Decisions made by medical boards granting disability benefits to concentration camp survivors suffering from psychiatric disorders

Psychiatry Clinic of the Kraków Medical Academy, Head: Prof. Karol Spett^{1, 2, 3}

Among the few who survived Nazi German concentration camps, many had to be treated for a long time, either in hospitals or sanatoriums, for the diseases they developed during and after their incarceration. Many never went back to work due to a physical disability, tuberculosis, or other conditions leading to irreversible impairment of their health.

Within a few years after the War, it became clear that the problems of survivors were going to be a challenge from the medical and social point of view, because they could not be resolved on the basis of current medical theory and practice. As the main symptoms and the progressive deterioration of health were largely similar with all the survivors, a new diagnosis was proposed, asthenia progressiva gravis or KZ-syndrome⁴, to refer to their condition.

In this article, I shall not discuss the aetiology, course, and prognosis for this syndrome, but I need to assert that the vast majority of survivors went back to work either immediately upon, or within a few months of leaving the camp, sometimes against the advice of their doctor. In many cases, employment proved to be a therapeutic factor and survivors became more empowered and recovered some of their self-confidence and a belief that they still were valued members of society. I do not need to add that most Polish survivors did not want any special privileges. They were dedicated employees and worked as hard as those who had never been imprisoned in a concentration camp, or even surpassed them, putting in more effort and obtaining better results.

Returning. Artwork by Marian Kołodziej. Photo by Piotr Markowski. Click the image to enlarge.

One might think that apart from those survivors who left the camp with a physical disability, the rest were in as good a physical condition as other Poles and generally had the same health problems as those living in the same milieu. Indeed, that was the attitude that prevailed for well over a decade after the War, even though on an international scale more and more publications were appearing about the special health problems experienced by survivors: it was often pointed out that this group of patients had its special characteristics and that their condition required careful examination. The majority of doctors have generally overlooked the obvious fact that incarceration in a concentration camp was a stress of an unprecedented and hitherto unknown magnitude and therefore it was bound to have an impact on the physical and mental health of its victims. Those physicians who serve on medical boards awarding disability benefits⁵ or qualifying survivors for further employment have been encountering even more misgivings due to the fact that many of the after-effects of concentration camp confinement may only become manifest even after a decade or more.

In very many cases, survivors’ presenting problems have been summed up as ordinary neurotic disorders,⁶ diagnosed as psychotic disorders, neurasthenia,⁷ somatoform disorder, factitious disorder⁸ or even dismissed as malingering (sic!). Hardly ever has the fact that the patient was confined in a concentration camp been paid attention to and related to his presenting problems.

Doctors who sit on the medical boards and decide if a person is fit for work or should receive a disability pension tend not to remember that most of these patients used to work hard for many years and often held important positions. Suddenly, a seemingly trivial factor, such as a mild dose of flu or other infection sparks off a variety of severe symptoms, which are difficult to treat.

The syndrome may become more intense in menopausal women. In men over fifty, it may be diagnosed as old-age anxiety or depression if a superficial review of their condition is all that is performed by way of a medical examination. However, a more careful scrutiny reveals organic-based symptoms, such as impaired memory and concentration, emotional lability, sometimes blunted affect, or less frequently cognitive decline. Also, disordered perception, anxiety, and symptoms of depression may be observed. A psychological examination may identify organic disorders, and the patient’s EEG may be abnormal.

I have served as an expert witness for Sąd Ubezpieczeń Społecznych⁹ on twelve occasions, issuing decisions in cases involving twelve survivors who, in my opinion, undoubtedly suffered from poor health due to their confinement in a concentration camp. In all these cases the incarceration was ignored and only in two cases did the medical board confirm the degree of disability diagnosed by the Psychiatry Clinic of the Kraków Medical Academy. Regrettably, I was unable to obtain the award of a disability pension for the thirteenth patient, despite appeals from the Clinic and ZBoWiD.¹⁰ Below I present a brief description of this case.

