Psychological reactions to psychosomatic stress in 100 former prisoners of the Auschwitz-Birkenau concentration camp

How to cite: Teutsch, A. Psychological reactions to psychosomatic stress in 100 former prisoners of the Auschwitz-Birkenau concentration camp. Medical Review – Auschwitz. August 14, 2017. Originally published as “Reakcje psychiczne w czasie działania psychofizycznego stresu u 100 byłych więźniów w obozie koncentracyjnym Oświęcim-Brzezinka.” Przegląd Lekarski – Oświęcim. 1964: 13–17.

Author

Aleksander Teutsch, MD, 1918–1980, psychiatrist, Chair of Psychiatry, Kraków Medical Academy.

An attempt at a psychiatric analysis of psychological reactions and types of behaviour in concentration camp conditions and the estimation of the degree of adjustment to the camp situation is one of the subjects being scientifically described by research workers at the Department of Psychiatry for Adults in Kraków. The research is based on the examination of 100 survivors of the Auschwitz-Birkenau concentration camp made in the years 1959-1961.

As the literature on the subjects indicates, all the research carried out abroad basically aimed at determining the permanent long-term effects of imprisonment in the camp on both the physical and the mental health of prisoners. Regarding the period spent in the camp, we can find works based almost exclusively on autoptical observations made by former prisoners such as doctors, psychologists, and sociologists; there are no works, however, that approach this problem from the perspective of psychiatric examinations of the former prisoners. Such an approach constitutes an essential authoritative and cognitive basis for this present work.

Though the literature on the subject is limited, it would still be impossible to discuss all the works in detail. The observations recorded by survivors concerning psychological life and types of behaviour in concentration camp conditions do not vary much and, where they do differ, this results from different theoretical approaches to the phenomena and their various interpretations; more somatic in the case of some authors and more psychological, psychoanalytical, or even existential in the case of others.

Most authors emphasise uniformity in the psychopathological symptoms in the majority of the prisoners. Primitiveness, emotional and intellectual degradation, defective memory, decreased spontaneity of reactions, tendency to experience irritability and emotional instability, emotional apathy, lowered sexual drive, and the dominant instinct of self-preservation in thoughts, feelings, and activities, are usually enumerated as some of the basic changes.

Authors who are psychoanalytically oriented write about “regression to infantile behaviour,” (Bettelheim, 1943; Cohen, 1954), and about different defensive mechanisms of the ego that contributed to adjustment to the camp situation. Some believe that the psychopathological phenomena mentioned above result from drastic somatic factors, whereas others put great emphasis on extreme psycho-traumatic factors. According to those authors who represent the existential approach (for example, Frankl, 1947), psychological reactions and behaviour of the camp prisoners are not ultimately determined by somatic and psycho-traumatic factors; instead, they advocate the view that man, as a special creature, is able to counteract and resist degrading and destructive influences of somatic and psychological factors upon his psychological life and behaviour.

Some authors (Bettelheim, 1943; Cohen, 1954; Frankl, 1961) distinguish several different phases of adjustment to the camp life. The phases are described in similar ways by different authors and they are connected with a psychological reaction to imprisonment in the camp followed by a long period of specific psychological changes that lead to personality alterations in the prisoners and their final adjustment to the camp situation. The final phase of adjustment is referred to by Cohen as a “resignation phase,” whereas for Frankl, this third phase consists of psychological reactions to liberation.


The Auschwitz-Birkenau concentration camp (27 January 1945)

The research described here was based primarily on a psychiatric examination of the former prisoners with special emphasis on autoanamnesis, retrospective evocation, and the reconstruction of psychological states and reactions as well as types of behaviour during their internment in the camp. In order not to omit any essential aspects of the problem described here and in order to make the research uniform, a questionnaire constituting the basis of the interview was used. In each case, the whole life history of a given subject was reconstructed. Regarding the period spent in the camp, emphasis was put on such aspects as cause of the imprisonment, length of time spent in prison and in the camp, prison experiences, the most difficult moments and problems of the camp life, development of different moods, attitudes on death, traumas and illnesses experienced during the camp period, possible amnesic gaps, sleep, manifestation of sexual drive, thirst for revenge, attitudes on fellow prisoners, and self-estimation made by the subjects themselves, concerning ways in which they overcame the difficulties of the camp life and factors that were essential to surviving the camp period. The analysis of the material resulted in the observation that immediately after imprisonment, the majority of the subjects experienced a short psychological reaction manifested in states of depression, feelings of fear and horror, a sense of helplessness, loneliness and confusion, lack of appetite, and insomnia. This reaction was of differing intensity in different subjects, its period of duration varied from several days to two weeks, and in only a few prisoners lasted from one to three months. In some subjects, especially at the beginning, the reaction was accompanied by such vegetative symptoms as diarrhoea, trembling of the body, increased sweating, occasional nausea, and even vomiting. In several persons, a depressive-anxious state was transformed into a more apathetic one, which appeared alongside the beginning of hunger emaciation.

