102

E. Luchterhand: Early and Late Effects of Imprisonment in Nazi Concentration Camps

Social Psychiatry

Early and Late Effects of Imprisonment in Nazi Concentration Camps * Conflicting Interpretations in Survivor Research ELMER LUCI-ITERHAND Department of Sociology, Brooklyn College of the City University of New York Brooklyn, New York

Summary. This paper explores some of the disagreements in the literature on prisoner behavior in the Nazi concentration camps. It also cites wide differences in the findings of early observers of imprisonment effects. Conflicting views of psychoanalysts on the "symptom-free interval" are noted. A high degree of agreement on the pattern of late effects known as the "CC syndrome", is indicated. The paper reports that there is apparent acceptance of the limited evidence available that clinical records of survivors of Nazi persecution who lived in hiding but were not in camps also fit the "CC syndrome". Studies are reviewed which suggest that a narrowly psychodynamic or neurobiological emphasis leads to defective interpretations. In this connection disagreements over the importance of the guilt factor ("existential", "survival", or "survivor guilt") are examined. Finally, the paper considers some probable relationships between duration of CC experience, the factor of stress, and early and late sequelae of NCC experience. R~sum~. Ce travail ~tudie quelques-uns des dEsaccords existant dans la litt~rature sur le comportement des prisonniers des camps de concentration nazis. I1 note aussi de grandes divergences dans les r~sultats d'observations antErieures sur les effets de la d~tention. Les rues divergentes des psychanalystes quant ~t d'intervalle sans sympt6mes,, sont relevEes. Darts l'ensemble, les auteurs sont d'accord quant ~t la structure des effets tardifs connus sous le nom de ~CC-syndrome,,. Le travail rel~ve que les t~moignages limit,s obtenus sont facilement acceptEs et que les rapports cliniques des pers6cutEs qui ont survdcu en se cachant et non pas dans des camps correspondent dgalement au ~CC-syndrome,,. Des dtudes sont discut~es qui laissent supposer qu'une accentuation purement

The immediate purpose of this paper is to examine, from a sociological standpoint, some conflicting interpretations in research with Nazi concentration camp (NCC) survivors. The long-term concern is with theory building. Because of the way research has developed in this forbidding area, it will be necessary at times to range far afield from the home ground of sociology. The complexity of man-made, collective stress situations and the effects on the victims over time and in widely differing social environments adds greatly to the usual risks in interpreting others' work, especially when that involves crossing disciplinary boundaries. But in the language of Seeley, if we who work in related fields are ever to "stop playing autistically in our corners and encounter each other", such risks must be taken. As used here the term NCC system includes those ghettos which came under Nazi rule or were created by the Nazis, and were effectively transformed into transit camps. The NCC's comprised the core of a * This paper was prepared with the support of Grant No. 4040, Penrose Fund, American Philosophical Society. It is a revised version of one that was presented at the Vlth World Congress of Sociology at Evian, France, September 1966.

psychodynamique ou purement neurobiologique m~ne ~ des interpr6tations insuffisantes. A cet 6gard, les divergences sur l'importance du facteur de la culpabilit6 (,existentMle,,, <
ZusammenJassung. Diese Arbeit geht einigen Meinungsverschiedenheiten innerhalb der Verhaltensbeschreibungen yon H~iftlingen nationalsozialistischer Konzentrationslager nach. Sic berichtet ferner weitgehende Unterschiede in den Ergebnissen yon friihen Beobachtern der Auswirkungen yon Gefangenschaft. Sich widersprechende Ansichten yon Psychoanalytikern fiber das ,,symptomfreie Intervall" werden aug gefiihrt. Es wird ein hoher Grad yon 13bereinstimmung hinsichtlich der Struktur yon spS.ten Auswirkungen, die als ,,CCSyndrom" bekannt wurden, verzeichnet. Es wird berichtet, daft die beschdinkt erh~iltlichen Zeugenaussagen offensichtlich akzeptiert werden und dag die klinischen Berichte von diesen Verfolgten, die in Verstecken, abet nicht in Lagern iiberlebten, auch in das ,,CC-Syndrom" hineinpassen. Es werden Untersuchungen besprochen, die vermuten lassen, daft eine rein psychodynamische oder rein neurobiologische Akzentuierung zu unzulS.nglichen Interpretationen fiihrt. In diesem Zusammenhang werden Meinungsverschiedenheiten fiber die Bedeutsamkeit des Schuldfaktors (,existentiell", ,,I3berleben" oder ,,Uberlebensschuld") untersucht. Schlieglich zieht die Arbeit einige wahrscheinliche Beziehungen zwischen der Dauer der CC-Erfahrung, dem Strel~faktor und frtihen oder sp~iteren Folgeerscheinungen der NCC-Erfahrung in Betracht.

more extensive special oppression system of the state, which was directed at various population segments. Thus oppression did not begin and end at the camp gates. A useful definition of oppression is provided by Klein, Zellermayer and Shanan (1963). They refer to it as "'a long series of traumatic experiences" that threaten basic biological and psychological functions and the life of the individual. The development of a body of knowledge on the NCC system and its immediate direct effects on survivors and long-range indirect effects is occurring under exceptional difficulties. The NCC system was exceedingly complex. Besides differences in camp operation by time, place and type, the prisoners differed greatly in age, ethnic and national origins, "offense" category (indicated by color-coded triangles, six-pointed stars, etc.), and by circumstances of liberation and of re-entry into civil society. The route of re-entry varied--a military hospital of the allies, a DP camp, quick emigration to a foreign country, or repatriation. Travel was sometimes by government transport, with a hero's welcome at the end of the line, but often by resources organized by the survivors themselves. For Jews, Gypsies and a

VoI. 5, No. 2, 1970

E. Lucllterhand: Early and Late Effects of Imprisonment in Nazi Concentration Camps

handful of Spanish Loyalists who escaped Franco only to be caught by Hitler, there was some kind of re-entry but no return. Literature on Prisoner Behavior: Disagreements

