Adult child survivor syndrome on deprived childhoods of aging Holocaust survivors.

UNLABELLED: The present paper aims at understanding the psycho-(patho-)logical status of aging child survivors (CSs) of the Holocaust. BACKGROUND: CSs had deprived childhoods, were exposed to massive trauma and losses, then rebuilt their existences. Their post-Holocaust malaise was suppressed and split off from daily life and overt activities, only to reappear, after a delay, in different forms and intensities, further aggravating upon aging. METHOD: Following a definition of age, origin, number of living CSs, types of early traumatic impacts, and introductory remarks on what CSs experienced as children and as young adults in the postwar society, the psychosocial research on adult and aging CSs is reviewed. RESULTS: The concept of childhood-deprivation and its late sequelae can be substantiated. Definitions of child-survivor complex, CS syndrome and adult child-survivor syndrome are proposed. Non-professional caretakers discerned earlier the existence or extent of the adult CS syndrome Limitations of psychiatric investigation of ACs are the lack of agreed-upon diagnostic criteria.

Narrative group therapy with aging child survivors of the Holocaust.

Child survivors of the Holocaust, aged 1-16 years at liberation in 1945, now well beyond mid-life, are approaching the gerontic stage of their psychosocial development. They find themselves confronted with the demands of aging, as well as unmet needs related to their damaged early development. AMCHA, the National Israeli Center for Psychosocial Support of Holocaust Survivors and the Second Generation, attempted to create a framework for exploring and meeting these needs. An account is given of a narrative group consisting of aging, non-clinical child survivors who met once monthly over a period of more than five years. The individual narratives spun out within the group meetings weave a common texture which served as a context for mutual recognition, dialogue and restoration of meaning to fragmented childhood memories. Retrieval of the lost life stories served as a bridge for the belated "homecoming" of the "lost children." One of the problems is how to resolve the group with the right amount of tears because, regardless of the achievements, mourning is not completed.

Child survivors of the Holocaust: symptoms and coping after fifty years.

Holocaust survivors who were children during WW II have now reached the age of 52 to 67. Until about 10 years ago their voices were barely heard in society. Their successful adaptation to life may have contributed to this invisibility. However, reaching this stage of life, which is associated with the need to review life and with the crises of retirement and renewed losses, has activated the survivors to deal with their childhood. The impossibility of avoiding traumatic memories and an urge to deal with them have also contributed to the societal process of the survivors organizing and speaking out. Very little is known about this group with regard to their mental health status and the way they cope with their childhood memories. The present controlled double-blind study uses a randomized nonclinical sample and focuses on the level of psychosocial and post-traumatic symptoms, on achievement motivation, and on the way child survivors perceive the surrounding world. The results indicate a slightly higher level of psychosocial symptoms in the child survivors group (CS) than in the control group, a high level of post-traumatic symptomatology, and achievement motivation based mainly on the fear of failure. Surprisingly, the child survivors group shows a pattern of more positive views of the world than does the control group. This can be understood as a greater need to compensate for the lack of security suffered in childhood by creating a meaningful world in a chaotic reality.

A controlled double-blind study on children of Holocaust survivors.

The effects of the Holocaust on the offspring of survivors have remained unclear in discussions between clinicians, clinical researchers and empirical researchers. The authors report on a controlled double-blind study designed to test these effects using the sensitivity of clinicians to intrapsychic constellations and processes. The all female sample was randomly selected from several Jerusalem neighborhoods. The index subjects (n = 31), born between 1946 and 1960, had at least one parent (mother) who suffered persecution at the hands of the Nazi regime during WWII. The controls (N = 31), matched for age, educational status and birth order, were born to parents who had not lived under the occupation of the Nazi regime and had not suffered losses of close relatives in WWII. In-depth double-blind interviews, conducted by experienced psychodynamic psychotherapists, focused on personality characteristics without questioning individual development. The only measure used was a 48-item questionnaire completed by the therapists at the end of the interview. The study showed that daughters of Holocaust survivors are characterized by more problems in the realm of separation individuation issues. It also confirmed previous findings that the offspring of Holocaust survivors do not show more psychopathology than the general population.

