the legal circumstances of the prisoners are similarly bleak. Most are destitute and must rely on the services of the county Public Defenders offices for their legal defense. Typically, these lawyers are overworked and underpaid, both conditions that guarantee poor representation in the legal arena. In addition, the laws that allow for the incarceration of these individuals are, by their very nature, designed to minimize the constitutional right to liberty that all citizens supposedly enjoy. The state, acting “as the parent” of the prisoner, is not only acting “in their best interests” to help them “recover from their illness”, but is also defending the rest of the citizenry from their “propensity to dangerousness.” These are significant legal obstacles, and the prisoner who can mount an effective defense against them and gain his liberty is nonexistent, for all practical purposes. This perception is omnipresent in the daily life of the prisoners.
In threatening or survival circumstances, it is normal for captives to look for any evidence of hope. In the setting of the state mental hospital, this desire can be manipulated by altering the daily treatment experienced by the prisoner. Hospital staff can be selected and moved about throughout the hospital by administrative decision. Some of these staff members have negative, controlling, abusive attitudes toward the prisoners. Others are more helpful, and are trying to have a therapeutic effect.
By changing these personnel through periodic rotation, an individual prisoner’s daily experience can be altered considerably, from bleak, unfriendly relationships and punitive discipline, to bright and encouraging comments and small rewards of food, exercise, work, and other perks. This
is the familiar “good cop, bad cop” routine. Through such devices, the prisoner comes to believe that “some of the staff” is on his side, pulling for him to gain his freedom again. Over time, this method gains the cooperation of the prisoner in activities, such as forced drugging, that he originally may have opposed.
SUMMARY OF EVIDENCE
The evidence points to the conclusion that Stockholm Syndrome would be a logical strategy for prisoners held in mental health hospitals to adopt. All four of the generalized conditions necessary for the development of behavioral attitudes supporting the Syndrome are present:
- Perceived threat of danger from violence from the prison system used to enforce captivity;
- Isolation for other information input through physical isolation and limited communication opportunities;
- Perceived inability to escape due to prison surroundings and overwhelming legal obstacles;
- And the perception of small kindnesses as manipulated through the personnel policies of the mental hospital administration.
Observation of the actual behavior of prisoners in the hospital confirms the emergence of Stockholm Syndrome among a significant proportion of the inmate population. Typical behavior includes extreme passivity, negative attitudes towards any prisoner who complains or demands his rights under the law, an active willingness to comply with whatever demands are made by the hospital personnel without complaint, and an unwillingness to voice any request for relief from uncomfortable or painful circumstances for fear of antagonizing the staff. When adopted by a large segment of the prisoner population, these attitudes help the mental hospital routine operate smoothly, with minimum disruption to the daily regime as dictated by the hospital administration.
THE END RESULT
Adopting the Stockholm Syndrome may, indeed, help the prisoner endure the treatment mandated by the state mental hospital authorities. But the larger questions are, “Does it help him gain his freedom?” and, more importantly, “What is the effect on his health and well being, especially after he gains his freedom to return to society on the outside?”
These are questions that must be examined in a separate paper.