The idiosyncratic disorder observed in survivors of the Nazi German concentration camps

How to cite: Kłodzinski, S. The idiosyncratic disorder observed in survivors of the Nazi German concentration camps. Bałuk-Ulewiczowa, T., trans. Medical Review – Auschwitz. May 18, 2020. https://www.mp.pl/auschwitz. Originally published as “Swoisty stan chorobowy po przebyciu obozów hitlerowskich.” Przegląd Lekarski – Oświęcim. 1972: 15–21.

Author

Stanisław Kłodzinski, MD, 1918–1990, lung specialist, Department of Pneumology, Academy of Medicine in Kraków. Co-editor of Przegląd Lekarski – Oświęcim. Former prisoner of the Auschwitz‑Birkenau concentration camp, prisoner No. 20019. Wikipedia article in English

There have been numerous Polish and foreign publications in the post-war concentration camp bibliography on the state of health of survivors of Nazi German prisons and concentration camps. Most of these publications have been fragmentary, covering only one of the diseases observed in a given group of survivors, or written with the aim of providing a multi-specialist, though usually superficial review of the diseases. Moreover, authors have generally tended to focus on homogeneous groups of survivors, for instance the survivors of just one camp resident in a specific area. Hitherto no specialist bibliography has been compiled on the idiosyncratic condition of the survivors of Nazi German prisons and concentration camps. Numerous Polish papers on the subject have been published in Przegląd Lekarski – Oświęcim and in the proceedings of the First and Second Convention of ZBoWiD1 medical practitioners. Lists of reference works are attached to articles in these proceedings volumes; and readers will also find bibliographical entries in the Oceny (Assessments) of this diverse volumes of this journal, and in Sprawozdanie (Reports) section of this edition of Przegląd Lekarski – Oświęcim. The articles listed in papers in Sprawozdanie have been delivered as papers at international conferences. Numerous publications on specific aspects of the problem are being produced in the West, especially in the Federal Republic of Germany, usually in connection with survivors’ compensation claims. Such works are being published in the scientific journals (e.g. Der Nervenarzt) or as books (e.g. Matussek et al.). It would take an entire team of bibliographers to draw up a full list of all the works on the subject, which would make up a separate volume of its own.

The dispersion in terms of subject matter of the research done hitherto is paralleled by the broad timespan of these studies. In many cases the diagnostic picture of disorders observed in survivors in the first few years after the War differed quite considerably from their present condition. Many survivors died shortly after liberation, chiefly of serious infectious diseases such as tuberculosis, or due to other, irreversible and progressive conditions. In others who survived this initial period and managed to adjust to normal life, the idiosyncratic post-concentration camp disorder underwent modification. Many survivors went through a period when their condition disappeared and was hidden from view, only to reemerge later. This is why scientists conducting systematic medical research on the problem in Poland, France, Denmark, Holland, and other countries have observed that new symptoms of the disorder appeared at a later stage, but they were always connected with survivors’ confinement in a Nazi German concentration camp.

Thus, it is self-evident that the research carried out in the first phase following liberation showed that survivors were suffering from serious pathological conditions which enhanced and accelerated the mortality rate in the group. Currently, after many years, those survivors still left alive constitute a population which has undergone a considerable degree of biological selection. Their predominant illnesses are chronic conditions interlaced with acute periods or relapses.

These pathological conditions have affected both the somatic and mental health of survivors. Researchers have tended to observe and report these conditions separately. The observations made hitherto have been affected by the intensifying rate of specialisation in the diverse branches of medicine. The tendency has been for many specialists to examine one and the same survivor, and for each of them to examine the individual’s condition merely from the aspect of his own specialist field. For instance, the same survivor was the subject for a study on post-concentration camp arthritis, carried out by an arthritis specialist; while another specialist focused on arterial hypertension or tuberculosis, etc., in the same survivor. Not surprisingly, there have been many papers reporting considerable differences in the incidence rate for the various diseases and disorders observed in different groups of survivors.

