OAKLAND, Calif. -- For American hikers and University of California, Berkeley, graduates Shane Bauer and Josh Fattal, the realization of their recently gained freedom may take a while to sink in. The process of readjustment could be tough and painful.
"They've been in prison for such a long time, it would be surprising if they weren't suffering from trauma," said Francine Shapiro, founder of the EMDR Humanitarian Assistance Program. EMDR, or eye-movement rapid desensitization, along with trauma-informed therapy, is internationally recognized as an effective treatment for people who have suffered significant exposure to trauma, such as veterans, and victims of terrorism and kidnappings.
The challenges of coming home for Bauer and Fattal may manifest in a variety of ways. The long-term nature of their ordeal means that their trauma will be deeply embedded in their memories. As they readjust to freedom, anything that reminds them of their captivity could become what psychologists call a "trigger," or something that takes them back to their time in Iran's Evin prison and reignites the experience.
"They're going to have emotions that can get triggered," Shapiro said. These triggers could include noises similar to what they might have heard in prison, which, judging by the extensive human rights abuses that have taken place at Evin over the years, could include screaming from the sounds of torture all the way to the creaking sounds of jail doors closing. It could also include bright lights or the faces that resemble those of their interrogators.
According to Shapiro, "these things automatically link up with memories they've had." The result can be increased anxiety, depression, sadness or fear.
By most accounts, Evin ranks as one of the world's loneliest and scariest prisons. Maziar Bahari, a Newsweek correspondent who was detained at Evin for 118 days in 2009, was routinely beaten by professional torturers, called "specialists," and came to fear the sound of other cell doors opening because it signaled the arrival of a torturer.
Sarah Shourd, Bauer's fiancee and former prison mate at Evin, also recounted how her jailers took her clothes, her glasses, and questioned her relentlessly for many of her 410 days in captivity.
"It's hard for me to go back and think about life as it was before," she recounted in The Daily Beast, an online news magazine. "I'm a changed person."
For some, the experience of detention leads to profound spiritual changes. Terry Waite, a British humanitarian who traveled to Lebanon in 1987 to negotiate for the release of American hostages in Iran and was himself taken hostage, has since spoken about the ways in which the experience changed him.
In a letter of support to an international nonprofit group, The Forgiveness Project, Waite wrote: "If one can understand why people behave as they do, then often the road to forgiveness is opened."
Waite, who was held for 1,763 days by the Islamic Jihad, eventually forgave his captors. "Bitterness is like a cancer that enters the soul," he wrote.
As Bauer and Fattal begin their readjustment, experts say they need to keep a few key things in mind. Regular sleeping patterns, constructive routines, and a slow and steady approach to reintegration are the three most important things, said George S. Everly, chairman emeritus of the International Critical Incident Stress Foundation, and an associate professor of psychiatry at Johns Hopkins University School of Medicine.
Everly and others say that long-term imprisonment is one of the worst kinds of trauma because the punishment begins to take on a never-ending quality. Humans tend to be better-equipped psychologically to cope with one-time traumas such as 9/11, hurricanes or car accidents. "The long-term incarcerations, frankly, are far more likely to make lasting changes in people," Everly said.
The worst possible outcome would be for Bauer and Fattal to become ensnared in the grip of a media all too eager to turn them into heroes. "The worst thing that could happen is that they become celebrities around this," Everly said. "All that does is reinforce their victim role."
Bauer and Fattal do have one strong advantage. They were traveling as journalists, which may mean they'll have a different, and perhaps more flexible, perspective on their own captivity.
"It's very easy to look at these stories through the trauma, PTSD frame and assume that people will be traumatized in a predictable way," said Mark Brayne, a British psychotherapist and former director of the DART Center for Journalism and Trauma.
Brayne, who has worked with hundreds of journalists and helped establish the BBC's trauma program for reporters, said no single template applies to everyone.
"Journalists draw from a range of possible options, they range from extraordinary resilience and strength where they draw meaning from these experiences to being profoundly unsettled in the long term."
The most important thing anyone can do, Brayne said, is "actually listen to what they say when they come out, and be respectful of their individual experience."