Did the Nazi Holocaust Cause Schizophrenia?*

After centuries of controversy, mental health professionals still cannot agree on the cause or causes of schizophrenia—the most severe form of psychosis. Theories of aetiology range from genetic, biochemical, and neuropathological approaches to those of an environmental or intrafamilial nature. In this contribution, the author considers the impact of massive psychological traumatisation, examining, in particular, the relatively neglected literature on the role of the Nazi Holocaust in the development of psychotic states. Reviewing the work of such pioneering clinicians as Bruno Bettelheim and William Niederland, each of whom observed acute schizophrenic reactions among survivor patients, the author then surveys the more methodologically sophisticated work of Udo Reulbach and his colleagues who have provided strong evidence that those survivors of concentration camps who endured the most objectively traumatising of experiences, including the death of both parents, would be far more likely, statistically, to receive a diagnosis of schizophrenia in later life. The author argues that the literature on the Holocaust provides important data for an understanding of the role of disrupted attachments and extreme traumatisation in the development of schizophrenic psychoses.