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Catastrophic grief and associated defences in elderly child holocaust survivors.

Introduction

This article will explore the catastrophic grief expressed by child Holocaust survivors who were interviewed in their old age. Case material is presented to demonstrate the prominence of enduring grief and the defence mechanisms employed to attempt to manage this intense grief. What was particularly striking is the manner in which Holocaust related grief emerged in interviews conducted with survivors despite the fact that it had previously remained largely unshared and unexpressed throughout their post-Holocaust existence, seemingly compartmentalised off in the psychic life of the survivors. While this phenomenon has been observed by previous writers, such as Dasberg (2001) in particular, this paper aims to elaborate and expand Dasberg's understanding of how survivors appear to have coped with the almost inconceivable losses associated with the Holocaust.

One-and-a-half-million children were killed during the Holocaust (Gutterman & Shalev, 2008; Valent, 1998). Those that survived were generally separated from their parents and many children were orphaned (Valent, 1998). Children not only lost persons who were significant to them such as parents, siblings and extended family, but they were also uprooted from their familiar childhood worlds, from homes, schools, play and community spaces.

Nobel Prize winner, Eli Wiesel, wrote about his experiences as a fifteen-year-old boy during the Holocaust in his book Night (1960). He was in the same age group as several of the participants who took part in this study and his words are instructive in capturing the sense of rupture from all that was previously familiar and the manner in which awareness of loss and destruction would remain indelibly imprinted in his mind:
Never shall I forget that night, the first night in the camp, which has
turned my life into one long night, seven times cursed and seven times
sealed. Never shall I forget that smoke. Never shall I forget the
little faces of the children, whose bodies I saw turned into wreaths of
smoke beneath a silent blue sky. Never shall I forget those flames,
which consumed my faith forever. Never shall I forget that nocturnal
silence which deprived me, for all eternity, of the desire to live.
Never shall I forget those moments, which murdered my God and my soul
and turned my dreams to dust. Never shall I forget these things, even
if I am condemned to live as long as God Himself. Never. (Wiesel, 1960,
p. 43).


In this paper we will discuss something of the paradoxical nature of remembering and blocking out (rather than forgetting) that emerged in exploring the reflective accounts of nine child Holocaust survivors concerning the impact of the Holocaust on their life experiences. Although the study upon which this discussion is based generated a large range of findings, including engagement with many terrifying, horrifying, degrading and life-threatening events, the focus within this paper is on the nature of the grief that survivors presented together with an exploration of how loss and grief appeared to have been managed in the past and the present. The losses sustained during the Holocaust were traumatic losses in that they were generally unanticipated, unnatural, and very often brutal. There was also something about the scale of loss that reflected collective traumatisation as will be further elaborated within the discussion. Although much previous research on Holocaust survivors has been conducted, the value of this paper is that it examines the impact of trauma from a long-term retrospective perspective. The testimony captures the traumatic memories of aging survivors recollecting and recounting their childhoods in concentration camps and events surrounding their incarceration. It is perhaps noteworthy that a significant body of the writing on the Holocaust has been produced by psychiatrists and psychoanalysts who were also child Holocaust survivors themselves such as Dasberg (1987; 2001), Cyrulnik (2009), H. Klein, (2012) and Auerhahn and Laub (2018). Their personal experience during the Holocaust adds a unique insight and depth to their understanding of loss and trauma and their writing is drawn upon strongly within this article.

Child Holocaust survivors and traumatic loss and bereavement

Based on research conducted with child Holocaust survivors Dasberg (2001) describes three severe types of traumatic impact on children and adolescents interned within camps. The first two concern firstly, deprivation (related to starvation, illness and cold, for example) and secondly, fear of harm and death (related to exposure to cruelty, prejudice, and witnessing violation and killing of others). The third major form of trauma exposure he identifies is that children suffered massive loss on many levels, including the loss of parents, siblings, grandparents and other family. The trauma was experienced at physiological, psychological and existential levels and required engagement not only with threats to the self, but also with threats to and loss of those who were significant to one. As captured in Wiesel's words just previously quoted, children had to survive a world that felt bereft of any good and in which threats to them and their caregivers were pervasive.

Kellermann (2001; 2009) noted the significance of these kinds of multiple levels of loss. Typically, the terms, 'traumatic bereavement' or 'traumatic grief' are used to describe the loss of Holocaust survivors (Witztum & Malkinson, 2009), but it may be more appropriate to refer to 'catastrophic loss' as the depth and scale and what was lost and destroyed went far beyond the sudden or unexpected loss of a single individual. Child survivors suffered multiple losses that subsequently loomed over them for the rest of their lives. Children were torn away from their parents and siblings in tragic and cruel ways. Separation was often sudden, with little preparation, and the ongoing exposure to further traumatic experiences made it difficult for mourning to take place (Kellermann, 2001).

Dasberg (2001) observed that after the Holocaust children were forced to adapt to their new environments and references to traumatic experiences, including grief about lost loved ones, were discouraged, leading to suppression and repression of such traumatic experiences. Children were under pressure to learn a new language and adapt to a new environment. Even when parents had remained alive together with children or were reunited with them, they were often compromised in carrying out parental functions, being deeply affected by massive traumatisation themselves. Child survivors felt an enormous pressure to please their caretakers and to be accepted in their communities based on their need to belong and succeed.

