The Transgenerational Impact of Cultural Trauma.  Linking Phenomena in Treatment of Third Generation Survivors of the Holocaust - Winship, G & Knowles, J (1997)  The transgenerational impact of cultural trauma - linking phenomena in the treatment of third generation survivors of the holocaust.  British Journal of Psychotherapy, 13, 2; 259-266.

Abstract:  The long term impact of the holocaust is considered with reference to material presented in the case histories of patients treated in an NHS Psychotherapy Department (West Berkshire).  The treatment of three third generation survivors of the holocaust are described.  Insofar as it is only recently that third generation phenomena is emerging, the clinical work is experimental.  In the spirit of a greater consideration of the interlace between psychoanalysis and cultural trauma (Hunter Brown, 1992), this paper examines the relationship between the magnitude of a cultural trauma (and it's resonance) and the time it takes for the trauma to be worked through.  The implications for the treatment of survivors of other cultural atrocities, for example, the Hungerford massacre and Dunblane, are considered.  A provisional psychodynamic diagnostic axiom is proposed by the authors and it is hoped that this may be useful for other clinicians.

Introduction:  Reports on the after-effect the holocaust began to emerge in the 1960's (Hoppe, 1968; Neiderland; 1968).  The experience of working with survivors highlighted a specific pathological phenomena which was driven by sequestered guilt and anxiety which Niederland (1968) called "survivor syndrome" (p.313).  It was also noted that there was an mobilization of mechanisms which defended against the painful memories of the holocaust - a wish not to think about the trauma and loss (Bergman & Jucovy, 1982).  However, in the 1970's clinical evidence began to accumulate which suggested that where defenses had been mobilized in survivors, symptoms began appearing in offspring, as if there had been an atavistic transgenerational transmission of trauma.  Attention was then turned to the second generation survivors of the holocaust where the failure or inability to mourn the loss of relatives was apparent and manifest in symptomatology (Epstein, 1979; Davidson, 1980; Barocas & Barocas, 1980; Bergman & Jucovy, 1982; Heller, 1982; Wilson, 1985; Wardi; 1992; Moses; 1993).     

Moses (1993) tackled the complex question of transgenerational mourning among Jewish survivors where he contested that the inability to mourn was an impasse reached where there is an unconscious unwillingness to mourn.  That is to say, mourning and resolution may be thwarted because it would be seen as constituting a step towards forgiveness and forgetting.  Wardi (1992) similarly noted how the process of preserving the memory of the holocaust may become

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intertwined with a death motif in some families.  She found that in some Jewish families a child may be assigned with the role of memorial candle, where they are invested with memories and hopes, sometimes being named after relatives who had been killed (cf; Heller, 1982).  Wardi founds that among her patients the identification with death could become deeply imprinted in the exchange between mother and infant, "You transmitted to me the smell of the little death, perhaps in the milk, perhaps in the blood, perhaps in the dream" (Semel, 1985; p.80. Cited in Wardi, 1992; p.48), thereby causing a surfacing of psychopathological identification with death later in life.  In the treatment of these patients the symbolization of the memorial candle was a recurrent theme throughout the group analysis.  The therapeutic endeavour was one of a process of making conscious through narrative and dream analysis, the previous unconscious identification with death and loss. 

