Post-Holocaust Antisemitism and the Ascent of PTSD

"the creation of DSM-III in 1980, an important innovation was the introduction of the category of Post-Traumatic Stress Disorder (PTSD). Most scholarly accounts of the evolution of the PTSD idea go back to railroad and industrial accidents at the turn from the nineteenth to the twentieth centuries and above all to the "shell shock" experienced by soldiers in World War I" (89)"What most accounts, peculiarly, skip over or only mention in passing is the crucial role of the aftermath of the Holocaust of European Jewry in its wholly unexpected, intricate intersections with subsequent controversies over the USA's military involvement in Vietnam. PTSD was a "invention-discovery" born of multiple, overlapping conflicts" (89)"a grotesque debacle fought out through the 1950s and 1960s over financial compensation for mental health damages among Jewish survivors of life in flight, hiding, or in the ghettos and concentration and death camps" (90)"Instead of conjecture about the sources of a particular disorder, DsM-III introduced the phenomenological (and, at the time, it was felt, infintely more objective) concept of a checklist of measurable symptoms" (91)"perhaps they were, like lazy workers or malingering soldiers had been imagined before them, best understood as "pension-neurotics" (Rentenneurotiker) - that was the literal term used, whether they were producing their (suddenly financially convenient) symptoms consciously or unconsciously. In fact, one West German-government sponsored guidebook for evlauting psychiatrists contended that therapy could only be helpful in cases where no pension had been given, because the granting of the pension itself prevented healing" (95)"To only feel morally indignant is to miss just how much the idea that Jews were a problem was part of the commonsense texture of public discussion in the aftermath of a mass-murderous dictatorship. Moreover, the blatancy of they hypocrisy around money is noteworthy. This was also a climate, after all, in which there were not just pensions available for concentration camp guards as well as their widows, but also entire organizations of gentiles dedicated to clamoring that they had been "victims of denazification" ("Entnazifizierungsgeschadigte") and/or "victims of reparations" ("Restitutionsgeschadigte" - this included people who were distressed that Jews whose property had been lost to "Aryanization" had come back to reclaim it)" (98)"The whole dynamic driving most neuroses, Kretschmer commented, had nothing to do with past experiences, but rather with future hopes (for money) or with a "hypochondriacal" inability to master one's present. Neuroses could emerge from either "familial conflicts or inner problems of character," but not from later external events" (100)"This double move of both denigrating and (mis-)appropriating Freud continued into the postwar era and showed up particularly in debates over whether the simulation of symptoms was "conscious" or "unconscious"" (101-102)"Among the issues sympathizers grappled with was the purported comparability between death camp experiences and those of POWs or victims of bombings or expulsions, and thus an argument about the uniqueness of what we now call the Holocaust began to take shape" (103)"A signally relevant figure in the United States was the New York-based William G. Niederland, who worked tirelessly, in hundred of sympathetic evaluations and in dozens of scholarly essays and media interviews, to achieve reversals of rejections. Among his many contributions were the development and explication of the concept of survivor guilt - a profoundly contested but, as it would turn out, strategically important topic - and the concept of hypermnesia (especially vivid intrusive memories). But one of the biggest contributions he made was to call attention to the point that life in hiding, often under subanimal-like conditions and in constant terror of discover, could be as damaging to mental health as life in the concentration and death camps, and also his insistence that the earlier experiences of persecution in one's hometown - perhaps especially for children being mocked and beaten up and excluded from one's former circle of peers - needed to be taken into account as well" (106)"Notably, moral outrage was not the main tack taken by the most successful sympathizers. Instead, the far more effective strategy was to combine fulsome praise for some small aspect of a prominent rejecter's insight - Niederland and Venzlaff both, for instance, praised Ernst Kretschmer on minor points - only then to go on to declare that, alas, the rejecters were sadly behind the times. They were simply not up to speed on the latest scientific findings" (106)"the provocative title summing up Eissler's scathing critique of the rejecter position: "The murder of how many of one's children must one be able to survive asymptomatically in order to be deemed to have a normal constitution?"" (107)"Eissler was not asking doctors or judges to feel pity. Rather, he reflected on how any one of the those professional men would himself react if he was arrested, put into prisoners' garb, forced to do heaviest labor in the worst weather and on the absolute minimum of food, had his children murdered, been hunted by dogs, threatened with being shot, kicked in the head and abused so badly that his face carried permanetly disfiguring scars - after three years of this, would be really be so stoic and be able to resume his daily life? As Eissler concluded with deadpan fury in 1963: "It remains a mystery how such a profound malfunction of the ability to identify can emerge among educated intellectuals." It was the rejecters, he said, who had an "emotional conflict" when they were conducting evaluations. The idea that a psyche, a soul, is not autonomous and impervious, that it can in fact be damaged, indeed damaged forever, by external experiences: this realization, Eissler proposed, must awaken strong gears. In short, Eissler began to theorize the issue of bias within counter-transference - what the evaluators were bringing to their encounters with