According to Hillel Klein (2012) it was Winnicott (1960) who coined the term 'protective shield' to describe the way in which parents generally attempt to protect their children against psychological harm. He stated that during the Holocaust parents were not able to function as protective shields for their children, nor as strong caretaking models for identification. Klein (2012) stated that children witnessed their parents being ridiculed, shamed and rendered helpless. In addition, children witnessed mass extermination. Thus, not only were parents unable to provide barriers to traumatic experiences for their children, they were also directly traumatised in front of their children, contributing to a profound sense of loss of functioning as 'good objects' who could provide a source of containment.

From an object relations perspective it has been argued that trauma damages the relationship to good internalised introjects (providing one has had 'good enough' early developmental experiences), compromising subsequent trust in others (Auerhahn, Laub & Peskin, 1993; Eagle, 2013). Becoming a victim of traumatic events 'can be experienced as an absence of or abandonment by the 'good object' introject' (Eagle, 2013, p. 124). 'The fact that one has been allowed to suffer so terribly suggests the failure and/or impotence of good objects to protect one and this may lead to the sense that such objects have been destroyed or cannot be trusted' (ibid, p. 124). Within the circumstances of the Holocaust, parents were victimised alongside their offspring and children were forced to come to terms with the limitations of their parents' capacities, often shockingly and prematurely. Thus, a further aspect of loss was associated with the demeaning and eradication of real caretakers and the associated anxiety about whether there were any potent good objects to internalise.

From a classical psychoanalytic perspective, the unresolved traumatic grief associated with significant trauma can be understood to take the form of melancholia as described by Freud (1917): 'the shadow of the object fell upon the ego' (Freud in Gerson, 2009, p. 1351). Elaborating on the construct of melancholia and loss in circumstances of traumatic rupture Garland (1998) observes that some survivors become overwhelmed by the simultaneous task of mourning their lost objects and the loss of their pre-trauma self that they present with a pathological form of mourning in the form of melancholia. In her theorisation this suggests remaining in a somewhat frozen and unresolved state. Given the scale of loss in such circumstances it is largely inconceivable that survivors of genocide are able to 'work through' the associated loss, as it is too traumatic and overwhelming for the psyche to comprehend or encompass. Genocide survivors, such as those who survived the Holocaust, struggle with the ongoing challenge of bearing or living with the enormity of the losses and violations they have endured and witnessed (Gerson, 2009). In the normal course of grief, the child would detach the libidinal investment from the lost object and in the course of mourning eventually invest in new attachments. In the case of child Holocaust survivors this process was compromised and many appeared to suffer from melancholia where they remained attached to their dead families and their ability to re-invest and re-attach seemed compromised. This was reinforced as there was no leave taking or rituals or gravesites to facilitate some sort of processing of absence and grief. They were not encouraged to vocalise their losses and the focus was on adaption to a new country and environment as previously mentioned. Thus, libidinal energy was largely invested in survival and re-adjustment to living in a post-Holocaust world.

It is evident that several different factors contributed to difficulties in managing to come to terms with and incorporate the reality of the losses associated with the Holocaust and to do the work of healthy mourning. The scale and circumstances of the loss were extraordinary and in most instances children and adolescents did not have caregivers who were available or able to help them to manage what had happened. Being children and adolescents their psychic capacity to bear affects and to find meaningful ways of understanding what had happened were also compromised. In addition, they were dissuaded from re-engaging with Holocaust memories in their post-Holocaust environments and required to devote their psychological energies towards contextual adaptation and catching up with developmental tasks. All of these factors contributed to very complex patterns in attempting to defend against the reality of having suffered catastrophic loss.

Defences against unbearable Holocaust related grief

Laub and Auerhahn (1993) describe how trauma shatters the functional barrier of the ego and leads to a fragmentation of the self. They explain that in the case of massive trauma primitive defences such as denial, amnesia, splitting and depersonalisation are used by the survivor to block out the overwhelming emotional reality of the events (Laub & Auerhahn, 1993). Defences in psychanalytic thinking are understood to represent strategies for managing (internally driven) conflict and overwhelming affect (Bowins, 2004). They are largely unconscious and may be both adaptive and pathological, often falling on a continuum and being deployed in both characterological and situationally-dependent ways. From a psychodynamic perspective repression and suppression are understood to be psychological defences that remove thoughts or feelings from awareness (Boag, 2010). Repression is understood to be largely unconscious whereas suppression is understood to entail a more conscious process, however Erdelyi (2006) suggests an 'unconscious-conscious continuum' to clarify this definition (p. 169).

According to Dasberg (2001), in order manage their mourning and traumatisation, as well as the pressure to adapt, child survivors appeared to develop a form of 'split self'. On the outside, they appeared to be functioning well, however, they carried an inner sense of loneliness, low self-esteem, anxiety and insecurity, contributing to identity problems (Dasberg, 2001). In this interruption to grief many child survivors used defence mechanisms to block feelings of overwhelming loss, contributing in some instances to shallowness or distancing in subsequent interpersonal relationships (Kellermann, 2001; 2009).

