A Hostage Trauma Assignment in Fiji

The Australasian Journal of Disaster
and Trauma Studies
ISSN:  1174-4707
Volume : 2002-2

A Hostage Trauma Assignment in Fiji

Abstract

Following a crisis in Fiji in which political hostages were taken, interviews were held with some of the Parliamentarians and staff that were released early, and visits were paid to the families of those still detained. Clinically in both groups trauma was very much in evidence, with supporting psychometric scores above those of a normative group of controls. Those with a diagnostic condition of either ASD or PTSD scored significantly higher than their counterparts on the GHQ20, the HSCL21, and the IES. The Fijian participants scored higher than the others, and the males scored higher than the females. Yet the manifest strength that participants drew from their religious beliefs suggests the outcome might have been worse had they not been so devout. At the same time many expressed a deep sense of outrage that drew attention to social justice as a basic psychological need. In conducting the research, cross-cultural and inter-organisational problems were encountered, with the former proving more manageable than the latter.

 

A Hostage Trauma Assignment in Fiji

Introduction

From time immemorial hostages have been captured and used as bargaining chips to achieve criminal, military, political, and religious ends. Criminals have either kidnapped individuals or held groups to ransom to extort benefits, and the military have taken prisoners to gain advantage in their campaigns. The politically inspired have taken hostages to demonstrate their authority and gain power, and the religious have used them both to promote ascendancy in this world and to gain favour in the next. But no matter what the particular ideological, motivational, and organisational base, the intention of captors was not to harm their hostages so much as to use them as bargaining tools without provoking a retaliatory backlash (cf. Wilson & Smith 1999).

In 1949 the United Nations (UN) formally condemned the practice of taking hostages (Osmanczyke 1990, pp. 387-8), and later it formulated articles for the prevention, prosecution and punishment of such activity (UN 1980: 1989). But its continuation obliged the UN to include hostages with the detainees for whose treatment it set minimum standards (cf. Williams 1990). In the late 1990's the frequency of hostage taking was sufficiently high for the International Red Cross and Red Crescent Society (IRCRC) to express its particular concern about it (viz. the Plenary Report of its 27^th Conference at http://www.icrc.org/eng). That organisation, operating under the principles of humanity, impartiality, neutrality, independence, voluntary service, unity, and universality (cf. Walker & Walter, 2000), was the watchdog for ensuring that as far as possible hostages came to no harm and were able to maintain minimal contact with their families. At times it also acted as an intermediary to facilitate dialogue between the parties concerned (personal communication Yves-Jean Duméril, ICRC, Geneva 20/7/2001).

Psychiatrically, hostage situations raise a number of general matters that Scott (1978), Turner (1985), Harkis (1986), and Frederick (1987) were among the first to address. Collectively their contributions can be subsumed by Wilson's (1988) comprehensive model that includes the complex nature of the traumatic event, the personality attributes of affected individuals before, during, and after the event, the nature of the recovery environment, and the cognitive processing of aversive sensory experience. At issue for health professionals is the prevention of posttraumatic stress disorder (cf. Ursano Kao & Fullerton 1992: van Der Kolk McFarlane Weisaeth 1996), the chronic symptoms of which Ehlers Maerker & Boos (2000) confirmed recently among former political prisoners as including the subjective perception of mental defeat and alienation, and permanent personality change.

An abundance of descriptive reports have been written about hostages that have been confined in buildings, camps, and schools, as well as in aircraft, buses, and ships¹. They mention the transient reactions of shock and disbelief, terror and dread, numbing and apathy, despondency and debility that vary according to the degree, duration, and kind of oppression, deprivation, and discomfiture imposed – as well as the structure and strength of personality of those held captive, and the lessons that the captives have learned from their previous life experience. The people most adversely affected are those with reserves of resilience already depleted from the long-term strain of stressful personal and family circumstances without having opportunities for replenishment from their social and cultural support systems. The least affected are both the aggressive criminal psychopaths and their polar opposites - the extraordinarily mature. The former are able to maintain their belligerence under all circumstances, and their well-balanced counterparts are able to make their situations more tolerable if they can discern a purpose for the extreme measures being taken against them (cf. Frankl, 1959).

But detailed research studies of hostages are rare, and those of their families are more so, despite Frederick's (1987) description of them as 'co-victims' and Wilson and Smith's (1999) more recent expression of concern about them. It is safe to say that their needs either have been overlooked or are presumed to present problems of lesser magnitude than those of the primary victims (cf. Taylor 1996). With regard to the hostages, Rahe Karson Howard Rubin & Poland (1990) did seek to establish the complex of psychological reactions of all 52 Americans on release from their 444 days in captivity. But their project was not entirely successful, because the subjects had to cope with many unexpected distractions from well-wishers in the form of emotional and gustatory nourishment that compromised their ability to respond (private communication Robert Rahe, Wellington, February 1982). With regard to the families, Dane (1986) used structured interviews together with a 'before and after' coping questionnaire to document the responses of 14 of the wives two years after their husbands had been released, and found a notable decrease in their use of denial, and a complementary increase in the use of problem solving and seeking social support - some of which was attributed to the stress-inoculation sessions with back-up counselling that they had received prior to the release of their husbands. She emphasised their right to privacy from the media, and considered that intervention services designed for them should be both client-centered and informative.

van der Ploeg and Kleijn (1989) made a notable joint study of a large proportion of about 500 hostages and members of their families that were involved in the epidemic of eight instances that occurred in Holland in the mid 1970's. Their study was in two parts: the first considering the short-term consequences and using interviews and questionnaires, and the second some six to nine years later considering the long-term effects and using questionnaires alone. They found that after about a month two-thirds of each group reported negative effects, and that at the time of the follow-up the number declined to 32% of the hostages and 19% of their family members. While commenting on the features of generalised anxiety disorder that proved difficult to treat, they also drew attention to the psychological strength that large numbers of the participants had derived from their experiences.