Throughout the literature it has been noted that certain events such as anniversaries acted as triggers which caused a re-surfacing of traumatic feelings among survivors (Pollock, 1970).  This process of anniversary reaction is well noted in psychoanalytic literature (Engel, 1975).  The fiftieth anniversary of the cessation of the Second World has spurred a cultural wave of interest in the Holocaust, not only from a therapeutic perspective (Barnett, 1995) but also in the public sphere.  The most striking recent emblem of this interest is arguably Spielberg's moving film Scheindler's List.  Other events in the near future also aim to mark the place of the holocaust in modern history such as the plan for a permanent holocaust exhibition at the Imperial War Museum in London, due to be opened in 1999.  A similar project is also planned for New York where already steel support columns are in place in Battery Park City which are the foundation for a holocaust memorial and museum.  This memorial, according to the New York Times (16.4.96; p.1), has aroused debate about the place of such cultural representations.  There are some concerns that this memorial will perpetuate the imago of Jewish victimization rather than being the basis for recovery through mourning.  On the same day as this discussion was aired in the New York Times, The Guardian (16.4.96; p.11) reviewed the potentially controversial new book by Goldhagen (1996).  Goldhagen strongly argues that German people were collectively complicitous in the massacre of Jews and that the event of the holocaust can not be reduced to individual or national responsibility.  Goldhagen's polemical book would seem to contemporaneous with a new generation of research into the holocaust and it's impact.  It is against this backdrop of controversial debate, at this time of the fiftieth anniversary of the liberation of the concentration camps, that we present case vignettes where the long term impact of the holocaust was apparent in the case presentations and treatment of three patients.               

Case Vignette A: A 38 year old woman was referred for psychotherapy.  Her problems appeared to have begun in 1990 when she suffered a mis-carriage.  She was bed ridden for three months and as a consequence lost her job.  Her physical and psychological condition deteriorated over the following years and she was eventually diagnosed as suffering from LUPAS with an associated depression.  During the course of her therapy a very turbulent history emerged.  Her mother was a Jew who had lost both of her parents during the holocaust.  When the patient was twenty one her father committed suicide.  She underwent psychotherapy for two years.  Initially therapy was very difficult - she would bring a note book and write things down during the session.  After a year she had

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made some progress.  She decided to stop her anti-depressant medication and had also stopped bringing a note book to the session.  However, after eighteen months as the therapy moved towards closure, initiated by the therapist, she became depressed again although her physical condition did not deteriorate markedly.  It was at this time also that discovered that she was pregnant again.  During the last six months her attendance was sporadic and she did not attend her final sessions.  She re-contacted the psychotherapy department two months later to say that she had given birth.

Case Vignette B: A 35 year old man presented with anxiety and intrusive persistent thoughts that he may have "accidentally" done harm to others.  He lived alone and did not have any current relationships with women.  His family lived close by and reported that he had good relaxed relationships with his parents and brothers.  During the fifty year anniversary of the ending of the second world war he began to talk about his mother's family experience in Poland during the war.  His thoughts about this had been stimulated by his mother talking about this time - a topic of conversation which had previously been a "no-go area" for the family.  His maternal grandmother had survived being taken for a cleansing programme by hiding in a woodland near her village with her two year old baby (the patients mother).  The rest of the family, husband, brothers, uncles and aunts, were all taken away and were never seen again.  Two years later the maternal grandmother had been arrested whilst the patient's mother was in the care of friends.  At the end of the war the patient's mother was in the care of nuns in a convent.  She was eventually brought to England and adopted.  The patient's mother grew up knowing that she had lost her family.  Now, fifty years on, she explained to her son that she felt that she must have been, in some way, to blame for "accidentally giving her family away".  She had made conscious efforts to never remember her family of origins, instead inserting thoughts of her adopted family.  She recalled now that when the patient was an infant, she had experienced difficulty keeping "unwelcome ghostly memories at bay".  Although the patient had not told his mother of his symptoms, he was struck by the fact that she used the same words to describe her distress as he did when describing his own.  During the course of therapy the patient and his family had revisited the Polish village from where the family originated, spending several days their taking many photographs.  The patient reported that the family were surprised that they could feel happy there as well as sad and tearful.  He said that he and his mother had shared a mutual feeling that it; "was not their fault".  They had cried together because the grandmother was not there to share this feeling.  Following this visit, the patient experienced relief from his previous anxiety.