According to Kellermann (2001), Holocaust survivors differ from one another in a multitude of ways, including developmental history, nature of traumatic war experiences and post-war acculturation and adjustment. The most striking difference lies in how they differ regarding vulnerability and resilience suggesting that further exploration and clarification would be useful in respect of the apparent value and costs of utilisation of forms of defence. Cabral and Levandowkski, (2013), note that the construct of resilience has been embraced within psychoanalytic thinking, albeit perhaps not under that name. In many instances the concept of resilience is connected to writing about the internalisation of a good enough object that provides the ability to endure distressing experiences (Bibiana, Medeiros & Freitas, 2018; Bibiana, Santana, Machado, Bastos & Freitas, 2018). The French psychoanalyst Boris Cyrulnik (1999) states that resilience is also representative of an individual's ability to adapt to different environments and overcome problems, suggesting the presence of a healthily functioning ego. Given the complex interaction between the setting, the subject and other individuals in the environment, the subject in development perceives themselves within, or as the result of, these interactions, including the underlying adversities of the setting. He further explains that pain can evoke defiance. Resilience is described as an oxymoron or a paradox (Forna, 2009) in that within the survivor's internal world 'heaven and hell cohabit' (Cyrulnick, 2009, p. 3). Resilience cannot arise without an experiential engagement with powerful adversity and distress such that the two are always inter-related within the psyche. Cyrulnick adds that Holocaust trauma caused the self of survivors to split into a wounded self and another more functional part that mobilised the momentum of despair to create happiness and find meaning. It is evident that Cyrulnick's theorisation parallels that of Hillel Klein in some respects but introduces a somewhat different perspective in highlighting the kind of compensatory mechanisms involved in transforming despair rather than only repressing or supressing these negative affects. Cyrulnick's (2009) description of resilient survivors seems close to Kellermann's (2009) description of 'paradoxical integration' found in resilient survivors where trauma symptoms and resilient functioning co-exist. Dasberg (1987) described the more resilient survivors as 'hardening', with the connotation that adjustment was at the expense of a full emotional life and he was perhaps more pessimistic than Cyrulnick as he did not emphasise meaning or happiness as possible alternative outcomes.

Dasberg (1987) maintained that survivors emotionally constricted to avert dealing fully with trauma and mourning. Dasberg (1987; 2001) suggested that survivors who coped well used splitting as a defence to cope with their inner turmoil and adapt in the outside world. In alternative language, what Dasberg (2001) refers to as 'splitting' may be more clearly understood as repression, suppression or compartmentalisation. He seems to refer to a kind of vertical split within the psyche. This employment of the term splitting refers to the banishing or shutting away of feelings, thoughts and memories related to a particular period of life experience or perhaps what others might refer to as compartmentalisation, rather than to the traditional Kleinian idea of splitting, which emphasises attempts to keep good and bad aspects of self and other separated out (although there may be overlaps between Klein and Dasberg's usages of the term 'splitting'). Dissociative states occur in response to acute trauma (Bowins, 2004). Within the literature isolation or compartmentalisation are understood to be milder forms of dissociation that are more conscious, however the awareness of affect is more present (Bowins, 2004). Compartmentalisation is defined as a subconscious defence mechanism that underpins attempts to cope with conflicting feelings or cognitive dissonance (Leary & Tangney, 2012). Bowins (2012) defines compartmentalisation as 'learning to place simultaneous experiences in separate psychological spaces to aid in coping' (p. 310). He suggests that it is a functional defence that enables coping and prevents overwhelming affect from spilling over and interfering with performance. Within this article the term is understood to refer to a form of separating out of life experiences in such a way that Holocaust experiences co-exist alongside a more functional present oriented self but remain largely locked out of awareness. However, these facets of history can readily be reintroduced into consciousness under specific circumstances, such as in this instance in response to the invitation to describe and talk about Holocaust related experiences.

Dasberg (2001) states that child survivors used splitting to enable them to cope, and as such, splitting became a characteristic feature of their functioning: 'This split is a feature of incomplete and postponed mourning, and also between a traumatised inner core and outward adaptation' (Dasberg, 2001, p. 6). There is a split between outward apparent psychosocial adaption and an inner self that has unmet dependency needs and remains highly traumatised. Survivors hid their vulnerabilities in an attempt to seem normal and adapt to their new environments as refugees. This left them at risk for bouts of depression and symptoms of post-traumatic stress, and for experiencing emotional outbursts that alternated with emotional detachment (Dasberg, 2001). In addition, survivors experienced anhedonia, guilt and amnesia regarding periods of their childhood. According to Dasberg (2001) child survivors struggled to regulate aggression and experienced conflict with authority figures, as well as experiencing frequent marital conflicts. Thus, when child survivors presented clinically, they were often given diagnoses such as those of chronic depression, anxiety disorders, personality disorders, PTSD, and in rare cases, psychotic disorders. According to Brom (2001), Dasberg's (2001) concept of the 'child survivor syndrome' is helpful as it encapsulates the full picture of 'the psychosocial consequences of the Holocaust in those who grew up under Nazi occupation' (Brom, 2001, p. 1). Thus, it is apparent that formulating what might represent resilience in the aftermath of the trauma of the Holocaust and the scale of loss it entailed is extremely complex. A central aspect of the debate concerns the use of defensive styles associated with dissociation including repression, suppression and compartmentalisation, and the degree to which the deployment of such defences appeared to protect and/or compromise individuals in their subsequent functioning as will be elaborated in the discussion of illustrative case material.

Method

A qualitative study was conducted into the long-term impact of the Holocaust on nine child survivors who were interviewed in their old age with a focus on how their life trajectory had shaped their engagement with the life tasks associated with Integrity versus Despair (Erikson, 1965). The survivors comprised a non-clinical sample of individuals and consisted of those who volunteered to take part in the study on the basis of an invitation from a Jewish community leader. All of the participants had been interned in concentration camps for periods during their childhood or adolescent years and all were resident in South Africa at the time that they were interviewed. A case study method was employed to examine the experiences of aging survivors and extended, in-depth, semi-structured interviews were used to generate data on the following features: pre-Holocaust life and family of origin; Holocaust and concentration camp trauma exposure, impact and coping; life post liberation; and experiences of aging. Participants were generally interviewed over several weeks in order to build trust and to generate in-depth data. Thematic content analysis, informed broadly by psychodynamic theory, was used to extrapolate themes of trauma and resilience, and to understand how participants appeared to be navigating old age specifically in relation to Erikson's (1965) formulation of the life stage of Ego Integrity versus Despair. Aspects of each participant's developmental trajectory were explored in order to better understand the impact of Holocaust trauma as experienced during the life stages of childhood or adolescence. Both within-case and across-case features were identified.