For example, Zdawski confirmed tuberculosis in 11% of the group of survivors he examined, while Kłodziński reported an incidence rate of 34% in the group he studied. Szwarc recorded a 49.4% incidence rate for mental disorders in women survivors and 36.2% in male survivors; while Szymusik observed a 64% incidence rate. Leśniak’s in-depth specialist examination showed that 91% of concentration camp survivors had developed personality changes. Some of the statistical results obtained by various authors are presented on pp. 171–172 in the 1971 edition of Przegląd Lekarski – Oświęcim. Of course, such comparisons are relative, even though the differences between results may look very substantial. Misinterpretations may arise if there was a considerable difference in the times at which the studies were conducted, or if different approaches and presentations of the diagnoses were applied (e.g., a separate presentation of TB on the data, as opposed to a collective presentation of the data for all the respiratory diseases; or a separate presentation of figures for myocardial infarction as opposed to the joint presentation of all instances of circulatory system diseases). Moreover, we should bear in mind that the smaller the tested group, the greater the risk of misinterpreting the observations. Drawing the right comparative conclusions and synopsis turned out to be difficult, even if the research was comprehensive.

There can be no doubt that making an accurate determination of the aftereffects of a survivor’s confinement in a concentration camp calls for an evaluation from the general medical point of view with the consideration of all of his or her disorders. As yet there have been no fully comprehensive studies of survivors’ health from the holistic point of view, treating somatic and mental disorders as an integral entity, although there is a keen awareness of the need for such studies. Physicians noticed a long time ago that if they took the same approach to the examination and treatment of concentration camp survivors as they did for other patients they got nowhere—obtaining neither a full grasp of the condition survivors were in, nor effective and enduring results of treatment. They were obliged to abandon the well-trodden paths of traditional medicine.

The idea came to some of the researchers that there was a distinct aetiology shared by all survivors, comprising the idiosyncratic experiences they had gone through and conditions in which they had lived in the Nazi German concentration camps, and this was what determined the distinct character of the development of the disorder in survivors. Attempts to give an unambiguous and full description of this distinct and idiosyncratic proved abortive, so various observers—starting with Targowla—tried to define and label it, arriving at a variety of names. We are still using different, variously understood terms for it, such as asthénie progressive (progressive asthenia), post-concentration camp asthenia, chronic post-concentration camp progressive asthenia, or the KZ-Syndrom (concentration camp syndrome). A researcher’s choice of the term to use in their work usually depended on their specialist field and on the abnormalities they decided to examine in a group of survivors. Some observers, for instance Blaha, kept to the classic terminology, such as premature atherosclerosis; others like Kolle stopped at a one-sided examination and focused only on psychiatric disorders, producing diagnoses such as chronic reactive depression.

One of the most serious attempts to integrate the subject and identify the criteria which would help to arrive at a unified definition of the specific, idiosyncratic pathological aftereffects developed by survivors due to their confinement in a Nazi German concentration camp was undertaken by Dr Antoni Kępiński (1970; read the English translation on this website). One of the aspects he considered very important in the assessment of a survivor’s health was the holistic nature of an individual’s physical and mental condition. I shall not recapitulate Kępiński’s observations in this fundamental study, with which readers of Przegląd Lekarski – Oświęcim are familiar, but instead I shall try to supplement it with a few remarks of my own.

The holistic nature of the mental and physical aspects of a person’s state of health was a patent phenomenon in the concentration camps. In academic medicine we often tend to forget about this unity, because for many, chiefly methodological reasons, we are inclined to treat the human body as an object, which lets us engage in a variety of diagnostic and therapeutic manipulations. But if we adopt such an approach, we will never be able to explain how the bodies of so many concentration camp prisoners were able to withstand and survive the multifarious stresses they were exposed to in the camps; how prisoners who were starving, often severely beaten, running a fever, short of sleep, and frozen stiff, managed to perform hard labour; how they managed to survive for scores of hours in a bunker with poor air circulation; how they managed to keep up on their feet during roll calls that went on for hours, rain or shine, when they were suffering from epidemic typhus or ulcerative tuberculosis; how they managed to walk on purulent feet; how they managed to withstand thirst, if they had no water for days on end; or how they managed to survive serious diseases despite not receiving any treatment. We will never be able to understand and explain these and other similar facts (and most of the researchers who study them have never experienced such conditions themselves) if we regard the human body merely as a complex mechanism.


