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About one thousand, now elderly, concentration camp survivors have been followed by the author, and about a dozen have been in psychotherapy with him. He finds that their ability to achieve successful old age is severely compromised by inability to integrate their lives. Parallels and differences between infantile trauma and adult catastrophic trauma are described; sequelae of both are alexithymia and anhedonia.
As the potential for real gratification, through action, diminishes with old age, an individual shifts focus to reminiscence; yet, Holocaust survivors have devoted their energies to "fighting off" memories. Remembering brings back the helplessness and shame of the past; even more ominously, self-integration might result in giving up being "angry witnesses," and is experienced by many as "granting Hitler a posthumous victory." Furthermore, affective and cognitive disturbances limit effective mourning. Even those who can grieve may have an unintegratable quantity of losses. Continued, unbearable identifications with both the victim and the aggressor complete the dilemma that prevents the aging Holocaust survivor from achieving a much needed intrapsychic integration. Survivors "show early aging" and high early death rates. They tend to somatize rather than to recognize emotions, to feel separate from their lives, to be unable to believe in a benevolent deity, and to have extremely restricted ability to fantasize, or to feel lovable.
The paper includes a brief critique of some of the recent literature on psychic trauma and a discussion of a treatment approach which focuses on the phenomenon of "primary repression," a defense that leaves survivors cognitively restricted and limited in their abilities to experience mature emotion.