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Martin S. Bergmann and Milton E. Jucovy, eds. Generations of the Holocaust. New York: Basic Books, 1982.
The negative effects on victims of brutality are long-lasting. Danish investigators were the first to document the lasting negative physical and psychological consequences of the Nazi concentration camps on survivors. They noticed symptoms of physical abnormality and disturbances in mood within two or three years after the war in members of the resistance movement who had been held in concentration camps by the Nazis. They assumed that these symptoms were related to problems the ex-prisoners were having with readjusting to civilian life, and would disappear in time. Some five years later, it became apparent to them that their assumption was wrong. The symptoms were not disappearing. Herman and Thygesen then coined the term concentration camp syndrome to describe this group of persistent disorders, which included headaches, gastro-intestinal disturbances, disturbance in mental functioning, depression or moodiness, anxiety, pathological fatigue, insomnia, nightmares, etc.1
This syndrome was brought to the attention of the English speaking world by Niederland,2 an American psychoanalyst who was apparently unaware of the early Danish work. jointly with Krystal, another psychoanalyst, he published an almost identical description of what they termed the survivor syndrome.3
Simultaneously with Niederland's first reports, a Norwegian group published almost identical findings. In a more exhaustive study than either of the preceding two, Eitinger and Strom also found increased mortality rates, physical diseases affecting every organ system, and a decline in occupational status over the years among non-Jewish Norwegian survivors.4 They were unable to do an equivalent study of Jewish Norwegian survivors because of the 762 Jews deported only 24 were still alive at the time of follow-up.
Subsequent studies of American, Australian, British, and Canadian POWs interned in the Japanese or in the Korean camps documented similar long- term effects up to 30 years after the war.5 Prolonged forced labor and malnutrition took their toll without regard to ethnicity, political leanings, religion, or social status.6
Yet those who survived the concentration camps and lived long enough, reestablished their lives, often in new countries, reentered the work force, married, and had children. Then another potentially tragic tale began to unfold. It appeared that the negative impact of the Nazi persecution was to affect yet another generation.
From two different centers in Montreal, the Jewish General Hospital and McGill University's Student Counselling Center, came the first reports of a special, psychologically unhealthy quality of the relationship between survivors and their children, which resulted in difficulties for the children. Rakoff, later joined by Sigal and Epstein, two psychoanalysts, reported an unusual degree of mutual involvement, an enmeshment between parent and child.7 The children were expected to share in the unyielding intensity of the parents' mourning and to complete the interrupted lives of dead members of the family. They were not only expected to replace dead relatives, but to become the idealized, perfect version of them. Any suggestion of an unwillingness to share the parents' experiences of suffering, victimization, or suspiciousness of the surrounding world, any hint that they wished to lead their own lives or to follow their own ambitions, was met with protest and outrage by the parents, as if it were a betrayal or an abandonment. As a result the children were reported to be guilty and depressed, and to feel alienated from the community. They were also observed to be rebellious and, if there were more than one child in the family, to demonstrate an excessive degree of rivalry with each other. Trossman, observing young university students, noted that their rebelliousness sometimes took the form of dating non-Jews, in one case even a student of German extraction.8
A host of studies and extensive clinical reports confirmed and extended these original observations. Sigal, noting the similarity between the presenting complaints of children of survivors and those in a number of other groups, proposed that parental preoccupation was the common denominator.9 In the case of survivors, this preoccupation with their physical or psychological distress, or with their interrupted lives, interfered with their capacity to respond appropriately to the changing needs of their children as they developed. None of these lapses in "good enough" responding, to use Winnicott's term,10 was crucial in producing subsequent psychopathology in the child, but the many lapses could result in a cumulative trauma, claimed Sigal, borrowing Khan's concept.11 Krystal suggested that some parents actually unconsciously encouraged aggressive behavior in their children, getting them to express what they, the parents, had been unable to express for fear of being killed in the camps. Axelrod, yet another psychoanalyst, and her colleagues thought that severe psychological disturbances were precipitated in the patients whom they studied because the parents did not tell them about their experiences during the Holocaust.12
Whatever the cause, anyone observing repeated serious suicidal attempts by mothers whose adolescent or adult children attempted to leave home in pursuit of studies or a career cannot doubt that at least some children have had the responsibility for their parents' survival imposed upon them.