The Wailing Wall. Mene, tekel, peres. Marian Kołodziej. Photo by Piotr Markowski. Click to enlarge.

So we shall have to accept that the component which played the key role was the nervous system, integrating all the functions of the body and capable of controlling its individual mechanisms to keep them working despite the serious damage they had sustained. If we bear in mind that the nervous system played the predominant role, we shall find it easier to understand why some of the somatic processes followed a different course than they do in normal conditions. Of course, it would be hard to determine how far the regulating influence exercised by the nervous system can go, and whether it would be possible at all to establish a boundary between the somatic processes and the controlling nervous processes, subjectively perceived as “mental” processes. At any rate, it was the feature generally referred to as “psychological resilience” that exerted the crucial impact on the ability of the body of an inmate held in a Nazi German prison or concentration camp to adjust to life in extremely inauspicious conditions. If the prisoner’s psychological resilience cracked up, their somatic resistance would break down as well.

A prisoner whose mental powers were too weak to keep struggling to survive lost their physical powers as well, falling into the Muselmann condition. The chief cause of prisoners turning into Muselmänner was a mental breakdown. Some prisoners who were more emaciated than Muselmänner managed to hold on mentally; they kept trusting they would survive, preserved what still remained of their humanity, and tried to think not only of themselves. Despite their poor physical condition, such prisoners managed to put up with the hardships of life in a concentration camp. But there were others who were not in such a bad shape physically, yet nonetheless adopted the Muselmann (“don’t-care-any-more”) attitude, concentrating all their efforts on obtaining food. They soon perished. Usually the Muselmann attitude started when a prisoner put themself over and above everything else, and fancied that it was all a conspiracy against them, that the concentration camp, the physical violence, the hunger was directed against them alone, forgetting that others were suffering too. Then they would lose faith in others and see themself as the most injured and unhappiest. A prisoner who adopted such an egocentric attitude could not find a way out of the problem—primarily by looking for support in their fellow-prisoners, which was the necessary condition for survival. The Muselmann’s loneliness was one of the main causes leading to their mental breakdown. The hardships of life in the camp could only be borne by those who developed a community spirit shared with fellow-prisoners. If an inmate in the early phase of the Muselmann condition received help from a friend or colleague, they had a chance of breaking free from that state. Some prisoners were saved from a sense of loneliness by a parcel, a letter, a photo, or a secret message from home. It was a strange kind of loneliness, isolation in the midst of a huge crowd.

One of the many aetiological factors helping in the assessment of survivors’ present-day health is their physical condition during their incarceration in the camp—whether they were in a good shape physically and how fit they were. Fitness and generally being in a good shape physically, putting up with the hardships and the hunger definitely helped prisoners survive, but they were not the crucial factors. One could observe prisoners who had an athletic build cracking up and turning into Muselmänner faster than their fellows who had a much feebler physical constitution. Although a prisoner’s mental attitude was the most important condition determining their survival, quite naturally, other factors played a contributory part. For instance, one could observe a difference and a gradation in the ability to withstand the concentration camp hardships between the incarcerated nationals of different countries. This phenomenon may be explained by differences in mental attitude to incarceration and different degrees of habituation to hardship. It is a well-known fact that the Russians were the most resilient. Like the Jews, Russian prisoners were generally treated worse than prisoners of other nationalities. Nevertheless, they managed to put up better than others with physical traumata, such as being stripped naked and made to stand out of doors in the snow for several days, or going without food for long stretches of time. With Russian prisoners, the prevalent attitude was that they could “do it,” they could survive confinement in a concentration camp. On the other hand, with prisoners from Western countries, for instance Dutchmen, Belgians, Frenchmen, as well as Italians and Greeks, the overriding attitude was that they could “not do it,” that they were bound to perish. And they were the ones who broke down far more readily. In general, a community spirit enhancing chances of survival could be observed among the Polish and Russian prisoners.

Another thing which helped prisoners retain their mental resilience, and which to a certain extent also had an effect on their post-concentration camp attitude and state of health, was if they could designate and adopt an aim for themselves, which they would then steadfastly strive to achieve. Their aim might have been surviving the camp, escaping from it, organising better circumstances for themselves in the camp, wanting to help others, spiting the SS men (e.g. by sabotage), keeping to their religious, national, or political principles, etc.

