Emotional Wounds that Never Heal

, October 21, 2002

Jewish Political Studies Review 14:3-4 (Fall 2002)

This essay discusses the discriminatory content of the Compensation Laws (Wiedergutmachung) for Holocaust Survivors in West Germany. It explains how this was based partly on the lack of knowledge of the long-term after effects of psychic trauma, but even more so because of the unwillingness of German physicians to understand and accept the harm the Holocaust inflicted upon the survivors.


At the end of World War II, tens of thousands of Jews, who had survived the Holocaust, died of illnesses and starvation. For them, liberation came too late. Those who did survive were mostly alone, and as they had no place to which to return, they stayed in Displaced Persons camps throughout Germany for several years. Regaining their physical strength was the main objective, and attention was mostly given to the visible consequences of the war. The survivors met a world that could not believe and in the beginning, and although there was much pity, mostly there was a wall of silence. The Allies wanted to restore Europe and the shattered image of Germany, and to forget the unbelievable. Mental health professionals (among them victims themselves) participated in the mass denial involved in rebuilding the future and not looking back.

Only two professional papers about the emotional long-term effects of the Holocaust experience were written at that time. In 1946, J. Tas, a Dutch psychiatrist and Bergen-Belsen survivor, wrote about the suppression of the many emotions, such as anger and fear, in the returning survivor and, as this mechanism will continue to exist, he considered them to be prone to serious psychic disturbances in the future.1 P. Friedman, an American sociologist, reacted very strongly against the rehabilitation plans in the D.P. camps. He proposed an overall psychosocial program, including psychological support, as well as measures for economic and social integration of the survivors in their new homelands.2 Nobody acted upon these ideas, and it took at least 25 years until it was clear that the needs of the survivors were more complex than estimated.

The Compensation Law

Almost immediately after the war, the three Western allies introduced laws and regulations in their respective occupation zones, with the intention of rehabilitating the health and economic conditions of the victims of persecution, including the Jews. From 1949 until 1953, the individual states in West Germany issued their own regulations based on those of the occupying forces, but were in no hurry to implement them. As there was no precedent in history for such an indemnification law, Chancellor Konrad Adenauer was the first to push for legislation and later for the enactment of the law.

There are no real figures available about how many Holocaust survivors were then in Europe, where and how they survived, their ages, country of birth, or how many went to which countries. But it was clear that thousands were so debilitated and impoverished that they needed the money urgently and could not afford to refuse it, even if this meant that they had to submit to humiliating interrogation.

According to Tom Segev, it was Berl Katznelson who, in 1940, introduced the idea that Germany should pay for Jewish property that was stolen and for the suffering they were responsible for.3 His ideas were most probably based on the fact that after World War I, Germany was forced to pay compensation to various Western European countries.

In September 1951, Konrad Adenauer made a declaration in the Bundestag stating that Western Germany regrets the actions of Nazi Germany and will compensate the Jews who suffered from the Nazis. The State of Israel started negotiations, about compensation for looted properties. Through this act, Israel granted postwar Germany the moral-political qualification to become the “other Germany,” and thus made it easier to return to the family of nations.

R. Teitelbaum makes it clear that during those years of negotiations, the discussions were about money allocated for the absorption of new immigrants, and for the development of the infrastructure of the new State.4 He blames the Israeli government of indifference and a total lack of understanding of the individual survivors and their personal suffering.

In those years, these new contacts with the “new Germany” contradicted the moral values of many in Israel. There were protests about accepting what some called “blood money,” and some survivors refrained from taking compensation. However, the majority of the survivors thought that restitution was owed to them and should be accepted, and because it constituted an admission of guilt on the part of the Germans, even though the money would not restore their losses.