An extensive literature exists on the NCC's consisting largely of personal accounts of survivors. Among these are a few which reflect some limited organization around a conceptual framework from medicine, psychoanalysis, politics, and in several instances, the social sciencesunotably works by Kogon (1947), and Kautsky (1946). Out of the small fraction of the prisoner population that survived, only a few were prepared by formal training to deal with the sociopsychological complexities of the holocaust. Of these, still fewer found the strength or circumstances with which to do so. Perhaps because of the needs of the camp administrations, the possibilities for survival tended to be greater for members of the medical profession than most other occupational categories, and they have contributed insightful personal accounts as well as technical observations. Without the prisoner contributions, the NCC system would indeed be "a dead planet inhabited by corpses" (Rousset, 1947), known largely by the reports of observers with the military. As it is, knowledge about the NCC system while much better than for other genocidal events in history, has been burdened with gross reporting errors, misimpressions and the quick publication of poorly grounded theories. Brief reference will be made to only two instances. The sociologist Bloch interviewed survivors informally at several locations after liberation. Projecting from his knowledge of the much more visible and developed prisoner organization in penal institutions in the United States, be disregarded the evidence of the emergence--unevenly and in most places feebly--of a prisoner social system. He referred to the camp populations by the phrase, "modern feral communities", and pictured the behavior of prisoners as a continuous, tooth-and-claw struggle against each other (1947). While the particulars of Bloch's interpretation had little direct impact, it is highly likely that they provided a base of support in sociology for the propositions of Bettelheim, first published in a long article (1943 1). These include the claims that the longer prisoners were confined, the more they identified with the Gestapo, and that " A prisoner had reached the final stage of adjustment to the camp situation when he had changed his personality so as to accept as his own the values of the Gestapo". The theme of identification with the aggressor, so familiar in psychoanalytical writing, was elaborated into a stage-theory of prisoner adjustment. Bettelheim's 1 A shortened version was reprinted in 1947 in T. M. Newcomb and E. L. Hartley (eds.), Readings in Social Psychology, and in successive editions of the readings, published by the Society for the Psychological Study of Social Issues.

103

propositions have been generally challenged by Foreman (1959), Eitinger (1964), and by writers on the holocaust, including Donat (1964). Luchterhand interviewed survivors in the United States in an exploration of several Bettelheim claims and propositions. The findings, first reported in 1952, and subsequently re-examined in relation to work by others (1967 b), generally fail to support Bettelheim's central propositions. This early work and the disagreement revolving around Bettelheim will be referred to later in discussing etiological approaches to behavior disorders among survivors. Early and Late Effects of Imprisonment in the NCC's

The term "early" is used here in references to the period of medical rehabilitation and personal reorganization following liberation. This was a period of intensification of socialization processes to meet the demands of non-camp society for behavioral, attitudinal and motivational changes appropriate to new occupational, family and sociocultural circumstances. The duration of this period of rehabilitation and personal reorganization varied widely for different individuals. This period was a demanding one, but it was sometimes enriched socially by contacts with people whose roles--occupational or other--involved acts of helpfulness. It is within this early period, that the "symptom-free interval" which is referred to so often in the literature of psychiatry and psychoanalysis, occurred. Reference will be made later to disagreements in the literature surrounding the "symptom-free interval". From data gathered in 1950 at immigrant transit camps in Israel from 192 NCC veterans and 577 other Europeans serving as controls, the sociologist Judith Shuval analyzed various attitude and personality effects. She reports (1963): (1) that under fairly favorable conditions, the CC veterans were more pessimistic about their future in Israel than the controls; (2) that CC experience "hardened" the individual to better withstand the relatively minor new strains of the transit situation than the controis--that "although the experience of the concentration camp was a negative one, the evidence here points to a kind of positive aftereffect in the sense of assisting the individual to weather additional strain". In a paper which won the Helen L. DeRoy award of the Society for the Study of Social Problems for 1957, Shuval (1957m1958) also reports on a test of the claim of "unchangeability" of basic traits of personality even in the face of so extreme an experience as internment in a Nazi concentration camp". Shuval compared camp-survivor and control population scores on a "quasi-scale of psychosomatic complaints". Finding no difference between the two populations she concludes that, "This evidence, while in itself fairly limited, would tend to bear out the findings of other research on this subject". As is well known recent interpretations by psychiatrists and

104

E. Luchterhand:Early and Late Effectsof Imprisonmentin Nazi ConcentrationCamps

psychoanalysts contradict this conculsion overwhelmingly, if not universally. In the same award-winning paper, Shuval reports on her test of claims by various observers regarding the "increased mistrust, suspicion, and perception of hostility of the outside world", ascribed to CC veterans. She found no difference between her survivor and control populations and concludes, "... five years after liberation, any distrust and perception of hostility which were found among concentrationcamp survivors immediately after liberation has disappeared". Early medical and psychiatric studies of NCC survivors provide evidence of a high incidence of illnesses. The first large-scale, systematic study was done in Denmark, a country that by October 1945, had already enacted a law providing compensation for victims of the Nazi occupation, with special consideration given to political prisoners and resistance deportees. Beginning in 1947, Helweg-Larsen and associates studied 1300 repatriated, Danish, survivors by means of questionnaires, supplemented by psychiatric interviews with 52. The authors report that nearly threefourths gave evidence of "neurotic symptoms of varying degrees of severity", with most of these being neurasthenia-like. For many the symptoms markedly reduced social and vocational adjustment. Appearance of the symptoms in some cases occurred only after a period of latency. Helweg-Larsen and associates (1952) referred to the prevailing pattern of disordered behavior as "repatriation neurosis". They attempted to show that loss of weight could be taken as an index of stress of all kinds experienced in the camps. In their conclusions, the possibility is offered that "from a common repatriation neurosis a limited number of cases" might take "a longlasting and possibly chronic course without tendency to recovery". Considering this eventuality, the authors suggest that "the etiology in such cases must to a greater extent be conditioned by somatogenic and lesional disorders". Herrmann and Thygesen (1954) examined 120 NCC survivors. They undertook a systematic description of "asthenic and vegetative symptoms", noting their relationship to emotional and intellectual functioning. They referred to the prevailing pattern of behavior disorder in their clinical cases by the term, "'concentration camp syndrome", and stated that it was logical to assume that a lesional disorder existed although they did not have proof. Str5m and associates examined 100 survivorpatients in Norway by methods of internal medicine, pneumoencephalography, neurology and psychiatry. On the basis of physical tests, evidence of damage to the central nervous system was found in 90 cases. Out of 96 who were examined by psychological tests, 92 showed patterns based on organic damage. As the significant features of the "CC syndrome" StrSm et aL (1962) refer to "a chronic state