In their hostage study Easton and Turner (1991) relied on a postal survey to seek psychometric data from 828 British citizens that had been held in the Persian Gulf in 1990 for periods of up to five months, using the total scores of the GHQ28 (Goldberg & Williams, 1988) and the Impact of Events Scale (IES) (Horowitz Wilner & Alvarez, 1979). Of their 381 (46%) valid returns, about half of their participants signified that some deterioration in their physical and mental health and family relationship had occurred, but more than half mentioned that the hostage experience had enhanced their personal values and strengthened their religious faith. The researchers estimated that about one quarter of their sample was in need of counselling and support. Yet informative as their survey was, the researchers were in no position to substantiate their findings without conducting the recommended interviews (cf. Goldberg and Williams 1988, p.9). Then Bisson Searle and Srinivasan (1998) used the same method and measures for studying the reactions of 71 British servicemen and their families that had been taken hostage in the same Gulf war, except that they surveyed their participants twice (once at six months after the final hostage had been released and the second time at 18 months). They too obtained a mixture of both negative and positive responses - but they acknowledged that without the necessary confirmation from clinical interviews their findings must remain suggestive rather than definitive.

However, Desivilya Gal and Ayalon (1996) used 'in-depth interviews and a battery of questionnaires' with 59 survivors of a '16-hour harrowing seizure' in Israel some 17 years after the event. They measured the degree of exposure and resulting physical injury, and the frequency of occurrence and severity of traumatic stress symptoms. They found that the survivors that had sustained severe injuries had poorer long-term adjustment than their counterparts, and they drew attention to the need for including measures of subjective indictors of trauma intensity in future studies of such a population.

The Present Focus

The situation for the hostages and their families in the present study began on Friday 19^th May 2000, when a small group of heavily-armed and balaclava hooded men burst into the Parliamentary debating chamber in Suva and took 64 of the assembled company captive. The attack was spearheaded by a dissident group of the military that ironically was named the Counter Revolutionary Warfare Unit. The same day their avowed supporters ended a protest march in the city by torching and looting shops owned by the ethnic Indian community before camping in the grounds of Parliament. Their aim was to form a new Government in which political power would revert from an existing democratically elected multiethnic political party to one dominated by indigenous Fijians. Their strident rallying call was about land rights, but they made ominous rumbles about sundry economic, ethnic, personal, political, religious, and social structural issues.

The existing Government had been in power for exactly one year, under the leadership of the country's first ethnic Indian Prime Minister. It was said to have followed scrupulously the 1997 Constitution that had been set up to remedy serious discontent after two coups along similar lines had occurred a decade before, and to be intent on introducing major reforms for the benefit of the whole population. But evidently its policy, performance, and speed of operation were not to everyone's liking.

After some initial hesitation the military establishment assumed control of the country, imposed martial law, established road blocks to monitor vehicle movements, closed all educational institutions, imposed a nightly curfew on the streets, and began a patient series of negotiations with the rebels. Then it installed a new President and a Prime Minister with responsibility for appointing an Executive to restore national stability, and promised to have the Constitution of the country reviewed again before seeing that fresh elections were held. It also guaranteed an amnesty for the rebels provided they did no harm to the hostages and surrendered their weapons.

By day 37 the military had made sufficient progress to obtain the release of the women MPs, followed on day 52 by nine of the males, and then on day 56 the remaining 18 males. But within a few days of the armistice it took the ringleaders into custody on charges of treason when some of their followers were found to have retained their weapons. Then elements of the same rebel military unit that had led the initial attack on Parliament sprang into action in an abortive attempt to depose the Chief of Defence Forces, secure the release of their leaders from the island prison where they were held on remand, and gain political control of the country. Subsequently an uneasy tension prevailed, and 20 months after the initial attack on Parliament rebel supporters made yet another attempt to take key figures hostage in exchange for the release and pardon of their leaders that were still awaiting trial.

The protracted nature of the coup made it a continuing rather than an encapsulated traumatic event. As such it did not have the somewhat orderly unfolding of disaster phases that occurs usually after a short impact period – viz. heroic, honeymoon, disillusionment, and restabilisation (Young Ford Ruzek Friedman & Gusman, 1998, pp. 17-18). At the time of writing (February 2002) the population is far from settled, and the economy of the country is in a poor shape. Legal challenges are afoot because the fresh elections did not follow the Constitution and allow the Mahendra Chowdry led Fiji Labour Party with more than the requisite 10% of votes to join a multi-party government. The rebel leader George Speight has just pleaded guilty to a charge of treason, been sentenced to death, and has had the sentence commuted to life-imprisonment. Nine of his associates have pleaded guilty to the lesser charge of 'wrongly confining abducted persons' and have been sentenced to periods between 18 months and three years imprisonment. Two others took no part in the plea bargaining process and are awaiting trial on the original charge of treason.