The human nervous system, which controls the entire body, both as regards its inner processes, as well as its interactions with the outside world, must have a clear-cut purpose all the time, otherwise its operations would become chaotic. Perhaps the choice of a purpose mobilised a prisoner’s nervous system, and thereby the whole of their body, enhancing the physical resilience. Selye’s concept of stress, which focuses on endocrinal mechanisms, does not seem to provide a sufficient explanation for inmates’ resilience to concentration camp stress. Perhaps a better answer is offered by Pavlov’s theory of nervism, which says that it is the nervous system that performs the integrative and controlling functions.

Many survivors suffered a mental breakdown and fell ill with somatic diseases more frequently after their liberation from the stressful environment in the concentration camp. The mortality rate rose in the population of survivors. This may be explained by the fact that they were relieved of the tension associated with focusing on the aim they were trying to achieve in the camp. Their nervous system no longer needed to rally all the time and relaxed, which in turn led to a fall in their immunity to disease. Survivors who managed to find a new purpose in post-concentration life, such as an academic or professional career, social and community work, going into politics etc., did not fall into the trap of relaxation, and adjusted to post-concentration camp life far more smoothly than those who did not discover a new purpose in life.

If we look at life in a concentration camp from the viewpoint of homeostasis, that is maintaining a balance between the body and its environment, we shall have to say that concentration camp life was not homeostasis-friendly. As we all know, it was an existence fraught with tension, danger, and full of physical and mental trauma all the time. In a concentration camp balance was never in a stable state, but always associated with courting death.

On leaving the camp, many survivors found it extremely difficult to grow accustomed to a more tranquil rhythm of life. Some seemed to be deliberately seeking danger and risks. Some tried to drown the boredom in their life in drinking or partying, or in aimless hyperactivity. There were incidents of groups of survivors organising trips to some parts of occupied Germany, ostensibly to hunt for wanted SS men and kapos, but in point of fact they engaged in committing a variety of robberies and sex crimes. It was one of the ways of keeping the body in a state of tension. Some survivors again joined underground resistance movements,2 got into trouble with the law, or crossed the border illegally. Of course they landed up in jail again. The hyperactivity of other survivors led them to volunteer for service in the combat units fighting against gangs of the Ukrainian Nationalist Army,3 or join the police or secret service forces.

I have given a brief overview of how some of the components of the aetiology of the specific post-concentration camp condition make it such a distinct and idiosyncratic state, what sort of an influence they may exert on survivors’ attitude, personality, and conduct, and to what extent they distinguish survivors from other, sick or healthy persons who have never been confined in an concentration camp.

A full analysis of the idiosyncratic pathological condition caused by confinement in Nazi German prisons and concentration camps would additionally require an in-depth determination of the following: the rate of change in the processes of disease survivors have been suffering since the end of the War; what constitutes the differences and special features of survivors’ state of health, as perceived from the medical point of view; the full picture of all the diverse pathological, somatic and mental conditions they are suffering from simultaneously; the advantages to be gained from the point of view of social medicine of further medical research on the developments in the condition of the rapidly decreasing population of survivors; the contribution such research could bring to medicine etc. Obviously, one paper will not be enough to answer all of these questions, and only some of the relevant issues can be tackled at a time.

Observations of survivors’ current state of health show that usually they are suffering from several somatic diseases coupled with a variety of psychogenic disorders. This has been confirmed in numerous medical research projects. However, in practice survivors have tended to see a doctor for treatment of one of their diseases, whether somatic or mental. Only when they were given a thorough medical examination did it turn out they were suffering from disorders affecting several systems. For example, a survivor who was receiving treatment for hypertension was found to be suffering from peptic ulcer disease, or chronic neurasthenia; another patient had pulmonary tuberculosis combined with chronic depression or alcoholism; and yet another, who had sustained a cardiac infarction, was diagnosed with pulmonary TB and a liver abscess as well.

