Massive Psychic Trauma

Abstract

The reviewer has spent their life living in a majority Holocaust Survivor community. From decades of experience with Survivors, their children and grand-children, I can wholeheartedly recommend this book as an insightful and detailed investigation into the sequelae (emotional fallout) which Survivors and their descendents are subjected to. This book published in 1968 is in response to the (then) West German indemnification laws (Bundesentschädigungsgesetz, or BEG) which came into effect in 1953, 1956, and 1965. Psychiatrists wherever Survivor claimants resided were tasked with evaluating potential claimants for their level of psychological damage and subsequent social dysfuntion resulting from Nazi persecution. Light is shone upon the then predominant German psychiatric idea that psychological (psychic) damage was only associated with neurological trauma. A great deal of effort is expended in the book demonstrating that psychological damage is caused via trauma, which may or may not be associated with neurophysiological damage. Having poured over the book in detail I am able to give a thematic analysis of the psychological damage which occurs from Nazi persecution.  Theme: Refusal of Therapy by Survivors. Dr. Emanuel Tanay explains that therapy could actually be offered for free to Survivors, but would be refused because from the Survivor perspective, p. 224 “one of the reasons these patients are driven to deny their emotional damages is that to admit them would, in their minds, represent a victory for their Nazi persecutors.” Dr. Tanay shows how Survivors are highly aware of the affective state of the therapist, and could even feel threatened by a therapist who is connected to their own emotional world. p. 232, Tanay “If treatment is indicated, it encounters many threats, among which the recognition of illness itself threatens to overwhelm the patients with self-disgust and feelings of defeat and anger which are residual from the persecution.” Theme: Affective Shutdown and Post-traumatic Alexithymia. Again and again Survivors will recount their experiences of being emotionally “dead” or “unfeeling” or “I lost all feeling”, etc. This leads into Survivors tending to lead lives almost like that of the “walking dead” or “death-in-life”. Parallels are drawn to Hiroshima Survivors from the contributions of Robert J. Lifton. Theme: Decathexis of Words. This is the loss of the meaning of words in the face of overwhelming traumatic experiences. p. 62, Niederland “many survivors refrain from speech because, perhaps, they no longer believe in words”, p. 128, Niederland “one characteristic feature of the Nazi persectution is that the experience cannot be communicated” and p. 138, von Brauchitsch “there are those who are unable to express themselves, unable to abreact [therapeutically confront] the original traumatising situation, and who may develop symptoms of muteness or bizarreness. Some patients have even lost the facility of language to voice their feelings of persecution, or anguish.” The Decathexis of Words has negative implications for the therapeutic goals of mentalization or symbolization as opposed to somatization of trauma. Words and phrases such as “somatization,” “psychosomatic disease,” “desomatization,” “somatization of affect,” “resomatization”, “somatic symptoms,” “partial or complete somatization,” “psychosomatic defenses,” “somatic illness,” etc, occur 108 times in the book.  Theme: Use of Guilt as a Mechanism to deal with their own Aggressive Feelings. p. 234, Dr. Hilel Klein “the problem of guilt in survivors is complex insofar as it serves to turn the aggression inward, and thus prevents both overwhelming anxiety on the one hand and misdirected hostility on the other.” Theme: Countertransference Reactions to Survivors. The goal of the examination of Survivors by a Psychiatrist is to report the Survivor’s “degree of disability, social impairment and suffering” resulting from Nazi persecution. Henry Krystal explains the mindset needed by the Examiner (Psychiatrist) is a “friendly, compassionate attitude.” Countertransference reactions are where the individuals in the social world of the Survivor or Abuse Victim have their mind “derailed” or “cattleshuted” by the unaddressed psychological issues of the Survivor. Countertransference reactions lead to the Examiner being, in a sense, “coerced” to acting in a manner that is uncharacteristic or possibly unethical.  p. 140, Krystal “the stories which he [the examiner] hears, the people with whom he deals, are bound to provoke a strong emotional response in him. All of the descriptions of human degradation, abuse, and murder must be dealt with in his own mind. … a painful but necessary opportunity to discover the extremes of evil, and the depths of degradation of which one’s human mind is capable.”  