Case Vignette C: A female patient (25 yrs) with a history of anorexia and suicidal depression was treated in once weekly individual therapy.  During one of the early sessions she described a recurring nightmare; "I get trapped in a toilet, a cubicle with cold white tiles, and I cannot get out".  She said that her mother told her that from the age of two she used to scream when she was taken into a public toilet.  Her fear of public toilets was disabling and she organized her life in such a way so as to avoid situations where

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she may need to make use of them.  During the course of the first months of her therapy she made a link between the toilet dream and her vomiting.  She described feeling repulsed by the imagery in the dream and later described that she felt "repulsed" by her contact with her mother, that she could not bear to be hugged by her.  This fear of physical contact was also manifest in difficulties in her marital relations with her husband.  After several months in therapy she reported one week a similar dream to the toilet dream except in this dream she was in a shower (this was recounted in the first session after the easter break);  "I was in a shower with cold white walls, I noticed that all the shower tubes were all tangled up".  The dream was a nightmare that woke her up.  When asked about her associations with the shower she said that she could not think of any.  Then quite suddenly in the session she had a recollection of a time when she was at school, age twelve, when she passed out in the changing rooms.  She associated the showers with her changing rooms at school.  Her passing out, she thought, may have been linked to the fact that she had started to starve herself at this time, the onset of her anorectic behaviour.  In the session she further recalled that at this time at school she had been reading Anne Franks diary.  She then made an association between Anne Frank hiding under the floor and the picture she had in her mind of her showers at school.  She went on to say that she remembered seeing a picture of Anne Frank at this time and thinking how much she looked like her.  The following week she had a further association with the shower dream in which she made a link between Anne Frank and the gas showers in a concentration camp.  The therapist noted that the dream occurred over the Easter break and asked if the patient knew that this was an important festival in the Jewish calender.  The patient said that she was not aware of the Jewish festival.  However, in the following sessions she began to talk about her memories of going to Jewish weddings and Christenings.  She told the therapist at this time that her father was a Jew.  Although she was not brought up in the Jewish faith (because of her gentile mother) she recalled how (aet, 9) telling her friends at school that she was a Jew.  Her father had told her off saying; "that some people would not like it".  She began to wonder about her father's denial of his Jewishness and vaguely recalled him talking about relatives of his aunt who she thought may have been killed in the Holocaust.  She said that she often felt very angry about derogatory jokes about Jews.  Her contact with her therapist throughout this first seven months in therapy time was quite distanced where she appeared to struggle to embrace any immediacy.  When asked about this she was able to articulate just how fearful she was of coming into the consulting room.  The consulting room was associated with a toilet.  After ten months she presented the following two dreams; "I'm in a coal bunker with a black friend.  Adolf Hitler is there.  I don't know if he's friendly or not.  Me and my friend climb the stairs, there are hundreds of them.  When we get out at the top it's light.  We ask people what town we're in.  We can't find out.  Then I realize why, it's because were on another planet".   She associated the dream with "an uphill struggle in therapy".  The therapist said that he wondered if she was unsure as to whether she can trust the therapist or not, is the therapist a friend or a persecutor.  The immediacy of contact with the therapist became more apparent over the following sessions.  A short time later she presented the following dream:

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"I'm in a bathroom talking to you.  Were sitting on the edge of the bath relaxed and joking.  Then you stand up and look in the mirror.  I say; 'you should look in this mirror instead, it's amazing, you get a token'.  Then I go into the bathroom next door and it's like the old toilet that I used to dream about.  I vomit".  In the following session she reported that for the first time she had told her parents that she was in therapy.  Her mother had hugged her.  She said that this experience was awful and that she did not want to come to therapy any more.  However, over the next three months she began to work more with increasing immediacy in her contact with the therapist.  She realized that it was difficult for her to speak to the therapist.  She said that she felt that her words would be disgusting.  The therapist was reminded of Rey's (1994) patient who would not talk because she thought that her words were; "poisonous, dangerous objects inside her stomach, and if she talked they would hit the therapist and do him great harm" (Rey, 1994; p.184).  The therapist said; "I think you fear that your words are disgusting and that they may do me great harm, you feel that you have something so terrible inside your tummy".  The patient responded that she had always felt that there was something bad inside her and recalled that when she cut her wrists when she was 14 she thought she was trying to get something bad and horrible out from inside herself. 