The condition of survivors found to be in the advanced stages of several diseases all at the same time may be explained by the fact that chronic disease had such a negative influence on their entire system that it triggered disorders in other body organs. However, we may assume that their condition can be attributed to one aetiological factor—concentration camp stress, which affected the entire body, but its impact was strongest on the way its particular systems—the locus minoris resistentiae (least resistant ones)—worked. An important point relating to a survivor’s disease progression is the fact that usually for a long time only one of the systems in their body appeared to be malfunctioning. With the passage of years, and sometimes under the impact of such one-sided treatment, the survivor’s other systems turned out to be dysfunctional as well. For example, a survivor who was treated for pulmonary TB for a long time could turn out to be suffering from pulmonary heart disease once the TB had been successfully treated.

Another feature characteristic of survivors apart from the fact that they suffer from several diseases at the same time is their diminished immunity. Sometimes even minor ailments such as a leg ulcer can oppress them for a long time, recur persistently, and resist treatment.

A phenomenon which is the converse of diminished immunity—the ability to endure chronic disease for a long time—may be observed in some survivors, who continue to suffer from severe somatic disorders for years, and from the point of view of a normal medical prognosis should no longer be alive. The disease appears to develop in them at a slower rate, and these survivors continue to live despite the odds against them.

To a certain extent, survivors’ mental health is analogous to their somatic condition. Again, a characteristic feature is the chronic nature of their psychogenic disorders and their resistance to ordinary methods of treatment. In many survivors several coexistent syndromes may be observed. For instance, they may have a chronic neurasthenic-depressive syndrome combined with symptoms of a chronic psycho-organic syndrome. This subject has been addressed by Fejkiel, Leśniak, et al., and Szwarc at the Fifth International Federation of Resistance Fighters’ Medical Congress held in Paris, 21–24 September 1970.

Just as in the case of somatic diseases, a reduced level of immunity may be observed for psychogenic traumas, accompanied by a higher capacity to endure them. For instance, a single, minor mental trauma might have been enough to make a survivor break down; but on the other hand the same survivor might have been able to cope with other, serious mental disorders which lasted a long time, and not lapse into a state of psycho-social degradation as readily as other patients who had never been confined in a concentration camp. Sometimes a survivor’s enhanced endurability may be explained by the fact that he or she had been able to live in circumstances with needs reduced to a bare minimum; in such cases the survivor may be described as leading a life reminiscent of what it had been in the concentration camp, on a minimum income and in primitive conditions. On the other hand, the opposite may be observed in other survivors: they are neurotic, want to satisfy all their needs as soon as possible, and live in luxury. The underlying factor is simply their anxiety that the extreme poverty they experienced in the camp might recur.

There is also an interesting group of survivors who look healthier than their peers in the general population and younger than their real age. They do not want any medical assistance, and generally feel quite fit; they lead an active life and are full of initiative. Some of them try to distance themselves off from what they went through in the concentration camp and do not want to keep in touch with other survivors. Some survivors pursue activities focused on matters connected with their concentration camp experiences; others repress their recollections of the camp and endeavour to do well in their professional, social, or political work. There are also some elderly survivors with serious somatic diseases who feel young. They live as if their illnesses and age did not matter. This phenomenon may be explained in the following way: their concentration camp experiences have made them feel that if they managed to survive the camp, everything else will be much easier and they will cope with it. Moreover, in their lives time has “stopped” at the time of their confinement in the camp, and they are still the age they were in the camp, because everything that came later was less important. The stress of the concentration camp may have made them more immune to illness than ordinary people, giving them a sense of psychological youth coinciding with a sense of biological youth. Admittedly, there are only a few such individuals, yet they constitute a group of somatically healthy and active survivors.

The feature most commonly observed in the research done in Poland as well as in other countries is that for most survivors the period of involution starts at an earlier age than the average for the general population. Such research results have induced the government of France to grant survivors a retirement pension at an earlier age (Panasewicz, 1961 and 1969).