Most of the host of reports following those of Rakoff and Trossman were based on interference, since they were derived from interpretations of interview or test data. A group of psychoanalysts in New York hoped that the insights offered by the in-depth explorations of thoughts and motivations through psychoanalysis would provide some definitive answers concerning the unique qualities of the intrapsychic life unique to these children. By using the patients' own associations as they emerged in the treatment, the analysts would discover links which patients would have been unable to report in a standard interview or on a test because they were not consciously aware of them.
On the basis of the case material published in Generations of the Holocaust, which presents some of the deliberations of this group of psychoanalysts, one can observe that they did not limit themselves to the examination of material from formal psychoanalyses. They hoped that their joint clinical experience would enable them to probe for unconscious links in cases treated by less intense therapies as well. This book is unique in that it not only reports the analyses of a number of children of victims of the Holocaust, but also of some children of the perpetrators, the Nazis.
The editors of the book, Martin Bergmann and Milton Jucovy, note the difficulty the group experienced in obtaining hard evidence linking the Holcaust experience of the parents and the psychological functioning of the patients. Sometimes analysts in the group, or those who presented their cases to the group, ignored the obvious links between the parents' Holocaust experience and the patients' difficulties, or neglected to obtain any information about the parents' experiences. Others tended to see these links everywhere. Either tendency could be a reflection of the analysts' own problems in coming to terms with the Holocaust.13 The psychoanalysts who probably experienced the greatest difficulty were those who were attempting to treat patients who retained their Nazi ideology. The professional integrity and clinical acumen with which these psychoanalysts pursued their work must be admired.
Some of the case material in the book provides convincing evidence for a link between the parents' Holocaust experience and the children's problems, even when the parents may not have spoken to their children about the experiences. Gampel reports the case of a seven-year-old girl who was brought for a consultation because of amnesia and "absences."14 She would appear to lose contact with her surroundings, and, when she recovered, she would be confused. In a response to a question during the interview, the child said she did not want to be "an electric fence in the Warsaw ghetto. They put soldiers' children there and if they touch the fence and electrocute themselves, they will die." When, in the next session, the analyst asked the mother to help her understand the significance of this statement, the mother blanched. She informed the analyst that her husband had been in the Warsaw ghetto as a child and then in a concentration camp but had never spoken to the child about his experiences. When asked about his origins, he would only volunteer that he had come to Israel as a child. The analyst reports that as a result of working on the link between the girl's symptoms and her father's history, the symptom disappeared.
Kestenberg gives a brief report of a four-year-old boy who had a bus phobia and was a bedwetter.15 Only when pressed did his father remember a bus trip to a farm where he sought refuge from the Nazis. After an initial denial, he also remembered that his father was asked to remove him from their hiding place when he wet himself at the age of eight. Kestenberg suggests that the father probably also wet himself at the age of four, when the family fled Germany.
In yet another case, described by Herzog, a patient revealed, with great shame, that when her son was very small she would occasionally forget to feed him.16 Her family complained that she had them all on a diet. In fact, she used her grocery money to make contributions to an international relief fund. In her analysis she remembered sitting in what might have been a highchair. Her mother seemed to be hurriedly forcing food into her mouth. It appears that the patient was continuing to feed starving children, via the relief fund, as her mother had done, and her family was reexperiencing the starvation and the consequences of maternal preoccupation that she had experienced.
The links to the parents' experiences were found in adults, too, Herzog tells of a thirty-year-old patient who would become very anxious if he had to become involved in a project that would require his presence over an extended period of time. The patient once commented, "It's harder for them to catch you if they don't know where you are." Herzog links these anxieties to the fact that the patient's father had escaped the Nazis and made his way to Russia where he was interned in Siberia.
Herzog suggests that the long-term impact of the Holocaust on this patient's father was also responsible for another of his personality traits. The patient often dealt with older colleagues in such a way as to provoke their anger. Herzog presents details from the patient's analysis that suggest that his behavior was a generalization to these colleagues of his wish to provoke some sort of response from his father, who was emotionally numbed by his experiences during the Holocaust. The patient's preoccupation with themes of killing and being killed, and images of his mother as a murderess, became linked in his analysis to his mother's wartime activities with the partisans.
