The Effects of the Holocaust: Psychiatric, Behavioral, and Survivor Perspectives
e Journal of Sociology
ffects of the H olocaust: Psychiatric, Behavioral, and Sur vivor Perspectives
Case Western Reserve University 0 1 2 3 4
Cleveland State University
0 Harel , Zev; Kahana, Boaz; and Kahana, Eva (1984) " The Effe cts of the Holocaust: Psychiatric , Behavioral, and Survivor Perspectives,"
1 Cleveland State University
2 Eva Kahana, Ph.D. Case Western Reserve University Cleveland , Ohio 44114 , USA
3 Boaz Kahana, Ph.D. Cleveland State University Cleveland , Ohio 44115 , USA
4 Zev Harel, Ph.D. Cleveland State University Cleveland , Ohio 44115 , USA
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In large part scientific curiosity has focused on
matters relating to the human capacity to endure
extreme suffering, the nature of adaptive survival
mechanisms employed by Holocaust victims, the
pathological consequences of the trauma, and the adjustment
of survivors to post-war conditions. Professional
interest has largely been directed toward the
pathological effects related to the Holocaust experience,
including its impact on the children of survivors, and
only to a limited extent on methods which can be used
to aid survivors to adjust socially and
psychologically to post-war conditions.
Beliefs held by public officials and health and
human service professionals concerning the needs of
vulnerable individuals largely determine allocation of
resources, treatment strategies and care practices
(Perrow, 1967, Harel, 1978)
. For this reason, an
exploration of the needs of Holocaust survivors, based
on perceptions held by the public, professional groups
and by survivors themselves, is important. Common
perceptions of these problems are more likely to
facilitate communication and understanding between
survivors and members of the helping professions as well
as with the general public.
The perception that a public is empathetic toward
survivors of the Holocaust experience is likely to
enhance the integration of survivors into the
mainstream of community life, whereas a perception that
the public is disinterested and holds malevolent views
are more likely to have an alienating effect.
Moreover, a perception that professionals are sensitive
and understanding of survivor needs is of paramount
importance if these individuals are to seek the
services provided by health and human service
professionals. For these reasons, then, our discussion is
intended to 1) explore the implications of stress among
survivors, 2) to evaluate the perceptions of the
Holocaust held by survivors, 3) to assess the impact of
their traumatic experiences on the adjustment process,
and 4) to present an overview of survivor reaction to
the attitudes of the general public and members of the
Jewish community toward the Holocaust.
In the sections that follow, selected empirical
studies of Holocaust survivors are reviewed and the
theoretical and methodological imitations of this
research are discussed. Second, the validity of the
research conclusions, based on medical and psychiatric
perspectives, is questioned and a suggestion to view
the long-range effects of the Holocaust from social
and behavioral science perspectives is advanced.
Finally, observations based on interviews with survivors
are presented in an effort to highlight the long-range
effects of stress on survivors, and to suggest ways in
which Holocaust victims can be assisted in adjusting
to the demands of everyday life.
THE HOLOCAUST LITERATURE
A review of the literature dealing with the
effects of the Holocaust on survivors reveals an
overwhelming pathological emphasis; an emphasis which,
retrospectively, may have been inevitable. Reports of
the psychological and physiological damage inflicted
upon Holocaust victims circulated within a few years
after the end of World War II; however, it was not
until the sixties that an extensive body of literature
began to appear on this subject (Chodoff, 1966).
These findings documented a wide range of physical and
psychic impairments suffered by Holocaust survivors
including severe headaches and heart palpitations,
nonrational fears and anxieties, dependence and
indecision, and various forms of social maladjustments. In
turn, these symptoms were interpreted as constituting
a syndrome characteristic of individuals subjected to
the peculiar trauma experienced by Holocaust victims
(Eitinger, 1961; Trautman, 1961; Engel, 1962; Strom,
et al., 1962; Chodoff, 1963; Klein, 1974; Oswald and
Chodoff (1966), in summarizing the immediate
effects of massive psychic-trauma, has shown that
bitterness, resentment, depression, weight loss,
emotional and autonomic lability, irritability, apathy, low
self-esteem, and difficulty in concentration were
commonly manifested among survivors. As for long-term
effects, Chodoff identified two clusters of symptoms,
the first of which included tendencies toward social
isolation, apathy, helplessness, and a high degree of
dependence. Such persons also were described as being
passive and fatalistic. Characteristics identified in
the second cluster suggested that Holocaust survivors
were inclined toward suspicion, hostility, and
distrust. These individuals also had a tendency to
demonstrate despair, envy, bitterness, cynicism, and
belligerence toward others.