Social Psychiatry

of lassitude and loss of memory, coupled with marked neurasthenia or a chronic progressive asthenia..." The "Concentration Camp Syndrome"

The complexity of the NCC system, the heterogeneity of the prisoner population, and the varied circumstances of liberation and re-entry into civil society have been mentioned. Despite these differences, the patterns of disordered behavior reported in the literature are decidedly similar. Venzlaff (1964) gives the following summary statement: "The leading symptom of these conditions, described by various authors, is a general psychophysical asthenia, coupled with impairment of drive and vitality, with manifold autonomic symptoms and mental disturbances such as emotional hyperesthesia, inability to concentrate, apathetic depression, inner restlessness... "'One could hardly hold any one of the many traumatizing factors from the countless strains of concentration camp imprisonment responsible for this syndrome..." Two etiological models appear in the survivor studies done by psychiatrists and psychoanalysts, with the emphasis varying by theory orientation. These might be called the neurobiological and the psychodynamic models. In the general terms of Redlich and Freedman (1966), the former "is based mainly on the clinical study of brain pathology (which stresses deficits and impaired capacities, 'release' or loss of controlled behavior, and lowering of the level of organization)..." Clearly, the emphasis in the three medical studies cited above is neurobiological. A study by Krystal and Niederland (1968) to be mentioned later exemplifies the psychodynamic emphasis. Other references will be cited which cast doubt on the utility of a narrow emphasis in either direction, and indicate more comprehensive approaches. Venzlaff (1964) has provided important support for the observation that clinical records of victims of Nazi persecution, living under cover, also show patterns of behavior corresponding to the "CC syndrome". In a study of effects of extreme oppression Klein, Zellermayer and Shanan (1963) lumped together NCC survivors with other victims of extreme Nazi persecution in a design using "nonoppressed" controls. They do not report distortion due to combining CC and non-CC oppressed, and thereby provide incidental support for Venzlaff's observations extending the "CC syndrome" to the non-camp oppressed. The particulars of persecution inside and outside the camps were manifestly very different. Outside the camps there were no shattering induction routines, selections, transports, mass-debasement assembly situations, mass witnessing of executions, punishment assemblies, corpse piles, death ditches, gas chambers or crematoria. In order to have similarity of clinical pictures--and no

I7ol. 5, No. 2, 1970

E. Luchterhand:Early and Late Effectsof Imprisonmentin Nazi Concentration Camps

writer was found who challenged this reported similarity-there must have been important psychological commonalities in the experience of CC and nonCC oppression. This question is being examined in other work. For the present it may be suggested that the concept of oppression may be a necessary addition, if not a replacement for the concept of trauma in studies of extreme persecution. The "Symptom-Free Interval": Conflicting Interpretations

In psychiatric and psychoanalytic literature there are frequent references to an interval in survivor histories when there was "relative freedom from symptoms". In dealing specifically with schizophrenia caused by CC experience, Venzlaff (1968) states that "we must not indulge the naive expectation that the onset of schizophrenia.., must develop immediately upon the release from the camp. On the contrary, in most schizophrenic syndromes, one can expect a symptom-free period." The general question of "bridge symptoms" assumes special importance in the determination of cause of behavior disorders in N C C survivors where it is the basis of claims under the German Restitution Laws. In the literature growing out of forensic practice, various interpretations of the "symptom-free interval" have been offered by psychiatrists and psychoanalysts. Gronner (1968) states that "I think a useful construct would b e . . . the psychoanalytic dream model. Thus, seen in the light of latent and manifest content, what may appear to be an absence of bridge symptoms is essentially the patient's attempt at adaptation--perhaps with some slight or not so slight characterological deviations-- which he tries to maintain until he is overwhelmed by the latent pathology and becomes seriously disturbed". He adds that "these symptoms could be reconstructed in all cases (My emphasis. E.L.) given enough time and study and a good anamnesis". Krystal (1968) suggest "the possibility of the absorption of the symptoms by masochistic character traits or somatizations which do not become conspicuous for a long time". Sterba (1968), reporting on work with displaced children, states that "Unlike adults, who had a symptom-free period, the children survivors of concentration camps developed emotional disorders as soon as they were settled in this country.. 2' As she sees it, under threat of annihilation, the childhood "egos developed an 'emergency regime' which broke down and fell apart immediately, as soon as . . . pressure to control one's reactions ... was relieved. It is to be expected that an adult, whose ego is stronger than a child's, whose defense mechanisms are more entrenched, would not display the same symptoms immediately after having been settled." Niederland interprets the "symptom-free interval" in terms of guilt (1961, 1966, 1968). Because of

