Holocaust and the effects on the prisoners - Research Paper Example

?Running Head: HOLOCAUST AND THE EFFECTS ON THE PRISONERS Holocaust and the Effects on the Prisoners Holocaust and the Effects onthe Prisoners Introduction The Holocaust, in its systematic extermination of Jews, created situations previously unknown in history. During this period, threats to life were faced constantly, with victims not knowing if they would be allowed to live another day. In concentration and labor camps, innocent people suffered with physical pressures, such as intense hunger, crowded quarters, disease, exposure to severe punishment and bodily torture, and heavy labor. Prisoners were often humiliated by soldiers to the point of dehumanization. Their heads were shaved, they were forced to wear prisoner uniforms, and their identities were replaced by a number on their arm. Those individuals in hiding, faced constant concerns of being caught. Mental pressures experienced by all victims during this horrific period included painful separation from family and friends, a lack of knowledge as to what fate would bear upon loved ones, and uncertainty about one's own existence. With their own eyes, they witnessed the destruction of families and communities. The values and social norms by which these individuals had led their lives were completely destroyed. For most survivors, the events of the Holocaust were ongoing, uncontrollable, and unexpected. Many were proximally close to the traumatic events, witnessing terror and horror brought upon them by other human beings. The experiences involved separation from family and friends and long lasting consequences which in many cases could not be reversed. It is a prevalent concept that all Holocaust survivors suffer from enduring psychological and physical distress as a result of their earlier trauma experiences. In this paper I will assert that all Holocaust survivors cannot be considered a homogenous group with the same patterns of symptoms and characteristics. They not only managed to resume their lives after the war but actually had rich and varied lives, were vital contributors to their communities, and maintained stable family and work patterns. Holocaust and the effects on the prisoners For a long time, discussion of the Holocaust was considered a taboo subject. Survivors spoke little about it and others did not seem to want to hear. A deep curtain of silence hung over one of the most horrendous events in human history. A number of reasons contributed to this circumstance. For years following the war, survivors were busy reestablishing their lives and homes and tried hard not to remember the past. It was not until the 1960s that interest in the Holocaust became more fully developed. It was at that time that the mental health community first became involved in dealing systematically with the after-effects of Holocaust traumatization. This was partially due to the political-moral decision of the Federal Republic of Germany to provide indemnification to individual victims of the Nazi regime for the hardships that they had suffered. In order to claim restitution, it was necessary to prove the existence of a causal link between Nazi persecution and health status, including mental health status. It became evident at that time to many of the medical professionals working with the survivors, that a host of symptoms, seemingly without organic cause, existed among their clients. These symptoms experienced were often linked to atrocities committed against the survivors. It became essential to conceptualize clinically the symptoms and conditions that appeared quite regularly in a great number of the survivors. The Concentration Camp Syndrome/ Survivor Syndrome, as discussed by Krystal (1968), and many others became known nosologically as a relatively fixed, lifelong condition characterized by a broad range of symptoms that could be traced to the Holocaust experience. Holocaust Survivors The Concentration Camp Syndrome Symptoms of the Concentration Camp Syndrome included (1) lasting depression with features of vigilant insomnia, nightmares during which fragments of the persecutory experiences recur, apathy and social withdrawal; (2) chronic anxiety accompanied by psycho-physiological symptoms; (3) personality changes, with a lowered threshold for stimulation; (4) guilt feelings (over remaining alive while others have died); (5) isolation of affect; (6) memory disturbances; (7) and an inability to verbalize traumatic events (Berger, 1988). Krell (1984) postulated that these reactions are logically and psychologically sane and sound consequences of an insane experience. The Concentration Camp Syndrome was observed to have a high prevalence in survivors (85%) and to be generally unrelated to pre-war or postwar adaptation and social environments. Eitinger (1980) and a team of University-connected physicians conducted clinical interviews and physical exams on a clinical population of 227 concentration camp survivors. Similar to research on general trauma, Eitinger found a close association between the severity of the Concentration Camp Syndrome and the duration and severity of torture to which survivors were exposed. Many of the symptoms described in the Concentration Camp Syndrome are notably similar to those currently known as PTSD. Matussek (1975) used physical exams and psychiatric interviews to determine the effects of traumatic experiences on concentration camp survivors. In this study, survivors were found to have a series of symptoms akin to the current PTSD syndrome. Kuch and Cox (1992) reviewed 124 German files of Holocaust survivors who had been applicants to West German compensation boards. They concluded that based on psychiatric assessments conducted for compensation purposes, 46% of the survivors would have met PTSD diagnostic criteria, based on the DSM-III-R. Concentration camp survivors were three times more likely to meet PTSD criteria than those survivors who were not in concentration camps. Other researchers