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

Contents
Long-Term Psychological Morbidity of Incarceration in Auschwitz

Zdzislaw Jan Ryn*

Introduction
Poland suffered the heaviest losses of all countries involved in World War II. In Nazi concentration camps and extermination centers located on the Polish territory, Nazis murdered 6.7 million prisoners, mainly Poles and Jews, including more than two million children and young people. About 90% of them died in concentration camps and prisons. The first victims were people of particular significance - intellectuals, artists, members of resistance movements, the clergy. The extermination of the Polish nation, similarly to that of other Slavonic 'nations, proceeded in a planned and premeditated way. Thus, besides enormous losses, Poland suffered as well irretrievable losses in the sphere of culture, education, and science.

The research on the long-term consequences of posttraumatic stress disorders was possible only in a few groups selected at random. We know that only about 20% of all prisoners survived the camps. The handful of those who are still alive today say that they have been granted a second lease on life and that they themselves do not understand how they survived the camps.

Personal contact with former inmates of the Auschwitz concentration camp is, from a psychiatric point of view, a strange and unique experience. The emotional atmosphere of this contact is formed mainly by two factors: the atrocities of camp existence, and the stamp that the camp impressed on the psyche of these people. Frequently, ex-prisoners are a puzzle to themselves, or at least are more acutely conscious than other people of the mystery of human nature and the delusiveness of human norms, forms, and appearances; for them, "The king is naked."

The stamp left by experiencing camp stresses seems to be something permanent or even progressive, in both the physical and psychic spheres. The stigma of the concentration camp has been transferred to the second or even third generation.

The complexity and diversity of the clinical picture of postconcentration- camp effects account for the abundance of terminology used. In the literature, descriptions such as the following prevail: the concentration camp syndrome, the survivor syndrome, or asthenia progressiva gravis, which corresponds to PTSD in modern psychiatric classification.

Camp Stresses and Adaptation
Immediately on entering the gate of the camp, the ritual of "welcome" introduced the prisoners to the horror of death. The atmosphere of death was created first of all by brutal and inhuman treatment of prisoners, as well as by the whole structure of prison life. The atmosphere of murder pervaded the community of prisoners so deeply that after two or three months the prisoner accustomed himself to it completely and was always prepared for death. The mass character and commonness of death in the camp led to the blunting of prisoners' emotional reactions. Then, a process ensued of reconciling oneself, becoming accustomed, and finally indifferent to the death of camp-mates, and - as was often the case - indifferent to one's own death. This process is considered to be one of the basic defense mechanisms in the adaptation to the camp stress, while at the same time it must be regarded as one of the greatest paradoxes of human existence.

For the majority of former prisoners, incarceration constituted shock unparalleled in their previous experience. The violence of the shock was for many unbearable, and a considerable number of prisoners died shortly after they were interned in a camp. Death frequently occurred before the symptoms of starvation and disease developed and while the general physical condition was still apparently good. This was caused most often by psychosomatic deterioration, which occurred after all defense mechanisms collapsed.

The camp pandemonium was beyond the psychosomatic endurance of many of the prisoners, and some of them committed suicide. This kind of death was frequent particularly in the initial period of incarceration. In this way, prisoners who were exposed to the most severe traumas perished - prisoners of Jewish origin, foreigners, intelligentsia, also older prisoners. The immediate reason for suicide was usually mental breakdown, depression-anxiety reaction following the loss of emotional support, somatic disease, direct imminent threat of death, etc. In many instances suicide played the role of a prisoner's dramatic protest against camp functionaries and the idea of the camp itself (Ryn and Klodzinski, 1976).

The prisoners who withstood the pressure of these unfavorable factors had to adapt as quickly as possible to camp reality and accept the norms of coexistence imposed by it. But the camp reality was so appalling that to many it seemed a nightmarish dream.

Adaptation to the camp conditions depended on many factors, both external and internal (Teutsch, 1962). An essential factor was the ability to find a group and form reciprocal ties with even the smallest community. Also of importance was the activeness of prisoners in appeasing their own needs (Kepinski and Klodzinski, 1973). For the cruelty not to kill them, prisoners had to develop a kind of callousness, blunt their natural sensitivity, withdraw into themselves, and retire into a concentration-camp autism of its own kind.

The most common reaction of prisoners was mental depression. In extreme cases, complete breakdown and prostration occurred together with loss of faith in the possibility of surviving. The prisoner in this state was referred to as a Muslim or Mussulman (Ryn, 1983, 1984; Ryn and Klodzinski, 1983, 1987). Jagielski (1968) described this stage of sickness most forcefully: "A Muslim has crossed the threshold of death in life."

But the most vital factor in the etiology of the concentration-camp disease was the mass loss of fellow prisoners, as well as the constant, direct threat to the prisoner's own life (Ryn and Klodzinski, 1982).

The survivors carried with them from the camp inhuman habits and stereotypes of behavior. They regarded the surrounding world with mistrust and suspicion, they felt misunderstood and rejected, and they were incapable of forming deeper emotional ties with family, friends, or close associates (Jagoda, Klodzinski, and Maslowski, 1976).[Page 1 of 4]

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*Jagellonian University, Collegium Medicum, Chair of Psychiatry, Department of Social Pathology, ul. Kopernika 21 a, 31-501 Kraków, Poland. E-mail: mzryn@cyf-kr.edu.pl