The Approach

The senior author was invited officially to visit Fiji on a short-term assignment 12 days after the coup to help to attend to the immediate psychological needs of the hostages. His plan was to deliver an initial clinical and debriefing service through joint medico/psychological interviews at an opportune time, and to identify factors of concern with the appropriate use of the 20 item General Health Questionnaire (GHQ20) (Siegert McCormick Taylor & Walkey, 1987), the 21item Hopkins Symptom Checklist (HSCL21) (Green Walkey McCormick & Taylor, 1988), and the 15 item Impact of Events Scale (IES) (Horowitz Wilner & Alvarez, 1979).

The particular clinical measures were chosen because of their relevance for the task, and because they had been used previously in cross-cultural settings: e.g. the GHQ20 had been used satisfactorily with Asian, Polynesian, and South Pacific ethnic groups (Siegert & Chung, 1995), and both the HSCL21 and the IES with Fijian samples (Paton & Gillard 1999). But none had been standardised on a multicultural Fijian population against which the results of the present study might be compared. Therefore plans were made with the assistance of Dr Henry Aghanwa, Senior Lecturer in Psychiatry at the Fiji School of Medicine in Suva, to standardise all three measures locally, and for Dr Frank Walkey to process the psychometric data as he had as third author for data obtained for the present report². With their own extensive cross-cultural appraisal of the psychometric properties of the IES, Paton Smith Ramsay and Akande (1999) made clear the importance of undertaking such procedures.

When the present study began, exigencies of the moment precluded a customary search of the journals for reports about hostages. But previous work with people in prison, in Antarctica, and with trauma casualties provided a framework for considering some aspects of their captivity and of their reactions to extreme adversity (Taylor 1970; 1989; 1991) and led to the preparation of two documents. One was a handout for hostages to explain the purpose and the process of the debriefing procedure they might expect to have available on their release, and the other was a questionnaire to focus on their individual perception of captivity. (It should be said that because Fiji was a member of the British Commonwealth and it followed the British educational system, English was a second language for the majority of its citizens).

The handout was written to encourage the hostages to take the trouble to draw into working memory any current traumatic experiences they might have, rather than to shut them aside to consolidate as troublesome elements in the non-declarative sector of their minds (cf. Taylor 1998). It warned them against casting themselves or to accept being cast by others into the role of victims, and suggested that should they need a role definition they might regard themselves as casualties that would recover. It mentioned Cheng (1993) and Mandela (1994) as inspirational models, without alluding to the phalanx of political prisoners that had written ideological treaties while in custody (cf. Abramowitz, 1946), and avoiding the mention of what were once described as potential benefits of short periods of incarceration (Greenwood, 1894)³. It also assumed that none of the hostages had previous experience of imprisonment from which they could draw positive pointers for handling confinement.

The primary purpose of the 31 item questionnaire, intended for administration on their release, was to help the hostages to detail and put into perspective the mental, physical, social, and spiritual aspects of their recent experience⁴. It also sought information about any practices they might have adopted to make their lives more tolerable, and about any lessons they had learned that might serve them and others should the need ever arise again. Once again its tenor was to encourage the hostages to seek positive aspects of their experience that at first might have seemed completely negative. It was to foster self-reliance and group reliance, and so create the placebo effect to counter the insidious effects of its opposite - the nocebo effect.

Here a word needs to be said about the proposal to apply techniques of psychological debriefing, because the intervention has created endless controversy among clinicians and researchers. In effect it is a systematic procedure that many health professionals use to help people recover their equanimity after the experience of some life-threatening event. It has many variations, the use of which might more often be determined by the enthusiasm and limitation of the debriefers than by the needs of the people they debrief. Consequently there are studies finding no evidence of one debriefing session reducing psychopathology (Raphael, Meldrum & McFarlane, 1995; Gist & Woodall, 1998; Rose Bisson & Wesseley 2001), and others defending the practice with researchers declaring deficient the strategies and procedures that the critics had used (Everly & Mitchell, 2000; Dyregrov, 2000).

The argument is reminiscent of the fierce interchanges between behaviourists and humanists on the effectiveness of psychotherapy that Seligman (1995) and Sherman (1999) seem to have settled by saying that such interventions do the most good and the least harm if practised by mature therapists with a keen sense of professional concern and accountability. A sage might say much the same for the outcome of debriefing procedures that have received appropriate scrutiny, been modified to suit individual needs, applied with discretion by trained personnel, monitored in their application, and followed-up to ensure that no further complications have arisen.

The Implementation

On arrival in Suva the first author, a Consultant Clinical Psychologist, located the second author Dr Epeli Nailatikau, at the time the Senior Medical Officer in the Fijian Forces, and accepted his offer of professional help and local knowledge with the project. It was thought that the combination of expertise might cover the culturally appropriate essentials required for medico-psycho-cultural trauma work (cf. De Girolamo & McFarlane, 1996). Then both accepted an invitation of the Ministry of Health in Fiji to join a multicultural and multidisciplinary National Trauma Recovery Team (the 'Trauma Team') that had been set up initially to attend to the broader health and welfare needs of the community in the crisis but had yet to have its first meeting.

