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

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

Jacob Lomranz

Implications for the Present State of Holocaust Research
The review of the literature confirmed that relatively little research has been conducted on what is clearly a very important subject, and that major failings are apparent, manifested in theoretical constriction, a lack of definitions for the concepts of stress, trauma, and coping, and the predominantly psychiatric, psychoanalytical, and psycho- dynamic orientation of the research. In terms of methodology, faults in basic research designs are evident, with investigations relying heavily on patients and clinical case studies, lacking randomly selected experimental groups, employing biased sample selection procedures, lacking appropriately defined control groups, ignoring the issues of what constitutes comparison or control groups, and utilizing research tools and questionnaires that are often inappropriate for posttraumatic populations. Findings overwhelmingly focus on psychopathology, since the studies almost exclusively ask questions about sickness and maladjustment, all mutually reinforcing the portrayal of a psychopathological image of the Holocaust survivor.

This state of affairs has created, and continues to support, a one-sided, defective, and partial image of the Holocaust survivor. Although research evidence on pathology is of the highest importance, reflecting the sufferings of many survivors, we know very little about how most survivors lived with their burdens, found strength in the midst of suffering, and attained long-term adjustment. In other words, we know much about posttraumatic illness, but little about posttraumatic health and adjustment. Although similar criticism has been voiced (e.g., Weinfeld, Sigal, & Eaton, 1981), it has not been seriously addressed, as this review indicates. The lack of clarity in the field, the still-unanswered questions raised at the beginning of this paper, and the current review all clearly lead to one conclusion: some of the basic theoretical and methodological approaches must be reconsidered and fundamentally modified. Researchers must be open to different approaches and questions and adhere to scientific scruples. I infer that in the future the study of the long-term effects of the Holocaust will necessitate the following modifications, discussed elsewhere (Lomranz, 1995) and outlined in the following:

(a) A Shift in Orientation: A shift in perspective might enable the formulation of questions as yet unasked in Holocaust research. We should attempt to investigate all victims as total lives living in their environments, and supplement the deficit-oriented PTSD approach with one that also studies adjustment, efficacy, resourcefulness, growth, and creativity (Antonovsky, 1979; Breznitz, 1983; Lazarus & Folkman, 1984; White, 1985); this approach is perhaps better designated by the term posttraumatic stress reaction (PTSR).

(b) The Concept of Traumatic Stress: Differentiation is required as to duration, variation, intensity of threat, and specific human environments, all part of the traumatic experience (Lazarus & Folkman, 1984), on the group and individual level. An overgeneralized and mistaken approach regarding the trauma rests on the assumption of what I have termed the "bulldozer effect," i.e., that the extremely intense traumatic impact of the Holocaust actually obliterated diverse and individual effects (Lomranz, 1990). The overinclusion of the term "survivor" prevents both differentiation and the study of the different and changing impact of the trauma across the life span.

(c) The Concept of Coping: Coping modes, strategies, and effects have been researched extensively (e.g., Gatz, in press; Hobfoll, 1989; Lazarus & Folkman, 1984; Pearlin, 1980; Wilson, Harel, & Kahana, 1988), but have not been sufficiently applied to the research on extreme trauma and posttraumatic adjustment. Furthermore, the experiences of stress and coping always operate on a time dimension. Life-span effects should investigate whether coping modes are consistent or change over time (Peskin, 1987), and should consider the impact of prior stress or crises, the impact of the changing culture, as well as how, in the same person, coping can be constructive on one level and fail on another level. Coping should be further differentiated, include personality skills and the human ability to suffer, live inconsistencies (Lomranz, in press), and yet adjust.

