Late Psychic Sequelae of Man-Made Disasters1

Lately von Baeyer has observed that gross injuries during concentration camp experience of long duration may be surprisingly well overcome whereas seemingly lesser sufferings may bring about serious late psychic sequelae. Let me define my point of departure concerning the meaning of "lesser" injuries in the context of my observations. It is the sum total of experiences of arrest with violence and bodily harm, and the consequent confinement in various Nazi prisons, physical suffering, and witnessing physical tortures and killings, the acute crushing of self-esteem along with the total deprivation of civil rights, and consequently a condition of helplessness and hopelessness. This affective condition calls for the choice of that defence mechanism which would best protect the self from intolerable anxiety and conflict, namely regression. The latter would provide, in accordance with the concepts of Grinker, Engel, and others, one pre-condition for psychosomatic reactions and disorders to which the overwhelming majority of victims of persecution succumb. Out of 118 patients examined by Hoppe no fewer than 117 belonged to this category.

This is one of the pathways along which the same psychodynamic factors are seen at work, and this explains why basic similarities exist in the late psychic sequelae of concentration camp victims of long duration on the one hand, and in those who suffered comparatively short imprisonment on the other, a fact which strikes us at first sight for various reasons as surprising, and one to which sufficient attention has not yet been paid. No obvious quantitative factor is at work within this well-defined group. In many cases which I have examined, guilt feelings, the "survivor syndrome", as Niederland has called it, was outstanding.

Personal experience during confinement of a few weeks in a Nazi prison revealed to me that the disorganization of personality structure may be a very rapid process. Restitutional processes are also remarkably i