Discriminatory Aspects of the Compensation Law

Milton Kestenberg argues that it was only in West Germany, unlike other countries, that a person who was persecuted by the Nazis was compelled to prove damage to his health.5 Proof was in the form of a medical examination only. Even in the former East Germany, survivors were granted a pension, without having to undergo any medical examination. To submit a health claim, a survivor had to complete the necessary forms in German, bring witnesses and medical certificates. In most cases, authorities demanded more information and more evidence, a procedure that took many years. Hereafter, the claim was referred to a physician, (mostly German-born) appointed by the German consulate. He had to decide that the claimant suffered considerable physical injuries or damage to health due to the persecution. Those who had more than 25 percent disability received compensation.

Kestenberg discusses the diverse discriminatory aspects of the law and the policy involved. One of the clauses, which caused difficulties for many claimants, was that compensation could be refused for wrong or inaccurate statements – which sometimes occurred due to simplification or by negligence in the presentation of evidence. Some claimants had to go through many reexaminations, such as being referred to another physician, and if there was a discrepancy, the claimant was ordered back to the first physician and if he was again rejected he could go to court, and undergo another examination in Germany. Over the years new regulations were invoked to prevent abuses, but also in order to delay and refuse claims. Many lawyers who were involved in all these procedures, profited greatly.

In the beginning, the German government thought that survivors should be compensated only according to the results of medical examinations. A link had to be shown between the persecution and the current symptoms and malfunctioning, as in the case of an industrial accident. However, none of the authorities grasped the unprecedented meaning of the Holocaust and the consequences on body and soul.


Changes in the Concept of Psychic Trauma

In order to understand some of the difficulties that arose in the enactment of the law, a few points will be illuminated which are connected to the development and change in psychology and psychiatry in general, and in German psychiatry in regard to psychic trauma in particular. At that time physicians (in the U.S. and Israel), who examined the victims, had never before encountered such a multitude of complaints and symptoms as reactions to the Holocaust. These included an increase in physical illnesses, higher mortality, and an increase in emotional disturbances. Regarding the latter, the patterns were rather unusual and did not correspond to the standard nomenclature for psychiatric illnesses. Therefore, a new diagnosis, Post-Concentration Camp Syndrome, was proposed in the 1960s.

The German authorities were not indisposed to paying reparations for physical injury, when it was totally clear that this was related and sustained in the camps. However, they strongly resisted acknowledging that the survivors suffered from emotional distress and that their incapacities were a consequence of that distress, and not connected to some kind of predisposition, or malingering. This very bureaucratic attitude was based on obsolete laws and knowledge.

The earliest compulsory compensation accident law was enacted by Germany in 1884, and enabled injured employees to get compensation from their employers, when injured bodily.6 The notion that people could be harmed by psychic trauma, and as a result become incapacitated, was only developed many years later. The arguments about the etiology of traumatized patients started some 150 years ago, with the discussion being around questions such as whether the basis is constitutional or psychological, whether the trauma itself is causing the disorder, or perhaps an organic vulnerability existed in the individual. Very important for the insurance was the question about malingering – perhaps the patient suffers from “moral weakness.”

The patients who came following industrial injuries, train accidents or combat soldiers from World War I, suffered from severe anxieties, startle reactions, sleep disturbances, nightmares and had difficulties in normal functioning. For many years, people suffering from traumatic reactions were treated as if they were suffering from a neurological disease. Later it was thought that the symptoms resembled hysterical reactions and somatizations, based on traumatic experiences during childhood, or were diagnosed as an expression of cowardice. During World War I, many soldiers in the English, French and German armies were treated, punished and even executed for their traumatic reactions, which were understood as simulation, suggestibility or a disease of the will.

A German psychiatrist, Karl Bonhoeffer (1926) regarded “traumatic neurosis” as a social illness that could only be cured by social remedies. According to his findings, all of his cases had a hereditary predisposition, an inherent weakness, and that the real cause was the availability of compensation: “Das Gesetz ist die Ursache der Unfalls Neurosen.” [The law is the cause of traumatic neuroses], that is, the disorder was caused by secondary gain, a compensation neurosis.7 His assumptions were accepted and became the basis of the German Health Insurance Law. In 1959, this law was slightly modified but it is still more restrictive than in most other western countries.