There are many more such illustrations in the book. Some are brief vignettes. Others are longer descriptions of the flow of the analysis. Some are detailed reports of the parents' backgrounds, with allusions as to how it affected the children. Others emphasize the children, with selected references to revelant aspects in the parents' background.
Not all the vignettes or more detailed expositions are as convincing as the ones just reported. There are places where one wonders whether the associations are the patient's or the analyst's. Thus, Kestenberg, referring to a patient's constipation says that the patient had become the mother of all Jews, whom she (symbolically) imprisoned in her intestines.17 When she did empty bowels, she was letting them all escape. Or again, "Her death wishes against her siblings were connected with her ideas about relatives who had died in the Holocaust" (p. 143). Oliner describes a boy who had been sent for a religious education, by parents who had turned away from religion.18 The boy began to force his parents to observe Jewish rituals. Oliner suggests that he did so because he had assumed the role of the Rabbi in the family who had been lost in the Holocaust.
Such interpretations as the ones just mentioned may seem strange, or even bizarre to persons who are not familiar with the symbols and linkages of the unconscious mind. Patients' apparent ramblings (free associations) in the course of psychoanalytic treatment, the associations evoked in them by dreams, and their emotional discharges in the course of these ramblings and associations offer convincing evidence for the acceptability of such interpretations. But in the absence of the stuff of the analysis that led the analyst to these conclusions, one must consider the possibility that they reflect the analyst's wish to prove a point, and do not necessarily derive from links in the patient's unconscious.
Even when case material is offered, alternate interpretations are possible. For example, Oliner reports a patient's dream:
Miss T. is living in a commune next door, and there is a lot of borrowing back and forth. She goes into this woman's house to take a shower. The woman comes home and thinks that perhaps her mother or father are in the house [later the patient said, "Funny, first I made her into an orphan"]; and when she finds out that they are not there, Miss T. gets worried and wants to rush lest the woman think that she is an intruder and call the police. The shower is not opened with a screwdriver but with a silver spoon that in the dream belongs to her and in reality is a spoon her parents brought from abroad.19
In thinking about the dream, the patient immediately connected the shower to the gas chambers. Oliner informs us that the woman was living with the patient's uncle and she had a shower for which one needs a screwdriver. The patient had the dream the night before a session in which she asked her analyst to change a session to another time. When her analyst had previously asked her to change her session to that time as it was more convenient for the analyst, the patient had said she was not able to. In keeping with the hypothesis first proposed by Rakoff,20Oliner suggests that the dream shows that the patient feels she can only be loved if she is the dead relative (who was gassed by the Nazis), as well as showing her identification with her dead parents.
This dream might equally well be interpreted in standard Oedipal conflict terms using the same associations. The borrowing back and forth could refer to her wanting to have what the analyst wants (the time change), or what her uncle's mistress has, namely, the uncle, who may be a father substitute, whose screwdriver operates the shower (the semen or the vaginal lubrication during intercourse). The woman, who may now also represent the patient in the dream since the patient has symbolically displaced the woman in her uncle's favors, begins to feel guilty about her wishes, which include killing her parents (she made the woman into an orphan according to the patient's later association, before she resurrected them as the parents in the dream). In the dream this guilt is represented by her concern that the woman will call the police (the self-punitive part of her personality). Under the threat of this punishment for her sexual, rivalrous wishes, she then dreams that she is not thinking about rivalry with her mother for her father's affections, but about a loving feeding (the spoon) which her parents both wish. Other interpretations in a similar vein are also possible.
What about the patient's association to the gas chambers? Surely this connection makes it likely that Oliner's interpretation is more accurate, since presumably members of the patient's family died in them, or at least at the hands of the Nazis. Not so. Associations to the gas chambers, to torture by the Nazis, or to being chased or hunted are produced by patients who have not lost members of their family in the Holocaust, or by any other unnatural means for that matter. Similarly, even among Jews who did not have families subjected to the Nazi persecution and without a rabbi among their forebears, it is not unusual to find that children who are sent for a religious education attempt to persuade or persecute their parents into becoming more observant, as did the patient described by Oliner. Thus, alternate interpretations are also possible for much of the case material in the chapters of the book that deal with children of survivors.