105

its explicit nature, it seems advisable to quote a recent statement by him (1966) in extenso: "I became especially aware of the severe burden of guilt these people carry when I explored what I have called the symptom-free interval, i.e., the period of relative freedom from symptoms some of these patients experienced between the time of liberation and their emigration to the United States. "The survivors indicated that during the years following their liberation they remained relatively free from disabling symptoms and self-punishing tendencies so long as they could fantasy their dead family members might miraculously reappear, and during their exposure to the considerable adjustment difficulties and hardships of settling in a new country. When in the end, they had to recognize that there was no hope, however magically resorted to in their thinking, of a return of the lost relative-many of them developed the typical survivor syndrome...'" In a brief reply to Niederland, Hoppe (1966) states, "The symptom-free interval was often not only relative but rather a phase of psychic suffering in secrecy due to a deep distrust of the world around." The statements by psychoanalysts on the "symptom-free interval" reflect considerable disagreement. 1. Gronner holds that with the proper study of histories, the missing "bridge symptoms" can be reconstructed in all cases. 2. Krystal offers as a possible explanation the absorption of "bridge symptoms" by masochistic traits or somatizations. 3. Sterba does not find the "symptom-free interval" in child survivors, but accepts its reality for adults. She explains it as due to the greater capacity of adult egos to withstand relief in civil society from the pressure in the camps to control one's reactions. 4. Niederland sees the "symptom-free interval" as a period in which fantasies of the return of deceased relatives persists, thereby delaying the full impact of "survivor guilt", which he sees as "the major pathogenic force". 5. Hoppe discounts the reality of the phenomenon by his characterization of it as "suffering in secrecy". Guilt and Late Effects: Conflicting Interpretations

Neurotic guilt is a pervasive theme in psychiatric and especially psychoanalytic writing. Some of the greatest man-made disasters coincide with the development and diffusion of psychoanalytic thought. In Lifton's work on Hiroshima survivors (1967) "guilt over survival priority" is the major theme and serves as a conceptual link for extended comparison with N C C survivors. Referring to the bombing of Hiroshima, he states: "In a disaster of this magnitude, the extreme conditions drastically limit the

106

E. Luchterhand:Early and Late Effectsof Imprisonmentin Nazi ConcentrationCamps

possibilities of cooperation and mutual aid, and thereby greatly accentuate the awareness of ordinary urges toward self-preservation. The idea that an individual's first and strongest impulse is directed toward his own survival becomes vividly displayed and, in this death-saturated context, totally unacceptable." He mentions the conflict over the cenotaph as growing out of a design that precluded a special obeisance to the dead which survivors "sought in order to relieve their extraordinary guilt". In keeping with the survival-guilt thesis, situations in which the dead are missing pose special problems for survivors. The architectural editor, Huxtable (1967) makes the interesting observation that "the only modern monuments of any measurable impact are those dedicated to a particularly grim form of modern death. They are the memorials to 20th-century group massacre that eschew most traditional figurative symbolism..." At the NCC museums in Europe the problem of the missing dead is certainly a factor of some weight in the rather remarkable monument art. This includes folk efforts to replace the missing grave by collective memorials. At Mauthausen, Austria, glaziers have mounted photos and snapshots of victims in a wall panel. From a narrowly psychodynamic viewpoint, such folk memorials may be seen as guilt-motivated collective obeisance to the dead. One defect in popular intuitions about "survival guilt" is that they tend to overlook the structured inequalities of societies and the constellations of attitudes that provide justification for differential life chances. Lifton cites the view of an Indian jurist who compared tendencies among Japanese to look upon the bombing as their own fault, with those of Indians who assumed the blame for British oppression. Lifton adds that "the astuteness of this comparison lies in its suggestion of the universal guilt of the victim (My emphasis. E. L.)." Guilt is an important theme in etiological interpretations of disordered behavior patterns in NCC survivors (Bettelheim, 1943, 1960; Chodoff, 1963, 1966; Krystal, 1966; Niederland, 1961, 1964). Since Krystal and Niederland (1968) have been more explicit in their discussion of the guilt factor than most observers, their position is reviewed in some detail. Krystal and Niederland (1968) assert "that the major pathogenic force is survivor guilt". They refer to guilt as a "nodal pathogenic factor", adding to it a second "basic pathogenic force", which they call "problems of aggression". Like Bettelheim, they attach great importance to prisoner identification with the aggressor. Krystal and Niederland (1968) assert "that the guilt is a form of pathological mourning. The survivor is stuck in a magnification of the guilt which is present in every bereaved person. The ... repressed aggression towards the lost object, prevents the completion of the work of mourning. Hidden in the

Social Psychiatry

self-reproach of many younger patients is probably their repressed rage against the now murdered parents who failed to protect them from the persecutions..." In apparent agreement with Freud's view, Krystal and Niederland see in the failure to complete the work of mourning, the source of "many depressive and anxiety reactions" and in some of their patients "projection and denial of psychotic proportions". However, they extend somewhat the classic view. Guilt as they present it, is not proportional to the hostility borne toward loved ones who have been lost. Rather there is "magnification" through the linking of the assumed death wishes of the survivor with the coincidental destruction of a people. In their interpretation this linking is accomplished through "unconscious identification with the aggressor". They state, "We feel that some unconscious identification with the aggressor may have been indispensable to survival. (In this, Krystal and Niederland are in disagreement with Bettelheim. E.L.) The violent, often sudden, destruction of the survivor's whole world makes the acknowledgement and working through of such identifications most threatening. To own up to death wishes in regard to a whole destroyed civilization is more than most people can do. Neither can the therapist assure the patient that his wishes did not have magic powers, since the most fantastic destructive and race-murder episode did, in fact, become part of their lives." The way in which intellectual systems of psychiatry may affect interpretation of the guilt factor is brought out in a comment by Hoppe (1966), replying to Niederland in discussions of a paper by the former. Hoppe states, "I agree with Dr. Niederland regarding the importance of survivor guilt but I cannot consider it the most pathogenic single factor ... From a genetic viewpoint, guilt feelings are characteristic of the phallic level; a regression to pre-oedipal stages is, however, distinctively noticeable in most victims." Eitinger (1964) analyzed data from 328 Norwegian and 262 Israeli survivors, or a total of 590 in six classificatory groups. He states that because of the way the research was carried out the question of guilt was not explored with all respondents, and he therefore cannot assess accurately the importance of guilt in his three Norwegian and three Israeli groups. Emphasizing that "the view given here must.., be considered with the necessary reserve", he states that, "Generally speaking we can say that there was a remarkable difference between the groups in this respect also (i. e., in manifestations of guilt. E. L.). "Among the Norwegian groups were a number of survivors who hinted that it was, of course, not always pleasant to belong to the privileged prisoners who received parcels and could gain advantages through them. There were also many who found the forced passivity during the sufferings of others, as