Various configurations of these two clusters of
symptoms, referred to as "concentration camp
syndrome," imply severe psychological and social
impairment (Chodoff, 1966). Survivors also have been
described as being characterized by "survival guilt"--a
guilt consisting of feelings brought on by the fact
that they survived the Holocaust, while relatives and
friends had not survived
perspective, according to Krystal (1968), is based on the
fact that after 1,500 years of degradation, Jews
learned to accept and internalize their enemies' views
about them. In concentration camps this perspective
led survivors to believe that death was actually
During the sixties, a number of comparative
studies were introduced into the literature. Nathan,
et al., (1964), for example, studied two survivor
groups, concentration camp survivors and "Russians"
(i.e., Polish Jews who had been exiled in the Soviet
Union). In this study it was found that survivors of
concentration camps were more likely to engage in
"atypical" behavior than were members of the
comparison group. Kanter (1970) observed that pathological
tendencies were less pronounced among ethnicly
conscious Jews than among Jews who had an assimilational
background. A comparison of former concentration camp
inmates admitted to mental hospitals with a group of
psychiatric patients in Finland and Israel by Eitinger
(1962) revealed that pathological tendencies were much
greater among Holocaust survivors. In discussing
these differences, Eitinger (1965) noted the
difficulty survivors experienced when they returned to their
pre-war locations to re-establish instrumental and
social anchors. Many had no home to return to and
often were the sole survivors of entire families.
While clearly not exhaustive, the above studies
are representative of the research reports which
concentrated on survivors. What is most striking about
this research literature is the agreement held by the
analysts that survivors had suffered lasting physical,
psychological, and social impairment. This view is
also held by many survivors as indicated in the
We've all been damaged, doctor, and I
think we are all a bunch of rotten apples.
We may look okay on the outside, but when
you get to know us you will see that we are
different and sick inside and no matter what
happens our lives will never be normal again
(Oswald and Bittner, 1968, p. 1398)
THEORETICAL AND METHODOLOGICAL LIMITATIONS
OF THE RESEARCH LITERATURE
The Holocaust literature has several theoretical
and methodological limitations. First, in terms of a
conceptual approach, most studies draw exclusively on
the psychoanalytic literature while completely
neglecting behavioral and social science perspectives.
Second, in explaining the behavior of survivors most
studies tend to draw theoretical inferences which are
well beyond the scope of their data to be justified
from a scientific standpoint. The result is that a
serious gap exists in the theoretical utility of these
studies (Des Pres, 1976).
The effort to bring behavioral science
perspectives to bear on the problem of the long-range effects
of the Holocaust experience on survivors has been more
recent. In one such study, Matussek (1975) reported
evaluating 245 survivors 15 years after their
confinement. Contrary to the findings reported by Chodoff
(1965) and Krystal (1968), Matussek concluded that no
identifiable concentration camp syndrome existed.
Moreover, Matussek suggested that a number of pre-war
factors (family structure and relationship) and
postwar factors (employment and marital harmony) may have
affected the adjustment and well-being of survivors.
Matussek also found that the nature and duration of
stress emerging from the concentration camp
experience, were related to passivity, retreatism, and the
lack of initiative demonstrated by survivors. In a
follow-up study conducted by Dor Shav (1978), a
comparison of concentration camp survivors (N = 42) with
a control group (N = 20) indicated that survivors were
more likely to be intellectually impoverished and to
suffer from a constricted personality than were
subjects in the control group.
In another project (Leon, et al., 1981), 52
survivors and 47 children of survivors living in a
midwestern city were compared on psychological adjustment
variables with adults and children of similar
religious and cultural backgrounds. No significant
psychological adjustment differences were found to exist
between survivor parents and members of the control
group. Where differences were found, these
differences were more likely to be related to cultural
factors than to concentration camp experiences.
Moreover, no significant differences were found to exist
between children of survivors and a control group of
children in their attitudes toward their parents.
Based on these findings, previously accepted notions
of survivor guilt, the presence of emotional blunting
in survivors, and the alleged maladaptive
psychological influence of survivor parents' experiences on
their children, can be questioned.