have questioned the existence of the Concentration Camp Syndrome/Survivor Syndrome, claiming that it does not and should, take into account the pre-Holocaust personality of survivors, the severity of the persecution, the developmental stage at the time of the occurrence of the trauma, the post-Holocaust adjustment experienced of the survivors, and the heterogeneity of the group (Fogelman, 1991). Hass (1990) reported that the early research may have yielded a distorted picture of the Holocaust survivor because the syndrome seen was taken only from a clinical population seeking therapeutic help, and therefore, could not be generalized to the entire population of Holocaust survivors. This assertion is reinforced by Antonovsky, Maoz, Dowty, and Wijsenback (1971), whose findings indicate that the non-clinical sample of survivors in their study experienced a poorer sense of well-being and a pessimistic attitude toward life, but not the severe pathological symptoms reported in the earlier literature. According to Solkoff (1981) much of the literature used to describe the Concentration Camp Syndrome was based on methodological flaws such as biased samples, no control groups, lack of "objective" assessment measures, and scarcity of appropriate statistical analysis. Many studies have reproached these methods stressing the need for better studies using non­-clinical populations and more appropriate statistical analysis (Berger, 1988). PTSD in Holocaust survivors In their study of long term consequences of the Nazi persecution based on a random sample survey of all household heads in a particular community, Eaton et al. (1982) compared 135 survivors whose primary experience was in a concentration camp, in hiding or in armed resistance compared to a control group of 133 Jews who were not Holocaust survivors. They found that even after 33 years there was still a moderately strong tendency for survivors to report more psychiatric symptoms than did the controls. For example, 36% of the men had four or more symptoms, compared with 22% of the controls, while 64% of the women had four or more symptoms compared to 43% of the controls. With the sex categories collapsed, the difference between survivors and control subjects was significant at the .01 level. The differences between the survivor and control groups cannot be attributed to a selective process of sampling since the two groups were generated by a random sample survey of all heads of households in the Montreal community. Thus, the authors concluded that their data provide a very conservative test of the hypothesis that the Holocaust experience produced harmful long- term consequences. Rosen, Reynolds, Yeager, Houck, and Hurwitz (1991) documented that clinical observations of Nazi Holocaust survivors disclose many residual emotional symptoms, including affective blunting, inability to grieve, and reduced tolerance of stress, even after almost five decades. The authors reported on a qualitative and quantitative study of sleep disturbances in a naturalistic setting by assessing the sleep patterns and sleep disturbances of a group of Holocaust survivors compared to an elderly healthy control group, as well as a group of elderly depressed subjects. All participants completed the Pittsburgh Sleep Quality Index (Buysse, Reynolds, & Monk, 1989). Sleep disturbances were found to be significant problems for approximately two-thirds of the sample of Holocaust survivors 45 years after the end of the war. The severity and profile of sleep disorders were distinct for the survivor group compared to the elderly depressed and healthy comparison subjects. The survivor group scored significantly higher than the healthy subjects on all subscales as well as on the total index score of the sleep quality scale. In contrast, the survivor group showed improved sleep on all subscales as well as the total index score with the exception of the sleep disturbance subscale, when compared to the depressed group. The Holocaust survivors had significantly more awakenings due to complaints of "bad dreams," "cannot breathe comfortably'" and "other." "Other" included hot flashes, bad memories, and nervousness. There was a significant correlation between number of years in a concentration camp and total score on the Pittsburgh Sleep Quality Index. Severity of sleep disturbance and frequency of nightmares were related to the duration of internment in a concentration camp. The survivors who experienced sleep disturbances and nightmares at least once a week had been imprisoned for longer periods than the group with less frequent nightmares. More recently, researchers have been using more appropriate methods of statistical analysis when studying Holocaust survivors. Binder-Brynes, Elkin, Giller, Kahana, Schmeidler, Southwick, and Yehuda (1996) have found higher prevalence rates of Post-traumatic Stress Disorder in a non-clinical aged population of Holocaust survivors as compared to non-survivor controls. Kahana, Kahana, Hard, Monaghan, and Hollard (1997) found that among the Holocaust survivors in their study, 61% reported that they think daily or several times a week about the Holocaust, even 40 years after the original traumatic experiences. A smaller group of survivors, ranging from 5% to 20% endorsed other symptoms of PTSD. Cohen, Brom, and Dasberg (2001) conducted a controlled doubled-blind study using a randomized non-clinical sample of child Holocaust survivors and a control group of non-survivors. The results of their study indicate that the child survivor group experienced a higher level of post-traumatic symptomatology (both on Intrusion and Avoidance factors) as measured by the Impact of Events Scale, greater motivation to achieve based mainly on the fear of failure as measured by the Achievement Motivation Scale, and a greater vulnerability to stressful stimuli as compared to the control group as measured by the Brief Symptom Inventory. A number of researchers have studied the response of Holocaust survivors to current life