Hadassah, Ladies and Gentlemen, dear friends. I would like to say some words about one category of prisoners with whom I, for obvious reasons, am especially concerned. Their psychological reactions have been of extraordinary importance to their own possible survival and to that of their fellow prisoners. And I’m referring, as you understand, to the prisoners, who were medical doctors. Even they had to cope with the actual situation, very often by what we call in psychiatry by denial. Without using this defense mechanism it would have been impossible for them to do their work and offer their medical help insufficient as it was. In spite of everything that has been said against becoming accomplices of the SS, the prisoners who were medical doctors alleviated countless sufferings and helped thousands and thousands of fellow prisoners to endure their fate. The fact that there remained a few hundred thousand survivors after the war, the fact that not absolutely all prisoners succumbed to the ill treatment is partly due to the prisoner doctors’ efforts. This is nothing to boast of. It was the simplest of duties, and those doctors who were fortunate enough to be able to help were more than grateful for this opportunity to do so. But from a psychological point of view, it was only their denial of the realities which made it possible for them to act and to work as if their human and medical activity was a normal one and of real help to their fellow prisoners.
A small example will perhaps illustrate what I have said. A colleague and I worked as prison doctors in the “infirmary” of a relatively small side camp of Auschwitz called Świętochłowice, where most of the prisoners did forced labor in a plant producing anti-aircraft guns. One day, a boy with terrible pains was brought to us…from the factory. It turned out that he had a ruptured ulcer of the stomach. Under the most primitive of conditions, on the kitchen table, with shoe-horns and surgical hooks and so on, we managed to close the rupture. And, improbable as it was, our patient survived. But, as with other patients, on whom we had to operate under similar conditions, or whom we could treat with the [indistinguishable], he had to go back to his work and his sufferings in the camp, and unfortunately I’m unable to say whether the operation was a real success. That means whether the patient survived not only the operation, but also the war. Fortunately, we have examples of prisoner patients whom we treated against all possible odds and who survived not only their disease, but also the camp, and whom I’ve met subsequently in different situations after the war. These meetings with former patients, whose treatment was possible or meaningful only when carried out under the complete influence of a denial reaction while disregarding the realities and facts of life, belong to the most important and positive experiences in my medical life. The fact that one can be of help in the most hopeless of situations, and that this help can have long-lasting positive consequences for others cannot be overestimated.
Another example: during the liberation of Auschwitz, for an unknown destination, the staff of the camp hospital marched as a close group together with the other prisoners on one of the seemingly endless and hopeless death marches. Late one evening, exhausted, we reached a sort of a barn in which we could stay overnight. A prisoner came to the camp hospital group because he had severe pains in his legs and back and asked for help. Hopeless as the situation was for everybody, for us just as for everybody else, he received some consolation and a pill against the pains. Without complete denial of the actual facts of utter hopelessness and of the knowledge that everybody unfit to march along with the others was bound to be shot, even this very modest help would have been impossible. And again, I do not know whether this fellow prisoner survived the march or not, but I know that the medical profession would have betrayed itself if this poor fellow had not received this small, perhaps pain-relieving tablet.
You know that emotional blunting has been described as a practical, universal defense mechanism amongst concentration camp inmates. One deep and unchanging grief: the troubling concern about the fate of ones’ nearest whether as they have been arrested at the same time as oneself or whom their whereabouts were unknown; the murderous behavior of the guards; the killing of one’s comrades; the floggings and executions; in brief, all of the unbearable and incredible realities of daily life had, to a certain degree, to be dealt with as if they did not exist. One tried to avoid the awareness of the difficulty of the situation by a type of psychic [indistinguishable] from the realities. It is true that basic psychology tells us that such primitive mechanisms are not very efficient, and that even this moderate effectiveness is achieved only at great costs. We know that in normal life a problem cannot be solved when there is no awareness of it, but in extreme situations there was no realistic possibility of solving the problems, and denying these situations was the only positive way of functioning.
Therefore, may I be allowed to say a few words on general coping in the camps. The group of people who were able to mobilize the most adequate coping mechanisms were those who, for one reason or another, could retain their personality and their system of values more or less intact, even under conditions of nearly complete social [indistinguishable]. Those who were most fortunate in this respect were, as mentioned, the persons who thanks to their profession, could both show and practice interest in others, who could retain their values inside the camp at the same level as outside the camp…These few fortunate ones were some doctors and nurses, as mentioned by your chairperson. They were more preoccupied with the problems of their fellow prisoners than with their own, and came through their trials in a better mental condition than the average inmate of the camp. But only a tiny minority, however, had this good fortune. The greater part had to find other ways of surviving.
I think it necessary to stress that not every kind of denial had a positive function. The most tragic one was a prisoner’s inability to assess how far he could go in using, say, the medical way in order to avoid excessive hard work. While denial of the general death sentence could give positive results, denial of the camp’s tendency was tantamount to being killed immediately. You know all the first process of selection immediately after the Jewish prisoners had left the cattle cars in Auschwitz…and after the arrival in the camp the prisoners were asked if they had some serious diseases, and those who were really were chronically ill or hoped that they could get an easier life by stating that they were seriously ill were selected immediately and sent to the gas chambers. In other words, the prisoner who thought that he could gain some advantage by stressing, for example, his chronic [unclear] pains or by aggravating coughing periods was in a very serious and life threatening situation. Prisoners who denied their being in a life threatening situation, who escaped into daydreams, who did not accept the grim realism of camp life and its immediate, ghastly demands, prisoners who did not try to find an operative adaption mechanism, were also selected very quickly. In Auschwitz, a prisoner who was not able to grasp the total tendency from the outset or who tried to escape reality by denial and fantasy would hardly survive the first working day. It would be pointless to enumerate all the situations that could have a fatal result for a prisoner who was not sufficiently reality-oriented. From the time the alarm sounded in the morning, jumping out of bed precise and correct building it, the roll calls, standing in the right row, marching and so on and so on until the last distribution of the evening portion of a lukewarm watery fluid which sometimes was called soup, sometimes tea or coffee, the whole day was controlled and every moment full of danger. A fatal blow on the head was the most probable result of not assessing the bitter and grim realities of the moment or trying to escape them by any sort of denial.
Denying death could be life saving under certain circumstances, while denying the small seemingly unimportant facts of daily life and struggle would result in a certain and premature death. In [indistinguishable] of the circumstances involved, however able to explain the contradictions showing that basic human values and positive human relationships were of salient importance under…even under these most extreme situations. And I shall try to elaborate on this topic tomorrow in the concluding lecture.