The Effects of the Holocaust: Psychiatric, Behavioral, and Survivor Perspectives

The Journal of Sociology & Social Welfare, Aug 2018

In this paper the authors review perspectives related to Holocaust victims, limitations of Holocaust studies are discussed, and suggestions for viewing the long-range post-traumatic effects of the Holocaust upon its victims from social and behavioral science perspectives are advanced. The views of survivors toward post-war adjustment, drawn from interviews with Holocaust victims, are also presented.

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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 Follow this and additional works at; http; //scholarworks; wmich; edu/jssw - The E Psychiatric, Behavioral, and Sur vivor Perspectives 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 Bittner, 1968) . 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 (Chodoff, 1963) . This 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 deserved. 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 following: 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) , or 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 (Harel, 1983). 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; McGrath, 1980) . Much of the stress research tends to focus on assessing the effects of stimulus conditions on physiological and psychological response repertoires (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 on survivors. 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 stress, 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) place on 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 components. 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 situations" (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 property. 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 Holocaust. 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. 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Zev Harel, Boaz Kahana, Eva Kahana. The Effects of the Holocaust: Psychiatric, Behavioral, and Survivor Perspectives, The Journal of Sociology & Social Welfare, 2018,