The decision to employ a qualitative research method was partly influenced by the small number of remaining child/adolescent Holocaust survivors who were/are still alive in the world, and in South Africa in particular. In addition, the focus of the study was primarily clinical in nature, seeking to document individual histories from a developmental perspective with a particular focus on the apparent impact of experiences surrounding the Holocaust on the mental health and internal and relational worlds of the survivors. A retrospective view was taken, examining people's lives both during the event and over the decades since the Holocaust ended. After the interviews were transcribed, main themes and sub themes were extrapolated from the data, using thematic content analysis (Braun & Clarke, 2008). An interpretivist approach was used to understand the psychological dynamics of each case and the similarities and differences across cases were explored. All three authors of the article were involved in the data analysis, each having independently read the interview transcripts and having generated an analysis of the core themes. These initial analyses were then compared and refined in order to generate higher order themes and in order to foreground those themes on which there was most consensus across analyses. This article presents findings relating specifically to the theme encapsulating experience of loss and grief and the defensive mechanisms designed to deal with the existence of unresolved grief. This emerged as a very prominent theme in the data corpus.

Ethical issues

Permission from the relevant university ethics committee was sought to ensure that all relevant concerns had been addressed in conducting this research study. It was recognised that participation would in all likelihood be very personally demanding--even if interviewees perhaps wished to be able to give some form of testimony concerning their Holocaust experiences. The procedures for approaching subjects and ensuring informed consent were consequently very carefully formulated. The basic principles of confidentiality, or protection of identity, and free choice concerning participation, informed the approach to potential participants and the conducting of the research.

Confidentiality was assured, for example, by use of pseudonyms in the write-up, although given the specificity of their life histories it is likely that some participants might be recognisable to themselves and close others. In addition, 'thick disguise' (Winship, 2007) was used to protect the confidentiality of some of the participants to ensure that their story would not be recognised, given the sensitivity of some of the material that emerged.

Participants had the option of withdrawing from the study at any point and it was made clear that an appropriate, negotiated referral would be made for anyone who might experience research related distress. In every case a follow-up interview was conducted a week after the research interviews had been completed and an additional follow up phone call was made one month later to assess any possible longer-term effects. None of the participants reported research related traumatisation and no participant requested referral for counseling. Some interviewees reported considerable psychological relief at having been able to talk about their life histories and traumatic experiences in considerable depth.

Given some of the overarching concerns that arose from conducting the study, aspects of the findings were presented to Jewish Community Services staff and as a consequence a special psycho-social service was set up to reach out to child survivors who might be struggling with ongoing grief, and to address psychosocial and material needs. This service has been running successfully for the past year and has made a significant contribution to reaching out to child survivors in the Johannesburg community.

Findings/case material

Case material from six of the nine survivors interviewed is presented below in order to illustrate both the nature and extent of grief that presented and the employment of the defence of dissociation, and more specifically compartmentalisation, to manage this catastrophic grief. These particular cases were selected to illustrate the continuum on which Holocaust survivors appeared to fall regarding their capacity to compartmentalise their ongoing grief and the apparent impact of this defense. At the one end of the continuum were survivors who completely supressed/repressed their trauma, in the middle those who were able to compartmentalise their grief, and at the other end of the continuum those survivors who were mostly unable to use defences to shore off their grief and were overwhelmed with sadness and distress. The discussion will first give some brief background on each case, together with some analytic commentary on aspects of what their material illustrates in relation to loss, grief and defence, and thereafter will move on to a broader discussion of the findings as they reflect observations across the cases.

Miriam

Miriam was eighty at the time of the interview. She was twelve when the Holocaust began and sixteen when it ended. She was an only child and described her father as 'a very kind man' and her mother as' a very cultured and dynamic woman' who was involved in arts and culture and travelled frequently. She reported that from the age of two her Catholic Latvian nanny looked after her and slept in her room. Miriam said that her nanny Natasha 'was like a mother to me'. Miriam described her childhood as happy and secure. On closer observation it seemed that her nanny was a very important nurturing object who cared for her in place of her mother, who was somewhat absent owing to her travelling. It was evident that Miriam had felt well supported and loved and had introjected primarily positive object relationships with all three significant caregivers.

Miriam's father was killed soon after the Holocaust began. She remembered that her mother had returned home shaken after hearing that her father had been murdered. She reported that her mother whispered--'they are all gone, murdered in cold blood!' Miriam reported that she and her mother were terribly afraid for their own survival and were unable to process their loss and mourn properly for her father. Ghetto selections took place frequently and people were shot and buried in mass graves. She and her mother were captured and sent to Kaiserwald and Stutthof concentration camps where they endured great suffering and witnessed death on a large scale. After surviving the Holocaust, Miriam and her mother came to South Africa.

