The National Center for Post-Traumatic Stress Disorder

This article highlights the emotional problems of Holocaust survivors from a historical point of view. We focus on the experiences we have had with the survivors in the United States, our discoveries and recognition of the aftereffects of their traumatiza­ tion, and, briefly, on harmonizing these observa­ tions with other contemporary studies of trauma. Liberated survivors, finding themselves alone and feeling driven to reestablish families rapidly, some­ times made inappropriate choices. They tried to emigrate, reestablish some kind of security, and cover up or deny all their difficulties. When survi­ vors finally found themselves in charity clinics con­ nected with resettlement services and were informed that they could apply for restitution for damages to their health, they complained of physical symp­ toms and did not even think of mentioning emo­ tional symptoms. Occasionally survivors mentioned that they had been beaten over the head and now suffered from headaches. It fell to some psychia­ trists, particularly a few psychoanalysts, to recog­ nize and describe what Niederland (1961) termed the “problem of the survivor.” He told of a group of psychodynamically oriented psychiatrists and psy­ choanalysts who were reviewing and appealing “case after case” of claims that were rejected by the German restitution authorities. Among the thera­ pists mentioned by Niederland were Bychowski, Eissler, Hammerschlag, and Schur. This paper is typical of early Holocaust publications containing descriptions of patients’ complaints and persecu­ tion histories and explanations of the psychodynamics of the damaging experiences. A parallel process was going on in Germany, where a group of leading psychiatrists had been struggling to change the prevailing organic-descriptive orien­ tation. By their own reports, and by reviewing for the restitution authorities the case evaluations sent in from outside Germany, they were implementing changes in attitude and procedure. It took a few years for survivors to settle down and reestablish a (family) life pattern before they could renounce the denial and numbness. The emerging descriptions of survivors’ problems helped both to shape awareness of the post-trau­ matic pattern and to form a prototype of what came to be recognized as PTSD in DSM-III. They also helped prepare us for understanding Vietnam vet­ erans and other populations of trauma survivors (Cohen, 1985; Hoppe, 1971). Lifton’s (1963) work on Hiroshima survivors was useful as well; in fact, he participated in workshops on the Holocaust that were held at Wayne State University (Lifton, 1968). As a result of this and other parallel efforts to under­ stand the problems of Holocaust survivors, symp­ toms could be clustered into chronic anxiety and startle reactions (or hypervigilance), and dysphoric reactions in which depression was predominant. We also began to discern problems of survivor guilt and shame, a gradually increasing freedom to vent anger, and results of the destruction of basic trust (Chodoff, 1980; Krystal & Niederland, 1968; Niederland, 1968). Some authors also pointed to disturbances of memory: amnesias, hyperamnesias, and distur­ bances of consciousness, which in retrospect we later recognized as trances (Jaffe, 1968; Niederland, 1968). In addition, they were hearing about night­ mares (but, for complex reasons, not flashbacks), sleep disturbance, and the connection of nighttime symptomatology with bad (depressed, anxietyfilled) days that followed. We found that depressive reactions were related to multiply-determined mas­ ochistic life-patterns. Study proceeded to problems of treatment, the dynamics of specific experiences in the context of traumatic situations (with acknowl­ edgment of pretrauma history), the psychic reality of the experience, and the vicissitudes of the survivor’s life after liberation (Hoppe, 1968; Tanay, 1968). However, at the same time we still struggled with models of traumatic neurosis left over from World War I and general psychoanalytic concepts that had not been changed since Freud’s formulations. We had to reconsider the nature of trauma, of the “stimu­ lus barrier,” even of affect. Much of the psychoana­ lytic conception of affect was still dominated by the economic point of view of psychoanalysis, and gradually a literature had developed in which af­ fects were recognized as the organism’s system of signals. By changing this view, we could identify the genetic history of affects and find the developmen­ tal paths of affect differentiation, verbalization, and desomatization. We could then see that unlike the infantile form of affects, which was mostly a somatic reaction, the adult form had cognitive, physiologi­ cal (customarily called expressive), hedonic, and ac­ tivating components. The hedonic component had