Besides such psychological reactions, shorter or longer, single or repeated crises with apathetic-depressive moods could be observed in the later period spent in the camp. Results of the examination suggest that in this critical period, a reduction in active contact with others, increasingly passive behaviour, decreased willpower, weaker faith in the possibility of surviving, decrease in self-discipline, and, in some individual cases, suicidal thoughts – paradoxically connected with the fear of death – were present. Advanced hunger emaciation was accompanied by the above symptoms in extremely intensified forms. In some persons, the states described above were connected with particularly difficult experiences such as interrogations in the political section of the camp, loss of family or friends, unfavourable changes in camp conditions, or the necessity of leaving the group to which they felt they belonged.

In the first three to six months of the camp period, the majority of subjects experienced a lack of sensitivity, emotional apathy, and decreased emotional reaction to various traumas in the camp. There were also subjects, however, who reacted strongly to traumas for a long time. In this period of emotional apathy, as the examination results indicated, most of the subjects also started to develop resourcefulness and initiative as manifested, for instance, in attempts to make contact with others, developing specific behaviour tactics, organising extra food supplies, becoming members of certain camp groups – usually small, consisting of several persons – and in some subjects it was manifested in the decision to take an active part in the camp underground movement.

Among the subjects examined, there were persons who took care of themselves – their personal hygiene and even of their aesthetic appearance – as much as was possible. There were also prisoners who managed to learn skills such as, for instance, a foreign language or a craft. Resourcefulness and initiative sometimes fringed upon pugnacity or even daring. There were also subjects who not only had an optimistic attitude, a faith that they would survive and the will to do so, but who also positively influenced other prisoners. Some of the subjects did not have any suicidal thoughts or tendencies in the entire period spent in the camp. There were also prisoners who even in the periods of intense starvation managed to avoid eating garbage, contaminated or inedible food, or smokers who did not exchange their small food portions for cigarettes but forced themselves to give up smoking in the camp. The psychological features and types of behaviour described above were referred to as positive. Their presence or absence in the camp life of the subject, along with the presence or absence of longer periods of crises, served as a criterion for estimating the degree of adjustment to the camp conditions.

Adjustment was understood as a number of various psychological reactions to stimuli typical of the camp situation.

Based on the empirical criteria described above, which were established using an analysis of the subjects’ life histories, three groups of different degrees of adjustment to the camp conditions were distinguished. The first group included the 37 percent of subjects who did not experience any deep or lasting psychological crises, that is, depressive-anxious or apathetic-depressive states. Subjects from this group were characterised by positive psychological features and types of behaviour.

The second group included the 44 percent of subjects who suffered from a prolonged initial psychological reaction that lasted longer than two weeks, difficulties in developing positive psychological features and types of behaviour that lasted longer than three months, or individual psychological or psychosomatic crises during their time in the camp.

The third group included the 19 percent of subjects who suffered long-lasting and permanent psychological and psychosomatic crises.

For all the groups enumerated above, the following terms were used for the degree of adjustment: for the first group (I) the degree of adjustment was specified as “fairly good,” for the second group (II) “moderate,” for the third group (III) “bad.”

The introduction of borderlines, divisions, and conventional terms and expressions, obviously simplified such a complex problem. Introducing this on the basis of the analysis of 100 camp life histories, however, appeared to be more justified than introducing any other a priori schemes and criteria. Such a procedure was necessary from the perspective of the requirements of material quantitative analysis.

When quantitative analysis was attempted, appropriate correlation tables were first prepared where independent variables were represented by such factors as gender, age, profession, education level, reason for imprisonment, total period of imprisonment in the camp, type of work performed in the camp, cerebral-cranial injuries experienced in the camp, and typhus (abdominal and exanthematic). Degree of adjustment to the camp life was treated as a dependent variable. Results of the quantitative analysis and the examinations of the hypothetical correlation can be presented in the following way:

There was no statistically significant correlation between age and degree of adjustment to the camp. The most numerous classes of persons, 20-29 and 30-39 years of age, constituting 75 percent of the total number of the subjects, constituted 84 percent of group I. The higher age classes constituted only 8 percent of this group. In group II, ages 20-29 and 30-39 constituted 70 percent, and the higher ages 27.4 percent. In group III, ages 20-29 and 30-39 constituted 63.2 percent, and 40-42.2 percent. This group did not include representatives of the age range of 50 and over, and the percentage of the youngest class (up to 19 years) was the highest and equalled 15.8 percent, whereas in group I it was 8 percent and in group II 2.6 percent.

