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Niederland reviews his experience with concentration camp victims and formulates their present psychiatric state in terms of current psychoanalytic thinking. This attempt is of forensic relevance in that to gain restitution from West Germany the victim must prove a causal connection between the state of ill health and the traumatic experience to which he had been subjected by the Nazi regime. In the author's opinion 'expert' testimony in West Germany pays little or no attention to the vast body of scientific knowledge which has accumulated in psychiatry.
In breaking down the concentration camp experience into psychodynamics, four aspects are distinguished and discussed: the assault on the ego; the assault on the superego; factors contributing to survival; and clinical consequences of persecution and survival.
Survival guilt is noted to be the most pathogenic single factor, i.e., guilt for surviving while loved ones perished. Such guilt is usually not permitted to enter consciousness, remains for the most part repressed, and tends to manifest itself clinically in depressive, persecutory, psychosomatic, and neurovegetative symptoms. In the matter of psychotherapy the author stresses the need to relive the traumatic experiences and situations and to re-experience, in relation to the therapist, the pain, anxiety, and guilt connected with those events.