Discussion: It would appear that the phenomena of transgenerational transmission of unresolved anxiety and grief is apparent in these case presentations are similar to those described in previous studies of holocaust survival where the failure or inability to mourn loss are apparent and manifest in symptomatology (Hoppe, 1968; Epstein, 1979; Davidson, 1980; Barocas & Barocas, 1980; Bergman & Jucovy, 1982; Heller, 1982; Wilson, 1985; Wardi; 1992; Moses; 1993).  In presenting the cases, it might be argued that in the third generation survivors, the symptomatology was exacerbated by the depth of repression of the previous second generation where survivor guilt had been interiorized in attacks on the self.  In vignettes B & C, an anniversary reaction would appear to be manifest in the material presented in therapy where there was a re-telling of family histories.  The resonance of the process of psychotherapy was such that it was not just the patient but the families too who appeared to be re-working the previously unworkable trauma.  This unfolding of a traumatic family narrative, almost beyond imagination, which had previously been buried through repression, surfaced in a stunningly specific way.  It does not seem to the case where there was a transmission of psychopathology, rather the striking specific frozen images, words and feelings, which were transmitted (the "accidental harm" (case B), the fear of persecution (case C).  The symptomatology was not transmitted with such specificity.  It could be argued that the depression of the second generation was replaced by anxiety (a nameless dread perhaps) which caused the third generation survivors to be suffer more borderline and serious somatic symptomatology.  

These are provisional hypotheses that occur to us in light of the treatment of these three cases.  These assertions are based on a small sample group and it would be necessary to corroborate this argumentation with other clinical evaluations with patients whose suffering has a comparable aetiology.  It is probable that other psychoanalytic practitioners will encounter such patients in the future.  The working hypothesis we would like to suggest is that depressive anxiety, suicidality and

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somatization may be more severe, exerting greater unconscious disturbance, in third generation survivors where the trauma of loss has become more sequestered.  With this in mind we would like propose two provisional diagnostic axioms based on Niederland's (1968) "Survivor syndrome" (p.313); i) that the magnitude of a social trauma may be directly proportionate to the time it takes to mourn (in the case of the holocaust experiences of all of the cases it would appear that the time to mourn for some people has been fifty years) and ii) the delayed (pathological) mourning process may cause increasing disturbance during subsequent transgenerational transmission.  It would appear from our case vignettes that rather than being forgotten, trauma becomes more difficult to locate resulting in severe pathological manifestations of trauma re-enactment.  For example in case C, her passing out in the showers would seem to be an enactment of some unconsciously driven fear, possibly a phantasy of the holocaust which had been deeply buried.  Her inward turned self destruction had manifest itself later in suicide attempts during her adolescence and her chronic self starvation might be understood also in this way as a form of re-enactment.  And is it possible that in Case B, that the LUPAS condition was also a severe somatization of a failure to mourn.

It is perhaps hopeful that the case studies presented here do suggest that even severely disturbed patients can benefit from psychotherapeutic intervention which can act as a mourning location point where pathological organization (Steiner, 1990) is superseded by an adaptive (though painful) knowing where the impossibility of mourning (Moses, 1993; p.110) can be adumbrated by the capacity to think, remember and work through (making the unconscious conscious).  Anamnesis was of

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fundamental importance in the therapy described - the unconscious never forgets.  The process of remembering the past is imperative if we are to avoid repeating it.

Our findings from this work have implications for history telling in the psychotherapeutic process where other major cultural traumas are a feature.  For instance, in our locality we have noted the response to the Hungerford massacre where citizens who were directly or indirectly affected by the events came forward to seek psychotherapy over a period of several years.  The importance of dealing with a current crisis, as in post traumatic stress disorder, is obviously crucial, however the longevity of suffering and the after affects of a cultural trauma need also to be emphasized.  This long term view is perhaps important to bear in mind in considering the affect effects of other cultural traumas, for example, Dunblane. 

