A Victim Of Stockholm Syndrome

She was beautiful. Early forties, slender, blond hair with a few streaks of gray. She could not stop crying and could not think of any way out of her predicament. Several had been suggested. The one she kept thinking about, however, was suicide. She thought it was the only one, and I believe it never is. This woman literally could not look at an electric cord without thinking how to choke herself with it. She could not look at a plastic bag without thinking how to asphyxiate herself with it.

Patty Hearst/SLA

As far as I am concerned, this is a biological problem. It has something to do with low serotonin in the central nervous system. I remember years ago, reading about a study done in Detroit, comparing the serotonin in the cerebrospinal fluid (the fluid around the brain and spinal cord) in people who had been gunshot victims with levels of the same chemical in people who had shot themselves. Those who had shot themselves had less.

People are still working hard to track the brain chemistry of suicide.

Whenever someone tells me they are thinking seriously about suicide, there is very little I can do. I have to confine such people for their own safety. Every state has such a law. Despite critics of psychiatry accusing folks such as myself of taking away the freedom of people who do not deserve such interventions, the process is difficult and I would not do it unless I believe it to be lifesaving. But this woman had been through a lot of prescription drug treatment and it had not stopped her from returning to this piteous state.

My job, I have always thought, consisted first of pattern recognition, trying to find ways to fit people into patterns and use those healing patterns to cure them, if that is fast and easy. Then, when people do not fit into the patterns, I have to look further.

She had a unique situation. As far as I could figure, this intelligent, articulate, and beautiful woman had some kind of a hostage scenario with her husband. He was angry, potentially dangerous, and she believed he could kill her at any time. He had been quite cruel, there seemed to have been beatings. However, she had never pressed charges, never sought shelter outside the home.

There were only the two of them in the home; children were far removed physically and mentally and leading their own lives.

I found myself thinking about a condition called “Stockholm Syndrome.” Not the stuff of brain chemistry or medicine; more the stuff of love and hate.

Here is a discussion, with photos, of the original botched bank robbery in Stockholm where four hostages kept for six days refused to testify against their captors.

One became engaged to marry one of her captors.  Notable is their discussion of the psychoanalytic context. When people are that dependent upon someone else for their lives, it certainly is similar to the state of a highly dependent infant.

“Regression” is a state in which someone behaves as they were at a far earlier stage of development. In general, this is tough enough to induce and hard enough to control that only specialized psychotherapists do this. The idea of “regressing” people can get pretty controversial.

Perhaps the most famous and controversial example of regression is that of Margaret Bean Bayog and a patient who ended up — committing suicide.  I think there is another way of looking at the data.

I think of Stockholm Syndrome more as an example of operant conditioning. This is the stuff that college and even high school introductory psychology courses are made of.

This is the situation where a mouse who pushes a lever gets food. The mouse “learns” that when food is desired, the lever should be pressed. They call it “positive reinforcement.”

Humans learn to do things for rewards. We work for paychecks — that is far and away the example most often cited.

As for “negative reinforcement,” if an animal gets a disagreeable response, like maybe an electric shock, for example, putting its foot in the wrong place, you better believe the animal will figure out not to put its foot in that place.

Things really get interesting when we are talking about “intermittent reinforcement.”
My favorite example of this is the slot machine. You know that it is going to pay off sometimes, but you don’t know when. You get little intermittent payoffs; sometimes a little money, more often some lights and sounds.  If you doubt this system works, just watch the people along the rows of slot machines in any gambling casino. They are plainly in some kind of altered state of consciousness as they pump money into these machines.

I remember when I took my first college course in psychology, watching a mouse who pumped a lever for food pump faster and harder when the food pellets came only occasionally (intermittent reinforcement) than when they came with every push of the lever (positive reinforcement).

A captor who performs seemingly token (at least to someone on the outside of the system) acts of kindness is giving the captive a sort of intermittent reinforcement that may be incredibly compelling.  Back to the beautiful, suicidal patient. It is still not certain what will happen to her. She may be starting to recognize the need to be away from her husband for at least a little while. I do not expect her to show any interest in the idea of having her response to her husband “deconditioned.” She still claims she loves her husband.

The only official suggestions on how to treat Stockholm Syndrome seem vague; things like medication with psychotherapy.

Sometimes, the ideas about treatment just seem more theoretical than real life.

As often in psychiatry, the answer seems to be to take whatever theory and experience fit the patient sitting across the desk. To find, in the life of another patient or in some skillfully written literature or even in a life known to me — even my own — a moment, a situation, where it is possible to identify with the patient. To take lessons from brain chemistry where they seem to be real and scientific and believable, but to use any paradigm, any scenario, anything that illuminates the mystery of patient suffering and to try to apply it, never agreeing to give up or surrender.  The route to this objective is usually through time spent with the patient — not talking, but listening.