Subsequently they helped to write terms of reference for the Trauma Team and to energise it while continuing with their own narrower objective. They also helped to make provisional arrangements that might be suitable for debriefing the hostages when they were released: these included the use of a secure, comfortable, and private setting in which the families could join them, and from which the united family groups might be escorted home safely afterwards. Their aim, as expressed previously by McDuff (1992) from a study of many kinds of hostage situation, was to 'create a healing social environment immediately after release…that encourage(s) strong cohesiveness…isolates the victims from external groups, promotes abreaction, and provides an opportunity for rest and replenishment… restore(s) a sense of power to the victims and …reduce(s) their feelings of isolation and helplessness and of being dominated by the terrorists'.

It was understood that a satisfactory outcome would depend on obtaining the cooperation of the hostages, their families, both sides of the political divide, the Director of the local Red Cross that was in daily contact with the prime parties, and of the pulsating collection of reporters and journalists from the national and international news media. Accordingly attempts were made to elicit support from the different parties. The one sector that caused the most apprehension, i.e. the news media, proved to be most cooperative. At a specially held press conference it accepted a prepared statement requesting respect for the privacy of the hostages and their families immediately they were released, in return for an opportunity to interview one of the more robust hostages at a designated centre at a convenient time a day later. The direct questions from journalists about the aims and objectives of debriefing were answered, but a request from one to be present during such proceedings was declined.

The clinicians also made approaches to the authorities on both sides to see if it were possible to gain direct access to the 31 hostages that were still in custody. When that proved unfruitful, they made the first of what they hoped might have been a series of tape-recordings containing advice for the captives (and even the captors), and they sought the approval of negotiators on both sides to have them available for the hostages to hear. They also contacted the families to let them know what provisions had been made for the reception of their loved ones, and to see if they might pass on information in their letters that might help the hostages to sustain their resistance to the strains of captivity.

While the plans to interview the hostages were on hold, the first and second authors sought joint interviews in convenient places such as homes or offices with the hostages that had been released early. Their aim was to assess their reactions to the critical event (cf. Frederick 1987) and to look for signs of the role relationships and the emotional attachments that are known sometimes to develop between captors and captives (Zimbardo 1972: Strentz 1979: Turner, 1985)⁶. During the interviews the first author also administered the clinical questionnaires, most of which were completed on the spot.

In practice the former hostages were difficult to locate, because they had scattered to the four winds - some had gone into hiding and others had left to spend time with relatives abroad. Similarly the families of the hostages still in custody were widely spread, and for security reasons a few had made a point of constantly shifting their whereabouts. Those that stayed put had reinforced their surroundings and taken extra precautions to have relatives and friends keep a watchful eye on visiting strangers. Whereas their partners had been taken prisoner, they had been obliged by circumstances to make themselves prisoner for self-protection. The reactions of the first few interviewed was so extreme that the clinicians felt obliged to extend their programme to include them⁵.

Accordingly, they interviewed key family members in depth, assessed their clinical needs, and had them complete the same three GHQ20, HSCL21, and IES questionnaires as those intended for the hostages. Dr Nailatikau wrote prescriptions where appropriate for minimal dosages of medication to reduce anxiety and induce better routines of sleep. Both clinicians gave advice to help individuals put their suffering into better context and to strengthen their systems of medical and social support, and they maintained liaison afterwards where possible. Then because it was thought other families of hostages might be experiencing similar problems they made a 15 minute advisory radio broadcast in Fijian and English to reach out to them.

As a result, a few other family members did emerge from seclusion to make direct contact. One was the wife of a member of the rebel group that had similar fears about her neighbours and similar problems to face in dealing with her children as did some of the wives of the MP's that her husband's group had taken hostage: the other was her friend with a husband in the same group that was relatively untroubled.

When finally the remaining hostages in Parliament were released, their return was conducted in haphazard fashion, despite the careful arrangements that had been made and agreed upon by all parties⁷. The women MPs were sent directly to their homes in the middle of the night with little or no warning to their families (and only with understandable reluctance could they be brought together again for a debriefing session the next morning), and there was still no indication of when the rebels were likely to release the men. In these circumstances, after 30 days on the project, the senior author left the local Trauma Team on stand-by and returned to New Zealand with the understanding that he would be recalled when necessary.

About two weeks later the remaining hostages were released suddenly in two batches. But because of further organisational interference the procedure proved to be only for a brief medical examination that deliberately excluded the consideration of psychological factors⁸. The first author could not get back to Fiji, and was obliged to maintain contact with his colleagues from a distance and open informal lines of communication through them for the longer-term hostages to take up later when they were ready.

In due course it might be possible to complete the study with the former hostages providing perhaps less reactive and more reflective responses^{9, 10} But there is presently more than sufficient research information available to share with health professionals about the reactions of the hostages that were released early and of the families of the hostages that were still in custody – especially since comparative information has been obtained on the GHQ20 from the HSCL 21, and the IES from a large control group of the Fiji population that had no direct connection with the hostages and is currently being processed.