The preceding illustrations serve to highlight the difficulties confronting the research group. They recognize these limitations, and others. Kestenberg, as well as Bergmann and Jucovy, is aware that the general formulations derived from the cases studied by the group do not necessarily apply to those who have not sought analysis. They acknowledge that the group has studied too few cases to be able to suggest that their observations encompass all the problems faced by survivors which were transmitted to their children, even among those who do come for analysis.21
The editors also acknowledge that the group has not been successful in defining a syndrome for children of survivors. Yet one can find, scattered through various chapters of the book, some attempts to generalize and particularly in the chapters by Oliner, by Martin Bergmann, and by Maria Bergmann at the end of the book.22 The most consistently presented view is that the parents, particularly the mothers, are overwhelmed by anxieties deriving from their experiences of persecution by the Nazis. These unresolved anxieties result in a variety of difficulties for the children. Most of these difficulties are reflected in problems they have in establishing their own identity and separateness from the parents. Among these difficulties are the feeling of being the incarnation of one or many dead relatives; acting as a punitive parent or a sexual partner to the parent; a fear of involvement with others or of commitment to careers; other problems in the expression of aggression, manifested either through rebelliousness and a need to dominate others, passivity and allowing oneself to be victimized, or phobic states, and other manifestations or experiences of anxiety. The list of potential negative consequences is great.
Some of the contributors do mention that some children may achieve constructive, sublimanatory solutions. The circumstances in which they are raised give these children the impetus to assume responsibilities maturely, to be active, creative, and socially aware. The editors cite with approval Hillel Klein's observation that survivor's guilt found in survivors and their children is not necessarily pathological.23 It can provide a link to the past, a sense of continuity with the Jewish people, and a sense of identity.
An overwhelming proportion of Generations of the Holocaust is devoted to presentation and discussion of psychopathology in survivors and their children. In this respect the book is rich in clinical insights and the contributors draw on a number of psychoanalytic theories-drive theory, structural theory, Mahlerian theory, selfpsychology-for their formulations. But what about the well-functioning aspects of the same patients' personality, or those who are psychologically sound? And how applicable are the clinical observations and the theoretical formulations to survivors or their children as a group?
When Melanie Klein, a prominent, controversial psychoanalyst, was asked by a student why she never discussed the healthy aspects of the personality of patients in analysis, she replied, "That's not where the trouble is." Clinical psychoanalysis deals with troubles. It should not be surprising, therefore, that psychoanalysts presenting case material emphasize psychopathology rather than health. They do not have the opportunity to observe healthy functioning with the same depth as they observe psychopathology. Nor do they have the nuance in their vocabulary for healthy functioning that they have to describe psychopathology.
The second question is more difficult to answer. It actually consists of two questions. The first is, how accurate is any given interpretation of the clinical observations that were made? The second is, to what proportion of the entire group do these observations apply? There are at least two tests for the correctness of an interpretation. The first is the consistency of the patient's associations with the analyst's formulation. The other is the consistency of the patient's associations and affective reactions following the interpretation, and the degree to which the patient gains new insights as a result of the interpretation. As the alternate interpretation of the dream reported above has illustrated, there may be more than one interpretation possible of the same associations. Waelder, many years ago, pointed out that many aspects of a person's unconscious determine his or her associations at any given moment.24 Thus many interpretations may be correct. The issue is one of salience or revelance to the patient at any given point in an analysis. And it is the analyst's intuition concerning the issues that are most salient for the patient that determines which of many possible meanings s/he will interpret. It is at this juncture that the analyst's personal interest rather than the patient's unconscious may determine the course of the patient's associations, and even the course of the analysis. Here is where a great deal of subjectivity enters into the understanding of people by the psychoanalytic method. Hence the heated debates within psychoanalytic societies that have led to exorcisms, the formation of splinter groups, or of entire new schools of psychoanalysis.
