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Those who have experienced extreme trauma and their descendents have taught us much about resilience, renewal, and redemption-outcomes that are all recalled in this period of the Jewish Passover, Christian Easter, and Holocaust Memorial Week.
Near the end of her groundbreaking book, Children of the Holocaust, Helen Epstein wrote that her mother, who was a so-called survivor of the Nazi Holocaust, warned her to finish the book or Helen would get sick. It was a warning I should have been given, too. Not that I was also a second generation descendent of a Holocaust mother. Not even close to that.
I had recently undertaken an infinitesimally less risky endeavor. But still.
At the end of this endeavor, I did get a bad cold. It was first time I'd been sick in the nearly 2 years since I retired from clinical work. It was an upper respiratory infection, where I felt filled with some "yucky stuff" needing to get out. I suppose this also applied to my mind, both in a literal and figurative sense. This would not be the last personal impact and insight I would get.
I really should have anticipated this reaction. I knew that therapists who work a lot with those with PTSD often get secondary trauma from the empathy required to help the most. Goodness knows. I was one of these therapists who worked with refugees, prisoners, and other survivors of trauma-including Holocaust survivors. Being Jewish, working with traumatized Jewish patients was the most challenging.
I also had long been fascinated with the response of Nazi doctors and psychiatrists. Many embraced Nazi ideology. The mentally ill were early targets for extermination. The Jewish psychiatrist Robert Jay Lifton interviewed many and concluded that a particular kind of mental dissociation, which he called "doubling," allowed the physicians to isolate the harm they participated in from an often emotionally normal life at home.
There is a documentary film called Hitler's Children, subtitled "Thou Shalt Honor Thy Mother and Father", taken from the Ten Commandments. Perhaps you've seen or heard of this movie?
The children don't refer to Hitler's own children. At best, he had one illegitimate child that he didn't know of, who is reputed to have fought for the French resistance in World War II. Rather, the children in the film depict how several second and third generation descendants of the very high ranking Nazis-Franz, Goering, Goeth, Himmler, and Hoess-wrestle with the legacy of their family history and legacy. All these particular Nazi leaders were either hanged or committed suicide at the end of the war. The maker of the film is a third-generation Israeli survivor of the Holocaust, as was a reporter in the film. The explicit goal of the filmmaker was to show some of the "survivors" of the other side, whether they could change, and whether they could help to counter Holocaust deniers.
The filmmaker screened scores of German families to find 5 who would agree to be interviewed and filmed. Some families even threatened him. Therefore, the results are not a representative sample, but were quite revealing in their own right.
Two of the interviewees wrote books to try to clear themselves from the soiled family name and to help redress the family's legacy. One is Niklas Frank, son of Hans Frank. (The father was Governor-General of occupied Poland during World War II; he was executed after being found guilty at the Nuremberg trials for his actions arising from his involvement with the Nazi party.) Niklas tirelessly travels to German schools to educate the children and feels that Germany would still be susceptible to violence with an economic downtown. On the other hand, his sister has refused to disavow her father; she moved to South Africa and enthusiastically supported apartheid. Apartheid and psychology have an important link to Nazi Germany: the prime minister during the escalation of apartheid was a psychologist who went to Nazi Germany to learn how to apply the party's principles and strategies in South Africa. The other interviewee had married a Jewish Israeli offspring of a survivor; their backgrounds came through their unconscious in arguments, and they ended up divorcing.
Another "child" fled Germany for America, to settle in a rural area in New Mexico. She and her brother sterilized themselves to ensure "there would be no more Goerings." Of course, this decision paradoxically mirrors the Nazi view on eugenics, yet may have relevance that couldn't have been known at the time of the sterilzations. As our new knowledge of epigenetics emerges, merging nurture and nature even more, we know that experiences, such as undue stress, can modulate the actual genetic inheritance.
In the film, Rainer Hoess, for the first time, visits the Auschwitz concentration camp, where his grandfather was the commandant, and where his father lived as a child. He meets a group of Israeli students, and shares an embrace with an elderly survivor of the death camp. "Too soon", his Israeli fellow traveler reacts to the apparent emotional change.
Yet, we psychiatric clinicians know how hard it is to accept the reality of such extreme trauma. The daughter of Goeth has a panic attack when she finally realizes what her father did when he was featured in the movie Shindler's List. Fiction here becomes nonfiction.
Of course, we know much more about the descendants of the Holocaust survivors than we do of the Nazi descendants. However, even so, until the late 1960s, not much was known of either group. Those who came to Israel came as a symbol of weakness and shame, and along with the need to help build a new country, had to bury the past. In the US, those refugees who were able to come usually tried to assimilate as fast as possible, and those who then became parents tended to keep their history to themselves. Even though reparations made psychotherapy free, it was rarely sought and the patients often attributed their problems to the present adjustment, and the therapists of that time did not appreciate the lasting effects of the past trauma. Germany was undergoing rapid economic recovery, and families usually tried to ignore any family history of Nazism-including those who still embraced Nazi values.
