Dissociative phenomena in former concentration camp inmates.

Dissociative Phenomena in Former Concentration Camp Inmates Ruth Jaffe Certain patients who had been imprisoned in concentration camps show a traumatically acquired personality change in which, together with frequent pseudo-neurasthenic symptoms, there is a severe impairment of psychical integration. In some such patients we find, as part of this impairment, a tendency to dissociative phenomena which did not exist previously, and which has, therefore, to be considered as a subsequently acquired disposition. These phenomena are distinguished by states of altered consciousness in which highly traumatic, dissociated material emerges, this being elaborated generally in a repetitive and sadomasochistic way. The material consists of real experiences of the traumatic past, of traumatic experiences of other persons with whom the patients identify, of pure fantasies, and mostly of a combination of all these. The real experiences had frequently been undergone while the patients were in a semi-stuporous condition; the fantasies, however, originate in daydreams. Consequently, the ideational content of these phenomena, never having reached full consciousness, could not acquire ego-integration. These dissociated states occur in short attacks, often lasting from seconds to minutes only. Contact with the outer world is disturbed. Frequently a detail of current reality which associatively triggers off an attack, merges with the dissociated ideas, and thereby becomes interpreted delusionally. In other attacks the dissociated ideas impinge on reality, thus creating a double consciousness. In yet other cases, normal consciousness alternates with the pathologically altered one. After the attack, insight into it, together with some memory of it, prevails. The consciousness of these patients is habitually hazy, their attention is inexact, easily exhausted and fluctuating, and their concentration is severely impaired. This general lowering of mental functioning probably facilitates their tendency to dissociation. Daydreams eventuate, which, through lack of regulation and control on the part of the ego, may deepen into hypnoid dissociative states, in which preconscious material emerges. With intensification of daydreaming, the images become more and more vivid and may take on a reality character. In marked cases the clinical picture is quasi-psychotic, the attack being characterized by clouding of consciousness, accompanied by delusions and hallucinations. Some patients engage in daydreaming all day long, succumbing to it for as long as they are left to themselves. The ego-defences are apparently too weak for their task, as in the following cases: Case 1. Katy was 24 years old when war broke out. During the psychiatric examination she suddenly turned her head, rose, bowed, made searching movements with her head, covered her eye with her hand, as if to see better into the distance, listened, talked to herself, and burst into laughter which resembled crying. The impression she made on the observer was that of a psychotic patient. After some minutes she regained composure and related that she had heard her sister's voice. Exploration in narcoanalysis revealed that this pantomimic scene is an almost exact repetition of a traumatic situation which she had gone through on her arrival at the railway station of the Auschwitz concentration camp. She had arrived there with her 8-year-old son and her younger sister who was the boy's maid. After the journey of several days in a closed cattle-van, she had got out exhausted and dazed. When recovering after the first minutes of perplexity and confusion, she saw two columns of people leaving the station in different directions, one consisting of the old and of mothers with children, and the other one