The Outcome

Ten short-term hostages and 31 family members of hostages were involved in the study¹¹. In presenting the results, the findings of the clinical interviews will be given separately for the two groups, followed by a summary of the associated psychometric data showing certain within-group and between-group data comparisons - including those with a normative control group. The outcome will then be compared with those from similar research studies that others have conducted elsewhere, before overall conclusions are drawn.

Response of the Hostages

The majority of the hostages in the study had spent between two and three days in custody, and the period was sufficient to have made an impact on them. Their dramatic capture had not taken them all by surprise, because some had noticed signs of unusually secretive activity between Members of the Opposition in the corridors of Parliament in the days preceding the coup. One had been warned not to attend Parliament on the day it occurred and to be away overseas. But none had expected quite such a turn of events as began with the initial assault in the debating chamber. They recalled the experience quite vividly. Several spoke of the unreality of that terrifying encounter, saying that they felt as if they were extras in a cowboy film watching the leading players with face-masks racing about firing pistols.

Once subdued by the insurgents, the hostages were segregated by race and gender, shunted into makeshift areas and subjected to strict rules of silence. Their hands were bound behind them, and they were made to sit on the floor within allotted spaces. As the hours passed, the older women were able to talk with the younger men that guarded them. They tried to discover their plans, appealed to them to respect their privacy, and demanded the return of their handbags containing their personal property. Challenging the captors in this way helped them to put their experience into better perspective, exercise some control over their situation of uncertainty, feel not quite so helpless in the strange circumstances, and create relationships that were not adversarial.

In the process, the women learned that the insurgents were highly trained members of a military elite that operated under strict operational rules by which negotiation and surrender would bring them and their families disgrace. They heard that the soldiers expected to face a counter-attack, and if in danger of defeat would not would hesitate to shoot them before killing themselves.

But when the expected counter-attack had not eventuated after 48 hours, the rebel leader ordered the release of all the women and all the administrative staff that were caught up inadvertently in the melee. He also offered all but the most senior of the male Parliamentarians the option of resigning their seats as a condition of their release. However to show solidarity as detainees with their male colleagues, four of the women Parliamentarians rejected the offer. But subsequently on day 21 after being released on compassionate grounds to attend a funeral, a woman MP stayed home with her husband and children. Nine of the males took their discharge, and that was because they were either in marginal states of health, had pressing concerns about the welfare of their families at home, or thought that the legality of any contract signed under duress could be questioned later in Court.

Then once released, the feelings of the MP's were torn with concern for the colleagues they had left behind. They also found themselves not entirely free of hostile surveillance. One received a personal reminder over the telephone from the rebel leader that he could be retaken at any time, and a few received anonymous threats that their houses were going to be burned down and their children assaulted. To counter such threats one MP sent his family away, stayed home himself, had his friends keep an eye on his isolated road access, and so fortified his property that he described himself as 'living in a prison'. Another gave the appearance of being self-possessed, but was quite unable to concentrate when driving her car and to resume her daily round of activities. All were dismayed that in the eyes of the rebels the spectacular progress the Government had made during its one year in office to benefit the poorer people in town and countryside had counted for nought. However, a few conceded that the unwelcome experience of being a hostage had in some ways strengthened them psychologically. None displayed the typical signs of emotional attachment to their captors.

From the interviews with the 10 ex-hostages, in diagnostic terms (DSM IV TR 2000) two were symptom free, four had symptoms, one had Acute Stress Disorder (ASD) that might or might not have diminished after the four week period specified, two had symptoms that lasted sufficiently to be termed Post Traumatic Stress Disorder (PTSD), and one had symptoms of a psychosomatic reaction.

Response of the families

The families that stayed put had also taken precautions to reinforce the security of their homes. They had chained their front gates, put extra bolts on their doors and metal grills over their windows, and erected tall steel-mesh perimeter fences to protect themselves and their property from intruders and missiles thrown from outside. They too had imprisoned themselves, and they had withdrawn emotionally and socially from all but a few of their closest friends and relatives that helped them by keeping guard. But in a state of hyperarousal they developed a thirst for news that had them glued to the extensive radio and television coverage of events. They listened carefully to catch the nuance of every word from the announcers, and they watched for signs of body language from television commentators that might convey extra shades of meaning. Speculation was rife – as after any disaster – and several were agitated by rumours of violence and sexual abuse that the captors were said to be inflicting on their partners. Some had special concerns because their partners were in marginal states of health for which they required special medication and dietary supplements.

The families felt ineffectual because they could do little but exchange brief personal messages via the good agencies of the Red Cross, and provide fresh fruit and changes of clothing that they suspected the captors did not always pass on. The messages they received in reply were limited in content and length and written mostly in stilted language – except for an imaginative exchange in allegorical form between two brothers about the political crisis.

