As noted, the first section of this chapter focuses on the trauma at hand and is intended to contextualize the after effects of war captivity in the actual experiences that had brought about their manifestation, namely war and war captivity themselves. Explicating the horrors of war is meant not only as a means for achieving a better understanding of the experiences inveterate in war imprisonment, but also to enable a comparison of the characteristics of traumata sustained on the battlefield and those which may be endured in the incarceration that may follow. Hence, we first situate war captivity within the general context of war stressors, physical, mental, and interpersonal; and then turn to the time of captivity itself and the harsh experiences it entails. Throughout this section, we primarily highlight the interpersonal aspects of captivity, the ramifications of which are further discussed in the next section.

In the second section, indeed the lion’s share of the chapter, we discuss the posttraumatic long-term ramifications of war captivity. As noted, we ground these consequences in a prospective longitudinal study of Israeli ex-POWs . Throughout this section, we tie our examinations to broader theoretical frameworks such as attachment theory and loneliness research. By integrating these with one another, we address the greater context of interpersonal deficit. In so doing, we are able to demonstrate how several aspects of ex-POWs’ psychosocial realities following repatriation are strongly related to what they have endured in their time of incarceration.

We bring this chapter to a closing by laying forth the implications of the observations made throughout the chapter for future research, clinical practice, and policy making.

When dealing with ex-POWs , one must realize that more often than not these are soldiers who have endured combat to some extent and have subsequently fallen captive by their enemies. This means that they have been exposed to combat stressors prior to captivity and have carried those burdens of war with them as they were marched, usually blindfolded, humiliated, and bruised, into their captors’ dungeons. Hence, in order to understand the experience of being a POW, it is imperative that one first have some awareness of the context that the POW has come from—that is an understanding of the immediate and ongoing implications of combat.

As Scarry (1985, p. 61) most poignantly notes, “The most obvious analogue to torture is war.” Both cases represent a reality in which human beings deliberately harm other human beings, and both very often leave scars on both body and soul. The person participating in combat is faced with many adversities. The most obvious of these are the constant threats to one’s physical integrity and indeed to one’s life. These include a multitude of physical deficits such as a dearth of sleep, nutrition, hygiene, and shelter. Additionally, on the battlefield, combatants are under continuous exposure to life-threatening circumstances as all around them bullets buzz and strike, and bombs explode and demolish. Naturally, these give rise to devastating sensations of fatigue, deterioration in health, feelings of uncertainty, helplessness, and dread. Indeed, combat entails a kind of continuous anticipated dread, a constant fear that something terrible is just on the verge of happening. All of these come together and take their toll not only on the combatant’s body but also on his psychological state (Solomon, 1993). But there are additional, less conspicuous yet no less significant aspects involved that are worthy of attention.

Combatants must often face interpersonal deficits such as loneliness (Dasberg, 1976; Solomon, Mikulincer, & Hobfoll, 1986) , lack of social support, and the denial of any sense of privacy (Solomon, 2001) . Combatants are further exposed to severe violence as they are condemned to witness the death and injuries of others, often their own friends and comrades. Moreover, they must often also behold the gruesome demise of the enemy, as they find themselves taking the role of the perpetrator, engaged in the aggressive and violent acts of killing. Furthermore, in the face of this reality, many soldiers may come to question whether they have betrayed “what’s right” (Shay, 1994) in the process of fighting for their country, thus sustaining what has been termed moral injury (Litz et al., 2009; Shay, 2014😉 .

Subsequent captivity then continues to drain the remaining vitality that the combatant has managed to retain, as it occurs after the soldier may be quite battered, tired, lethargic, and devoid of much of what has kept him going up to that point. It is imperative that we keep this in mind as we begin to examine the hardship of captivity within the depths of the captors’ dungeons.