Miriam was married with children. She had many hobbies and presented as a 'resilient' survivor. She described her traumas and the death of her father in an unemotional manner and said in a disdainful tone of voice: 'I don't do depression--I keep busy.' She told her story in a detached manner suggesting that she had developed and sustained rigid defences to manage her trauma. Her flat affect suggested the use of both dissociation and suppression to deal with her catastrophic loss. However, in her interviews Miriam spoke at length about the loss of her father. In addition, she said she was 'devastated about losing my nanny, who was like a mother to me.' Although she said she was never depressed or sad, she described this devastation in a very solemn voice. It was clear that her nanny was a central parental introject that she lost as a result of her Holocaust experience. Her deep sense of mourning regarding the loss of her nanny demonstrates that although she survived with her mother, the loss of her nanny who embodied her dominant maternal figure, was experienced as significant. It was evident from her constant mentioning of her nanny that Miriam was deeply impacted by the loss of this important mother figure who she missed for decades. She said that she never got depressed or sad about her nanny, however she was able to hold her nanny in her mind by cooking and baking--skills that her nanny taught her. Although she was able to use both dissociation and suppression in a powerful way, Miriam's sense of mourning and loss were evident when she spoke about her nanny. It was apparent that she still carried a powerful internalised attachment to her and retained a kind of loyalty to her in her continued applications of skills she had received from this woman who was significant at a very early time of her life. However, Miriam remained almost totally emotionally disconnected from her painful feelings and she seemed to regard her vulnerability as a weakness. In this way her defences of suppression/ repression helped to protect her from experiencing distressing affects associated with loss of key attachment figures and the life to which she was anchored before this was destroyed by the Holocaust.

Helene

Helene was a child survivor from Germany. She was seventy-six years old and in good health. She reported that she worked part time and enjoyed her friends and family, and it seemed that she was resilient in her functioning. She described her relationships with both her mother and her father as 'very close'. Helene was an only child and had happy memories of her life with her parents before the Holocaust. She was six years old when the Holocaust began and twelve years old when it ended. She and her parents were captured by the Nazi's and sent to Gurs concentration camp for six months and then to Rivesaltes. The camp commander at Rivesaltes agreed that some Jewish children could be released to French Jewish Authorities. In an attempt to save her life her parents sent her away when she was seven years old. She spent time in two children's homes and went into hiding in a Catholic convent. After the Holocaust her Jewish relatives found her. Her parents had been killed in Auschwitz however she was not told about this until much later. She came to South Africa where she was adopted by her uncle.
I never got depressed and tried to fit in and be normal. If I got sad,
I would read or listen to music. Reading was my refuge. I never
considered myself an orphan because I regarded my aunt and uncle as
surrogate parents... I never mourned my parents, the pain was
unbearable... I had friends, but I always felt lonely, I always smiled,
but the smile was a mask that hid my pain.


Helene said that she got very depressed for a short period after her first child was born and she struggled to attach to this daughter and continues to have ongoing disputes with her. Helene said that she thinks that this child 'bore the brunt' of her Holocaust trauma and she added that she thought that perhaps she was afraid of getting close and then experiencing loss again. She said that she was bored with being a mother and she struggled to believe that her husband loved her, suggesting that she struggled to some extent in her intimate interpersonal relationships. During the research interviews Helene became very tearful and cried inconsolably as she described her grief surrounding the loss of her parents. She also sobbed when she spoke of their suffering in Auschwitz:
I have never allowed myself to think about it until now! They must have
been hungry and cold, living in that hellhole. I cannot bear to think
of them as walking skeletons or fighting for their last breath in the
gas chambers... I cannot come to terms with their death.


During the follow-up interview a day later:
Helene: Yesterday I cried in front of you because the whole thing about
my parents hit hard. I cried when my husband died but never like I
cried with you, yesterday. I have never told anyone but you. I could
never bear to think of it, and I am not strong enough to face it, so
what I am saying is that you helped me tremendously. I had to face it
one day, I faced it, and it's dreadfully painful (crying).


Researcher: I can see.
Helene: I have never cried the way I am crying now, to think that a
woman like my mother had to live in such horrible conditions, and my
father who was a businessman had to be reduced to that. They were
stripped of their dignity, the thought of that is unbearable! (crying).


It was evident that Helene had compartmentalised her grief for decades and during the research interview her grief and mourning were palpable. However, it was nevertheless clear that she had functioned and continued to function well in terms of general life goals and that her use of compartmentalisation had enabled her to minimise the impact of her potential grief and the sense that if she engaged with this fully it might undo her. From the emergence of intense feeling states during the interviews it was evident that Miriam's grief had been managed by keeping her associations and feeling states at bay for most of her life.

Rina

Rina was a child survivor born in Holland in 1936 and was seventy-one at the time of the interviews. She was three years old when the Holocaust began and nine years old when it ended. She lived with her parents and her older brother. After the German invasion of Holland in 1942 when Rina was five-and-a-half, she and her family were taken to Westerbork, a transit camp where Jews were kept captive before being transferred to Auschwitz or Sobibor death camps. The family remained there for sixteen months. Rina had no memories of her father at Westerbork and this loss of memory surrounding him has been distressing for her, leaving a disturbing absence in her mind. She reported that she knew that her father was taken to Buchenwald concentration camp where he died from abuse. Rina, and her mother and brother were sent to Ravensbruck Women's camp for a further sixteen months. Tearfully, Rina said that as a child in the camp 'I wished that I could grow wings and fly over the walls of the camp to escape from the horror and misery'. Rina's testimony revealed how her fathers' suffering and the circumstances of his death continued to haunt and distress her: 'My uncle told me that my father was beaten so badly at Buchenwald camp, that he could not work, he stopped eating and got weaker and weaker, and then he died in the mud!' During this account Rina wept for the loss of her father and the loss of his dignity, as well as for her own internal loss of a protective, parental introject. She carried terrible pain knowing that her protector had died in such a defeated way. Rina described her lack of closure and unresolved grief for her father who was remembered as a damaged object. With adult perspective came a renewed identification and understanding of her father's suffering. She said that she was an over protective and anxious parent in relation to her own children and she always tried to look 'on the bright side and be grateful for what I have.' Her account suggested that she had largely successfully compartmentalised her grief and that she had attempted to be reparative to a degree in her own parenting.