(d) Theoretical Implications: Most of the studies reviewed are not theory-derived, and have an exploratory- descriptive nature rather than a theoretical-hypothetical structure. Indeed, except for the psychoanalytic orientation, a theoretical basis is rare and needs to be applied. The application of concepts from the behavioral and social sciences could contribute substantially to Holocaust research. Theories such as that of Baltes and Baltes (1994), Gatz (in press), and Hobfoll (1989), emphasizing conservation of resources and reserves, along with personality concepts, such as a person's tolerance for inconsistencies and dialectic thinking (Kramer, 1983; Lomranz, 1998), all seem especially relevant to the study of long-term traumatic effects. It is my contention, however, that the long-term effects of trauma in general, and especially that of Holocaust survivors, should also be comprehended in light of life-span, adult developmental, personality, and aging theories.

Adult developmental theory (Cohler & Galatzer, 1990; Erikson, 1963; Gutmann, 1994), gerontology (Hazan, 1994; Rosow, 1974), and traumatology (Wilson & Raphael, 1993) all deal with the impact of life events and change across time. "Aging" and "long-term effects" are inseparable, denoting both human existence and behavior in temporality. Moreover, very aged normal individuals are themselves "survivors" of age-related life stresses and losses. Virtually all Holocaust survivors today are elderly people who have had to cope with the double hazards of old age and posttraumatic effects. Thus, the ability to cope with developmental tasks in late adulthood can also be examined in light of the impact of long-term traumatic effects. It is worth investigating whether Holocaust survivors age differently than non-Holocaust survivors, and if so in what way. These questions should be examined in relation to adult socialization processes and the manner in which the survivor accomplishes developmental tasks, such as coping with milestones and transitions, e.g., the empty nest, retirement, the life-review process or adaptation to physical changes and losses.

(e) Methodological Implications: In addition to faults in methodology mentioned above, there is a scarcity of pretrauma demographic variables, such as the personal, familial, social and cultural background of the subjects, as well as present demographic information. Age and sex variables are ignored.

Although in some recent studies there has been a welcome improvement in methodology, certain pitfalls remain. Detecting long-term posttraumatic adjustment requires highly sensitive instruments based on the levels of experience to be detected. Some studies, yielding minimal differences between survivors and nonsurvivors - a research trend that may increase in the future - have used brief questionnaires or short, limited, self-scale measures to examine mental health or well-being. Such tools cannot always appropriately tap sensitive and intricate aspects in adjusted survivors, aspects that could, in fact, pinpoint the differences between them and control groups. The conclusion is twofold: (1) We should strictly apply scientific research designs and modify our methodological approach, developing instruments that are sensitive and discriminatively appropriate to the posttraumatic populations, using control groups (Lomranz, 1990, 1998; Shmotkin and Lomranz, 1998) and more cross-sectional and longitudinal samples. (2) It might be conducive to employ different conceptualizations and methodology, such as methodologies that combine idiographic and nomothetic approaches (Zarit, Eiler, & Hassinger, 1985), psychobiographical methods (e.g., Alexander, 1990), and "narratology" (e.g., Bruner, 1990; Josselson & Leiblich, 1993; Meichenbaum & Fitzpatrick, 1992). These appear to represent a more appropriate way of eliciting the relevant questions and generating hypotheses; in addition they may result in novel models, and hold promise of a richer theoretical and methodological approach to comprehending traumatizing effects in the general population.

These considerations have led us at Tel Aviv University to undertake a research project using a combined idiographic/nomothetic approach, based on a conceptual multidimensional framework that includes a life-span approach, the differentiation into stages of the traumatic impact, and the impact of historical and cultural events, all operating simultaneously and resulting in stress to be coped with by means of multidimensional resources comprised of personal, interpersonal, social, environmental, and cultural resources (Lomranz, 1995).

I would like to make it absolutely clear that the present review, implications, and suggestions are in no way meant to diminish the immense magnitude of the horrors suffered by survivors of the Nazi-inflicted Holocaust. However, only if we become aware of the deficiencies in existing research will we be able to focus attention on the magnificent ability of human beings to rebuild shattered lives in the aftermath of the severest of traumas. [Page 2 of 4]

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