Soldiers who fall captive by the enemy continue to be exposed to even more extreme interpersonal traumatic experiences than those sustained on the battlefield. It is important to take note of the fact that there is no “one” experience of war imprisonment, and experiences may vary as the captors vary. For instance, one might expect to see different forms of torture manifest in the Vietnamese camps, than in the Nazi concentration camps, the Soviet gulag, or the Japanese or the Islamic State of Iraq and Syria (ISIS) captivities.

Take for instance the population that is the focus of this chapter, namely Israeli POWs who were held captive in Arab countries. During the 1973 Yom Kippur War, 240 infantry Israeli soldiers fell captive on both the Syrian and Egyptian fronts. POWs held in Egypt were released after a relatively short period of time extending slightly more than a month. However, POWs in Syria were held for as long as 8 months. One significant difference between these two captivities is that during captivity in Egypt, the prisoners were held in separate cells, while in Syria, after a period of rigorous interrogations, POWs were held in two groups, each situated in a large shared room. While sharing a conjoint cell may be expected to somewhat alleviate POWs’ loneliness , it has also been reported by ex-POWs to have been a source of new stress due to lack of privacy and intense unregulated contact with other POWs (Avnery, 1982; Lieblich, 1994) . These experiences gave rise to feelings of humiliation , guilt, frustration, and shame—all significant stressors.

However, some attributes are similar in many instances of war captivity and are less bound to the captors’ identity. Many times for instance, the abuse begins long before arriving at the enemy’s captivity facilities. Israeli POWs on either front disclose being subjected to humiliation and beating from the moment they lay down their weapons and throughout their journey to their location of imprisonment. They attest to being denied any opportunity for orientation as they were led to their destination blind folded and tied up. Indeed, the actual moment of falling captive is a stressor on its own merit.

Upon arriving and during one’s captivity, the POW is usually held in poor conditions of sanitation, is set in a climate of extensive maltreatment, and is continuously deprived of sufficient amounts of food and water (e.g., Hunter, 1993) . Whereas deprivation in combat is a matter of environmental and logistic constraints, deprivation in captivity is intentional, deliberate, and easily attributed to malicious human conduct. Various methods of control and coercion are employed by captors in order to deprive POWs of their most elementary sense of autonomy and replace it with a sense of humiliation, horror, and helplessness. Thus, it is of utmost importance to realize that captivity does not only include harsh conditions but is also characterized by vile and many times sadistic and pernicious interpersonal interactions between captive and captors (Avnery, 1982; Herman, 1992) .

Indeed, learning of the horrors of captivity bears with it the realization that there is no limit to the innovation, ingenuity, and creativity of human evil and torture . Instigated by a guard’s boredom, bad day, or sadistic nature, brutal beatings for no particular reasons may be a matter of course in the routine environment of captivity. According to POWs’ reports , torture during interrogation sessions often entailed, the usage of electric shocks, beatings, whipping, and many other methods for inflicting pain . POWs sustained burns, severe blows, and mutilation. However, bearing witness to POWs’ testimonies, one very rapidly comes to the understanding that torture and misconduct exceed the brutality of interrogations, and were extended to all realms of captivity. For instance, POWs disclose instances where they were forced to stand for days in their cells, facing the wall, and in full awareness that any failure to remain erect would result in brutal beatings. Or they attest of being deprived of any kind of liquid substance, literally in a state of scorched throats all dried up and longing for water. And in those moments, a guard would enter the cell, a bucket of water in his hand. As hope begins to well up, the guard would spill the water on the floor, just out of the prisoner’s reach. Or then again, they tell of mock executions designed to give the prisoner the sense that he is about to be executed by a firing squad—indeed that he is executed, as the trigger is pulled and no bullet is shot. We commonly think that a person may die only once. However, in the face of these firing squads, POWs have experienced their executions and deaths, time and time again. POWs recount being urinated on, or then again of those moments in which they realized that they are expected to urinate and defecate in their garments, and they tell of doing so. They tell of being thrown into an empty cell, deprived of any light or mental stimulation for days on end. They confessed their confusion as they sensed the walls of their cells are moving, just to realize that the sense of motion is due to the fact that their cell is infested with swarms of blood thirsty flees. Many POWs note that one of the most difficult experiences in captivity has been to see their friends being tortured and witness their agony, or otherwise the experience of hearing their screams echo within the dungeon’s corridors. It is both the horror of bearing witness to such torture and the terror of knowing that your turn is coming that made these experiences extremely intolerable.

