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DISCUSSION: Dr. Martin Wangh emphasized that physical impairment of concentration camp victims causes psychic impairment; the continued fear of danger to themselves after the experience can lead to psychic disorganization of psychotic proportions with ego dissolution. Dr. Wangh suggested that some psychiatrists need to deny the trauma because it is too painful to face or is too close to their own sadomasochistic impulses.
Dr. William Niederland emphasized the unique quality of the massive trauma undergone by concentration camp victims. These patients do not so much use the adult trauma to defend against the more primary infantile material but, on the contrary, often seem only too eager to discuss infantile material in traditional psychoanalytic ways as a defense against the overwhelming concentration camp experience, which must be avoided at all costs. He felt that the survival syndrome, a distinct clinical entity, can exist without pre-existing pathology.
In conclusion, Dr. de Wind, although he recognized the appropriateness of Dr. Niederland's discussion, felt that genetic factors were important even in concentration camp victims, and that the ability to handle oppression was an essential factor in the development of pathology as well as its treatment.