Concentration camp survivors and war disability benefits

The majority of the former prisoners of concentration camps died in the camps or immediately after liberation. This resulted both from the terror in the camp which led to the physical elimination of many prisoners, and from the hunger and numerous illnesses which spread in the unsanitary camp conditions. Hunger led many prisoners to the total physical and psychological exhaustion referred to as the Muselmann state. As scientific publications and memoirs suggest, almost one hundred percent of prisoners were in a state of total exhaustion at the time of liberation (97.7 percent according to S. Kowalski, 1964; 91.9 percent according to Witusik, 1968).

Immunity to even mild somatic illnesses was very low. Tuberculosis, alimentary duct diseases, circulatory system distortions, and psychological breakdowns often connected with the situation encountered after coming back home were common problems. Only a small number of Häftlings [German “prisoners”] returned to professional work or continued their education immediately after liberation. The majority were not able to start work or education for a period ranging from six months to four years after leaving the camp. The great intensity of physical and psychological experiences connected with concentration camp life must obviously have left permanent traces in both the physical and psychological health of Holocaust survivors. During the period of reconstruction in Poland after the war, however, the help of every member of the society was necessary and nobody had either the time or opportunity to do research into the health problems of former prisoners.

When the majority of camp survivors returned to professional work, often assuming very important posts, superficially it appeared that they had no health problems resulting form the camp experience. Consequently, they were treated in the same way as any other members of society and nobody cared to recognise their specific situation: if they suffered from some ailments, their symptoms and diseases were given the same labels as those of the rest of the whole population. Only individual doctors who were former prisoners themselves were able to notice an alarming number of various chronic illnesses and ailments, difficult to treat therapeutically, among their colleagues. Wieliczański (1964) and Kłodziński (1972) were representatives of the small group of such doctors.

By the end of the 1950‘s the first introductory attempts to examine chosen groups and then the whole population of concentration camp survivors were made, in order to ascertain possible regularities in the occurrence of health disturbances. The first scientific works were published (Andere and Ärztkonferenzen, no year of publication; Eitinger 1961; Helweg-Laren et al. 1952), and reports from conferences in Vienna (1952), Copenhagen (1954) and Moscow (1957) were prepared. Fragmentary physiological and psychiatric examinations initially conducted in Kraków were extended to Poznań, Wrocław, and Warsaw, and thus spread all over the country. At present, there are several dozen scientific publications dealing with the health problems of former prisoners in Poland.

All the research mentioned above has resulted in the fact that we are now able to observe some regularities essential to the process of disability certification for former prisoners and to establishing the causal nexus of the disability and the concentration camp experiences.

The following after-effects of camp life are characteristic:

1. co-existence of many diseases with dominant circulatory system ailments, psychological problems, tuberculosis, movement apparatus distortions;
2. chronic resistance to treatment
3. undulant progress: after the period of distinct weakness and moods of depression lasting from two to four years after liberation, a slight improvement could be noticed usually accompanied by the decision to go back to professional work. However, at the age of 50-55, around 15-20 years after the liberation, a sudden change for the worse could be observed in the health of the survivors expressed in a feeling of general exhaustion, depression and apathy, sleep disturbances and defective memory. This state was often accompanied by symptoms of premature ageing. In many cases the former prisoners were obliged to become pensioners with disability benefits.

A syndrome typical for former prisoners of the concentration camps was referred to as asthenia progressiva gravis by Targowla, and as KZ-Syndrome by Dutch research workers. The latter term was accepted by the majority of Polish doctors.

This work deals with the analysis of psychological disorders appearing in KZ-syndrome, which are dominant in the clinical picture from the very beginning and become axial with the course of time. The work is based on the results of research into the former prisoners made by the doctors at the Department of Adult Psychiatry at the Medical Academy in Kraków with Prof. A. Kępiński as the Head of the Clinic. The following doctors participated in the research: M. Dominik, R. Leśniak, M. Orwid, J. Gątarski, W. Półtawska, A. Jakubik, Z. Ryn, B. Monne‑Dzikowska, A. Teutsch, J. Mitarski. The researchers were also psychologists - E. Leśniak and J. Sarnecki - and one sociologist, T. Reguła. In total, around a thousand persons were examined, 850 of these for certification purposes.