A randomized controlled outcome and follow-up study of Mann's time-limited psychotherapy.

Thirty-three patients were assessed for suitability for time-limited psychotherapy (TLP). A battery of outcome measures was composed of patient self-report measurements and objective judgments by external ("masked") raters. Patients were randomly assigned to either the experimental group, which received TLP immediately, or the control group, whose TLP was delayed for 3 months. Patients were evaluated on outcome measures at TLP termination and again at 6 and 12 months after termination. Significant improvement was observed in the experimental group after TLP, but the control patients did not show any systemic changes after waiting. However, after TLP, the control patients improved significantly. The average effect size measured by the differences between gain scores of the experimental patients (before vs. after treatment) and those of the control patients (before vs. after waiting) was 0.986 SD. The gains achieved after therapy were stable in both groups after 6- and 12-month follow-ups.

Attitudes of therapists toward Holocaust survivors.

This study examined current feelings and attitudes toward Holocaust survivors in a sample of 205 Israeli mental health professionals. Subjects were asked to read two vignettes each describing an aged trauma victim who had recently applied for treatment. The first vignette presented a Holocaust survivor and the second a war veteran. The two "patients" were otherwise similar in background and clinical picture. After reading each vignette, subjects were asked to report their feelings toward the patient. Subjects also completed a detailed questionnaire that assessed attitudes on several issues related to the Holocaust. Feelings toward the Holocaust survivor were found to be more intense and more positive than feelings toward the combat veteran. Therapists' attitudes toward Holocaust survivors were also found to be highly and consistently positive. Compared to previous reports, they appear to reflect a change of heart in relation to the past. Therapist background variables were not found to play a major role in determining attitudes toward Holocaust survivors.

Demandingness and belligerence in hospitalized depressed Holocaust concentration camp survivors as perceived by the staff.

Twelve staff members, blind to the hypotheses, rated depressed, hospitalized concentration camp survivors, 40 years after their liberation, as more demanding, belligerent and irritating in their behavior towards staff in comparison with their matched counterparts. Survivors' behavior was discussed in terms of reenactment of traumatic scenes from their past. Staff shows consistent although not significant tendencies to dislike the survivors. Theoretical and clinical implications were drawn.

Two-year trial of maintenance neuroleptic dose reduction in schizophrenic out-patients: predictors of relapse.

Low dose maintenance therapy has been proposed as a pharmacological strategy for reducing exposure to neuroleptic drugs in schizophrenia. However, reliable predictors of post-dose reduction relapse, which could guide clinicians in selecting patients suitable for this type of treatment, have not yet been determined. In this study, 41 schizophrenic out-patients were assigned, on the basis of their previously clinically determined dosages, to one of two reduced maintenance fluphenazine decanoate regimes (35 mg/4 wks. or 10 mg/4 wks.) and were assessed, subsequently, for a 2-year period. Demographic, clinical and treatment characteristics of relapsers (22 patients) and non-relapsers (18 patients) were compared using univariate and multivariate tests. Four parameters: age, course of illness, duration of illness and duration since last psychiatric hospitalization, suggested, in univariate tests, significant discrimination between relapsers and non-relapsers. Stepwise discriminant function analyses defined a highly significant function (p < .01) which included only 3 predictors of relapse. In order of importance, these predictors were: (1) a history of chronic psychosis (2) male sex, and (3) an illness of short duration. Parameters such as age, baseline rating scales scores, magnitude of dose reduction and baseline maintenance dose failed to improve the ability to discriminate between relapsers and non-relapsers. Implications of these findings for clinical practice are discussed.

Aggression expression in grandchildren of Holocaust survivors--a comparative study.

