Tuesday, February 26, 2013

Israeli psychotherapists: Dismissed trauma of Holocaust

Haaretz   [...] Recent research by historian Rakefet Zalashik on the history of psychiatry in Palestine during the Mandate period and following the founding of the state [...]. Indeed, she claims in her 2008 book, "Ad Nefesh: Refugees, Immigrants, Newcomers and the Israeli Psychiatric Establishment" (Hakibbutz Hameuchad; in Hebrew), that the eugenics-based concept of "social engineering" was part of the psychiatric mainstream here from the 1930s through the 1950s. [...]

Eugenics wasn't the only dubious theory the German-Jewish psychiatrists brought with them, Zalashik adds: They also adopted German psychiatry's conception of trauma and its method of treating victims of emotional shock. 

Many psychiatrists in the young state believed that the psyche of Jews was more resilient due to the persecution they endured throughout history. In 1957, Fishel Shneorson published an article in the journal Niv Harofeh, about the emotional fortitude of Holocaust survivors. He argued that there was a lower rate of mental illness among survivors who immigrated to Palestine/Israel than among those who settled elsewhere. 

The theory, widely accepted by psychiatrists here at the time, was that the conditions in this country - the absence of anti-Semitism, combined with the survivors' participation in fighting for and building the nation - had a salutary effect on their mental health. Because of this, psychiatrists tended to attribute a large portion of Holocaust survivors' complaints to immigration difficulties and inter-familial issues, rather than to diagnose them as emotional problems and treat them accordingly. 

The dismissive attitude toward the effect of the Holocaust experience is evident in the case of one Romanian-born Jew, who was admitted in 1955 to Jerusalem's Talbieh Psychiatric Hospital to see whether he was suffering from a psychiatric problem. He was described as "possessing borderline intelligence, very weak social understanding and an infantile personality," and diagnosed as suffering from depression, anxiety, insecurity and aggression. 

Zalashik: "The therapists devoted three whole pages to the patient's life history, from his childhood up to his hospitalization, but this was all they had to say about his wartime experience: 'In 1941, during the war, the patient was taken to the labor camps and was separated from his family. In the camps he did not suffer from any illnesses. After his release from the concentration camps in 1945, he returned to Romania and learned that his entire family had been wiped out.'" 

'Compensation neurosis'
The psychiatrists' attitude toward the survivors' trauma took on added significance in 1952, with the signing of the reparations agreement between Germany and Israel. According to the law in Germany, survivors were entitled to seek compensation for damages caused them by the Nazi persecution. Israeli psychiatrists were asked to write professional opinions about the demands for compensation. Survivors who were not former citizens of Germany, or were not part of the German cultural milieu, were entitled to seek a disability pension from the Israeli Finance Ministry and from the National Insurance Institute, and medical opinions were required for this as well. 

Zalashik concludes that instead of using this opportunity to take a closer look at the survivors' psyches and recognize their mental anguish, the psychiatrists primarily saw themselves as the guardians of the state coffers, and were disinclined to acknowledge the psychological harm wrought by the Nazis. And when they did recognize it, they tended to assign the person in question a minimal level of disability. 

Psychiatrist Kurt Blumenthal went so far as to claim that many survivors were just pretending to have mental problems, when he wrote in 1953 about "compensation neurosis" or "purposeful neurosis," which was ostensibly characterized by an attempt to portray oneself as having suffered great damage in order to increase compensation one would receive. Psychiatrist Julius Baumetz, director of a Jerusalem mental health station, implored his colleagues to do their utmost to put an immediate end to such allegedly neurosis-driven demands, lest survivors' conditions deteriorate to a state of "infantile dependence." 

"The Israeli psychiatrists betrayed their role when they decided to worry more about the state coffers than about their patients," says Zalashik. "When people came to them complaining about nightmares, they told them they were making it up. One German psychiatrist I interviewed said that he was horrified by the opinions he received from Israeli therapists. He said they were so outdated and non-specific that they were harmful to the patients. The theories upon which they were based - i.e., that trauma does not cause any long-term change in personality - were already considered outmoded in Germany in those years." 

Zalashik says this atmosphere made it easier for the Health Ministry to decide that mentally ill Holocaust survivors should be treated in private psychiatric institutions instead of by the public health care system. Survivors were kept in these institutions for decades. Eventually, these facilities became hostels; to this day, they are home to about 700 Holocaust survivors.

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