Under protracted siege conditions, the anxiety of family members mounted, tempers became frayed, and none knew quite what to do for the best. Some of the younger children lost their appetites, had sleep disturbance, showed regressive behaviour, and were unusually disobedient. Adolescents became restive about their enforced loss of social independence, and those with ambitions worried about the closure of schools on their subsequent examination performance, scholarship results, and entry to University. A few acted courageously in making non-violent public protests for a resolution of the political conflict, and one played an active part each day in delivering goods from the family homes to a Red Cross Centre. Grown up children still living at home had the prospect of long-term unemployment with no statutory benefit system to support them as the country's economy went further into decline. But all had an overriding concern to keep their families together.

The partners of hostages, the majority of whom were women, tried to maintain a brave front while attending to the needs of others. Many with young families had to cope with the daily routines of their households, allay the anxieties of their children, and nurse their frail and elderly grandparents, while trying to cope with their own worst fears. One found it particularly difficult to assume the role that her husband had of being the disciplinarian of the children in the family. A few were in a state of utter terror. One had shut herself in a bedroom for two days because of anonymous telephone threats on her life. Another was under threat because the local newspaper had omitted to include her husband's name and picture with those of the other MPs, and the caller wanted to know where she had hidden him. But another tried to regard her husband's absence from home as a matter of routine, because his work often took him away for long periods and she was used to managing alone.

Overall the strain took a toll physically and emotionally on the parents at home, as some of their children were quick to point out. Many had lost their appetite - one to the point of losing seven kilograms in weight, having difficulty in concentrating, and becoming so forgetful about what she had just done about the house that she was fearful of losing her mind. Another tried to make a virtue of her loss of interest in food by fasting for 19 days, until she could be persuaded to do otherwise¹². Many had difficulty in sleeping and were troubled by dreams about the fate of their spouses – such as the wife that dreamed repeatedly of her husband being murdered by the rebels. Another was so distraught that in desperation she was determined to march on Parliament the very next day to try to secure her husband's release, until she too was persuaded to adopt another plan.

Most were devout in their religious beliefs whether Christian, Hindu, or Muslim, and they drew on their respective scriptures to try to account for their tormenting situation and to sustain themselves. They cited passages on the question of vengeance, and they attributed their adversity to a Divine plan that had been devised to test the strength of their faith. Those with partners that had been in Parliament at the time of the two previous short-lived coups in 1987 were somewhat resigned to their situation and more inclined to respond to the rebels with tolerance if not forgiveness. But those whose partners had been involved in Parliament for just one year were mortified, because they could think of nothing that their spouses might have had done to justify the measures taken against them. For them the capture was a traumatic affront to their very existence - a breach of natural justice. Some were determined to persuade their partners not to return to politics.

From these interviews with 31 family members, in diagnostic terms (DSM IV TR 2000), 11 were symptom free, 2 had symptoms, 15 had Acute Stress Disorder (ASD) that might or might not have diminished at the end of the four week period specified after the event, and three had symptoms that lasted sufficiently to be termed Post Traumatic Stress Disorder (PTSD).

Psychometric data

Dr Walkey, the third author, analysed the data with the use of the conventional SSPS package (1999). In general they showed that the clinical measures retained their psychometric properties when used cross-culturally¹³. In detail, between-group comparisons showed that the scores of the entire group of hostages and family members on all GHQ20 measures of disturbance, illness, and stress, were high relative to those of the normative control group obtained from the general Fiji population (Table 1). In fact no less than 71% of the combined hostage and family group fell into the top normative decile for the Total Response category, 68% for Anxiety Dysphoria, 63% for Sleep Problems, and 61% for General Illness.

Table 1: Comparing the scores of members of the Hostage and Family Groups diagnosed with PTSD and ASD (Stressed) with the remainder (Other).

STRESSED (N 20)    OTHER (N 21)

N.B.
* The degrees of freedom vary because equal variances could not be assumed.
# The data are presented for the sake of completion, but the brackets reflect the ambiguity of the particular factor.
** Hopkins Symptom Checklist, PD = Performance Difficulty, GFD = General Feelings of Distress, SD = Somatic Distress

Looked at more closely the scores of the hostages were only just above those of the family members on all the scales, but the scores of the hostages and family members that were diagnosed on clinical interview with either ASD or PTSD (N20) differed significantly from those of the remainder on the same three factors and the total score of the GHQ20, on all three factors and the total score of the HSCL21, and on both factors and the total score of the IES (Table 2).

Table 2: Comparing the GHQ – 20 Scores of the Hostage and Family Groups with those of the Control group.

* The degrees of freedom vary because equal variances could not be assumed.
# The data are presented for the sake of completion, but the brackets reflect the ambiguity of the particular factor.

Analyses by ethnicity showed that the Indian ethnic group (N 27) respondents significantly higher than the Fijian (N 11) on:

• the GHQ20 Sleep Problems (Indian, mn. 10.63, s.d. 4.43:, Fijian, mn. 6.45, s.d. 5.45, t (36) = 2.47, p< .05)
• the GHQ20 Total score, (Indian, mn. 31.70, s.d. 14.08: Fijian, mn. 20.45, s.d. 14.36, t (36) = 2.22, p < .05)
• the IES Intrusion scale (Indian, mn. 24.22, s.d. 10.68: Fijian, mn. 14.18, s.d. 9.25, t (36) = 2.73, p< .05), and
• the IES Total score (Indian, mn. 44.56, s.d. = 17.93: Fijian, mn. 28.91, s.d. 21.74, t (36) = 2.29, p< .05).