Ninety-seven Israeli children (59 girls and 38 boys), with a mean age 10.1 +/- 1.9, participated in this study. Fifty-four of them were grandchildren of Holocaust survivors, and 43 were controls. All subjects were administered the EAS, a projective test designed to assess the extent of externalization of aggression in reaction to frustrating events. Grandchildren of Holocaust survivors did not differ in their expression of aggression from controls. As difficulties in externalizing aggression are considered in the literature to be a central factor in the maladaptation of survivors and subsequently in their sons and daughters, the results of the present study were interpreted to be one possible indication that transgenerational transmission of trauma has ceased in the third generation.

Trial of maintenance neuroleptic dose reduction in schizophrenic outpatients: two-year outcome.

BACKGROUND: An open trial was undertaken to assess the feasibility of reducing maintenance doses in a public clinical setting and to identify eventual predictors of outcome after dose reduction in schizophrenia. METHOD: Forty-one remitted and chronically psychotic schizophrenic outpatients were assigned, on the basis of their previously clinically determined maintenance dosages, to one of two reduced fluphenazine decanoate regimens: 35 mg/4 wk (19 patients) or 10 mg/4 wk (22 patients). Subsequently, patients were assessed, for a 2-year period, by means of the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Simpson-Angus Scale, and the Abnormal Involuntary Movement Scale. RESULTS: Chronically psychotic patients, who represented 74% of the high-dose group and only 14% of the low-dose group, had a significantly higher cumulative relapse rate (81%) than remitted patients (38%). For most remitted patients a dose of 10 mg of fluphenazine decanoate, injected every 4 weeks, was satisfactory. Both remitted and chronically psychotic patients displayed reductions in the severity of neuroleptic side effects. CONCLUSION: Maintenance dose reductions may be beneficial for many schizophrenic outpatients. Chronically psychotic and remitted patients maintained on lowered dosages differ significantly in the stability of their course of illness.

The unfinished story of trauma as a paradigm for psychotherapists (a review and some empirical findings on paradigms and prejudices).

Notwithstanding the medical connotation of the term "trauma," (defined as wound, injury), when trauma comes in the wake of organized violence, it is thus a part of complicated inter-actional, cultural and historical phenomena. Two of the currently valid diagnostic and therapeutic paradigms are spelled out in this article, i.e. The first presented is the one of the "unfinished story," of the impact of the primary trauma then and there, and the second presented is one of the post-re-entry "alienation" of the secondary trauma here and now. Shifting the latter to the foreground focuses attention upon the functioning of the therapist rather than on that of the victim. A review of the literature on the behavior of the post-violent society towards its post-traumatic subjects in general, will also be presented. Furthermore, clinicians' attitudes, in particular, suggestive of 5 levels of therapist functioning that could then be discerned in empirical subpopulations of Israeli psychotherapists (N = 34), in relation to the Holocaust trauma, was also examined. We found that their attitudes and reactions were influenced by their own and their parents' past roles in history, their cultural backgrounds, and clinical subculture or setting that they belonged to. The implications of these findings for post-trauma therapy are briefly discussed in this essay.

The impact of the Demjaniuk trial on the psychotherapeutic process in Israel.

The Demjaniuk trial was a national experience and people showed great interest in it, more than the organizers of the trial had expected. Many therapists expressed interest in the trial. They stressed the importance of the trial and their identification with it. In some questionnaires, therapists reported dramatic reactions and revival of survivors syndrome. Therapists who were sensitive and perceptive to the subject of the Holocaust reported definite reactions in their patients. On the other hand, therapists who were inclined to isolation, denial and avoidance of this subject, reported that their patients did not react or that their reactions were only superficial. Therapists reported that second generation patients tended to stronger identification with their parents following the trial. The trial served as a catalyst for the treatment and also made them more interested in knowing more about their parents. It broke down a barrier between survivors and those who did not experience the Holocaust, according to one of the therapists. In our opinion, it also broke down a barrier between first and second generation. Many therapists reported strong identification with their patients, especially when both therapist and patient were of the same generation in relation to the Holocaust. Some patients reacted strongly to the trial and needed more frequent treatment sessions, more drugs and sometimes even hospitalization, but in many cases the trial had a positive influence on the therapeutic process and important content emerged in treatment. The trial enabled many patients to work through the mourning process, which previously they did not allow themselves to experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Why we were silent--an Israeli psychiatrist speaks to Germans on psychic pain and past persecution.