Lenna

Lenna was a child survivor from Hungary. At the time of the interview she was seventy-five and in good health. She reported that both her parents were very warm, however her father was very ill with tuberculosis and she and her younger brother went to live with her aunt when Lenna was four years old. Lenna reported that her aunt was kind and loving and she would stay with her during the week and move back home on the weekend. This arrangement minimised the risk of the children contracting the disease. Lenna reported that she was traumatised by her father's illness and her father died when she was seven years old. She was eight years old when the Holocaust began and thirteen years old at the end of the war. She was imprisoned at Auschwitz for a year and was then moved to Bergen-Belsen for three months before liberation. Her entire family were killed in the Holocaust. After meeting her husband, she moved to South Africa where she built a successful business and she described apparently highly successful functioning in this and other arenas. However, like others Lenna used compartmentalisation to block off her Holocaust experience, as focusing on it left her feeling traumatised and miserable:
Lenna: I avoid talking about the Holocaust because it brings up
feelings I would rather not think about. I try to push it back. I don't
know if I can talk about the camps. I try blocking it. There are things
that come to my mind very often, and I push them away or try to do
something or go somewhere to distract me, and sometimes I succeed, and
sometimes I don't.
Researcher: When you don't succeed, what happens?
Lenna: It goes around and round inside me, and I get more and more hurt.


Lenna functions well externally but at times battles to block her Holocaust experiences and feels consistently upset when she thinks about them. She said:
I don't think anyone who went through the camps like Auschwitz,
Bergen-Belsen or Majdanek is normal. I don't believe you can be normal!
You live with the memories and the people you lost, and what you
experienced, it's there with you all the time, so how can you be
normal? It's not something that is finished and gone, and you get on
with your life. So, you build yourself a way of life; you try to act
normal, you laugh, you dance you go to movies and theatre. I have it
all in front of my eyes, and it's hard to forget!


This comment illustrates rather vividly what Dasberg (2001) says is the parallel existence that many survivors experience. Part of them is stuck in their camp experience, while they function as if 'untouched' in their present lives. This is consistent with what Dasberg (2001) described as an inside/outside split where survivors look resilient on the outside, but experience suffering in their internal world. As Lenna mentioned, she struggled with survivor guilt and experienced anhedonia. In addition, despite functioning well externally, she had symptoms of post-traumatic stress and unprocessed grief. Her account of her engagement with her Holocaust experiences was consistent with what Cohen, Brom and Dasberg (1998) described, in that it was evident that her functionality coexisted alongside a trauma infused internal world that could be relatively quickly accessed under certain circumstances. As she ages Lenna finds that her grief for her family continues and her survivor guilt remains intense and contributes to a more 'despairing' engagement with life.

Lenna added that she avoided conflict in her close family relationships and never discussed her feelings with anyone, consequently her communication skills within relationships were very limited. Her internal suffering remained too difficult to articulate and was therefore unshared and hidden from others (Dasberg, 2001), emerging more indirectly in her level of emotional constraint in interpersonal relationships.

Shmuel

Shmuel was seventy-nine at the time of the research interview. He was a child survivor from Poland who was eleven years old when the Holocaust began and seventeen years old when it ended. After being separated from his family he was interned at Auschwitz, Gross Rosen and Buchenwald concentration camps, from where he was later liberated. His father, mother, sister and two older brothers were killed at Auschwitz. In addition, Shmuel's extended family, friends, and community were all killed in the Holocaust. He said that very few people from his hometown survived.

When speaking about the loss of his mother Shmuel explained that he continued to feel grief and sadness until the present time because he was so close to her. Shmuel felt that he had no closure as he had no time to prepare to separate or to say goodbye to his mother. During the interview he became very emotional whenever he mentioned his mother. Shmuel described compartmentalisation in a similar way to others, illustrative of apparently adaptive functioning from an external perspective but with clear evidence of co-existing internal suffering. Shmuel was resilient and very successful in his external world. However, when he was interviewed he spoke about his ongoing sense of catastrophic grief about his parents, and his deep disappointment in God. It was clear that he was private about the suffering, pain and disillusionment he felt and had never discussed the details of this with his wife and family, despite claiming that he was very close to them. He carried his despair silently and almost secretly. He reported that during the Holocaust he lived in fear and witnessed death, cruelty and starvation, yet what seemed to be the hardest was his loss of his mother and immediate and extended family. Shmuel described a lack of closure regarding the loss of his beloved family and observed that he has lived with the associated sadness all of his subsequent life. He said that he thinks more about the Holocaust now because he has fewer current worries, such as concerns about money--as he gets older, he gets sadder.

With compartmentalisation it is evident that inhibition of memories and states associated with personal Holocaust history is employed as much in the service of the individual as it is to protect those around them from the magnitude of their experiences. The damaged Holocaust-infused part of the self exists alongside the socially functional part of the self, but is as far as possible kept boxed up or compartmentalised away in some manner. He continued to say in a deeply sad tone of voice: 'I hate a cemetery. Because my parents are not there and I don't know where their bodies are! I get upset, even though I am nearly eighty it still upsets me'. This statement demonstrates that there is no mourning site to visit and no closure for an unending grief that continues into old age. Shmuel was profoundly sad as he talked of his immediate family losses and being robbed of the opportunity to say goodbye. He felt torn from his family without warning and he was deprived of the opportunity to mourn and achieve closure, leaving him in a kind of grieving limbo.