• the IES Intrusion scale (Males, mn. 26.73, s.d. 10.58: Females, mn. 19.03, s.d. 10.34, t (39) = 2.10, p< .05), and
• the IES Total score (Males, mn. 50.18, s.d. 21.17: Females, mn. 35.73, s.d. 18.32, t (39) = 2.15, p< .05).

The males also gave higher scores than the females on all other measures except the HSCL21 Somatic Distress scale and the HSCL21 Total Score, although not at a level of statistical significance.

Discussion

As might be expected, the distribution of scores by ethnicity showed that the ethnic Indians perceived themselves to be at greater risk than the Fijians. The distribution of scores by gender proved consistent with that in other studies in which both sexes were exposed to the same stressors (Goldberg & Williams, 1988, p.81) and it negated the sexual stereotype that once prevailed of males being problem-focussed and females emotional-focussed (cf. Frances, Widige, & Sabshin, 1991). It suggests that both sexes might have been deft in their use of different methods of coping according to circumstances as the most effective way of dealing with problems, as Strenz and Auerbach, (1988) implied from their study of respondents in an exacting 4 day hostage simulation experiment, and as Zeidner and Saklofske (1996) concluded from their academic review of numerous studies.

Both the hostages and their family members both showed similar high levels of psychological symptomatology as were reported by van der Ploeg and Kleijn (1989) in the first part of their study, and they displayed similar signs of having strengthened their character from their experience. Further comparisons would depend on the present researchers being able to undertake a follow up study.

Comparisons made between the psychometric data obtained in the present study and those in that of Bisson Searle and Srinivasan (1998) - after pro-rating for the different number of items in the two versions of the GHQ20 and 28, and switching from the Likert method of scoring used in the one to the binomial used in the other - showed that while the Impact of Events (IES) scores for the two entire samples were similar (with approximately 25% in the participants in both scoring above the critical level of 35), the Total GHQ score for the Fiji group (N 41, adjusted mn. 9.95) was much higher than either of those obtained for the Gulf (first N 95 mn. 7.09, and later N 54 with a mn. 4.96: private communication....Bisson, 31/12/01). The results of the GHQ data obtained by Easton and Turner (1991) fell between that of Bisson et.al.(1998) and the present study, but their IES data seemed to be higher¹⁴.

While no specific psychometric comparisons could be made between the results that Dane (1986) obtained and those from families in the present study, there were some findings from the interviews in common – i.e. that the participants in both studies experienced strong feelings of anxiety, helplessness, mood swings, and vulnerability.

Conclusions

The present study set out to serve the needs of designated hostages, but of necessity it was extended to include key members of their families. It used standard clinical interviews and psychometric procedures to determine levels of psychological symptomatology, involved an indigenous professional in order to surmount cross-cultural barriers, and subsequently set about standardising the clinical measures on a comparable sector of the Fijian population.

The clinical and psychometric data obtained, showed both groups to have suffered traumatic effects, with the ethnic Indians giving higher readings than the ethnic Fijians. Then regardless of their ethnic backgrounds the males gave higher readings than the females.

Overall the adversity of the individuals was personal, interfamilial, and communal, with the hostages after release trying to achieve a satisfactory understanding of the problems they had faced while having been held prisoner, and the family members of those still in custody trying to cope with their continuing fears, intimidation, and uncertainty.

Two fresh topics turned up that are worthy of further consideration. The first was the adaptive significance of religious belief, and the second was the centrality of social justice as a human need. Many participants, particularly the family members, alluded spontaneously to the presence of the first and to the absence of the second when trying to explain how they were coping with their plight. The references to religion made clear that, despite its use by some militants to foster more bigotry and fanaticism than peaceful co-existence¹⁵, religion provides a code for living that can be countenanced with caution in the process of helping individuals and communities to recover from trauma (Taylor 1999; 2001).

Therefore as a matter of routine, clinicians and researchers are advised to include an appraisal of value systems among the complex of factors about which they inquire when making their diagnostic and prognostic assessments of traumatised people. The World Health Organisation might also be invited to extend its definition of health from the complete state of mental and physical well-being, to acknowledge explicitly the underpinning of moral and social values (see Ottawa Charter for Health Promotion 1986 update December 1997).

Similarly the spontaneous appeals that the subjects in the present clinical study made for social justice, suggest that morality extends beyond the development of conscience, group relations, criminality, and mental health, to reflect a fundamental human need of individuals to establish and maintain a binding social contract with others in their local community. As such the psychological need for social justice deserves recognition in its own right, and its abrogation could be added to the list of causative factors of traumatic stress disorder.

Questions about the kind of organisational framework required to establish a fully effective post-disaster trauma service have been set aside for further consideration (cf. Taylor in press). But at least in the immediate future the present study has made one clinical measure of traumatology available with known cross-cultural psychometric properties for the use of health professionals in Fiji (the GHQ20), and shortly there could be two others (i.e. the HSCL21 and the IES). In the not too distant future it would be ideal were it possible to full the gaps in the present study and to follow-up those that have already participated. The outcome has the potential for benefiting all concerned, including the different components of the community at large - academic, general, and scientific.