tlol. 5, No. 2, 1970

E. Luchterhand:Early and Late Effectsof Imprisonmentin Nazi ConcentrationCamps

regards witnessing floggings or hangings, very humiliating. However, we never got the impression that these experiences had had such an affect as to form the core of a neurotic feeling of guilt." He notes that some "self-reproach for their own inadequacy, especially under interrogation and torture", was indicated in responses from one Norwegian group. He emphasizes that guilt was manifested "with secondary reactions, which proved inaccessible for a satisfactory therapy", in instances where the respondents' statements under torture led to more arrests. He reports many cases of feelings of guilt in one Israeli group with direct expressions of self-reproach. He states that this centered around their lack of resistance toward the Germans in general. Eitinger (1966) refers to differences in his findings for Norwegian respondents, and the observations of American investigators studying Jews now living in the United States. He states: "We are not able to find the large number of guilt feelings among our patients which several authors here (in the United States-E.L.) could demonstrate in their patients. Our patients are, in contrast to the Jewish ones, not the sole survivors of large families; they are, on the contrary, the only heroes and the only sufferers of their families and surroundings, and these facts do not, of course, create any sort of guilt feelings." This point is developed again by Eitinger and Askevold (1968). In the years 1950 and 1951, the writer interviewed intensively 52 former prisoners in the United States (1952, 1966/67, 1967). Four classified themselves as non-Jews. With only several exceptions, all of them had lost members of their immediate families and many were sole survivors. No doubts were expressed about the death of family members, and only rarely were there expressions of some kind of self-reproach. Most of them seemed to be making a rather satisfactory adjustment to post-camp life. The exceptions will be mentioned later. The proper study of guilt in survivors would be a complex undertaking. It would require research on prisoner and SS behavior and social systems and on relationships in non-camp society. An example of the manifestation of guilt by a survivor at liberation may help slightly to make the point. The writer talked with a Jewish member of a Sonderkommando in Mauthausen. Two weeks before liberation, he had been assigned, with others, to the job of loading bodies into the crematorium retorts. For two weeks he had slept in comparative comfort in a warm dry spot behind them. The man referred repeatedly to the fact that all prisoners on the Sonderkommando were exterminated every few weeks and hence, in the usual course of events, he would not have remained alive. At first, in mentioning this, his manner reflected a certain self-assurance based presumably on the full understanding of his position by fellow survivors who had shared his degraded

107

identity of concentration camp prisoner. Moments later in the same uninterrupted flow of description his language and manner began to reflect concern with the image that others outside might hold of him. Duration of CC Experience, Stress and Late Effects

One of the difficulties in interpreting findings of studies of NCC survivors arises from the massive impact of stressor situations in the camps. Massive refers to stress of such magnitude that the common distinction between "physical" and "psychic" becomes exceedingly difficult to maintain. Despite the powerful linking of the two in the NCC's, there is heuristic value in the distinction. Since the NCC system developed in the direction of continuous and mounting violence the longer one was confined in a camp, the more physical stress and damage one was likely to incur. With psychic stress, on the other hand, things were more complicated, as will be indicated later. From all that is known about the camps, it would seem plausible that incidence of the "CC syndrome" in any survivor population would vary directly with length of imprisonment. In his crosscultural research on survivors in Norway and Israel, Eitinger (1964) operationalized the "'CC syndrome" and provides data not otherwise available on its presence or absence in survivors by length of imprisonment. He grouped his cases according to whether they had been in the NCC's less than three years, or more. (It happens that Bettelheim defines "old" prisoners as those in the camps three years or more.) The writer examined the published data for possible differences in the effects of length of imprisonment on survivors in Norway and Israel and obtained the following results. With the two groups combined (N = 590) the frequency of cases in which the "CC syndrome" is present is significantly higher for those in the camps three or more years than for those with less time (p=0.001). Looking at the Norwegians separately (N=328), the result is the same. But looking at the Israelis separately (N = 262), time in the camps makes no statistically significant difference in the presence or absence of the "CC syndrome". While it is risky to interpret results of such a secondary exploration they illustrate some of the hazards of inference. Eitinger (1964) states with reference to his Norwegian respondents that %.. for the majority, they suffered the greatest stress during the period from their arrest and until their delivery into the concentration camp, in the form of mechanical head injuries and other kinds of torture. On the other hand, this period was of secondary importance for the Israeli groups". Here Eitinger's interpretation, in a kind of comparative study which no one else seems to have undertaken so far, appears to conflict with the relationships noted. For agreement, the relationships would have to be reversed.

108

E. Luchterhand:Early and Late Effectsof Imprisonmentin Nazi ConcentrationCamps

If further work should confirm the statistically indicated relationship, how might it be interpreted? For many if not all of the survivors in Israel, experience of extreme oppression under the Nazis began long before induction into the camps, whereas for the survivors in Norway (predominately nonJews) there was much less of such experience. The Venzlaff observations on disordered behavior patterns in clinical records of survivors of non-CC oppression might therefore account in part for the indicated lack of relationship between time in the camps and presence of the "CC syndrome" in the Israeli sample.