Survivors’ premature involution begins when they reach an age of 50–55, after a spell of relative adjustment to post-concentration camp life. At this age they develop a condition marked by fatigue and exhaustion, apathy, withdrawal, and restricted activity. At the same time, they are inclined to look back at their lives and draw up a balance of their successes and failures. Their recollections of the camp become more intensive, and nightmares connected with the camp occur more often. They grow more embittered and disappointed by the disparity between the picture of life after liberation the way they imagined it would be when they were confined in the camp, and the reality. At this point in their lives, some survivors resume discussions about the camp and refresh their contacts with other survivors they knew in the camp. At the same time, they may be observed to be undergoing a discreet form of psycho-organic syndrome, manifested by symptoms like memory reduction and excessive emotionality, sometimes in the form of emotional dysregulation, and impairment of the control mechanisms (leading to enhanced irritability, exasperation, outbursts of anger, etc.).

A large number of survivors have EEGs indicative of a pathological condition, showing dispersed organic change displayed in the scan in the form of a flattened basic rhythm and slow activity. On closer examination, the onset of premature ageing may be observed even in those survivors who are active and look healthy, with symptoms like emotional disorders or withdrawal under a smokescreen of apparent activity. This is confirmed by additional tests, such as the EEG.

Survivors’ premature involution may be explained by their concentration camp experiences, and all the researchers who have addressed the subject concur on this point. Some say that concentration camp confinement has speeded up atherosclerosis in survivors. Most probably it is not merely a question of atherosclerosis, but also of general impairment due to long-term stress, hunger, and hypoproteinemia (abnormally low protein level in the blood). A contribution to the development of this condition must also have come from a variety of psychological factors during confinement in the camp as well as after liberation. A long spell of repressed aggression is now generally believed to contribute to the emergence of atherosclerosis; and, of course, this is exactly what happened in concentration camps, as inmates could not discharge their aggression against their oppressors. Some survivors continued to hold back their aggressive feelings after liberation, which forced them to give up their dreams and plans, and gave them a sense of being injured. They found that the people around them did not understand them, so they preferred to stick to the company of other survivors. In some survivors this psychological situation, leading an inhibited life, may have accelerated ageing processes.

As regards survivors’ psychological and social adaptation to life after the concentration camp, one of the things we have observed is the problem they have had with adjustment. After the first appearance of adjustment problems, it generally took survivors several years, sometimes more than a decade, to adapt to living in freedom. There is a large group of survivors who have finally managed to adapt after a long spell of maladjustment; they are satisfied with their present-day life, have been successful in their professional and social life, are active and do not feel lonely. They don’t bear a grudge against society at large for failing to understand and appreciate them. Often these people may be observed to be more outgoing and interested in other people than the average attitude reported for the general population; their empathy is expressed in their desire to be helpful, or in their social and political commitment, their ambition to “make the world a better place.” Many individuals from this group of survivors have graduated from university and hold key appointments. Some of these survivors are excessively attached to the ambition of doing well financially; while others disregard or look down on money matters. As with other survivors, formal relationships do not mean much to them; they try to build up an opinion of an individual on the basis of their true worth, not of their social status.

There is another group of survivors who appear to have adjusted well to life after the concentration camp; they are working, and even scoring successes, but one can see that they have distanced themselves off from everyday life, as if it didn’t really matter to them. They seem to be living out of a sense of duty. Usually, they take a favourable attitude to the people around them, but they keep themselves to themselves in a world of their own, and only speak the same language as other survivors. Under their superficial mask of successful adaptation, one may sometimes spot a profound disappointment with ordinary life, both social and family life, in the conditions of freedom. A secret hankering after the utopian life they dreamed of when they were in the concentration camp still lingers in them. They are doing their social and family duties well, but in general they don’t put very much emotional commitment into them. Their emotional life is reserved for matters associated with the concentration camp. They like collecting books and articles on concentration camps, they seek the company of other survivors, and come alive when they can talk about their concentration camp recollections.

There is yet another group, survivors who have not managed to adjust and have still not found a place for themselves in the world of freedom. They are not managing in their family life, their spouse does not understand them, and they tend to divorce. They feel they are not understood and not appreciated at work. They often change their job. They turn to drinking for consolation. They break the law. This group also includes those who ever since liberation have felt sick and unable to take up a job. Their efforts to be granted a disability pension and compensation take a long time, which makes them neurotic. They are profoundly dissatisfied with life and feel society has let them down. They think they have not been compensated for the undeserved ordeals they went through in the concentration camp.