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Notes:

1. When accessed on 9 February 2002 under 'hostages and trauma', PsycInfo gave 19 entries, PubMed 226, and the more extensive Google 'about 5 010'.
2. At the time of writing the first of such standardisations – on the GHQ - has been completed, and those for the IES and the HSCL21 are in process.
3. In particular the temptation to quote Greenwood (1894), cited in E.T. Campagnac, 1922, p. 214) was resisted - i.e. 'Imprisonment is wasted on persons of inferior character. Waste it not, and you will have accommodation to learn the monk's lesson…that that a little imperious hardship, a time of seclusion with only themselves to talk to themselves, is most improving. For statesmen and reformers it should be an obligation'.
4. If the first three dimensions were consistent with the WHO's definition of health (Ottawa Charter, 1986 rev. 1997), the fourth was an elaboration that the first author's previous post disaster experience with other Pacific Island communities had shown to be important (Taylor, 2001).
5. There is now evidence of a complementary relationship – tentatively named the Jolo syndrome after the remote jungle-clad islands in the Philippines in which Muslim rebels had just held 19 hostages for a long period. It refers to the strong attachment that the captors made to their two French captives that made the captives fear they might never be released (Reuters of 22 September 2000). The dynamics of the phenomenon and of its opposite the Stockholm syndrome or Hostage Identification Syndrome (HIS), can both be conceptualised as akin to the polar opposites of the transference and the counter-transference relationship that arise commonly during the process of psychodynamic psychotherapy.
6. Regrettably the circumstances did not allow us to extend ourselves further and mount a systematic study of the clinical status of all of the family members. Consequently we had to be content with confining our attention to the most troubled of those that either were present or were drawn to our attention when by arrangement we called at their homes.
7. The mismanagement was disappointing but not altogether unexpected, because important but underlying factors are known to generate resistance between groups of professed helpers after any disaster when unity and cohesion are much in demand - To quote Young, Ford, Ruzek, Friedman, & Gusman, (1999, p. 11),
   'Turf and organizational politics are pervasive and volatile at disaster service sites, Incident Command center(s), and at national headquarters of response agencies…Organizational and personal struggles may result in mental health professionals and programs becoming scapegoated as wasteful and an interference with the 'real' work of restoring a community's physical and medical integrity after disaster. Alliances must be chosen carefully so that mental health is not marginalized'
8. At this late stage in the proceedings, the Director of the local Red Cross, no less, from earlier having given his tacit approval, declared his personal resistance to psychological factors. He was impervious to persuasion, despite the statement by his own international body, the International Federation of Red Cross and Red Crescent societies, in their World Disasters Report (1998 ch.3) that in the five major international aid agencies the 'Psychological support in the aftermath of crisis is increasingly being brought into relief operations …(and they are) addressing issues of disaster mental health'. He proceeded to exclude the Trauma Team from the debriefing programme, to the point of blocking their entry to the Red Cross building in which by prior arrangement to satisfy him it was to be held. The problem for clinician/researchers is to design strategies in advance to deal with unexpected mavericks.
9. The absence of the longer-term hostages from the study was regretted, but hope springs eternal because there was a delay of over 20 years in one study of former prisoners-of-war to the effects of their captivity and in another of political prisoners (cf. Engdahl Harkness Eberly Page & Bielinski 1993: Ehlers Maerker & Boos 2000). But by arrangement Dr Henry Aghwana, Consultant Psychiatrist of the Fiji Medical School, made himself available to assist Dr Nailatikau with interviewing them if and when it becomes possible. The matter is important, because in an Argentinian study, six months after their release some 65% of hostages taken in various criminal and terrorist activities acknowledged having psychological symptoms (Bigot & Ferrand, 1998).
10. In the present instance, aside from the organisational friction and perhaps the desire to avoid the revival of 'malignant memories' (Schwartz & Kowalski, 1992) the former hostages will have had to protect themselves and their families from the continuing hostility against them in some quarters of the community, and to prepare a foundation for their own future careers whether in or out of politics. There was also another election in prospect, and the former hostages had good reason to fear that their political opponents might try to make capital out of any suggestion they might not be functioning 100% as a result of their incarceration.
11. Three participants were omitted from this research report - one of the hostage family members because of incomplete data, and two family members of rebels because they were the nascent elements of an identifiable separate group.
12. Not to discount the role of religion in pastoral affairs, the woman's explanation seemed to be more of a rationalisation of a pathological process than a reflection of her spiritual testimony.
13. The failure of the fourth factor, depression, to emerge, was consistent with the prior clinical observation of Consultant Psychiatrist Dr Henry Aghanwa of the Fiji School of Medicine that the Fiji population tended to accentuate symptoms of somatic illness rather than depression (private communication, March 2000).
14. The data presented did not use a specific IES cut-off score from which comparisons with the present results could have been made.
15. The propensity to perpetrate violence in the name of religion is well documented. In a recent indictment, Sells (1996) details the attempts that were made in Bosnia to cloak a basic ethnic war with religious overtones to justify the atrocities perpetrated there, Ignatieff (1998) does the same for Afghanistan, and Reid (2001) goes further back to make a critical reappraisal of the complex motivations of the Crusaders.

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