Psychic Stress In the writer's early study referred to previously, respondents were selected purposively to get maximum variation in time spent in the camps. Three kinds of evidence of psychic stress were used--uncontrollable panic, uncontrollable rage, and preoccupation with the suicide. A fourth indicator of stress, the Muselman or near-Muselman condition, was employed because of its dual utility for physical and psychic stress. Respondents who gave clear evidence of stress by any one of these indicators were rated as severely stressed, and all others as moderately stressed. Out of 47 respondents for whom the data were complete, 30 were classified as severely stressed. Because the study was designed to test the Bettelhelm propositions and because the interviews were very long, the post-camp life of survivors was only sketchily explored. As mentioned previously, most of them seemed to be making a rather satisfactory adjustment to post-camp life. Among the severely stressed a few reported nightmare replays of camp situations, frequent headaches, joint and muscle pains, and frequent visits to physicians or psychiatrists. With imprisonment times ranging from 4 to 144 months, a completely unexpected observation emerged: The 8 who were most afflicted had short imprisonment times, ranging from 7 to 29 months, with an average of 18.8 months. The average for the 39 others from whom comparable data were gathered by the writer was 37.7 months. Because of the nature and size of the sample, this finding might easily be dismissed, especially if there were clear inconsistencies in other findings. This was not the case. It may be that the camps, "the most awesome contrivances for the destruction of freedom and man", provided various forms of relief from some of the psychic stresses which they created--the while generating other stresses. This view is consonant with a statement on trauma offered by Gardner Murphy (1947). Basing himself on work by R. L. Munroe, Murphy writes that "'the traumatizing fear cannot ordinarily be removed directly, because no stimulus that can be used practically in reconditioning is as strong as the traumatic stimulus..." The camp, by

Social Psychiatry

the endless repetition of its violent procedures, amply provided such stimuli. Among the instances that might be cited were the mass debassement ceremonies. At the whim of a visiting official, the Jews were sometimes assembled on the Appellplatz ("parade ground") and put through a blasphemous litany rejecting everything sacred in their lives. If the first Appell was stressful, the second might already provide relief. In interviewing to assess the effects of prolonged punishment assemblies, occasional evidence was found of progressive loss of fear, with at least temporary benefits tO prisoner relationships. No evidence was found that would justify Bettelheim's extreme claim about the emergence of a mood of "quasi-orgiastic happiness" (1943) during an especially severe punishment assembly. But the error, if it is one, is productive in that it spotlights the understandably neglected processes that provided occasional relief from stress. It is clear, of course, that most other situations involving the massing and crowding of prisoners--almost always accompanied by acute suffering--were highly destructive of relationships (Luchterhand, 1966/67). There is a tendency in recent survivor studies-but not in earlier personal accounts--to assume that outside of prisoners connected with "medical facilities" in the camps, the working of the NCC system foreclosed all possibility of prisoner cooperation and sharing. One of the common phenomena of the camps was the peculiar speed with which replacement occurred in the event of death of the partner in a friendship pair or separation by transport, change of work detail, or quarreling. As the writer has stated elsewhere (1967), this speed "suggests (1) intense affectional needs caused by the continuing and universal bereavement, and (2) ease of replacement. It is not only that there were many partners to &oose from but that many of the masks and other impediments to social interaction in pre-camp life were swept away in the fearful levelling of induction to the system". There is much evidence for this writer's claim (1952, 1967) that "'the pair was the basic unit of survival". It carried an exceptional burden of providing protection, information, help in "organizing", opportunities for necessary exchange and sharing, and for the relief of feelings of guilt. But the hard evidence for the complex psychic outcomes of NCC stressor situations comes from psychiatry. That many prisoners experienced some abatement of signs of pre-camp behavior disorders has been reported by Kral in a paper on Theresienstadt (1951). It should be noted, however, that Kral's paper refers to a special camp that in its early period resembled a Nazi gehtto. Groen (1947), had a number of Jewish patients in Amsterdam before, during, and after World War II whom he treated for ulcers. He followed these patients into concentration camps where the majority of them lost their ulcer symptoms under conditions of new and extreme stresses. When,

Vol. 5, No. 2, 1970

E. Lud~terhand: Early and Late Effects of Imprisonment in Nazi Concentration Camps

however, the survivors among his patients returned to their pre-camp professional and business activities their ulcer symptoms returned. A respondent of this writer who reported very severe headaches each month since her first menstruation suddenly remembered that she had had no headaches in the several normal periods at the beginning of her imprisonment. The personal accounts of survivors contain various examples of the complex psychic outcomes of extreme situations. Venzlaff (1968) takes issue with the rather common assumption that prisoners who became psychotic had no chance to survive. He cites the example of three Auschwitz prisoners who survived despite the fact that schizophrenic symptoms appeared while they were in the camps. He notes that "up to a certain limit, in extreme situations, even schizophrenics will respond with an astonishing degree of adaptive behavior. There is also evidence that under extreme somatic stress (malnutrition, exhaustion, terror), the more conspicuous symptoms of schizophrenia do clear up and are masked by reaction to the concentration-camp situation." He cites observations by W. Schulte (1953) that among war prisoners acute stress can prevent the outbreak of a psychosis or delay it until the end of the emergency, and of Kornhuber (1961) that the liberation of such prisoners can precipitate psychosis. There seems to be little tested knowledge about the relationship of stressor situations to the origin and development of many behavior disorders and even organic psychoses. Similarly, little is known about factors that may alter, delay, or halt the manifestations of such disorders and psychoses. It has been noted earlier how such an elementary form as the pair, or the more complex prisoner assembly may affect the impact of stressor situations on the individual. Caudill (1958) refers to the transmission of strain through such linked systems as physiology, personality and human groups, and the involvement thereby of several such systems "in the process of adaptation and defense". Some evidence has been provided in this section that incidental processes occurred which apparently reduced some kinds of psychic stress in prisoners, while undoubtedly generating others. It can never be known for how many prisoners, of what categories and under what camp conditions such processes may have resulted in net gains for psychological adjustment with time in the camps. It is tempting to speculate about the differential effects of stressor situations on survivors of long-term and very-shortterm imprisonment in camps such as Buchenwald. One may surmise that any difference in effects would be more likely to show up before liberation and during the early period rather than later. The effects of such a differences on survivor adjustment would probably be outweighed in time by responses of, and conditions in the "host" society. Among other contaminating factors might be a greater effect of aging processes on survivors of long-term than short-term