This is the background to the negative reactions by German physicians in accepting emotional distress as an outcome of wartime experiences. According to their understanding, a post-traumatic reaction is limited in time, and only immediate shock reactions were accepted. However, when complaints persisted, even for longer periods, it was thought that the victim’s problems were based on a predisposition, a degenerative inclination, a traumatic childhood experience, compensation needs or simulation.

Delayed Reactions

A claim by a then 40-year-old Jewish survivor who, as a little child was hidden in a drawer for two years, was at first rejected because, as the German physician stated, “the quiet surrounding” the child was living in, could not have caused any severe trauma. As Kestenberg explains, the consistent view of German psychiatrists was, that a child, who spent the early years of his life in a concentration camp or in hiding, will not remember the details of that suffering and therefore cannot be permanently damaged.

The vehement discussions in the 1960s, mostly between American psychiatrists and German authorities on this question (Whether symptoms are a result of traumatic experiences or personal constitution) were expressed in an article by an American psychiatrist, K.R. Eissler:8 “Die Ermordung wie vieler seiner Kinder muss ein Mensch symptomfrei ertragen, um eine normale Konstitution zu haben?” [How Much Suffering Can One Bear, Without Getting Problems?]. One has to take into account that this so-called “scientific discussion,” was held by German medical examiners and judges, many of whom had been working in their professions during the Nazi regime as collaborators or even as perpetrators. Ernst Klee in his book, Was sie taten – Was sie wurden [What They Did, What They Became], describes cases of physicians who, during the war, undersigned the approval for the killing of mentally ill patients and Jews, and after the war became the final decision-makers for accepting or rejecting the application for compensation.9

The unwillingness, the discrimination, the delaying tactics and the hostility of the German authorities, including physicians, psychiatrists and judges, demonstrated a refusal and resistance to acknowledge the suffering of the Jewish survivors. They acted as if they had to protect themselves against so-called Jewish deception. In the opinion of the author, these people felt that they would be admitting the guilt of their involvement with the Nazi terror if they granted compensation to a survivor.

It was in the 1980s that a comprehensive new diagnosis called Post-Traumatic Stress Disorder (PTSD) was accepted worldwide. It was based on research of the reaction of Holocaust survivors, World War II and Vietnam veterans, Hiroshima survivors, and also of victims of political regimes, and sexual and domestic violence. It took until then to become scientifically established and accepted, that people who have endured horrible events can suffer psychological disturbances, either immediately after the event or many years later.

The common denominator for all these traumatic events is the feeling of terror, intense fear, helplessness, loss of control, and the threat of annihilation. The many reactions after these life-threatening situations can be summarized in three categories: irritability and sleep disturbances, recurrent memories in which the traumatic situation is relived, and emotional and/or mental constriction whereby life restriction occurs; and beyond that, changes and alterations in personality. All these are understood as normal reactions after an abnormal situation. However, there is no uniform reaction pattern. For some people these post-traumatic reactions will diminish or stay with them forever; or they may reappear when the persons become older (a delayed reaction).

The Holocaust Survivors

It is clear that the survivors group is very heterogeneous. People come from different countries and ages, different personality structures, varied familial and cultural backgrounds, and very different experiences. What they have in common are the traumatic experiences and the many losses – physical, emotional, social and spiritual. Those who survived returned alone or with very few relatives, as so many were murdered. As mourning had to be suppressed for many years, many, if not most, survivors are still in grief about the injustice and numerous losses. This is often expressed by emotions such as worry, anger, distrust, sadness, distress and loneliness.

After having examined many survivors for their compensation claims, it is unbelievable that only with the establishing of the new diagnostic category PTSD, that emotional suffering was acknowledged as a reason for compensation. The personal mental consequences of the Holocaust entered societal consciousness only via a psychiatric diagnosis. Even so, for the German authorities, causality had to be proven. Only those symptoms were recognized as valid, when a link could be shown between the persecution and the current malfunction which had to be present at the time of liberation and treated at that time. Delayed damage was at first not recognized, and only since 1970 were psychiatric conditions recognized as caused by the persecution. However, the discussion about these delayed reactions is still going on.

