Echoes of the Holocaust
Shalom Robinson, M.D., Editor

Contents
The Skewed Image of the Holocaust Survivor and the Vicissitudes of Psychological Researcht

Jacob Lomranz*

Research on Holocaust Survivors
The Holocaust inflicted intense, prolonged, repeated, cumulative, and unimaginably inhuman traumatic conditions on its victims. The Nazi bureaucratization of stress, trauma, and death-immersion experience was unprecedented in human history. Its colossal impact created a tremendous challenge to its victims' ability to make lifelong adjustments. Several studies have reviewed the nature and effects of the trauma, as well as coping modes (e.g., Kahana, Kahana, Harel, & Rosner, 1988; Robinson & Hemmendinger, 1982). Not surprisingly, the overall effect of the Holocaust on survivors was physically and mentally damaging, not only leaving every survivor with scars (e.g., Brink, 1994) but transmitting posttraumatic effects even to many second- (e.g., Bar-On, 1994; Robinson & Winnik, 1981) and third-generation individuals (e.g., Rosenthal, 1998). We might well ask whether delineation of this "overall" effect is sufficient. Over fifty years after what was perhaps the most devastating man-inflicted trauma in human history, scientific study of the Holocaust is still plagued by disagreement, research problems, limited knowledge (Nadler, 1994), perplexity, and equivocation as to the long-term effects of so enormous a trauma.

How can this state of affairs be understood? In an attempt to obtain an answer, a research review was conducted, with particular attention to the following issues: How is the damage inflicted by the trauma reflected in behavior? Does traumatic stress interfere with normal adjustment, personality structure, aging, and life-span development? If so, how? How can we explain the fact that extreme torment does not necessarily result in disorder? How can we study trauma-experienced persons who are seemingly well adjusted, and comprehend the human strength capable of coping constructively even with the severest trauma? What is the nature of the theories, methodologies, variables, and dimensions with which we operate? Are these psychodynamic, behavioral, or psychoanalytic? Are they based on cognitive processes or derived from intrapsychic variables? Are they based on social or on medical psychology? Are they appropriate? Do we perform laboratory studies, use questionnaires, or rely on case studies? What is the impact of culture on coping with the Holocaust? What is the impact of mass trauma on the general culture? Have we considered the most relevant questions? As specific research questions are formulated, do they pertain to coping, pathology, or adjustment?

A Literature Review on Holocaust Research
Studies conducted on first-generation Holocaust survivors were reviewed in terms of quantity, content, and methodology. The current review is an extended one, modified on the basis of a previous review (Lomranz, 1995). It covers English-language articles (chapters in books excluded) that have been computerized under PsycINFO and PsycLIT, published between 1974, when such information began to be computerized, and 1993.

Findings of the Review: The review delineates what is investigated in research on the Holocaust and how it is investigated. It immediately becomes clear that many of the questions raised herein have not been addressed and can be answered only by inference. Systematic consideration of the nine categories in Table 1 (see note at the end of the paper) reveals the following characteristics and limitations of the studies:

(1) Over the course of twenty years, psychological research on Holocaust survivors has generated a total of 182 studies. An average of 9-10 studies per year on this issue would seem to be a meager crop, especially in view of the fact that stress and trauma have become a central theme of psychological investigations (e.g., Hobfoll & de Vries, 1995; Wilson & Raphael, 1993).

(2) The research is dominated by psychoanalytic or psychodynamic theoretical orientations (131 studies). These approaches actually account for more than the designated 72%, since most of the other theoretical orientations (e.g., family or personality - developmental studies) are also based on psychodynamic approaches.

(3) The studies are largely restricted to psychopathology and intrapsychic variables and dimensions, 42% focusing directly on psychopathology. In addition, the greater part of other variables presented in this category (e.g., parenting or psychotherapy) all deal with psychopathology, bringing the total percentage of studies dealing with psychopathology to 85%.

(4) In terms of method, the designated "theoretical" studies consist mainly of clinically oriented essays, discourse, and discussions, based on generalizations of case studies. Most of them do not stand up to the expected standards of theoretical scientific review papers. In fact, only 20% of the studies used empirical methodology, primarily various questionnaires.