No statistically significant correlation was found between age and the degree of adjustment to camp life. It should be emphasised that the percentage of women was highest in group III.

With reference to profession or character of work performed before imprisonment, no statistically significant correlation was found with the degree of adjustment to the camp life. However, non-manual workers (typically white-collar workers) were most numerous in group I and manual workers constituted the majority of group III.

The correlation between education level and the degree of adjustment to camp life was also not statistically significant; it should be emphasised, however, that there was a progressive increase in the number of persons with elementary education from group I to group III: they constituted 46 percent of group I, 63.6 percent of group II, and 73 percent of group III.

The structure of groups I and II varied regarding the marital status of the subjects at the time of their imprisonment. In group I the majority of subjects were single (65 percent) and in group II the majority of examinees were married with families (60 percent). However, no statistical significance was found here, either.

Cerebral-cranial injuries experienced during the camp period, as well as typhus (abdominal and exanthematic), were jointly treated as negative factors. A number of the subjects who suffered from at least one of these factors increased progressively from group I to group III. In group I there were 60 percent of such persons, in group II73 percent, and in group III 90 percent. This apparent tendency, however, was not confirmed by statistical calculations. Analysing the negative factors enumerated above we can notice that in the middle age classes between 20 and 49 years, the number of persons who suffered from at least one of the above-mentioned factors increased progressively. Thus in the 20-29 age class it comprised 58 percent, in the 30-39 age class 72 percent, and in the 40-49 age class 93 percent.

There was no statistically significant correlation between the length of time spent in the camp and the degree of adjustment.

Regarding the factor referred to as “cause of imprisonment,” 59 percent of both groups I and II were persons imprisoned for their underground activities. In group III, such persons constituted only 26 percent. The rest of group III was imprisoned for other reasons; their imprisonment was largely arbitrary (48 percent); for instance, because of roundups in the streets or in trains, or being taken as hostages. It should be emphasised that cases of persons who took part in the underground movement but who were imprisoned for other reasons, sometimes arbitrarily, were also included in the “cause of imprisonment” under the rubric “result of membership in underground organisations.” Correlation between the “cause of imprisonment” and the degree of adjustment to the camp life was statistically significant when method 2 was applied, and with a theoretical chi squared of 9.488, n = 4, and p <0.05, the empirical chi squared was 9.630.

Work performed in the camp was referred to as “favourable,” “moderately hard,” and “hard.” “Favourable” work included all administrative and supervisory functions, work in the kitchen, hospital block, etc. “Moderately hard” denoted work which, although it might be regarded as hard from the perspective of physical effort, possessed some positive aspects such as the opportunity to work inside a building or under a roof, and included work in factories and skilled work. “Hard” included work requiring not only great effort but also performed in the open air where prisoners were exposed to unfavourable weather and physical conditions, such as field work, road work, or work in a quarry. Since a great number of the subjects examined performed different kinds of work in different periods of their camp life, it was necessary to average all these different types and periods of duration. Among all 100 subjects, “favourable” work was performed by 14 percent, “moderately hard” by 32 percent, and “hard” by 54 percent. In group I, “moderately hard” and “hard” work were dominant, and in group II, with the majority of manual workers, “hard” work was dominant. In group III “hard” work was also performed in the majority of cases; in this group there were no cases of “favourable” work.

There was a statistically significant correlation between the type of work performed and the degree of adjustment to the camp life. With a theoretical chi squared = 9.488, n = 4, and p<0.02, the empirical 2 was 9.630.

To illustrate the degree of adjustment to camp life, short camp biographies of the three different degrees of adjustment specified above are presented below.

Group I (“fairly good” adjustment to camp life)