We may learn of yet another technique, one that was also evident in the Israeli POWs experience and has become part and parcel of the attempt to break the POWs’ spirit, namely the use of false propaganda. Recall that combatants have fallen captive in the course of combat. Hence, their knowledge of “the big picture” of both the war efforts and their state’s faring was extremely limited. This was of great import for their captors who knew very well how to use this piece of information against them. In fact, during the Yom Kippur War, Israeli POWs were repeatedly exposed to anti-Israeli propaganda, misinformed of the death of Israel’s leaders, the triumph of Arab states over Israel, and the Arab occupation of Israel altogether. At times, captives were informed that their homes were destroyed and their loved ones and relatives were killed. These acts of misinformation then served to exacerbate feelings of hopelessness and despair. Far from being an exhaustive account of the horrors of captivity, the above may provide a preliminary notion of what the experience may be like.

Deprivation of a benevolent human interaction may enhance the captive’s dependency upon his captors and strengthen these distorted and harmful relationships. How confusing is it when the person on whom you depend for food and for relieving body wastes is at the same time the person who is in charge of your most agonizing experiences? These confusions are apparent, for instance, in certain attributions made by POWs vis-à-vis their captors (Avnery, 1982) . POWs tell of categorizing guards as “the good guard” and the “bad guard” as they compared their captors’ cruelty. It is noteworthy that it is not that the “good” ones were kind, but rather that they were not as cruel as others. Nevertheless, the attempt to infuse some meaning of goodness even in those menacing times is noteworthy.

Given all of the above, it then becomes quite clear that war captivity bears extensive multilayered and multifarious interpersonal aspects. Taking these into account, several questions arise regarding the impact of war captivity on interpersonal perceptions, experiences, and actual relationships in postwar quotidian life:

In light of the aforementioned, distinct attributes of war captivity , Solomon and her colleagues set out to prospectively examine the long-term impact of war captivity on interpersonal relationships among Israeli ex-POWs . The study targeted all Israeli land forces soldiers who had been captured by Syria and Egypt in the 1973 Yom Kippur War. The study then followed these ex-POWs over the course of a 35-year period, summoning them in for follow-up assessments in 1991, 2003, and 2008 (See Solomon, Horesh, Ein-Dor, & Ohry, 2012) .

Veterans were then divided into two groups: (a) ex-POWs and (b) a control group consisting of combat veterans, who fought in the same fronts as the ex-POWs but were not taken captive. Controls were matched with the ex-POWs in personal and military backgrounds. In this comprehensive study, both groups were assessed and compared across an array of intrapersonal and interpersonal domains. Among these, were psychopathologies (e.g., PTSD, depression, anxiety) comorbidities, and psychosocial aspects, along with a wide gamut of other variables. In the current chapter, we focus on those findings relating to the interpersonal aspects that were found significant in the aftermath of war captivity.

One variable involved concerns ex-POWs’ attachment patterns. Indeed, as will become evident below, a significant implication of the interpersonal violations in captivity for the time that is to follow may be the detrimental effect on one’s capacity to draw upon his attachment resources in times of need. In order to address these ramifications, we first provide the theoretical foundations of attachment theory and its significance for understanding traumatic aftermaths .

… Prolonged captivity disrupts all human relationships and amplifies the dialectic of trauma. The survivor oscillates between intense attachment and terrified withdrawal. (Herman 1992, p. 93) .