Only after some of the second generation started to display various symptoms did more formal studies emerge. As the torturous medical experiments yielded some useful medical information, so did the psychological trauma. Though for the most part, having some typical symptoms of anxiety, fear, and melancholia did not mean a full-blown psychiatric disorder, either in survivors or their children, the interviews and some case reports contributed to our current understanding of PTSD. On the more positive side, they have taught us much about resilience, renewal, and redemption-outcomes that are all recalled in this 2-week period of the Jewish Passover, Christian Easter, and Holocaust memorial week.Now, the third and even fourth generations from World War II are emerging. The third generation seems to be able to connect as grandchildren usually do with grandparents. New research indicates that such closeness has preventive effects on depression. The third generation seems to becoming the memory bearers as the survivors are dying off.
The potential of the fourth generation in the USA, Israel, Germany, and other countries to learn from - and transform - the trauma in order for such destruction to be less likely is a legacy that would benefit us all. As in the transition out of apartheid in South Africa indicated, telling a convincing narrative, communicating the truth, and being able to forgive, can lead to the beginnings of reconciliation.
To my surprise and intrigue, I was asked to be the discussant of a showing of the film at our local Jewish Community Center. Why, I asked? Why not a Holocaust expert, or a child or grandchild of a survivor? One, the coordinator answered, is because you are a psychiatrist, and because I sense there are deep psychological issues in the film. That made great sense to me.
Then, she added, you worked in a prison. That sealed the deal for me, as I immediately associated to the connection. When I first visited the prison, it looked at a distance just like the pictures of the Theresienstadt concentration camp. I had nightmares that night. Then, I soon recalled what I heard about many of the children of the male inmates, some of whom committed horrendous crimes. Many of the children were already getting into trouble. One prominent judge in England had even recommended that the children of criminals should be adopted by others because he was starting to see the grandchildren of those he had sentenced many years back.
I was also reminded of the mafia and their offspring. . . of the common continuation of abuse in the children of those children abused. . . and of the Old Testament's wisdom in saying that the crimes of the father would be visited upon the third and fourth generations. The effects of trauma just don't end when the actual trauma itself ends, either in the traumatized or insidiously in their loved ones. Modeling, repetition compulsion, and identification with the aggressor are all powerful psychological processes that can perpetuate trauma.
In the midst of my researching topics connected to the film, I had an obvious personal insight that somehow had eluded me until then. Though almost an infinite number of things influence the conception and birth of any one of us, one undeniable factor in my being born was the Holocaust. My father, a lawyer, joined the USA army toward the end of the war. He was sent from Chicago to Dayton, Ohio where, at an armed forces mixer, he met my mother, who herself had a chronic medical illness. Exactly 1 year after the Czechoslovakian uprising against the Nazi uprising, I was born on May 5, 1946. As far as we know, the remainder of my father's family never had left Europe and were all killed in World War II. Surely, some of this history, unconscious or not, suggests some survivor guilt in me and an attempt at some relief in a career serving the underserved.
Though it is obviously relevant to me, how is this film and its information relevant to the everyday psychiatric clinician? Anyone who works a lot with patients with PTSD should watch for how it affects them. Besides the care of patients, prevention for the descendants of those suffering from trauma may be possible. In the USA, that is especially relevant for the children of groups most exposed to trauma in the distant and recent past, such as Native Americans, certain poor ethnic minorities, and women sexually traumatized.
Though memories can be false, we also have to be careful not to underestimate trauma. Freud himself grappled with whether the sexual abuse reported by his female patients was imagined or real. He reversed course, going from real to imagined. No wonder, then, that Freud, a self-described Godless Jew, underplayed the danger of the Nazis in Austria until his daughter Anna, who later became a child pschoanalyst, was threatened by the Gestapo. Then he and some of his family escaped to London. This denial of the potential brutality mankind is capable of must be one reason so many were slow to appreciate what the Nazis were doing, what later occurred in the killing fields of Cambodia, the genocide in Rwanda, and even more recently with the chemical warfare in Iraq and Syria.
We can be the canaries in the coal mine for such dangers.
Finally, we always have to be on guard that our medical ethics and Hippocratic Oath are not usurped by other ethical priorities-whether they be political (as in organization ambition), business (as in for-profit managed care), or security (as in correctional work).
For more information:
. Davidson M. The Perfect Nazi: Uncovering My Grandfather's Secret Past. 2011.
. Epstein H. Children of the Holocaust: Conversations with Sons and Daughters of Survivors. 1988.
. Kellerman NPF. Holocaust Trauma: Psychological Effects and Treatment. 2009.
. Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. 1988.
. Rosenthal N. The Gift of Adversity: The Unexpected Benefits of Life's Difficulties, Setbacks, and Imperfections. 2013.
. Tutu D, Tutu M. The Book of Forgiving: The Fourfold Path for Healing Ourselves and the World. 2014.
. Wollschlaeg B. A German Life: Against All Odds, Change is Possible. 2009.