p. 141, Krystal “these patients come in with stories filled with every horror imaginable, with symptoms and actions which are likely to impinge upon every sore spot, every unresolved conflict the examiner may have, no matter how successfully he has kept it hidden in his contacts with ‘ordinary’ people.” “He may be driven to unconsciously identify with the victim or the aggressor. He may act out his anger or disgust, or indulge his reaction formation to these affects. He may scorn the persecutor or feel disgust with the vanquished.” Theme: Psychotic Regression vs Therapeutic Regression. Psychotic Regression induced via massive traumatization is the reduction of an individual to an infantile or almost animalistic mindset and is an adaptive response to extreme circumstances. Therapeutic Regression is a component of the therapeutic process where the patient, now supported and psychologically “held” via the Therapeutic Relationship can re-experience and heal from previously unaddressed childhood issues. p. 240, Hilel Klein [patient=Survivor now in therapy] “the Germans’ aim was to dehumanize, but the patients repressed their feelings of shame and guilt by a state of depersonalization and specific regression to a state of aggression mixed with helplessness towards their torturers. Such patients relate about themselves with guilt that they ‘were beasts’ and didn’t feel anything.” p. 216 “a regression to early infantile behavior was forced upon the patients in the concentration camp.” p. 132, Szatmari “as a result of magical thinking due to the ego regression of our patients here, however, there is a direct tendency to view the death of the mother, father, sister, or brother as their direct responsibility; the event is obviously viewed through the aperture of early infantile aggression. This happens again in many of the nightmares, where the guilt repeats and fortifies itself, maintaining the repetitive pattern of the regression. It can be considered as a dread of one’s own aggressive omnipotent impulses, similar to the world destruction fantasy of the schizophrenic.”  p. 133, Krystal “the problem of aggression is one of the most difficult areas in psychotherapy with survivors, insofar as the aggression occurred under circumstances so horrendous that it is almost impossible for the psychotherapist to prove to the patient that he did not ‘cause’ the destruction and that his fantasies were not actually endowed with omnipotent power. As Dr. Szatmari pointed out, the circumstances of the persecution can be viewed as a seduction of the survivor into psychically participating in all impulses that he would have otherwise managed to repress or sublimate or deal with in more normal ways. There is no doubt that the persecution experience created a psychic situation in which infantile fantasies were revived and lent the feeling of reality.”  p. 96, Breiner “we see a regression to a very primitive developmental phase. In a sense, these individuals are reliving their childhoods, but now, a very sick childhood—the type of childhood that would produce a psychosis if it were originally experienced chronologically. Thus, the experience effected a reality-forced regression, not in the service of the ego organization [as would occur in a therapeutic situation] but in the service of survival. Perhaps this model will help us to more fully understand the childhood of adults who are in our state hospitals.”  Within the context of a therapeutic relationship, regression to an infantile state does occur for the aims of healing unaddressed infantile issues related to a not overly traumatic childhood. The threat of therapeutic regression for the Survivor is that it now has an overlay of the psychotic evil “hellscape” that occurred during their Nazi persecution experiences. The result being, that therapy becomes even more out of reach for Survivors. There are numerous references to this in the book. Theme: The Challenges of Therapy in the Context of such Massive Traumatization.  p. 247, Dr. Hilel Klein “we are faced with the therapeutic dilemma not unlike that posed by schizophrenic, manic-depressive, and other severely disturbed patients. Their disturbances are so severe that modification of their problems may be effected only by very intensive and extremely long-term treatment. Such treatment would likely produce regression of such proportions that it would have to be done in a hospital. This would be especially necessary since the transference would at some point cause these patients to experience the therapist as extremely destructive, and either the need to provoke the therapist to assault or rejection, or the patient’s assault upon the therapist or himself had to be expected.”  Therapeutic over-enthusiasm is cautioned against, p. 321, Niederland “we thought we could help him through rehabilitation work in the workshop, but were unsuccessful. Sad as it is, I must also pursue the negative experiences; we cannot permit ourselves to be misled by our own enthusiasm or therapeutic ambitions. I believe we came with our help too early, as the report will show you.” p. 324, Niederland “the process of