Over the years some of the very discriminating articles have been changed slightly. To give an impression and some understanding about the magnitude of the problem, the following presents some results of a 1997 sociodemographic study by the JDC-Brookdale Institute.10 A comparison was made between survivors and those who emigrated from European countries before World War II, from the same age group (60+). In the survivors group it was found that 19 percent were depressed (vs. 11 percent), and 50 percent had sleeping difficulties (vs. 44 percent).

The returning survivor had a basic need to share his traumatic experiences with others, his community, in order to regain his sense of living in a meaningful world. The response of silence, as was encountered for too many years, only strengthened the feeling of shame – of being a stranger, again being rejected, but now by his own fellow Jews. For a survivor to speak about his experiences in the 1950s and 1960s invited humiliation, ridicule, and disbelief.

In order to partly overcome the breach between the survivor and society, resulting in a distrust of society, there is first of all a need for recognition, acknowledgment of the inflicted harm, and some form of justice. The responsible ones should be brought to trial, in order to rebuild the sense of right and wrong. To bear witness and give voice to the inflicted suffering in a broad social context, gives the survivor a feeling of rehabilitation and especially a sense of belonging to the larger society.

Psychosocial Needs of the Survivor

In the 1970s, the compensation law for victims of World War II in Holland was also implemented in Israel, and many Dutch survivors applied for it. Soon, however, the Dutch Embassy was inundated with people who complained that after telling their story they lost their emotional balance and concentration; they became restless and started to suffer from nightmares again. For a certain time, the Embassy hired social workers in order to give some support, until the Dutch government decided that the local authorities in Israel should be doing this, but they were absent.

The Immigrant Organization of Holland (I.O.H.) took the initiative and founded ELAH (Center for Psychosocial support for Holocaust Survivors from Holland) in 1979, mostly with financial support of the Dutch Government. Based on the positive experiences and convinced about the need for a similar service for the broader population of Holocaust survivors in Israel, the late Manfred Klafter became the founder of AMCHA in 1987. AMCHA is the largest organization of this kind in the world, taking care of the psychological and social needs of the Holocaust survivor and his family in Israel. It is financially supported by a few groups of “Friends of AMCHA” throughout Europe. There are now four large branches in the big cities and seven satellites across Israel, serving approximately 5,000 survivors.11

For many of the survivors, the Holocaust was a break in their life, which left many scars – feelings of powerlessness, and living in a world without justice or safety. Basic assumptions such as being in control of his own existence, or that life is meaningful and comprehensive, are shattered, which changes the person’s self-image and his view of others.

The survivor who returned to normalcy expected some correcting acts, of restoring the moral standards of society he belonged in. He hoped for any visible sign of solidarity, of social reintegration, and not the least, punishment of the perpetrators. But none of this happened. Even when, in the different countries, laws were accepted to compensate for the damage that was inflicted, new injustice was done. In order to get some money, the survivor had to fill out the application forms for compensation, to retell the story about persecution, misery, and the annihilation of family members. He had to prove that they really were killed, which meant for many of the survivors reliving the painful experiences, thus suffering secondary traumatization and dehumanization.

The Holocaust is seen as the absolute standard of evil in society. Moral, ethical and political questions are linked with metaphors of the past. Hitler and the Holocaust are used in order to give expression to the total evil in the present. Interest in the consequences of the Holocaust and about compensation for the victims has unknown universal proportions of global magnitude.

Ours is a victim culture, with much attention given to minorities and human rights, as a universal message that satisfies the social and political needs of many. The silent cry of the Holocaust survivor had to make room for the voice of political interest groups such as the Aborigines of Australia, African-Americans, South Africans, and many others, who also demand restitution. The globalization of the Holocaust became a standard for many victim groups, worldwide.

In the summer of 2001, masses marched through the streets of Durban, demanding the destruction of the State of Israel. This author witnessed the same phenomena in the streets of Berlin in 1938, when collaboration with the murderers of the Jews belonged to the cultural norm of the European countries.

