Recovery and regression in concentration camp survivors: a psychodynamic re-evaluation.

This paper focuses on the adaptive capacity of survivors, and, by reframing the psychodynamics of the "survivor syndrome", employing Object Relations theory and Self Psychology, attempts to shed light on the recovery process and the subsequent regressive responses in later life. Historically, an understanding of the survivor syndrome was impeded by the severity and uniqueness of the trauma. Survivors demonstrated symptoms that were not always congruent with the established diagnosis "traumatic neurosis", and conventional psychoanalytic psychotherapy which aimed at lifting the repression of the persecution often failed. Despite reports of "late" physiologic sequelae, recent work has focused on the survivor's capacity to recover. Survival during the persecution entailed maintaining perceptual defences, maintaining an attachment to the world and the objects in it, and despite the fragmenting effect of these two sets of mechanisms, maintaining an integrated sense of self. Three clinical vignettes are presented to demonstrate that during the recovery process a degree of reversal of the survival mechanisms was necessary. This required taking into oneself or acknowledging the anger evoked by the persecution, which, associated with the fragmenting effect of the persecution on the sense of self, often resulted in guilt and self-loathing, and affected the vicissitudes of the survivor's personal story. Often the self-selfobject function required bolstering by particular relationships. The triggers for later regression responses in survivors are events that evoke rage or serve as a symbolic bridge to memories of the persecution, and life changes that generate altered relationships that had served a self-selfobject function.(ABSTRACT TRUNCATED AT 250 WORDS)