When asked if he gets depressed, Shmuel said he has never suffered from depression, however, he has 'gotten used to being sad.' He said that worse than the cruelty and torment of the Holocaust was the loss of his family, for whom he continues to grieve. The lack of closure and inability to engage in ritualised mourning practices leaves a gap where memory is the only memorial left for loved ones. Although Shmuel is very resilient and successful, his description of his mourning suggests the presence of an open wound, as described by Amir and Lev-Wiesel (2003). It was evident that he was able to compartmentalise this wound and keep it largely separate from his everyday life.

Menachem

Menachem was eighty-one years old at the time of the interview. He was born in a town in Poland. He reported that he was very attached to his father and his brother. He described his mother as 'very strict and very busy with cooking and cleaning and she didn't have time for us.' He was thirteen years old when the Holocaust began and eighteen when it ended. Menachem was himself captured and interned at a labour camp, Pustkow. He was then sent to Auschwitz for two years. He lost his whole family during the Holocaust. In 1948 he met his wife and her family and they emigrated to South Africa. He reported that he was later diagnosed with PTSD and depression. The trauma and loss he experienced had a shattering effect, compromising the negotiation of a coherent and positive identity. Up until the present time Menachem continues to feel guilt, helplessness and rage about the loss of his father and siblings. Menachem reported that the horror and loss he experienced gave rise to a spiritual conflict regarding God that presented him with a dilemma, as he had been raised in a religious home.

According to Menachem the pain of the impact of the Holocaust has intensified as he has aged. Not having his siblings around him was a constant source of sadness: 'I lost everybody.' As he got older Menachem reported being less busy allowing more mental space for his Holocaust related memories to return and re-traumatise him. He said he would never have closure because of the gravity of his losses and retained frustration in relation to not having been able to personally avenge the harm individuals had committed against his family and community.

Menachem seemed deeply depressed and despondent about his life. He appeared to be the most compromised of all the participants in terms of his current functioning and it was evident that he leaned strongly towards the polarity of 'despair' and did not have defences to help him to manage his grief. He tended to present as overwhelmed and unable to compartmentalise or cut-off his intense anger and grief, with such feeling states to some extent contaminating his family relationships.

Discussion

The several cases selected demonstrate the way in which child survivors use defences such as suppression and compartmentalisation to manage their catastrophic grief. A continuum was observed in the across-case analysis with on one side an almost total suppression of grief throughout the lifespan, as evidenced by Miriam and Lenna. In contrast, Helene, Rina and Shmuel were/are able to access their grief but in most instances their grief is compartmentalised in that it is acknowledged to the self but constrained and largely unshared. At the other end of the continuum is Menachem whose defensive system fails to help him to inhibit or manage his overwhelming grief and associated anger and despair and who has a dual diagnosis of PTSD and depression. Both Helen and Rina wept about the loss of their parents who died brutally. In each instance parents were internalised as damaged objects which may have intensified their trauma and grief. It may be possible that internalising dead parents in this way was so devastating that it caused a shattering of the self that led to either severe PTSD and depression as in the case of Menachem, or to the fairly extreme use of defences such as compartmentalisation and suppression, as observed in what may be termed the more 'resilient' survivors, Helen, Rina, Lenna, Miriam and Shmuel. It is, however, acknowledged that resilience may be contested as a descriptor in this kind of context. It is evident that the deployment of certain defences allowed survivors to remain largely functional but equally the nature of the trauma and loss they had suffered did not allow for the kind of integration and transcendence of life experiences associated with resilience.

A ubiquitous finding of the present research was that all child survivors described the massive losses they endured as children and their ongoing grief and lack of closure regarding such losses in their old age. Witztum and Malkinson (2009) suggested that Holocaust survivors be understood through the lens of traumatic bereavement. The magnitude of losses and the violent or dehumanising circumstances of the dying of attachment figures created particular difficulties, as did the lack of preparation for leave-taking. The term 'catastrophic grief' appears to best capture the experiences of child survivors as they suffered from multiple traumatic bereavements, associated with a range of complex emotions and memories. The term also conveys something of the extent and intensity of the loss in the context of the Holocaust. All the interviewees described the presence of catastrophic bereavement in their old age as was evident in the intensity of their affective expression, preoccupation with the manner of peoples' leave taking and dying, and the guilt they carried in many instances for having survived. The experience of catastrophic grief had an impact on the self in terms of the formation of a cohesive identity, autonomy, mastery and emotional regulation. In addition, catastrophic grief compromised their ability to form attachments after the Holocaust as they feared further loss and they struggled to share their Holocaust trauma with their spouses and children.

Findings of this research demonstrated that in the stage of Integrity versus Despair (Erikson, 1965) indicators of despair were continuing grief and vulnerability to depression, as well as compromised spiritual beliefs and complex relationships to religion and God. Catastrophic grief intensified the survivor's sense of despair in old age and the disconnection from others and God left them with a sense of existential loneliness. Despair and loneliness were found in both resilient and depressed survivors. However, it was also noteworthy that all survivors mentioned that they were able to glean a sense of meaning and satisfaction from their children and/or grandchildren, indicating that later life human attachments could yield a sense of renewal and hope.