Freud's lexicon of cultural enquiry might be further considered as a starting point for the discourse about the collective civilizing process of mourning (Freud, 1913; 1921; 1930; 1933).  It would appear that the task of mourning the tragedy of the Holocaust is a profoundly global process where the resonance is widely felt, particularly if we consider non-occidental cases of ethnic cleansing.  The holocaust has become an atavistic cultural emblem and the diachronic working through of this great tragedy of humanity in the twentieth century will undoubtedly continue into the next millennium.    

References: 

Barocas, H A & Barocas, C B  (1980)  Separation-Individuation Conflicts in Children of the Holocaust Survivors.  Journal of Contemporary Psychotherapy, 11, 1; 14. [Special edition of the journal].

Barnett, R  (1995)  The other side of the abyss: a psychodynamic approach to working with groups of people who came to England as children on the kindertransporte.  Brit J Psychotherapy, 12, 2: 178-194

Bergmann, M & Jucovy, M E (editors)  (1982)  Generations of the Holocaust.  New York: Basic Books. 

Davidson, S  (1980)  Transgenerational Transmission in the Families of Holocaust Survivors.  Int J Family Psychiatry, 1; 95-112.

Engel, G L  (1975)  The Death of a Twin: Mourning and Anniversary reactions:  Fragments of Ten Years of Self Analysis.  Int J Psycho-Anal, 56: 23-40.

Epstein, H  (1979)  Children of the Holocaust.  New York.  G P Putnams & Sons.

Freud, S  (1913)  Totem and Taboo.  SE. 13:  1-16. 

Freud, S  (1921)  Group Psychology and the Analysis of the Ego.  SE. 18: 67-144. 

Freud, S  (1930)  Civilization and it's Discontents.  SE. 21 

Freud, S  (1933)  Why War?  SE. 22

Goldhagen, D  (1996)  Hitler's Willing Executioners.  London. Little Brown. 

Heller, D  (1982)  Themes of Culture and Ancestry.  Psychiatry, 45; 247-261.

Hoppe, K D  (1968)  Re-somatization of affects in survivors of persecution.  Int J Psycho-Anal, 49: 324-326.

Hunter Brown, I  (1992)  Psychoanalysis and War.  Brit J Psychotherapy, 9, 2; 221-228.

Moses, R [editor]  (1993)  Persistent Shadows of the Holocaust.  Madison.  International Universities Press.

Niederland, W G  (1968)  Clinical Observations of The Survivor Syndrome:  Symposium on Psychic Traumatization Through Social Catastrophe.  Int J Psycho-Anal, 49: 313-315.

Pollock, G H  (1970)  Anniversary Reactions, trauma and mourning.  Psychoanal. Quart, 39: 334-362. 

Rey, H  (1994)  Universals of Psychoanalysis.  London.  Free Association Books.

Steiner, J  (1990)  Pathological organizations as obstacles to mourning.  Int J Psycho-Anal, 71-94.

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Wardi, D  (1992)  Memorial Candles: Children of the Holocaust.  London.  Tavistock/Routledge.

Wilson, A  (1985)  On Silence and the Holocaust: A Contribution to Clinical Theory.  Psychoanalytic Enquiry, 5, 1; 63-83, [special edition: Knowing and Not Knowing the Holocaust].

FURTHER READING ABOUT HOLOCAUST SURVIVORS: 

Luel, S A  (1984)  Living with the Holocaust:  Thoughts on Revitalization.  Chapter in:  Psychoanalytic reflection on the Holocaust, ed. Luel, S A & Marcus, P.  New York: Ktav Publishing House, p.169-177.    

Lyotard, J  (1990)  Heidegger and "the jews".  Mineappolis: University of Minnesota.