stressors. Peretz, Baider, Ever-Hadani, and Kaplan (1994) studied cancer patients who had survived the Holocaust. In their study, survivor patients were interviewed and then compared to a matched group of non-traumatized cancer patients and a group of healthy Holocaust survivors. The emotional distress scores (on the Brief Symptom Inventory (BSI)) of the cancer patients who had survived the Holocaust were found to be significantly higher than that of the non-traumatized cancer patients. According to the researchers, when these traumatized individuals faced another life-threatening situation they failed to mobilize basic coping mechanisms such as adaptive denial, and therefore experienced a greater degree of psychological distress. Although the group of healthy Holocaust survivors showed a normal degree of psychological distress, their profile suggested that they would likely react with extreme psychological distress and coping difficulties when faced with a severe new threat. On the BSI, healthy Holocaust survivors were capable of suppressing certain emotions (paranoid ideation and hostility) during the years following their ordeal, however depression remained high. Positive outcome in Holocaust survivors Despite the evidence that a large percentage of Holocaust survivors retained the wounds of trauma from their experiences during the Holocaust, it has been found that many survivors adjusted well, becoming effective and contributing citizens. In his study of the coping strategies of Nazi concentration camp survivors, Dimsdale (1974) conducted semi-structured interviews and classified the coping strategies of the participants, as follows: (a) differential focus on the good, which refers to experiencing small gratifications, such as getting through the food line without a beating, as well as the simple appreciation of beauty even in such a brutal environment; (b) survival for some purpose was an extremely strong motivating strategy; for example, the person who had to survive to help a relative, to bear witness and testify to the world about their experiences, or survive in order to seek revenge; (c) psychological removal involved insulating oneself from the external stress and developing ways of blocking emotion. Strategies of removal included intellectualization, religious beliefs, and time distortion, such as focusing only on the immediate present. Also included under psychological removal from the stressful situation was the important role that humor played in diffusing the stress; (d) mastery over their actions and attitudes allowed the individuals to express some autonomy once they realized that the purpose of the camps was extermination. Mastery included such actions as helping a fellow inmate or celebrating a Jewish holiday that was forbidden. Mastery enabled the individuals to continue thinking of themselves as humans; (e) the most basic coping and important strategy was the will to live. For some, the will to live was the only coping strategy intervening between the individual and the surrender to death; (f) the mobilization of hope was also basic to survival. There were two kinds of hope; one was a belief that the war would be won by the allies and the camps would be dismantled. The second belief was more passive, conveying the attitude that "Where there is life, there is hope;" (g) group affiliation was critical for providing information, advice, and protection, as well as reinforcement of the person's individuality and worth; (h) regressive behavior such as excessive crying occasionally elicited a helpful response from other inmates or from camp guards; and finally (i) "null" coping or fatalism allowed some individuals to experience the stress passively and to rely on fate. Leon, Butcher, Kleinman, Goldberg, and Almagor (1981) reported that the survivor group in their study did not manifest serious psychological impairment when compared with control groups of non-Holocaust survivors. Shanan and Shahar (1983) found that Holocaust survivors tended to be more task oriented, expressed more favorable attitudes toward family, friends, and work, and coped more actively than controls. Helmreich (1992) found that survivors of the Holocaust not only managed to resume their lives after the war but actually had rich and varied lives, were vital contributors to their communities, and maintained stable family and work patterns. Conclusion It appears clear from the various studies on Holocaust survivors, that they cannot be considered a homogenous group with the same patterns of symptoms and characteristics. They not only managed to resume their lives after the war but actually had rich and varied lives, were vital contributors to their communities, and maintained stable family and work patterns. Literature reviewed in this paper revealed that concentration camp survivors have achieved impressive lifestyle success in terms of family support, stable family situations, energetic activity levels, extensive and active social relationships, financial stability, and strong religious affiliation. Although research has shown positive outcomes in Holocaust survivors, there does seem to be sufficient evidence to assert the existence of PTSD symptomatology in many of these individuals. References Antonovsky, A., Maoz, B., Dowty, N., & Wijsenback, l. (1971). Twenty-five years later: A limited study of the sequelae of the concentration camp experience. Social Psychiatry, 6, 186-193. Berger, L. (1988). The long term psychological consequences of the Holocaust on the survivors and their offspring. In R. L. Braham (Ed.), The psychological perspective of the Holocaust and its aftermath (pp. 175-122). New York: Binder-Brynes, K., Elkins, A., Giller, E. L., Kahana, B., Schmeidler, J., Southwick, S. M., & Yehuda, R. (1996). Dissociation in aging Holocaust survivors. The American Journal of Psychiatry, 153, 935-940. Buysse, D. J., Reynolds, C. F., & Monk, T. H. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. 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