According to attachment theory (Bowlby, 1982) , human beings are born with a psychobiological system (i.e., the attachment behavioral system) that motivates them to seek proximity to supportive others (i.e., attachment figures) in times of need. This is done for the sake of gaining a sense of safety and security (see Chaps. 8 and 22, for related discussion). However, people differ in their inclination to activate this attachment system. That is to say that while the predisposition to seek proximity and to rely on others as a source for protection and security is a universal phenomenon, nevertheless, some people are more reluctant than others to do so. According to attachment theorists, these varying inclinations in adulthood are a result, primarily but not exclusively of the person’s history of interactions with attachment figures throughout his or her developmental stages in infancy and early childhood (Bowlby, 1982) . Interactions with figures that exhibit availability, sensitivity, and responsiveness in times of need promote effective proximity-seeking strategies and encourage the development of a stable sense of security. This sense of security includes implicit beliefs that the world is generally safe, that other people are “well-intentioned and kind-hearted” (Hazan & Shaver, 1987; Mikulincer & Shaver, 2007) , that one is valued, loved, understood, accepted, and cared for by others, and that one can explore the environment with interest and engage rewardingly with other people. These beliefs are associated with and rooted in positive mental representations of self and others, which Bowlby (1973) called “internal working models.” Such internal models shape the person’s expectations regarding future interactions with the same or other relationship partners over time, especially in times of need.

Unfortunately, when a person’s attachment figures have not been reliably and consistently available, sensitive, and supportive in the critical early years of one’s life, he or she learns that seeking proximity to others does not relieve distress. Under these circumstances, negative working models are formed and a representation of self as not sufficiently lovable develops along with a representation of others as unaccepting, unreliable, and unresponsive, if not downright abusive or cruel. Conversely, affect-regulation strategies other than secure-based proximity seeking may develop. Attachment theory refers to these alternative patterns as “attachment-anxious” and “attachment-avoidant” orientations. According to the theory, individual differences in working models and distress-regulation strategies eventually become trait-like attachment “styles” or orientations–characteristic patterns of relational expectations, emotions, and behavior (Bowlby, 1982; Fraley & Shaver, 2000) .

In times of stress, a secure-based attachment pattern can constitute a source of power and comfort. This seems to be the case when facing traumatic experiences (for an overview, see Mikulincer & Shaver, 2007, pp. 387–391) . Indeed, previous studies have shown that attachment security can have healing effects for people suffering from PTSD and can improve their response to treatment (e.g., Forbes, Parslow, Fletcher, McHugh, & Creamer, 2010) . For those who fell captive, where no actual comforting and supporting figures are present, internalized positive and stable attachment figures might enable better adjustment and coping, during captivity and in the years after the war.

Solomon, Ginzburg, Mikulincer, Neria, and Ohry (1998) examined the implications of attachment in both immediate coping and long-term adjustment of Israeli ex-POWs. In this study, as expected, individuals with secure attachment retrospectively reported less suffering and helplessness in the time they were captive, compared to attachment-insecure persons. They also demonstrated the use of more active coping strategies and exhibited better long-term adjustment. In contrast, attachment-avoidant POWs reported feeling helplessness and hostility, and anxious individuals reported feeling abandoned and vulnerable. Both avoidant and anxious individuals reported long-term maladjustment following captivity. Secure attachment style then serves as a stress-regulation resource and revealed the important role that attachment style plays in adjustment following traumatic stress (See also Zakin, Solomon, & Neria, 2003) .

Whereas the protective effect of secure attachment against psychological distress is well documented, there remains the question regarding the possible effects of traumatic experiences on the attachment system. Although attachment orientations are initially formed in relationships with primary caregivers (usually parents) during infancy and early childhood (Bowlby, 1982) , as confirmed by several decades-long longitudinal studies (reviewed in Cassidy & Shaver, 2008) ; Bowlby (1988) also argued that relationships formed later in one’s ontogeny (e.g., friends, romantic partners, and therapists) can alter the sense of security in attachment. In fact, research indicates that a person’s sense of attachment security can change, subtly, or dramatically, depending on naturally occurring or experimentally induced contexts (Mikulincer & Shaver, 2007) .