Patient 1: A woman of forty who was held in Auschwitz in 1942–1945. On many occasions, she was beaten unconscious. After the War, she worked as a teacher and when she married, she became an office clerk. For many years, she has been suffering from camp-related anxiety and since 1959 from violent migraine headaches lasting for several hours and accompanied by photophobia and misophonia. For five years, she has been receiving regular outpatient treatment in the Psychiatry Clinic. During that time, she tried to take up a job, but had to give up her attempt to find employment due to the intensification of symptoms of anxiety. She has been treated for stomach and gallbladder disorders. Her EEG shows abnormalities typical for epilepsy. Presumably she has developed a condition resembling epilepsy as a result of cranial injuries sustained in the camp. This hypothesis has been corroborated by the fact that her symptoms have been much milder since she started to take antiepileptic drugs such as Luminal and hydantoin derivatives.

Presented below are the case histories of a few more patients and their symptoms related to confinement in a concentration camp.

Patient 2: A man aged 54, who had been receiving an invalid’s pension since 1959 for his medium-level disability, and suffered from chronic gastritis, cholecystitis, gastric ulcers, coronary dysfunction, and chronic rheumatoid arthritis. In 1963, the regional medical board for employment and disability dismissed all the previous opinions, diagnosed him with antisocial personality disorder and withdrew all his disability and welfare benefits. The man had been held in Auschwitz for five years. In that time, he contracted typhus, typhoid, and meningitis, and his skull was trepanned. He was severely beaten on many occasions. In 1946 he spent six months in hospital due to hallucinatory psychosis. In 1951 and 1963, two months after he lost his disability pension, he had a heart attack. For five years he has been receiving outpatient treatment in the Psychiatry Clinic. His symptoms are irritability and impulsiveness, recurring anxiety and restlessness, disturbed sleep, and memory impairment. The objective symptoms are emotional lability, viscosity (viscositas cogitationis), and gradually progressing organic dementia. The specialists in the Clinic have categorised the patient as affected by medium-degree disability caused by traumatic encephalopathy,¹¹ which is a consequence of the brain injuries he sustained in Auschwitz.

Patients 3 and 4: Two women aged 48 and 49. During menopause, after many years with an impeccable employment record, they started to show symptoms of anxiety and clear signs of premature aging. Despite these health problems, they wanted to continue working, but as they had become inefficient, they lost their jobs. During her incarceration in the camp, one of them was a victim of pseudo-medical experiments which rendered her infertile. Apart from symptoms typical for involutional neurosis, both women were observed to be suffering from mood swings as well as a lack of self-reliance.¹² One of them had the first symptoms of dementia. Initially, both patients were considered fit for work, but later as disabled to a low degree, one due to hysterical neurosis and the other due to cardiac and vascular problems. On the basis of their examination conducted in the Psychiatry Clinic, both women were diagnosed with asthenia gravis, caused by their imprisonment in the concentration camp, and premature aging. The doctors were of the opinion that these patients had a medium-degree disability.

Patient 5: A female white-collar employee aged 38, diagnosed by the medical board with severe vegetative neurosis and myocardial injury, the first symptoms of heart failure, second-degree respiratory failure, asthenia, and myopia. She was classified as a patient with a low-degree disability and the regional medical board decided she was fit for work. However, during a period of observation in an internal ward, she was found to be in the first stage of myocardial injury as well as suffering from circulatory failure, a clearly reduced body weight, and general exhaustion caused by polyglandular deficiency. The patient was diagnosed with anxiety and neurosis and, following an examination in the Psychiatry Clinic, she was again classified as a person with a low-degree disability. The patient was a survivor of Auschwitz, where she was held for two years, followed by a spell in Ravensbrück. She has had heart problems for a few ye ars now, as well as recurrent spells of anxiety and nightmares related to her concentration camp experiences. She finds it difficult to focus, and suffers from impaired sleep, loss of appetite, and intermittent spells with a raised temperature. She usually feels dejected and sad, and is prone to weeping. These symptoms have become more intense in the last two years. As regards her mental health, she is suffering from fairly severe neurasthenia,¹³ which along with her asthenia and polyglandular deficiency were incontrovertibly caused by her incarceration in concentration camps.