(5) Traumas are not specified and overinclusion with regard to the nature of the trauma is apparent. While we know that the specific characteristics of any trauma determine posttraumatic effects, only 24% of the studies detail such differences and about 76% of the studies refer merely to "survivors" without specifying whether they were inmates of death camps, work camps, partisans, refugees in Russia, fugitives hiding under false identities, etc. Moreover, those (24%) studies in which the traumas are specified turn out to be mainly case studies where patients by necessity elaborated their own traumatic experiences.

(6) Extremely small samples are used, most of the research being based on case studies.

(7) Disregard for the importance of proper sample selection procedures seems to be the rule. Although most of the studies were conducted on clinical populations, 40% of the studies do not specify the sample populations, except for a reference to "survivors"; only 19% of the studies were conducted on community subjects. It should be noted that the 73 studies on designated patients were conducted on a total of 904 subjects, ostensibly an average of about 12 subjects per study; in actuality this average is a result of the high number of investigations based on case studies, since only few studies had larger N's. The situation is not much better where community populations are sampled, inspection revealing that two studies alone account for N = 3130, again leaving a very low number (1,314) of subjects to be divided among the rest of the 33 community samples. Thus here, too, most of the studies were conducted on a small number of subjects.

(8) Most studies lack control groups (in design or, conceptually, in theoretical papers). Furthermore, most control groups, even when used (in 35 studies), were inappropriate.

(9) In observing the last category, which indicates the major themes and focus of the studies reviewed, we again find the strong dominance of clinical content, as indicated by the high proportion of studies on the issues of defense mechanisms, treatment techniques, generational transmission of pathology, deficiency, symptoma-tology, and psychopathology.

However, it is important to note that in the more empirical studies that employ controls, at least some of the investigated variables reveal minimal or no differences between survivors and control groups, contrary to what one would expect. Shuval (1957) did not find Holocaust survivors to be more distrustful of the outside world. Gay (1982), comparing bereaved Holocaust-survivor and non-Holocaust-survivor parents who lost a child in the Yom Kippur War, found only slight differences in variables of bereavement. Shanan and Shahar (1983) found that survivors coped more effectively with, and expressed more favorable attitudes toward family, friends, and work.

Although Baider and Sarell (1984) found that survivor cancer patients showed lower coping potentials overall, they also found no differences between that group and nonsurvivor cancer patients with regard to coping indicators such as leisure-time participation with family, conjugal decisionmaking, relationships with children, sadness, and helplessness. Harel, Kahana, and Kahana (1988) found survivors to use higher levels of coping and be better at communicating with their children; they conclude that their study generally indicates "less differences between survivors and individuals with similar backgrounds who have not experienced the Holocaust, on postwar coping and adaptation and in predictors of psychological well-being than would be expected on the basis of the clinical studies of Holocaust survivors" (p. 428). A similar conclusion was reached by Weinfeld, Sigal, and Eaton (1981), who compared social behavior regarding perceptions of anti-Semitism, level of economic and political satisfaction, and probability of emigration, and did not find significant differences between survivors and nonsurvivors. Levav and Abramson (1984) found that in their sample of 380 survivors, 45% of the men and 35% of the women did not suffer from posttraumatic symptoms of anxiety and emotional stress; Baider, Peretz, and Kaplan De-Nour (1993) found that Holocaust-survivor cancer patients reported significantly higher psychological distress than controls, but found no significant differences in the level of functionality and measures of adaptation between the groups; Carmil and Carel (1986), investigating a sample of 1,150 survivors and 2,159 controls, reported that 26% of the survivors did not complain of the various mental illness symptoms they investigated; Harel, Kahana, and Kahana (1988), Ornstein (1987), Porter (1981), Shanan and Shahar (1983), and Whiteman (1993) all emphasized data indicating the positive coping skills of survivors and their unusual ability to adjust and obtain a new internal integration.[Page 1 of 4]

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*Department of Psychology, Tel Aviv University