Martin Bergmann did use a method commonly used by social scientists to determine the reliability of their observations. Bergmann had noted problems in separation from their parents among children of survivors. He asked an independent outside observer, specifically Margaret Mahler, to conduct an independent review of many of the cases he discusses in his chapter. Unfortunately, she was not an unbiased observer, a prime requirement in science. Mahler has devoted much of her professional life to writing about separation/individuation. It is therefore not surprising that she observed such problems "almost universally" among Bergmann's cases. Had Heinz Kohut, Melanie Klein, or Harry Stack Sullivan, to name but a few prominent clinical theorists, been asked to review the same cases, they might well have found evidence for problems addressed by their respective theories to be almost as universal among them.
Arriving at universally applicable generalizations on the basis of associations obtained from patients in analysis is a notoriously difficult task. Genius of Freud's calibre is rare. The task is made more difficult by the fact that survivors are such a heterogeneous group. They not only differ in the personalities brought to the camps, but also in their experiences there and their response to them. The different orientations of Elie Wiesel, Viktor Frankl, and Bruno Bettelheim to their Holocaust experiences provide sufficient evidence for this point.
Yet tests of the generalizability of some of the findings reported in the Generations of the Holocaust are possible. A study conducted by Sigal and Weinfeld suggests the majority of children of survivors are not adversely affected by their parents' experiences, and do not relate to their parents or to the outside world in the manner that might have been predicted from clinical observations.25 Indeed, the facts even contradict some of the observations initially made by Sigal and Rakoff in the first empirical studies of the intergenerational effects of Holocaust.26
The vast majority of survey-type studies of children of survivors have been conducted on self-selected or clinic groups. The representativeness of their results is therefore open to serious question.27 Sigal and Weinfeld used random sampling methods to obtain a sample of some 250 young adult children of survivors aged 19-35 years. They compared survivors' children's responses to some 500 interview questions to those of a sample of about 75 children of Jews who immigrated to Canada from Europe before the Nazi persecution, and about 200 children of native born Jews. They found scant evidence to suggest that, as a group, children of survivors differed from other young adult Jews with respect to their conflicts with their parents; their problems in the control of aggression; their anxieties, phobias or guilt feelings; their feelings of self-esteem; their achievements, their relationships to their partners or spouses, or their parents' attitudes to their having partners or spouses.
In brief, their findings failed to confirm the clinicians' observations.
Who is right? We are dealing with two different kinds of evidence. The evidence obtained by Sigal and Weinfeld is based on reports of feelings, attitudes, and performance of which the respondents are conscious. Much of what is reported in Generations of the Holocaust is based on the discovery of links of which the patients may not be consciously aware. Yet reasonable inferences may be made as to how these unconscious links affect behavior. People with unresolved separation problems, or problems with their identities, are at increased risk for tensions in relationships with parents or partners, or feel less satisfied with themselves or with their achievements. People with problems in dealing with aggression are at higher risk for phobias, anxieties and guilt, and for difficulties in interpersonal relations. They may therefore be consciously aware of these consequences and able to report them, even if they are not aware of their unconscious determinants.
Sigal and Weinfeld did not find children of survivors to be at greater risk in these areas. They recognized that the absence of evidence is not evidence for absence. But two of their other findings suggest that if there were differences, they would have found them.
Consistent with the research evidence cited at the beginning of this review, children of survivors did report, more frequently than the others, that their parents were adversely affected by World War 11. Furthermore, as one might expect, they knew more about people, places, and events associated with World War Il and the Nazi persecution of the Jews.
A conclusion that reconciles the apparent differences between findings of the New York psychoanalytic study group and of the Montreal survey group is that, as a group, children of survivors are not more disturbed than others, but their problems, when they do have them, may derive from different sources. Generations of the Holocaust amply demonstrates that clinicians who work with survivors or their children are ill prepared for the task if they are not intimately familiar with these sources and their psychological repercussions.