The question arises: why do Jews as a group and Israel as a country, still have to fight for their right to exist? Can we ever expect moral conduct and justice from an immoral society? Nevertheless we have to strive for, and demand from the world, moral conduct towards mankind based on basic, human ethical standards.


The survivor is a witness and accuses the human community for its passivity and its silence. In a society where justice prevails, restoring human values after a war or other calamity, and to show solidarity with the victim must be an ethical demand, and repaying all material losses is a moral obligation. According to the proposed basic principles and guidelines of the UN (which are also based on the lessons learned from the experiences of Holocaust survivors) this includes the following forms of reparations:12

  1. Restitution of citizenship, residence, property, etc
  2. Compensation and rehabilitation for any economic, physical or mental damage, as well measures to restore the dignity and reputations of victims.
  3. Recognition for the injustice and humiliation the victim had to go through.
  4. Jurisdiction against those who participated in the crimes.

The implementation of these measures could have been done much more effectively, and less harmfully, more humanely and with more respect towards the Holocaust survivors. But the question remains: what kind of satisfying rehabilitation can be made for the psychological damage the Holocaust survivor went through – the inner pain caused by the humiliation, the dehumanization, and most of all, the irreversible losses? Is there any compensation for a mother who lost a child, or a child who lost his parents? Even if material losses can and should be compensated, the Holocaust survivors continue to live with many wounds that never heal.

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1. J. Tas, “Psychical Disorders among Inmates of Concentration Camps and Repatriates,” in Psychiatric Quarterly (1946) 25: 679-690.
2. P. Friedman, “The Road Back for the D.P.s,” in Commentary (1948) 6:502-510.
3. T. Segev, The Seventh Million (Jerusalem: Keter, 1991) (Hebrew).
4. R. Teitelbaum, Mizkar (Israeli Organization of Holocaust Survivors Newsletter), 2001.
5. M. Kestenberg, “Discriminatory Aspects of the German Indemnification,” M.S. Bergman and M.E. Jucovy, eds., Generations of the Holocaust (New York: Basic Books, 1982).
6. B. Kolk, et al., “History of Trauma in Psychiatry,” in Bessel A. van der Kolk, et al., Traumatic Stress (New York: Guildford Press, 1996).
7. Ibid.
8. K.R. Eissler, “Die Ermordung wie vieler seiner Kinder muss ein Mensch Symptomfrei ertragen,um eine normale Konstitution zu haben?” [The murder of how many of his children can one bear without symptoms, in order to prove that one has a normal constitution?] Psyche (1963) 17:241.
9. E. Klee, Was sie taten – Was sie wurden. Aertze, Juristen und andere Beteiligte am Kranken – oder Judenmord [What they did. What they became. Physicians, Lawyers and other Participants in the murder of Infirms and Jews] (Frankfurt am Main: FischerTaschenbuch Verlag, 1986).
10. J. Brodsky, “A National Survey of the Elderly in Israel,” JDC-Brookdale in collaboration with the WHO and the Claims Conference, 1997.
11. N. Durst, “Psychotherapie mit Überlebenden der Shoa” [Psychotherapy with Survivors of the Shoah], R. Ludewig-Kedmi, ed., Das Trauma des Holocaust zwischen Psychologie und Geschichte [The Trauma of the Holocaust between Psychology and History] (Zurich: Chronos Verlag, 2001).
12. E. Stamatopoulou, “Violations of Human Rights,” in Y. Danieli, et al., eds., International Responses to Traumatic Stress (New York: Baywood Publishing Co., 1996).

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Dr. Nathan Durst was born in Berlin and came to the Netherlands in 1939. He has a doctorate in clinical psychology from Groningen University. He came to Israel in 1971 and worked as chief psychologist in a psychiatric hospital for 15 years. He is a past chairman of the Israeli Psychotherapeutic Association and teaches at Tel Aviv University. He is co-founder of AMCHA (Israeli Center for Holocaust Survivors and the Second Generation) and works as its clinical director. He lectures in Israel, the United States and in Europe – mostly in Germany – about trauma and the Shoah.