A man (ref. no. T-15) with secondary education, single, 23 at the time of imprisonment, arrested in 1942 for political reasons. He was reserved, shy, with an inferiority complex, had some difficulties in establishing contact with other people. His mother was mentally ill, and his father was very nervous. During his eight-month internment in prison, he was interrogated and tortured many times. During that time, he suffered from a short period of depression and apathy and was kept in solitary confinement in a separate cell. He spent two years in Auschwitz and was then moved to another camp. After he was transported from the prison to Auschwitz, he did not show any clear psychological reaction. He adjusted to the camp life relatively quickly and easily and despite the fact that he did not have any “experience,” he managed to organise his life in the camp quite well. He had a “sporting” attitude to life and quickly established contact with other prisoners. He lived intensely, learnt foreign languages, and “everything that he could learn.” In his first period in the camp, he was convinced that he would not be able to survive since he was a “political prisoner.” However, he thought of death in a rational and cool way. In the later period, he suffered from depression, which was manifested in his attitude, “Whatever is to happen, let it happen.” He never suffered from any sleep disturbances in the camp. Dysenteric diarrhoea, several flu cases, and a difficult course of diphtheria were the only diseases he experienced. He also suffered from a hernia that resulted from lifting heavy loads and underwent an operation in the camp. His weight loss was relatively small, 20 percent of his previous weight. He related well with fellow prisoners, apart from a few unimportant arguments, conflicts, and skirmishes that were the effects of intensified irritability and explosiveness on both his and other prisoners’ part, as he stated himself. His work was usually “moderately hard.” The whole period in the camp passed without any phases of psychological or physical crises. His most difficult moments in the camp were when he had to witness the physical and moral humiliation of other prisoners and when he found himself in a situation in which he was humiliated, as could be deduced from his descriptions.

Group II (“moderate” adjustment to camp life)

A man (ref. no. T-3), 36 at the time of imprisonment, married with one child, with higher education. Heredity psychiatrically insignificant. Sensitive and hyper-reflexive personality with a hyper-compensated inferiority complex. He was arrested as a hostage in 1942. After a seven-day period in prison, he was moved to a concentration camp where he spent more than three years. Immediately after he was imprisoned in the camp he fell into a depressive-anxious reaction with an aversion to food, and nausea, vomiting, dysphagia, polydypsia, and polyuria. This reaction, though lessened over time, was present for around two months. In the initial phase, experiences of “de‑realisation” could be observed; he felt, “as if I were in some other dimension, as if it were not myself who lived in this world.” After this initial reaction had passed, he started to adjust to camp life, expressed resourcefulness, initiative, and, if it may be so expressed, reached a high degree of stabilisation. He forced himself into an internal discipline, which consisted of a very rigorous care of appearance and personal hygiene; he learnt foreign languages and was active within a small group of prisoners. For a short period at the beginning of his imprisonment in Auschwitz, he performed “hard” work; later, however, he always had “favourable” work. In the final period and after liberation he suffered two hallucination episodes of a clearly wishful nature. His worst camp experience, he confessed, was when another Polish prisoner slapped his face. His most nagging ailments in the camp were homesickness and worry about his family, a sense of helplessness and humiliation, as well as a sense of constant danger. After the period of the initial reaction, he slept well. He suffered from exanthematic typhus with delirium and subsequent cerebrasthenic hypo-amnesia. An initially strong fear of death was transformed into emotional apathy towards possible death after around three months.

Group III (“bad” adjustment to camp life)

A woman (ref. no. L-4), 36 at the time of the imprisonment, single, completed five grades of elementary school, working as a housemaid until the war; heredity psychiatrically insignificant. She was arrested in 1942 in a street round up. She spent two months in prison and then 30 months in concentration camps. After imprisonment, she was sad, depressed, tearful, experienced a strong fear of death, with a sense of the unreality of the surrounding world. She said, “It was horrible and nightmarish, there were corpses everywhere, there were lice and an orchestra playing”; “I thought I was mad and that I was having hallucinations.” She lived in constant horror and fear of death. Several times, she suffered periods of insomnia, frequently woke up at night, and had nightmarish anxious dreams about the camp. She expressed no initiative, she broke down, relied on the help offered by her fellow prisoners, could not make any decisions, allowed others to direct her as they wished, frequently had suicidal thoughts, and worked only “so that they wouldn’t beat me and wouldn’t kill me.” Her behaviour was an automatic imitation of other prisoners’ behaviour. She obeyed orders of other prisoners with an automatic slowness. When she once learnt that she had been selected for death, she suffered from shock, trembled, lashed out around herself, tried to escape, lamented, and begged for help. In the last period of her internment, she suffered a phase of complete hunger emaciation. During her imprisonment in the camp, she suffered from abdominal typhus, malarial fever, and leg swellings. Her work was “hard.” Starvation, constant fear of danger and death were the most difficult for her to endure.