I have described a few cases to demonstrate that serious health problems, both mental and somatic, may emerge many years after the patient’s release from a concentration camp sometimes after a period of milder symptoms which definitely required treatment, even though they did not render the patient disabled and unfit for employment. Also, it has been found that the symptoms observed in survivors of Nazi German concentration camps develop and intensify qualitatively and quantitatively in a different way than analogous symptoms in the general population [of Poland]. Therefore these conclusions should be made known to all the members of medical boards issuing certificates of fitness for work and awarding disability pensions and welfare benefits in Poland, just as has already been done in Kraków thanks to the initiative of ZBoWiD.

***

Translated from original article: Szymusik, Adam. “Dotychczasowy stan inwalidzkiego orzecznictwa psychiatrycznego dotyczącego byłych więźniów obozów koncentracyjnych.” Przegląd Lekarski – Oświęcim, 1965.

1. This article examines the procedure applied In Poland up to 1965 qualifying concentration camp survivors for welfare benefits and disability pensions, but the fact that it is limited to a review of the situation in Poland is not made clear in the original text and must be pointed out in the article’s English version addressed to an internationa readership.^a
2. The nomenclature for mental health phenomena (psychopatho-logical symptoms, syndromes, disorders etc.) is a reflection of current developments in the medical sciences and public opinion as to what is and what is not a normal or pathological condition. As advances in scientific knowledge are being made all the time, and public opinion is subject to change as well, it is not easy to accurately identify the names currently used in the ICD-10 o DSM-5 classifications which have replaced obsolete medical terminology. We have done our best to modernize the medical terminology for the translation of this article while keeping the standar medical concepts typical for the 1960s.^b
3. Kraków Medical Academy—now the Jagiellonian University Medical College (Collegium Medicum Uniwersytetu Jagiellońskiego).^a
4. The term “KZ (concentration camp) syndrome” was coined and disseminated by the team of doctors and psychiatrists who treated Polish concentration camp survivors and published their observations in Przegląd Lekarski – Oświęcim. The condition is generally referred to as “post-traumatic stress disorder,” concentration camp syndrome being the variant suffered by concentration camp survivors.^a
5. In the People’s Republic of Poland, individuals who wanted to claim a disability pension had to apply to a special medical board which examined them and either dismissed their application or declared them partially or fully unfit for employment, classifying them in one of three disability groups (mild, medium, or full disability). Welfare benefits, disability pensions, or both would then be awarded to claimants on the basis of the disability group in which they were classified. The system operating in Poland has undergone considerable modification in recent years.^a
6. Neurotic disorders (F41); or possibly somatoform disorder (F45) according to the modern nomenclature.^b
7. Neurasthenia or neurotic disorders (F48.0). Considerable cultural variations occur in the presentation of this disorder, and two main types occur, with substantial overlap. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety are all common. Sleep is often disturbed in its initial and middle phases but hypersomnia may also be prominent.^b
8. Dissociative (conversion) disorder (F44).^b
9. Now known as Sąd Pracy i Ubezpieczeń Społecznych (the Court for Employment and Social Insurance), a separate branch under Poland’s Labour Law, including complaints arising from applications for disability pensions or welfare benefits.^a
10. ZBoWiD, Związek Bojowników o Wolność i Demokrację, the main Polish war veterans’ association in the People’s Republic of Poland.^a
11. The nearest equivalent In the modern terminology for this disorder would probably be F07.2. postconcussional syndrome. This is a syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol.^b
12. This article was published in 1965, before the research on learned helplessness, which is probably the term authors writing on the condition would use today.^a
13. Neurasthenia, F48.0 in ICD-10. F48.0 See Note 7.^b

a—notes by Teresa Bałuk-Ulewiczowa, Head Translator for the Medical Review Auschwitz project; b—notes by Maria Ciesielska, Expert Consultant for the Medical Review Auschwitz project

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