As described by Dasberg (2001), child survivors in this study grappled with issues of aging. This appeared to be related to the suppression of their grief, as well as the loosening of defences and breaches between their inner and outer ways of experiencing. The study confirmed Dasberg's (2001) description of a vertical split where survivors carried significant internal or hidden distress and yet externally displayed adaptive functioning. The participants described vivid recollections that were visceral and had a strong sensory immediacy. This suggested that their trauma related memories were still very much 'alive' and it appeared that the trauma was compartmentalised and walled off in the psyche. This was also evident in the way that the catastrophic grief and traumatic memories were encapsulated in a survival shield that endured across decades. While the findings confirm Dasberg's (2001) formulation, we suggest that compartmentalisation might be a clearer term to employ than splitting since the presentation of the participants indicated a very clear walling off of historical experience that nevertheless could be relatively immediately accessed in the present. The integration of their mourning and Holocaust trauma was a complicated process in the final stage of aging particularly because it had been kept shut out of conscious view for so long. The group of resilient survivors seemed to function in line with the paradoxical integration described by Kellermann (2009). In normal circumstances the use of the kinds of defences associated with splitting, dissociation, repression, suppression and compartmentalisation may be viewed as 'unhealthy' as such defences block access to aspects of emotional life that then remain unprocessed. In the case of child Holocaust survivors, however, these defences appear to have been functional in blocking out unbearable trauma and catastrophic grief, not only at the time of the original events but also in subsequent life, enabling outwardly adaptive adjustment and functioning. Suppression was aided by post-war environments where there was an injunction not to speak about Holocaust experiences.

The survivors' resilience and adaptation in their present life was generally remarkable given their historical experiences. However, they retained Holocaust related damage and both the experience of complex traumatic stress and of catastrophic grief contributed to the experience of despair in old age. As children, the tragic losses they sustained destroyed their overall sense of trust in a benign and lawful world. This caused them deep and persistent sadness. The metaphor of 'silk bandages' (H. Gordon personal communication, February, 1989) is used to describe the way in which they hid their wounds and went to great lengths to preserve their sense of dignity in the outside world. What lay beneath the 'silk bandages' was the encapsulation of profound suffering and loss, some of which became more prominent as they moved into end of life stage.

Conclusion

The complexity of managing the effects of trauma and loss has been elaborated using subjective reports of child survivors decades after the Holocaust. It was possible to explore the impact of exposure to catastrophic loss at an external developmental period by observing the life-cycles of the survivors from a retrospective vantage point. Laub (1992) underscored the importance of Holocaust survivors giving testimony. In his understanding the role of the analyst and the role of the interviewer, while they have differences, are also very similar in impact and dynamics. Long and Eagle (2009) state that when the qualitative researcher is also a psychotherapist, 'he/she may also hold a function as a researcher-clinician and as an interpreter and container' (p. 20). The present research opened enquiry and debate into the role of research in exposing what has been compartmentalised or split off. The nature of the research interviews facilitated a process of unpacking the supressed trauma and grief in some survivors who had compartmentalised their trauma for decades. Perhaps their knowing that they were talking to a clinician helped them to feel a sense of safety and because it was 'research' they did not feel stigmatised about speaking to a professional. Those who spoke expressed their gratitude as it allowed them to unburden themselves of the trauma and grief that they had repressed and/or suppressed for decades. It is possible that psychotherapy, even at this advanced stage, may have similarly reparative effects. Although it is necessary to respect defences it is possible that they have diminishing functionality in old age and therefore that this may be a period in which survivors may be more open to the experience of release, catharsis and an opportunity to engage in mourning work of a different kind.

Auerhahn and Laub (2018) describe Holocaust survivors' ongoing sense of loss, trauma, loneliness and feeling like a refugee in a strange land. This was to a large extent substantiated by the findings of this research.

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Tracey Farber has recently been awarded with a PhD for her research Integrity versus Despair: The Experience of Traumatised Child Holocaust Survivors. She is a clinical psychologist in full time private practice and works adults and children within a psychodynamic framework. She specialises in working with traumatised clients and teaches trauma counselling skills to mental health workers She is currently the consultant supervisor to psychologists and social workers at King David schools. She has extrapolated concepts from her research to develop a model for teaching resilience that she presents to mental health workers, nurses, parents and teachers. tfarber@telkomsa.net

Cora Smith is an Adjunct Professor in the Division of Psychology in the Department of Psychiatry at the University of the Witwatersrand. She also holds a joint appointment post as the Chief Clinical Psychologist at the Child, Adolescent and Family Unit, Johannesburg Hospital. She has a Masters in Clinical Psychology and a PhD from the University of the Witwatersrand. She currently serves on the Human Ethics Research Committee at the University of the Witwatersrand. She previously served on the Ethics Advisory Subcommittee of the S.A. School Psychologists Association, the Ethic's Advisory of Educational Psychologists of SA and the Ethics Advisory Committee of the South African Psychoanalytic Confederation. She is the co-editor of the book Psychodynamic psychotherapy in South Africa: Contexts, theories and applications. Cornelia.smith@wits.ac.za

Gill Eagle is Professor of Psychology at the University of the Witwatersrand and an experienced clinical psychologist. She lectures primarily on the Masters programme in Clinical Psychology and is also a core member of the doctoral team overseeing research work in the area of psychoanalytic psychotherapy and practice. Her research interests lie in the field of psychosocial studies, with a particular focus on traumatic stress and on gender and sociocultural issues. She has published numerous articles and co-authored the book Traumatic stress in South Africa with Debra Kaminer. She runs a small private practice, working primarily within a relational psychoanalytic psychotherapy framework. Gillian.eagle@wits.ac.za

Tracey Farber

Private practice

Gillian Eagle

University of the Witwatersrand

Cora Smith

University of the Witwatersrand
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Author:Farber, Tracey; Eagle, Gillian; Smith, Cora
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Date:Dec 22, 2018
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