In sum, must studies have employed small and
nonrepresentative samples drawn for the most part from
those seeking help
(e.g., Chodoff, 1963, Eitinger,
1961, 1962; Kanter, 1970; Klein, 1974; Nathan, et al.,
1964; Oswald and Bittner, 1968; Trautman, 1961)
those who applied for restitution from the German
government (e.g., Chodoff, 1966; Engel, 1962; Oswald
and Bittner, 1968). While freely generalizing about
the entire survivor population, many investigators did
not use comparison groups
(see, for example, Chodoff,
1966; Eitinger, 1962; Engel, 1962; Oswald and Bittner,
1968; Strom, et al., 1962; Trautman, 1961)
. As a
result, recent studies which employ social and
behavioral science perspectives and more appropriate
sampling techniques raise serious questions about the
conclusions derived from clinical observations and
from studies based on nonrepresentative samples
THE STRESS LITERATURE
The stress literature provides a useful
perspective for understanding the coping strategies used by
Holocaust survivors to deal with their environment
(Appley and Trumbull, 1967; Levine and Scotch, 1973;
. Much of the stress research tends to
focus on assessing the effects of stimulus conditions
on physiological and psychological response
(Appley and Trumbull, 1967)
. However, a review
of this stress literature suggests that the medical
perspective may be too limited to provide an adequate
understanding of the effects of post-traumatic stress
The work of Lazarus (1967) is representative of
one group of stress researchers who perceive of stress
as a dynamic process involving cognitive psychological
mediation. In refining their conceptualization of
Coyne and Lazarus (1979)
suggest that coping
with stressful situations involves an ongoing process
of cognitive appraisals revolving around person-person
and person-environment transactions. This involves
the person's appraisal of the threatening event,
individual capabilities to respond adequately to the
stressful damand, the anticipated cost of the
response(s), and an appraisal of the consequences.
While not minimizing the importance of emotional
and physiological reaction, for the purposes of this
discussion it is important to note the emphasis that
Lazarus (1967) and
Coyne and Lazarus (1979)
problem solving directed coping strategies. Coping
with stress, according to these analysts, involves:
the stress condition or the environmental demand; the
cognitive appraisal and the subjective definition of
the demand condition; the cognitive appraisal of the
response repertoire; problem solving directed coping
patterns; and appraisal of the impact of the response.
Research evidence seems to justify the conclusion
that individuals who suffer extreme stress will
experience immediate and long-term physical, social and
psychological impairment (Levine and Scotch, 1973).
While the stress research tends to support this
position, other conclusions are also suggested. The
research indicates that substantial differences exist in
the manner in which individuals perceive and react to
stressful situations and conditions (Lazarus, 1967).
The effects also vary because stress is mediated
through subjective psychological processes which
include physiological, cognitive, and emotional
In McGrath's (1970) view, the effects of stress
are mediated through various psychological processes
such as cognitive appraisals of the threat and coping
resources. In turn, these are affected by the
personality structure of the individual and the organization
of the social milieu in which he/she is involved.
Stress and stress responses vary as a consequence of
the social experience and the ability of individuals
to cope with or to avoid the consequences of stress.
Some analysts prefer the term "extreme
(Haas and Drabek, 1970)
. One such analyst,
Torrance (1965), suggests that distinctive elements
emerging from extreme situations of stress are the
breakdown of conventional social structures and the
inability of individuals to anticipate or predict
outcomes. Life in concentration camps was
characteized by physical degradation, deprivation, lack of
food, extreme cold, and prolonged isolation. An
additional factor was the absence of a conventional
social structure. Conventional modes of behavior were
rarely applicable in such situations, and the human
capacity to endure unpredictable. As a consequence,
individuals were called upon to respond to conditions
for which they were unprepared. At the same time,
concentration camp inmates were aware that failure to
respond adequately held severe consequences for them,
including the threat of death (Des Pres, 1976).
THE PERSPECTIVE OF SURVIVORS
The perspective presented in this section is
based on responses to surveys and interviews with
survivors living in the United States and Israel.
Interviews were conducted with twenty-five individuals who
attended a gathering of Holocaust survivors in
Washington, D.C. during April, 1983, and with twenty-five
survivors now living in Israel. The interviewing took
place during the summer of 1983. Selected data from a
survey of 263 survivors who attended the Washington
gathering and from an ongoing cross-national research
project on the mental health implications of stress
are also included in the discussion.