In addition to the examples quoted above that illustrate the three groups, it is worthwhile to describe two other individual cases:

A woman (ref. no. M-20), 31 at the time of imprisonment, single, an office clerk, with secondary education; her brother was a psychopath, and her mother was very nervous. She was arrested in 1942 as a hostage. After a week in prison, she was transported to Auschwitz-Birkenau where she spent 31 months. Neither in prison nor after her imprisonment in the camp did she experience any distinct psychological reaction. During her later stay in the camp, she never suffered any serious psychological or psychosomatic crises. In objectively traumatic situations, she remained emotionally indifferent. Nothing could impress her. She stated that she adjusted to the camp life without any problems. During the whole period in the camp, she was convinced of her “special destiny.” In spite of serious illnesses and hunger, “I felt as if it did not concern me directly”; she was convinced that she would be saved. “I was able to foresee future events.” She maintained that she had not had any difficult experiences in the camp and that nothing had been too arduous. When she was in the camp hospital, one of the doctors gave her a slice of bread. She regarded that fact as “a symbol of our union.” Later, she could hear voices telling her that the doctor was her destiny. She had “a cheerful attitude towards life in the camp,” and was “indifferent to everything that was happening around.”

The subject was classified into group I. She underwent a clinical observation that confirmed the suspicion that her attitude was a continuation of a chronic schizophrenic process. The example given above proves that schizophrenic emotional apathy, autism, and “magical,” non-realistic thinking positively influenced the adjustment to camp conditions. It also evokes some reflection on the significance of partial selective emotional apathy, which was experienced by the majority of the subjects examined after several months in the camp. We may expect that if someone with normal emotional sensitivity, within the limits of a psychological norm, happened to find himself in one of those numerous traumatic situations in his everyday ordered reality, he will suffer from psychological shock to a greater or smaller degree. If such a person remained indifferent contrary to our expectations, we might suspect some pathological phenomenon. In the camp conditions, however, unchangeable emotional sensitivity should be regarded as abnormal since it made adjustment more difficult, whereas apathy and loss of emotional sensitivity were an adaptive phenomenon that helped one to endure the camp difficulties and protected a prisoner against depression, breakdown, and destruction.

A man (ref. no. T-4), with higher education, married, 33 at the time of imprisonment, from a family suffering from psychological anomalies, with a neurotic psychasthenic-obsessive pre-camp personality, shy, emotional, indefinite in purpose, with well-developed higher emotions, with a sense of responsibility and ambition, living with a constant feeling of guilt and an inferiority complex, hesitant, with obsessive feelings and an inclination to escape into a world of dreams. In his pre-camp life he always had adjustment problems. He was arrested in 1942 because of his underground activities. After five months in prison, he spent the next 33 months in concentration camps. He suffered a period of insomnia in prison, intensified hyper-reflectiveness, and obsessive investigation of all possible variants of his situation. During his internment in the camp, he did not suffer from any deeper or longer psychological or psychosomatic crises. He maintained that all the difficulties of camp life, of both a physiological and partially psychological nature, “almost did not touch him,” “did not get inside him,” did not leave any conscious traces, and “rolled off him like water off a duck’s back.” During the whole period of his internment, he was full of initiative and had a strong desire to survive. He had the feeling, as never before, that “he had managed to find himself and his place in the world,” he was also aware of his rich spiritual, moral life. His reaction to liberation was one of depression and he felt a kind of sorrow that “a good period had finished in his life.”

Taking his pre-camp deeply neurotic personality and his adjustment problems into consideration, one might expect serious difficulties in adjusting to the camp situation. His camp biography, however, clearly points to quite an opposite reaction. He was assigned to group I.

The two cases quoted above are exceptional within the group of the former prisoners. The latter case draws our attention to Kral’s (1951) observations made in the camp of interned Jews in Terezin, according to which in severe cases of neuroses of an obsessive and phobic character, the internment brought either a total elimination of symptoms or an improvement to such a degree that the sick could work and did not need medical care.

Auto-amnesic data obtained during the examination allowed us to distinguish certain psychopathological phenomena that could be observed in the subjects during their camp period in an incidental way. Thus, four persons suffered from delirium during exanthematic typhus, four persons experienced consciousness disturbances with subsequent amnesia probably connected with hunger emaciation, five persons suffered from episodes of non-realisation within the psychological reactions to imprisonment in the camp, five persons had cerebrasthenic states after exanthematic typhus and skull injuries, one person suffered from hunger hallucinations, one person had hallucinations in a state of ecstatic hysteria, one person experienced a dream stupor, one person had a panic reaction of primitive character, and another suffered from a hysteric reaction in the form of spasmodic laughter in a traumatic situation. Two persons had epileptic seizures in the camp and in one of these cases of epilepsy appeared several months after a cerebral-cranial injury.

The results presented above led us to the systemisation of psychological reactions and types of behaviour in the camp in a 100-person group of survivors as well as to recognising the function of the factors that were conducive to survival of the camp. Neither of the two problems has yet been satisfactorily dealt with.

Translated from Przegląd Lekarski – Oświęcim, 1964.

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