OAKLAND -- For American hikers and UC 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, a psychotherapist and expert on trauma care for victims of war, terrorism and kidnappings.
The challenges of coming home for Bauer and Fattal may manifest in a variety of ways. The long-term nature of the ordeal means the 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
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 prisonmate at Evin, also recounted how her jailers took her clothes and 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."
The Iranian regime has thrown several journalists, Iranians and foreigners, into Evin in the past several years. One of those, Roxana Saberi, an American television and radio journalist, was arrested by Iranian authorities in January 2009 and held in Evin for 100 days. She was interrogated regularly, and she often heard other prisoners suffering from torture and beatings. "I heard another prisoner on the other side of my cell whimpering and crying, and a woman guard telling her she was only hurting herself by not eating," she wrote in an email from Italy on Wednesday. "I heard a male guard instructing a male prisoner how to take care of his feet. I assumed they had just been lashed.
"I heard weeping of another prisoner when I was being interrogated. All this is part of the general atmosphere of fear that the authorities often try to create to break down prisoners in Iran."
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."