In evaluating their Holocaust experiences and
post-war adaptation, survivors present two general
concerns. First, survivors indicate that the
Holocaust still affects their lives, and that they
frequently reflect upon their traumatic experiences. At
the same time, they convey a sense of pride and
attribute a positive meaning to their ability to
survive. Second, in response to questions about their
perception of professional approaches toward
survivors, a concern that members of professional and
scientific communities do not adequately understand
the nature of their individual and collective needs
was expressed. Survivors are generally apprehensive
about the general public's perceptions of them and of
the manner in which professionals relate to the
symbolic meaning of the Holocaust. A collective concern
revolves around the Holocaust as a symbolic
representation. Survivors fear that the memory of the
Holocaust will be trivialized, forgotten or denied.
Because of the orientation that characterizes
contemporary life in the United States and Western Europe,
survivors fear that expressions of hostility toward
Jews and recent demonstrations of antisemitism could
lead to organized assaults on their life and
Survivors also expressed their concern that the
research literature has contributed to the development
of misconceptions about survivors and their children
which label them as being emotionally and socially
impaired. While resentful of being so labeled,
survivors are cognizant of the fact that they have been
scarred by their experiences. Proud of their
accomplishments, and those of their children, survivors
appear to be perplexed by the fact that members of
science and the helping professionals have created
pathological characterizations of survivors, while few
studies document the extent of adjustment, personal
well-being and the contributions that survivors have
made to the well-being of others.
Although admitting to having experienced
adjustment problems, survivors attribute this difficulty in
part to community reactions toward them including open
hostility, indifference, and a social attitude that
tends toward "blaming the victim." Generally
appreciative of expressions of bravery on the part of
righteous gentiles who risked their lives to save Jews
and their concentration camp liberators, survivors
appear troubled by the expressions of hostility toward
them in their countries of origin and in other
locations around the world. They are also troubled by the
disinterest in commemorating the Holocaust.
Survivors state that adjustment of stress victims
is likely to be aided by a more sensitive and more
understanding attitude both among the general public
and within the professional and scientific
communities. The survivor perspective is important because,
unlike other perspectives, it addresses the perceived
collective needs of survivors. One of these needs
relates to the symbolic commemoration of the
SUMMARY AND CONCLUSION
The literature offers a general conclusion that
Holocaust survivors have been traumatically affected
by their experience and that they suffer from a
variety of physical, psychological, and social impairments.
As a result, survivors are perceived as being
emotionally handicapped. Although some evidence exists to
support the notion that survivors have been severely
scarred by their Holocaust experiences, there is also
evidence to indicate that a large number of Holocaust
survivors have adjusted, and that survivors enjoy
reasonable states of psychological and social
wellbeing. Recent findings suggest that earlier
research conclusions about Holocaust victims may have
been overstated (Harel, 1983). These findings also
suggest that behavioral and social science
perspectives may offer a more useful framework for developing
an understanding of the long-range effects of the
Holocaust on survivors.
Holocaust victims have had to focus their
energies almost exclusively on survival. It is not
surprising, therefore, that much energy was directed
toward coping with stress in ways that would ensure
survival. Unfortunately, Holocaust victimization
studies have relied exclusively on psychoanalytic
perspectives. For these reasons the research literature
has not dealt with the coping strategies employed by
survivors, while Holocaust analysts have generally
ignored the environmental demands and realities with
which survivors were forced to contend.
Socio-environmental theory suggests that human
behavior is affected by objective environmental
conditions, by perceptions of environmental demands and
challenges, and by individual responses to their
social environment (Germain, 1978; Gump, 1974).
Holocaust survivors have been confronted with at least
three major challenges: first, they have had to cope
with their traumatic experiences related to their
incarceration in concentration camps; second, they had
to cope with the loss of family members and friends;
and finally, they were challenged by the demands
associated with relocation to new political, cultural
and social environments. It is important to note,
however, that a majority of Holocaust survivors
accepted the demands, challenges, and opportunities
afforded to them, and used effective coping strategies
to adjust to their post-war living conditions.
