We’re alive; now what? Long-term effects of Holocaust survival

In the first years after the war, there were conflicting opinions on what the long-term effects of the Holocaust on survivors would be. Ruth Kluger, in her memoir Still Alive: A Holocaust Girlhood Remembered, wrote of the problems a fellow survivor encountered after the war: When she went to a therapist for help, she was told “the camps in which Susi had spent her early teens could have no permanent effect on her, because she had been older than six when she first got there”, but she also struggled to find employment as a nurse because “a girl who had been in a concentration camp is unfit for nursing. What she had experienced must affect her ability to take care of patients. She’d be lacking in sympathy, the letter said”.

Now, we would expect post-traumatic stress disorder (PTSD); at the time, though that diagnosis didn’t exist. Although discussions of “soldier’s heart” dated back to the Civil War, and “shell shock” had been a major topic in World War I, the Diagnostic and Statistic Manual used to officially diagnosis psychological disorders wasn’t created until 1952. That very first manual included “gross stress reaction”, although it isn’t clear whether those psychiatrists thought it was specific to soldiers and combat, or whether it would also be diagnosed in civilian survivors.

In the post-Vietnam era, “gross stress reaction” was re-introduced in the form of PTSD, which could include all sorts of stressors, and many researchers developed an interest in the long-term effects of Holocaust survival. A Sydney Holocaust study suggested survivors have higher rates of depression, health problems, and PTSD (with 39% meeting all diagnostic criteria) than either pre-war refugees (12%) or people with similar background who hadn’t experienced the war (4%). PTSD is far from a universal response to trauma, however, and other studies try to tease out what protects some Holocaust survivors (how they form attachments to other people, for example).

A parallel but far less well-known idea to PTSD is PTG, or “post-traumatic growth“, a scientific name for the adage “what doesn’t kill you makes you stronger”. Survivors of the Holocaust might have emerged with stronger spiritual connections, a determination to live a more meaningful life, or simply pure grit. This is not mutually exclusive from PTSD; some call them two sides of the same coin, and one symptom of PTSD, “arousal“, seems to predict PTG. Holocaust survivors who reported greater social support and a greater sense of “potency” (a combination of self-confidence and “commitment to society”) experience more PTG, giving us some idea of what we might to do help people gain something from a traumatic experience.

Returning to the idea of narrative from the contemplation of memorials, we can also get some idea of a survivor’s future from the language they will use. Just as using first-person pronouns in poetry is linked to suicide, the language survivors use to describe their experiences predicts their future health. When professional Holocaust survivors who often volunteer to speak about their experiences were interviewed about their entire lives, they surprisingly used more positive emotion words than negative emotion words when describing their Holocaust experiences (although they were as positive as they were about the rest of their lives). Those who used more insight words (such as “understand” or “recognize”) also had better health and psychological adjustment four years later.

Unfortunately, despite all that we have learned about PTSD and PTG, even sixty years later the stigma about PTSD remains, preventing veterans from securing employment, leading to suggestions of yet another name change. It is a tough reminder, at the end of the class, that the more things change, the more they remain the same.


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