Bowe Bergdahl: What does a returning POW need?
After five years in Taliban captivity, US Sgt Bowe Bergdahl has arrived in Texas for the next stage of his "reintegration" to freedom. What does the programme consist of and what does a returning prisoner of war need in the long term?
The first stage of the military's reintegration mission is straight-forward - ensure the ex-captive is safe and out of immediate danger. The Pentagon says this takes 48-96 hours and often deals with emergency medical issues and time-sensitive intelligence debriefing.
The second and third stages begin what can be the lengthy task of processing the emotional and psychological effects of captivity.
"Bowe's been gone so long that it's going to be so difficult to come back," Sgt Bergdahl's father Robert Bergdahl said at a news conference soon after his son gained his freedom. Mr Bergdahl likened the experience to a deep-sea diver returning to the surface - it needs to be done slowly.
"If he comes up too fast," he said, "it could kill him."
Defence officials don't make such dire warnings, but they use the same term with which divers describe the process of slowly, deliberately returning to the surface: decompression.
In a press briefing about the US military's reintegration process, a defence department psychologist likened decompression to how one might take time to come to grips with a bad day at work before dealing with the responsibilities of home and daily life.
A prisoner of war (POW) has his ability to make choices taken away during captivity, the psychologist said.
To ease him back into what would otherwise be an overwhelming series of decisions, military psychologists explicitly describe to returning captives what they can expect in the near future and when they will have to make choices.
"We start off by giving them the ability to predict," sometimes down to an hour-by-hour schedule, said the defence psychologist, who spoke on condition of anonymity.
Talking about what happened during the captivity is also part of decompression, and can continue for years to come.
Dr Jeffery Moore, executive director of the Mitchell Center, which has studied how ex-POWs fare years and decades after their return, said those most at risk for delayed-onset post-traumatic stress disorder (PTSD) tend to be the people "who push the cork underwater" in an attempt to gain control over their emotions.
"They can't tell the problem is there until it pops up," he said.
But getting military members to describe what happened to them in captivity can be difficult.
"For some people, it's a very slow process in that before you can even talk about those issues, you have to establish a strong therapeutic alliance," he said.
"Other people, they're ready - they've had strong mentors, maybe even a senior officer that... served as a role model for what resilient people are like, including the ability to talk about emotions and bounce back from certain situations."
Decompression also helps returning captives plan for possible stressors in their day-to-day lives.
The defence department psychologist cited a returning captive who had been confined to a tiny cell that reeked of urine and faeces.
The psychologist told him that at some point he would have to use a petrol station toilet, "and you're going to flick the light, the light's not going to come on, the floor's going to be sticky and at about that same time, you're going to smell the urine and faeces smell from this unclean restroom. And you're going to have very vivid memories".
"And you have a choice at that time, how you choose to react," the psychologist said he told the ex-captive. "You can say, 'Oh my gosh I'm having a nervous breakdown, I thought I was over this.' Or you can say, 'That crazy doctor told me this was going to happen. Now what do I want to do?'"
Such plans enable returning prisoners to manage their reactions to strong memories and to deal with stress - including media attention.
Dr Moore said the Mitchell Center's research had identified how important resilience is for retuning POWs. While treatments such as cognitive behavioural therapy and eye movement desensitisation and reprocessing are at "the top of evidence-based treatments for PTSD", Dr Moore said building up psychological strengths - adding to that resilience - was highly-effective for long-term coping.
"All those repatriated I've spoken to have realised their experience does not inoculate them against stress in the rest of their lives," he said.