In the first years (1959-1961) psychological disorders could be observed in two-thirds of the subjects examined (Szymusik, 1964) with asthenia symptoms and various types of neuroses dominant; in the later period (1966-1968 and in 1973) psychological disorders could be observed in almost all subjects with the dominant psycho-organic syndrome accompanied by premature ageing and depressive states (Gątarski et all. 1969): the psycho-organic syndrome was recognized in 69 percent of the examined persons, depression symptoms in 59 percent of the subjects. The data from examinations made in 1973 has not been scientifically described yet; there is no doubt, however, that they support the statements made about the frequency of the occurrence of psychological disorders and their gradual progress. Many subjects who suffered from asthenic or neurotic syndromes now complain also of distinct psycho-organic disorders. In 50 percent of the subjects, a pathological electroencephalographic record was observed.

The following syndromes can be regarded as typical for the former prisoners of the concentration camps:

1. chronic progressive asthenia of various intensity with dominant irritability, explosiveness, numerous vegetative symptoms, anxiety and obsessive thoughts connected with the camp period; worse moods, apathy, sleep disturbances; a greater tendency to often complain of a feeling of constant tiredness, a sense of wrong, inability to adjust to their surrounding; alcohol abuse also sometimes accompanied the asthenic syndrome.
2. Premature ageing appearing usually after the age of 50, but in some cases as early as at the age of 40. Sluggish movements, emotional instability, and distinct symptoms of apathy were characteristic. The following are the main complaints: defective memory and sleep disturbances, problems with concentration, worse moods, inability to perform assigned tasks, and one permanent symptom was the lack or distinct decrease of sexual drive.
3. Other symptoms appearing more often in former prisoners than in the general population include: encephalopathy and characteropathy resulting from skull and brain injuries experienced in the camp, depressive‑apathetic syndromes, anxiety, neuroses usually connected with camp life, and neurasthenic and hysteric neuroses.

From the perspective of ZUS (Polish “Zakład Ubezpieczeń Społecznych”; the Social Insurance Institution), neither the symptoms of premature ageing or deeper depressive states of encephalopathy or characteropathy nor the deep long‑lasting syndromes could constitute criteria for assigning patients to the second disability group. Deeper neurotic states or asthenic syndromes of a moderate degree qualify patients for the third disability group. Milder neuroses and asthenic states of milder progress could not qualify the patients for any of the disability groups, though they resulted in, at least in the Kraków district, insurance institutions recognising psychiatric indications in the case of almost all survivor patients. However, a few years ago many cases of misunderstanding concerning the proper diagnoses of former prisoners could still be encountered and not even the intervention of the Department of Psychiatry was respected.

Many more difficult problems are faced when former prisoners apply for the status of War Veterans and for the appropriate disability benefits, which requires establishing a causal nexus between their present state of health and the camp experiences. Although there are regulations that allow to treat the consequences of a period spent in prison or the concentration camp as a war disability if the imprisonment was the result of military service or underground activities, the fact that the majority of former prisoners work professionally often becomes a reason for questioning their war disability.

This problem acquired a special importance in view of new regulations about war disability and disabled soldiers that came into force on 1st January 1973. The new regulation permits all members of society to retire earlier (women at the age of 50 and men at the age of 55 if they can qualify for the first or second disability groups, and women at the age of 55 and men at the age of 60 if they can qualify for the third disability group), the change of old-age pensions to disability pensions, the re-qualification of cases of so‑called “low percent invalids” (25-44 percent loss of working capacity), the increase of the pension premium from 10% to 15%, the addition of 350 Polish zloty to the pension of disabled soldiers, and finally the possibility of renewing the pension if the state of health becomes worse regardless of the time this occurs (previously the period of two years after the disability had been eliminated was binding).

In view of those regulations, there should be no obstacles to awarding war disability pensions to former prisoners of the camps. It may certainly be stated that all camp survivors were unable to undertake professional work after leaving the camp since they were totally physically and psychologically exhausted. Obviously not all of them became pensioners, some of them did not even apply for disability benefits, and some did not receive disability pensions because the existing regulations did not qualify them as disabled persons. However, if we are aware of the undulant development of progressive asthenia with a period of improvement or at least a decrease in the intensity of the symptoms, we can understand why some of the former prisoners were able to go back to professional work for longer periods.

There were even cases of former prisoners working too intensely as if they wanted to make up for the war period. This problem was studied by Orwid (1964). She explained the psychological mechanisms of such behaviour. Over the course of time, however, the after-effects of diseases, hunger, physical and psychological trauma experienced in the camp became more and more intense.

The fact that all the examinations, in Poland as well as abroad, apart from different research methods and different number of subjects in the examined groups, arrive at the similar results, supports the view that KZ-Syndrome should be recognised as a separate pathological unit characteristic of former concentration camp prisoners and related to the camp experiences.

Adapted from: Przegląd Lekarski – Oświęcim, 1974.