survivors" (107-108)"Eissler noted that contempt for the weak had complex roots, and appeared to be connected, he submitted, "with the whole problem of sadomasochism"" (108)"Ultimately it took Vietnam to bring the Holocaust fully into focus. As manifestly different as the cases of soldiers and survivors were, the incontrovertible fact is that the growing public discussion surrounding Vietnam veterans and the pressure of antiwar groups helped greatly to push PTSD into the DSM, with absolutely crucial positive results for shifting the mainstream of medical opinion internationally" (110)"the possible parallels between the experiences of survivors and specifically those soldiers who had experienced imprisonment in POW camps" (112)"The 1976 draft memorandum by Nancy Andreasen to Robert Spitzer, Lyman Wynne, Chaim Shatan, Robert Lifton, Jack Smith, and Leonard Neff on "Post-traumatic disorder" listed at the outset the range of traumatic experiences that could cause this disorder. They included: rape, military combat trauma, natural disasters like floods and earthquakes, accidents like airplane crashes or large fires, and also, expressly, "mass catastrophes... of human origin (Hiroshima, torture, death camps)"" (112)"In sum, and to put the overall point another way: initially the battle over reparations for survivors had forced advocates for survivors to articulate an early case for the uniqueness of the Holocaust, and the utter noncomparability of racial persecutions and concentration and death camp experiences with the experiences of soldiers or even of civilians during wartime. Yet, by a twist of historical fate, it later took the catastrophic decline in the USA's moral authority internationally due to the war in Vietnam and the rise of a passionate antiwar movement to bring not just soldier's but also survivors' traumas into Americans' public consciousness and into official medical nomenclature and professional policy" (113)"One great problem with the ascent of PTSD, however, and inevitably, was that it relativized and blurred the differences between victims and perpetrators... Or as the German-born (but longtime Chilean-resident) psychoanalytic psychotherapist David Becker has put it, the effect was an "amoralization" of trauma" (113)"Confession, conversion, and reform were still relevant purposes of torture in some instances. But a novelty particularly noticeable among the new Cold War dictatorships allied with the USA, especially though not exclusively in the Latin American countries of Chile, Argentina, and Uruguay, had as its main purpose "the breakdown of the individual" - the deliberate destruction of his or her identity" (114)"The other influences on Becker are the postcolonial literary theorist Edward Said (for his insights into the mutual entanglements of colonizer and colonized) and the psychoanalyst Frantz Fanon (whom Becker reads - especially in his Black Skin, White Masks [1952] - as a pioneering theorist of trauma in the colonial context), together with such tendentially nonpolitical but clinically innovative British psychoanalysts as Michael Balint (for his emphasis on the therapeutic relationship), Wilfren Bion (for his ideas on group process but also on how the analysis might serve as a "container" for the pain of the patient), Donald Winnicott (for his concept of creating a "holding" environment, his attention to the countertransference, but also his notion of therapy as a transitional space), and Masud Khan (for his idea of "cumulative traumatization")" (117)"another related problem with PTSD identified by Becker - here building on Keilson - is how the concept, even as it officially recognized external triggers of internal suffering, actually decontextualized the suffering by focusing on and measuring the level of ensuing pathology inside the individual rather than continuing to attend to the burdens of the experiences and environment. In short, it made what had been - and in many cases still was - a sociopolitical issue into a personal issue, and a medicalized one at that" (117)"In Becker's view, there was no question taht the T (for trauma) in PTSD was real. But he objected to the P, S, and D. All too often, there was no "post-", as crises continued; "stress" was far too mild a term for what traumatized people had gone through; and "disorder" localized the problem in the person rather than the situation" (117)"Two innovations from Keilson were thus crucial. One was his rejection of the measuring of symptoms (one simply could not, according to Keilson, express suffering in numerical terms). What should be catalogued, instead, were the experiences, the external contributory factors "as measure of the burden" (als Mass der Belastung) that the individual was carrying. Keilson's second main contribution was his insistence on seeing the trigger for trauma no longer as an event, or an experience restricted to a limited amount of time, but rather as a sequential process, one that absolutely needed to include the before and the after of the worst experiences - and also one that included Freud's concept of "deferred" effects" (118)"The result was a rejection both of PTSD as a diagnostic category and of the classic psychoanalytic ideal of analyst "neturality." Lira i particular called for "active non-neutrality" and advanced the notion of a "bond of commitment" (vinculo comprometido) that needed to be provided by the therapist, not least in view of what was after all an ongoing and, moreover, deliberate - albeit simultaneously continually disavowed - political repression. For a therapist to refuse to take a political position was to make it impossible for the patient to rebuild trust in human relationships or to recover the cognitive coherence that had been so intentionally destroyed both by the torturers' sadism and the government and communal denial surrounding it" (120)"The imperative to find more sensitive ways to conceptualize the continual imbrication of intrapsychic dynamics with sociopolitical contexts - and to seek better means to provide at least some amount of care and healing in the midst of ongoingly catastrophic situations - remained" (122)