To make an assessment of survivors’ adaptation to life after the concentration camp, we should take their “social status” into account. Some survivors could not reconcile themselves for a long time to the fact that in the camp they had an important, sometimes highly commendable part to play, but on liberation suddenly found themselves “back to square one” and had to start all over again, building up their social status from scratch. This problem is characteristic not only of concentration camp survivors, but also affects many other war heroes. It is connected with the question of power and authority. Many of the young inmates wielded a considerable amount of power and were fairly important figures in the artificial society of the concentration camp. But of course they lost that power when they were released, and this made some of them adopt an attitude of rebellion and defiance with respect to their social environment and its standards of conduct. This is a sociopathic group of individuals who aspire to gaining power and status at any cost.

The unique and extraordinary aetiology and idiosyncrasy of the pathological condition observed in survivors of the Nazi German prisons and concentration camps, and their attitude to life, which is very different from what we see in the general population; their problems and conflicts, the features of their character, etc.—all this creates a need for a special medical approach to the survivors of concentration camps. On the face of it, this would seem self-evident, yet it still calls for special attention, because in practice such an approach is still coming up against reservations, and may even lead to clashes between patients and caregivers.

A physician who is examining or treating a survivor cannot stop at reviewing their current state of health. In any case, if the patient trusts the doctor, they will bring the subject of the concentration camp experiences up in the very first things told. The doctor should not despotically interrupt such enunciations, but at least give the impression of understanding and empathising with the special nature of these facts. Otherwise they will never grasp the essence of the patient’s problems and their condition. Learning about these problems is a key component in dispensing both somatic and psychiatric treatment to a survivor. Not surprisingly, survivors prefer to be treated by doctors who are survivors themselves. They are best equipped to understand them.

Another important prerequisite for treating survivors and issuing official statements on their condition is for the physician to have a fairly good and comprehensive knowledge of the various branches of medicine. As I have shown, usually a survivor’s disorders involve several organs or systems, so the doctor should not just be familiar with one specialist field of medicine, which would make them unable to cope with the diversity of the problems. They should also have the basic skills for a psychiatric approach, because in virtually every case the survivor’s somatic diseases will be accompanied by psychogenic disorders.

Since the post-concentration camp syndrome is a chronic condition, the physician must be prepared to treat the survivor for a long period of time and that they will not be able to settle all the problems in just one or a couple of appointments.

A survivor’s state of health is often connected with their material and existential situation. The doctor must be ready to counsel in matters concerning the survivor’s everyday life; they must be able to offer advice and polite guidelines, helping the patient to deal with the conflicts survivors are faced with in their family life or at work. The doctor should provide assistance in the survivor’s efforts to obtain welfare and a disability pension; and should be ready to write well-thought-out letters of recommendation or testimonials to support the survivor’s applications for housing, holiday subsidies, etc.

One more issue which should be addressed in this article is the recognition of the idiosyncratic state of health of concentration camp survivors due to confinement in Hitler’s prisons and camps as a phenomenon which is significant for certain general medical issues. From the general medical point of view, it is important to determine how far human endurance can be stretched, what exerts an influence on it; whether physical processes can be separated off from psychogenic processes; what goes to make up assistance dispensed by another person, including a doctor; and whether the course of a disease is subject to change in conditions of extreme stress. The endeavour to throw light on this wide range of complex problems calls for a separate monograph. The most I can do in this paper is to formulate a few propositions.

If we treat the concentration camps as a macabre biological experiment and compare them with starvation experiments on animals, we will be able to establish that what the human body can endure exceeds the endurance of animals, and that the limit to human endurance cannot be precisely determined. While over 80% of the inmates confined in the Nazi German concentration camps perished, those who survived are a testimonial to the exceptional capacity of the human body to endure hardship. It is very difficult to say in retrospect why some inmates managed to endure and survive the concentration camp ordeals, while most of them perished. Obviously, the traumata were not dealt out in an even amount to all. Usually, those who survived were lucky enough to live in slightly better conditions than those who died. Yet without doubt the crucial factor was the individual’s inner capacity for endurance, and that differed from prisoner to prisoner. What could be observed in the camps was that some prisoners broke down and died under the impact of stresses that were relatively minor for the concentration camp, while others were capable of withstanding excruciating ordeals such as the bunker in the Death Block, being flogged, etc.