The majority of reports of the analyses of children of survivors included in Generations of the Holocaust contain an element of hope that their problems were or can be surmounted. Not so for the reports of the analyses of the children of Nazis or supporters of the ideals of the Third Reich. This section of the book contains lengthier reports of analyses conducted with great sensivity despite enormous obstacles for both patient and analyst. To retain an attitude of evenly-hovering attention and care in the face of vigorous expressions of ideologies that run counter to every civilized instinct is difficult indeed. The patients were confronted by such expressions in their parents, and the analysts were confronted by them in their patients, either directly, or in their patients' struggles to come to terms with their parents' ideologies or activities. We have no data for children of the perpetrators comparable to Sigal and Weinfeld's for children of survivors. If the descriptions contained in this section of the book represented the way in which substantial numbers of German children have been marked by their parents, there is another generation of potential perpetrators, with their families, and potentially others, as the victims. One can only pray that this group is as heterogeneous as is the group of survivors and their children.
5. George W. Beebe, "Follow-up Studies of World War Il and Korean War Prisoners," American Journal of Epidemiology 101 (1974): 400-22; Robert J. Keehn, "Follow-up Studies of World War II and Korean Conflict Prisoners: III. Mortality to January 1, 1976," American Journal of Epidemiology 111 (1980):194-202; Komaluddin Khan, "Psychosocial Sequelae to Prolonged Psychological Stress and Trauma" (paper delivered to the International Congress of Psychosomatic Medicine, Montreal, Canada, Sept. 1981); Victor A. Kral, Leon H. Pazdor, and Blossom T. Wigdor, "Long-Term Effects of a Prolonged Stress Experience," Canadian Psychiatric Association journal 12 (1967): 175-81.
6. One should note that the members of the resistance and of the Allied armed forces who were held in the Nazi prison camps did not suffer long-term ill effects. The reason is that they were subjected neither to forced labor and undernourishment nor to the beatings experienced by their comrades in the Nazi concentration camps or in the Japanese or Korean prisoner-of-war camps.
7. Vivian Rakoff, "A Long-Term in Effect of the Concentration Camp Experience," Viewpoints 1 (1966): 17-22; V. Rakoff, John J. Sigal, and Nathan V. Epstein, "Children and Families of Concentration Camp Survivors," Canada's Mental Health 14 (1966): 24-25.
9. J. J. Sigal, "Some Second Generation Effects of Massive Psychic Trauma," in Psychic Traumatization, ed. Henry Krystal and William G. Niederland (New York, 1971), pp. 55-66; "Familial Consequences of Parental Preoccupation" (paper delivered to the Annual Meeting of the American Psychiatric Association, Dallas, May 1972).
13. Yael Danieli, "Countertransference in the Treatment and Study of Nazi Holocaust Survivors and Their Children," Victimology: An International journal 5 (1980): 355-67; idem, "Psychotherapists' Participation in the Conspiracy of Silence About the Holocaust," Psychoanalytic Psychology 1 (1984): 23-42; Eva Fogelman and Bella Savran, "Brief Group Therapy with Offspring of Holocaust Survivors: Leader's Reactions," American Journal of Orthopsychiatry 50 (1980): 96-108.
22. See n. 18; Martin S. Bergmann, "Recurrent Problems in the Treatment of Survivors and Their Children," Generations, pp. 248-66; Maria V. Bergmann, "Thoughts on Superego Pathology in Survivors and Their Children," ibid., pp. 287-302.
25. J. J. Sigal and M. Weinfeld, "Control of Aggression in Adult Children of Survivors of the Nazi Persecution," Journal of Abnormal Psychology, 94 (1985): 556-64. "Enmeshment and Alienation in Families of Holocaust Survivors" (paper delivered to the Annual Meeting of the American Psychological Association, Toronto, Aug. 1984).
26. Sigal and Rakoff, "Concentration Camp Survival: A pilot study of effects on the second generation," Canadian Psychiatric Association Journal 16 (1971): 393-97; Sigal et al., "Some Second Generation Effects of Survival of the Nazi Persecution," American Journal of Orthopsychiatry 43 (1973): 320-27.
27. Norman Solkoff, "Children of Survivors of the Nazi Persecution: A Critical Review of the Literature," American Journal of Orthopsychiatry 51 (1981): 29- 42. Solkoff reviews the methodological flaws in this scientific literature.