Early conclusions about the effects of the
Holocaust may have produced an unintended burden on
survivors. This burden is reflected in the fact that
both survivors and their children have been labeled
as emotionally and socially impaired. Survivors, on
the other hand, emphasize that they directed their
energies toward achieving goals, establishing personal
and occupational identities and assuring their
socioeconomic well-being. They have reestablished
themselves as family members and have contributed to the
enhancement of Jewish communal life in the United
States and elsewhere. It is essential, therefore,
that the factors which contributed to this adjustment
be explored more fully in order to develop a better
understanding of the consequences of post-traumatic
stress on survivors.
Des Pres, Terrence
1976 The Survivor:
An Anatomy of Life in the
New York: Oxford
UniverDor Shav, Netta K.
1978 "On the long range effects of
concentration camp internment of Nazi victims:
25 years later." Journal of Consulting
and Clinical Psychology. 46:1-11.
"Pathology of the concentration
syndrome." A.M.A. Archives of General
"Concentration camp survivors in the
postwar world." American Journal of
"Concentration camp survivors in Norway
and Israel." Israeli Journal of Medical
Engel, Werner H.
1962 "Reflections of the psychiatric
consequences of persecution." American
Journal of Psychotherapy 26:191.
Germain, Carol B.
1978 "General systems theory and ego
psychology: an ecological perspective."
Social Service Review 52:535-550.
Gump, Paul V. 1974
"The behavior setting: a provisional
unit for environmental designers."
Pp. 267-275 in Rudolph H. Moos and Paul
M. Insel (eds.), Issues in Social
Ecology, Palo Alto: National Press
"Organizational analysis of institutions
for the aged." Journal of Sociology and
Social Welfare 6:792-801.
"Coping with stress and adaptation: the
impact of the Holocaust on survivors."
Society and Welfare 5:221-230.
"Exterminations camp syndrome: the
delayed type of double-bind (a
transcultural study)." The International
Journal of Social Psychiatry
"Delayed affects and after-effects of
severe traumatization." Israel Anals of
Psychiatry, and Related Disciplines
Massive Psychic Trauma. New York: International Universities Press.
1967 "Cognitive and personality factors
underlying threat and coping." Pp.
in A. Appley and R. Trumbull (eds.),
Psychological Stress. New York:
Leon, Gloria, James N. Buthcher, Max Kleinman, Alan
Goldberg and Moshe Almagot
1981 "Survivors of the Holocaust and their
children: current status and
adjustment." Journal of Personality and
Social Psychology 41:503-516.
Levine Sol and Norman A. Scotch
1973 Social Stress. New York: Adline
Internment in Concentration Camp and Its
Consequences. New York: Springer.
"A framework for the comparative
analysis of organizations." American
Sociological Review 32:194-208.
"Examination of Norwegian concentration
camp prisoners." Journal of
Torrance, Ellis Paul
1965 Constructive Behavior:
ality and Mental Health.
Appley , Mortimer and Richard Trumbull 1967 Issues in Research. New York: AppletonCentury-Crofts.
Chodoff , Paul 1963
Psychiatry 8 : 37 - 47 .
concentration camps." Pp . 384 -405 in S.
Coyne , James and Richard Lazarus 1979 The Ipsative-Normative Framework for the Longitudinal Study of Stress. Paper presented at the Annual Convention of the American Psychological Association , New York.
Haas , Eugene and Thomas T. Drabek 1970 "Community disaster and system stress: a sociological perspective." Pp . 264 -289 in J. McGrath (ed.) , Social and Psychological Factors in Stress. New York: Holt, Rinehart & Winston, Inc.
McGrath , Joseph 1970 Social and Psychological Factors in Stress . New York: Holt, Rinehart and Winston, Inc.
Nathan , T.S. , Leo Eitinger and H.Z. Winnik 1964 "A psychiatric study of survivors of the Nazi Holocaust: a study in hospitalized patients." Israel Annals of Psychiatry and Related Disciplines 2 : 87 - 94 .
Oswald , Peter and Egon Bittner 1968 "Life adjustment after severe persecution." American Journal of Psychiatry 124 : 87 - 94 .
Perrow , Charles 1967
Strom , Axel, Sigvald B. Refsum , Leo Eitinger, Odd Gronvik, Arve Lonnum, Arne Engeset, Knut Osvik, and Bjorn Rogan 1962
Trautman , Edgar 1961 "Psychiatric and sociological effects of Nazi atrocities on survivors of the extermination camps . " Journal of the American Association for Social Psychiatry 2 : 118 - 122 .