It is equally hard to determine the correlation between the intensity of a trauma and its aftereffects. What decided how much a prisoner could take was not just the age and how fit they was, but also certain social and psychogenic factors. As a rule, political prisoners tended to endure more than inmates who landed up in a concentration camp by random chance. Support and help from fellow-inmates were often a fundamental asset promoting survival, even when it was just a case of a kind word or a friendly gesture. Such incidents put prisoners back on their feet and rallied them for action. In the prisoners’ hospitals, at the time when they were staffed by political prisoners, kindness and empathy were very often the only forms of therapy available, as drugs and medications were few and far between, or not available at all.

Finally, I have to say that although the medical bibliography on the idiosyncratic condition caused by confinement in the Nazi German prisons and concentration camps is already fairly substantial, there is still a need for an all-inclusive synthesis. It would be a good thing if (apart from producing serial studies) researchers could concentrate on obtaining a satisfactory definition of the pathological phenomenon I have written about in this paper.

Translated from original article: S. Kłodziński, “Swoisty stan chorobowy po przebyciu obozów hitlerowskich.” Przegląd Lekarski – Oświęcim, 1972.

Notes

  1. ZBoWiD, Związek Bojowników o Wolność i Demokrację (the Society of Fighters for Freedom and Democracy), the official war veterans’ association operating in the People’s Republic of Poland.
  2. An oblique reference to the Indomitable Soldiers, Polish patriots who joined clandestine resistance units to fight against the post-war Communist regime. Many of them were concentration camp survivors, the best known example being Captain Pilecki.
  3. After the War the Communist government imposed on Poland had to contend not only with the Indomitable Soldiers, but also armed groups of Ukrainian nationalists left on the west side of the new border between Poland and the Soviet Union. During the War Ukrainian nationalists had massacred Jews and Poles living in their part of German-occupied Poland. The German occupying authorities tolerated, or even encouraged these outrages. Estimates of the number of victims run into the tens, or even hundreds of thousands.

Notes by Teresa Bałuk-Ulewiczowa, the Head of the Translating Team of the Medical Review Auschwitz project.

References

  1. Fejkiel, Władysław. “Die Bewertung des Gesundheitszustandes ehemaliger Häftlinge des Konzentrationslagers in Auschwitz, an welchen verbrecherische Experimente vorgenommen wurden.” Paper delivered at the Fifth FIR International Medical Congress, Paris, 21–24 September 1970.
  2. Gątarski, Julian; Orwid, Maria; and Dominik, Małgorzata. “Wyniki badania psychiatrycznego i elektroencefalograficznego 130 bylych wiezniów Oświęcimia-Brzezinki.” Przegląd Lekarski – Oświęcim. 1969: 25–28. English translation available online under the link.
  3. Kępiński, Antoni. “Tzw. „KZ-syndrom”. Próba syntezy.” Przegląd Lekarski – Oświęcim. 1970: 18–23. English translation: “The so-called ‘KZ-Syndrome’: An attempt at a synthesis.” Click to read the article in English
  4. Leśniak, Roman; Orwid, Maria; Szymusik, Adam, et al. “Resume der Krakauer psychiatrischen Untersuchungen ehemaligen KZ-Haftlinge.” Paper delivered at the Fifth FIR International Medical Congress, Paris, 21–24 September 1970.
  5. Matussek, Paul, et al. Die Konzentrationslagerhaft und ihre Folgen. Berlin, Heidelberg, and New York: Springer Verlag; 1971.
  6. Panasewicz, Józef. “Die Behandlung der Asthenie und der vorzeitigen Vergreisung bei ehemaligen Widerstandskämpfer und KZ-Häftlinge.” III-Internationale Medizinische Konferenz; Lüttich, 17–19 March 1961.
  7. Panasewicz, Józef. “Niektóre aktualne zagadnienia patologii wojennej.” Przegląd Lekarski – Oświęcim. 1969: 13–18.
  8. Szwarc, Halina. “Spätfolgen bei ehemaligen Häftlingen der Konzentrationslager.” Paper delivered at the Fifth FIR International Medical Congress, Paris, 21–24 September 1970.

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