Professor Dasberg, the Elie Wiesel professor at the Bar Ilan University and the co-founder of "Amcha", delivered this speech at the Humboldt University in Berlin on the anniversaries of the Kristalnacht and the recent unification of Berlin. Professor Dasberg was serving as the president of The Israel Psychiatric Association at the time.

Core symptoms of posttraumatic stress disorder unimproved by alprazolam treatment.

The authors report a random-assignment, double-blind crossover trial comparing alprazolam and placebo in posttraumatic stress disorder (PTSD). Ten patients fulfilling DSM-III criteria for PTSD completed 5 weeks of treatment on each agent. Improvement in anxiety symptoms was significantly greater during alprazolam treatment but modest in extent. Symptoms specific to PTSD were not significantly altered. The impact of nonspecific symptomatic effects on the outcome of drug trials in PTSD is considered.

Mental illness and religious change.

Over the last 20 years there has been a revival of interest in orthodox Judaism in Israel. In an area of Jerusalem with a large concentration of academies of study for 'baalei teshuva' (those who have undergone change to orthodox Judaism), it was noted that 12.6 per cent of referrals to the community mental health centre were newly religious. These referrals tended to have schizophrenia or severe personality disorders and were less likely than other referrals to have anxiety, depressive or adjustment disorders. Most of the newly religious referrals had psychiatric problems prior to becoming religious. Subsequent to religious change, many married and started a family before their psychiatric referral. The link between religious change and mental illness is explored.

Family expressed emotion: concepts, dilemmas and the Israeli perspective.

Family characteristics of high "expressed emotion" (EE) have been found to be predictive of relapse in schizophrenia and other psychiatric disorders. A causal relationship has been postulated between relapse and components of EE as assessed in the relatives with whom the patient has close social contact. Recently, conceptual and methodological aspects of the EE paradigm have become the focus of controversy. We present the dilemmas under debate and discuss the implications relevant to the study of EE in Israel.

A two-year follow-up of time limited therapy in a community mental health center in Jerusalem.

The present paper reports on a quantitative two-year follow-up of small cohort of somewhat unusual, selected, brief therapy cases treated by modified James Mann methods. The follow-up demonstrates the feasibility of conducting qualitative research in time limited therapy in a setting of community mental health care. The findings show favorable and durable clinical results.

Prescribing patterns of neuroactive drugs in 98 schizophrenic patients.

Ninety-eight schizophrenic outpatients receiving pharmacotherapy were surveyed on two census days, 18 months apart. From this study sample it was found that, as recently as 1987, 18% of the patients were prescribed three classes of neuroactive drugs--16% two antipsychotic drugs simultaneously. Of antipsychotics receivers, 44% were prescribed anticholinergics, 3% antidepressants, and 4% benzodiazepines. Between census days, a significant shift from use of oral antipsychotics to the depot form of administration occurred, while polypharmacy frequency remained unchanged. An analysis of the data will provide guidelines for rendering a more rational pharmacological treatment.

Post-partum psychosis in adult GM2 gangliosidosis. A case report.

Adult hexosaminidase A deficiency is a form of GM2 gangliosidosis with autosomal recessive inheritance. Only 35 cases (mostly among Ashkenazic Jews) have been reported worldwide. Symptoms include, in a third of the cases, psychosis. A 27-year-old sufferer with no prior psychiatric history, developed a post-partum psychosis, with affective and hebephrenic components, 3 days following her first delivery. She responded to lithium within 10 days of initiating treatment; the full episode lasted 1 month. We conclude that lithium is the preferred treatment for psychosis in such adult patients, especially in light of possible long-term neurological deterioration caused by phenothiazines. Ashkenazic Jews with atypical neurological syndromes presenting with psychosis should be tested for hexosaminidase A deficiency.