109

imprisonment. Thus aging might also tend to wash out the difference. What the foregoing suggests is a more-or-less rapid downward leveling in the psychophysical condition of the survivor population, with the rate being heavily influenced by the quality of relationships with members of the "host" society. Little is known about such relationships in different societies and their effects on survivors. We have some hints in the work of Winnik (1967), Eitinger and Askevold (1968), and especially in the cross-cultural study of Eitinger (1964). Even less is known about the effects of the survivor on society. References

Bettelheim, B.: Individual and Mass Behavior in Extreme Situations. Journal of Abnormal and Social Psychology 38, 417--452 (1943). - - The Informed Heart. Glencoe: Free Press 1960. Caudill, W.: Effects of Social and Cultural Systems in Reactlons to Stress. New York: Social Science Research Council, 1958, a pamphlet. Chodoff, P.: Late Effects of the Concentration Camp Syndrome. Archives of General Psychiatry 8, 323--333 (1963). - - Effects of Extreme Coercive and Oppressive Forces: Brainwashing and Concentration Camps. In: American Handbook of Psychiatry, Vol. III. Ed.: S. Arieti. New York: Basic Books 1966. Donat, A.: Jewish Resistance. New York: Waldon Press 1964. Eitinger, L.: Concentration Camp Survivors in Norway and Israel. Oslo: Universitetsforlaget 1964. - - Untitled Paper presented to a Sociology Seminar at Yale University. Mimeographed 1966. - - Askevold, F.: Psychiatric Aspects. In: Norwegian Concentration Camp Survivors. Ed.: A. Str~Sm. Oslo: Universitetsforlaget, 1968. Foreman, P. B.: Buchenwald and Modern Prisoner-of-War Detention Policy. Social Forces 37, 289--298 (1959). Groen, J.: Psychogenesis and Psychotherapy of Ulcerative Colitis. Psychosomatic Medicine 9, 151--174 (1947). Gronner, R.: Remarks in a conference "General Discussion". In: Massive Psychic Trauma. Ed.: H. Krystal. New York: International Universities Press 1968. Helweg-Larsen, P., et al.: Famine Disease in German Concentration Camps. Acta Psychiatrica. Supplement 83 (1952). Herrmann, K., Thygesen P.: KZ syndromet. Ugeskr. f. Laeger 116, 825--836 (1954). Hoppe, K. D.: "Author's Response" in discussion of paper. Psychoanalytic Forum 1, 85 (1966). Huxtable, A. L.: Monumental Questions. New York Times, March 26, 1967. Kautsky, B.: Teufel und Verdammte. Ziirich: Biichergilde Gutenberg 1946. Klein, H., Zellermayer, J., Shanan, J.: Former Concentration Camp Inmates on a Psychiatric Ward. Archives of General Psychiatry 8, 334--342 (1963). Kogon, E.: Der SS-Staat. Berlin: Verlag des Drudihauses Tempelhof 1947. Kornhuber, H. H.: Psychologic und Psychiatric der Kriegsgefangenschaft. Psychiatric der Gegenwart. Berlin: Springer 1961. Kral, V. A.: Psychiatric Observations Under Severe Chronic Stress. American Journal of Psychiatry 108, 185--192 (1951). Krystal, H.: Psychic Sequelae of Massive Psychic Trauma. Excerpta Medica International Congress Series No. 150, 931--936 (1966). - - ( e d . ) : Massive Psychic Stress. New York: International Universities Press 1968. - - Niederland, W. G.: Clinical Observations on the Survivor Syndrome. In: Massive Psychic Trauma. Ed.: H. Krystal. New York: International Universities Press 1968. Lifton, R. J.: Death in Life: Survivors of Hiroshima. New York: Random House 1967.

110

B.M. Astrachan: Towards a Social Systems Model of Therapeutic Groups

Luchterhand, E. G.: Prisoner Behavior and Social System in Nazi Concentration Camps (Ph.D. dissertation, unpublished). Madison: University of Wisconsin Library, 1952. - - T h e Gondola-Car Transports. International Journal of Social Psychiatry 13, 28--32 (1966/67). - - Prisoner Behavior and Social System in the Nazi Concentration Camps. International Journal of Social Psychiatry 13, 245--264 (1967). Murphy, G.: Personality: A Biosocial Approach to Origins and Structure. New York: Harper 1947. Niederland, W. G.: The Psychiatric Evaluation of Emotional Disorders in Survivors of Nazi Persecution. Journal of the Hillside Hospital 10, 233--247 (1961). --Psychiatric Disorders Among Persecution Victims - - A Contribution to the Understanding of Concentration Camp Pathology and Its Aftereffects. Journal of Nervous and Mental Diseases 139, 458--474 (1964). --Comments as "DiscussanC on paper. Psychoanalytic Forum 1, 8'0--81 (1966). - - An Interpretation of the Psychological Stresses and Defenses in Concentration-Camp Life and the Late Aftereffects. In: Massive Psychic Trauma. Ed.: H. Krystal. New York: International Universities Press 1968. Redlich, F. C., Freedman, D. X.: The Theory and Practice of Psychiatry. New York: Basic Books 1966. Rousset, D.: The Other Kingdom. New York: Reynal and Hitchcock 1947.

Social Psychiatry

Schulte, W.: Hirnorganische Dauersch~iden nach Schwerer Dystrophic. MiJnchen-Berlin: Urban & Schwarzberg 1953. Shuval, J.: Some Persistent Effects of Trauma: Five Years After the Nazi Concentration Camps. Social Problems 5, 230--243 (1957/58). Immigrants on the Threshold. New York: Atherton 1963. Sterba, E.: The Effect of Persecutions on Adolescents. In: Massive Psychic Trauma. Ed.: H. Krystal. New York: International Universities Press 1968. Str~Sm, A., et al.: Examination of Norwegian Ex-Concentration-Camp Prisoners. Journal of Neuropsychiatry 4, 43--62 (1962). Venzlaff, U.: Mental Disorders Resulting from Racial Persecution Outside of Concentration Camps. International Journal of Social Psychiatry 10, 177~183 (1964). - - Forensic Psychiatry of Schizophrenia. In: Massive Psychic Trauma. Ed.: H. Krystal. New York: International Universities Press 1968. Winnik, H. Z.: Further Comments Concerning Problems of Late Psychopathological Effects of Nazi-Persecution and Their Therapy. Israel Annals of Psychiatry and Related Disciplines 5, 1--16 (1967). Dr. E. G. Luchterhand Department of Sociology Brooklyn College of the City University of New York New York / USA

Towards a Social Systems Model of Therapeutic Groups BoRis M. ASTRACr~AN

Summary. Three distinct group therapeutic models are described and discussed in this paper, and an attempt is made to suggest a more inclusive, unitary model of the therapy group. The group models are 1) a member to therapist group, 2) a group to therapist group and 3) a member to member group. Each model carries specific implications about the focus of therapy and dominant group themes. Each model ignores much tO which the other models attend. A systems theory model of group therapy which encompasses the three models is outlined. In this systems theory the therapist is conceptualized as a central regulatory figure whose behavior is critical in defining the boundary between the group and its environment. The therapist's definition of the group's task and boundary has important implications for the relationships of group members. Modifications in therapists' regulatory behavior will lead to predictable modifications in intra-group behavior.

dont le comportement est critique dans la d6finition des limites entre le groupe et son entourage. La d6finition donn6e par le th6rapeute des t~ches et des limites du groupe a d'importantes implications dans les relations des membres du groupe. Des modifications dans le comportement r6gulateur du th6rapeute conduiront ~t des modifications pr6visibles dans le comportement ~ l'int6rieur du groupe.

R3sum~. Trois modules diff6rents de tMrapie de groupe sont d6crits et discut6s dans ce travail, et on essaye de sugg6rer un mod61e plus global, unitaire de groupe th6rapeutique. Les modules de groupes sont: 1) un groupe ~membre ~ tMrapeute~, 2) un groupe ,~groupe ~t th6rapeute,, et 3) un groupe *,membre k membre,,. Chaque module comporte des implications sp6cifiques quant au focus de la th6rapie et aux th~mes de groupe dominants. Chaque modhle ignore largement les pr6occupations des autres modules. Un module tMorique des syst~mes de tMrapie de groupe qui comprendrait les trois modules est esquiss4. Dans cette tMorie de syst~mes, le tMrapeute est conceptualis6 comme une figure centrale r6gulatrice,

Zusammenfassung. Drei verschiedene gruppentherapeutische Modelle werden in dieser Arbeit beschrieben und diskutiert, aul%rdem wird versucht, ein umfassenderes und einheitlicheres Modell der therapeutischen Gruppen vorzuschlagen. Die Gruppenmodelle akzentuieren 1. ein Gruppenmitglied gegeniiber dem Therapeuten, 2. eine Gruppe gegenllber dem Therapeuten und 3. ein Gruppenmitglied gegeniiber den anderen Gruppenmitgliedern. Jedes Modell bringt spezifische Folgeerscheinungen in bezug auf den Fokus der Therapie und die vorherrschenden Gruppenthemen mit sich. Jedes Modell ignoriert weitgehend das, worauf das andere achtet. Es wird ein systemtheoretisches Modell yon Gruppentherapie entworfen, das die drei Modelle umfaflt. In dieser Systemtheorie wird der Therapeut als eine zentrale normensetzende Figur begriffen, dessen Verhalten iiber die Definition der Grenzen zwischen der Gruppe und ihrer Umgebung entscheidet. Die Definition der Gruppenaufgabe und -grenze dutch den Therapeuten hat bedeutsame Folgen fiir die Beziehungen der Gruppenmitglieder. Ver~inderungen in dem normensetzenden Verhalten des Therapeuten wird zu voraussagbaren Ver~inderungen innerhalb des Verhaltens der Gruppen fiihren.

E n c o u n t e r groups, sensitivity t r a i n i n g groups (T-groups), " p s y c h o a n a l y t i c " groups, p s y c h o t h e r a p y groups o f a v a r i e t y o f descriptions, g r o u p d y n a m i c s groups (study groups), multiple f a m i l y groups, couples groups, m a r a t h o n groups, a c t i v i t y groups a n d countless other groups h a v e all been described as h a v i n g great therapeutic potential. (Christmas a n d Davis, 1965; C u r r y , 1965; Fidler, 1965; Foulkes,

1965; Gottlieb a n d Pattison, 1966; Gretekos et aI., 1966; H a d d e n , 1966; H a i g h , 1968; H a r r o w et al., 1 9 6 7 b ; H e s a n d H a n d l e r , 1961; Kernberg, 1965; L a q u e r et aI., 1964; L i e d e r m a n a n d Green, 1965; Marsh, 1931; W e s t m a n et al., 1965.) A d v o c a t e s o f each t y p e see the g r o u p as educating or reeducating, increasing self awareness, leading to deepened understanding, focusing on interpersonal transactions,