THE DIFFERENTIAL IMPACT OF HOLOCAUST TRAUMA ACROSS … · Holocaust survivors, and the differential intergenerational transmission of this trauma to survivors’ children and grandchildrenwere

THE DIFFERENTIAL IMPACT OF HOLOCAUST TRAUMA ACROSS THREE

GENERATIONS

Janine Lurie-Beck

Bachelor of Arts (Double Major Psychology) University of Queensland 1994-1996

Graduate Diploma Social Science (Psychology)

Queensland University of Technology 1997

A thesis submitted for the award of Doctor of Philosophy

in the School of Psychology and Counselling

Faculty of Health

Queensland University of Technology

2007

© Janine Lurie-Beck 2007 ii

Key words

Holocaust survivors, children, grandchildren, meta-analysis, intergenerational

transmission of trauma, anxiety, depression, post-traumatic vulnerability, parent-child

attachment, romantic attachment, family cohesion, separation-individuation,

communication, coping, world assumptions, post-traumatic stress, post-traumatic

growth, demographic differences.

© Janine Lurie-Beck 2007 iii

Abstract

In the current thesis, the reasons for the differential impact of Holocaust trauma on

Holocaust survivors, and the differential intergenerational transmission of this trauma to

survivors’ children and grandchildren were explored. A model specifically related to

Holocaust trauma and its transmission was developed based on trauma, family systems

and attachment theories as well as theoretical and anecdotal conjecture in the Holocaust

literature. The Model of the Differential Impact of Holocaust Trauma across Three

Generations was tested firstly by extensive meta-analyses of the literature pertaining to

the psychological health of Holocaust survivors and their descendants and secondly via

analysis of empirical study data.

The meta-analyses reported in this thesis represent the first conducted with

research pertaining to Holocaust survivors and grandchildren of Holocaust survivors.

The meta-analysis of research conducted with children of survivors is the first to include

both published and unpublished research. Meta-analytic techniques such as meta-

regression and sub-set meta-analyses provided new information regarding the influence

of a number of unmeasured demographic variables on the psychological health of

Holocaust survivors and descendants. Based on the results of the meta-analyses it was

concluded that Holocaust survivors and their children and grandchildren suffer from a

statistically significantly higher level or greater severity of psychological symptoms

than the general population. However it was also concluded that there is statistically

significant variation in psychological health within the Holocaust survivor and

descendant populations. Demographic variables which may explain a substantial

amount of this variation have been largely under-assessed in the literature and so an

empirical study was needed to clarify the role of demographics in determining survivor

and descendant mental health.

A total of 124 participants took part in the empirical study conducted for this

thesis with 27 Holocaust survivors, 69 children of survivors and 28 grandchildren of

survivors. A worldwide recruitment process was used to obtain these participants.

Among the demographic variables assessed in the empirical study, aspects of the

survivors’ Holocaust trauma (namely the exact nature of their Holocaust experiences,

the extent of family bereavement and their country of origin) were found to be

particularly potent predictors of not only their own psychological health but continue to

be strongly influential in determining the psychological health of their descendants.

Further highlighting the continuing influence of the Holocaust was the finding that

© Janine Lurie-Beck 2007 iv

number of Holocaust affected ancestors was the strongest demographic predictor of

grandchild of survivor psychological health.

Apart from demographic variables, the current thesis considered family

environment dimensions which have been hypothesised to play a role in the

transmission of the traumatic impact of the Holocaust from survivors to their

descendants. Within the empirical study, parent-child attachment was found to be a key

determinant in the transmission of Holocaust trauma from survivors to their children

and insecure parent-child attachment continues to reverberate through the generations.

In addition, survivors’ communication about the Holocaust and their Holocaust

experiences to their children was found to be more influential than general

communication within the family.

Ten case studies (derived from the empirical study data set) are also provided;

five Holocaust survivors, three children of survivors and two grandchildren of

survivors. These cases add further to the picture of heterogeneity of the survivor and

descendant populations in both experiences and adaptations.

It is concluded that the legacy of the Holocaust continues to leave its mark on

both its direct survivors and their descendants. Even two generations removed, the

direct and indirect effects of the Holocaust have yet to be completely nullified.

Research with Holocaust survivor families serves to highlight the differential impacts of

state-based trauma and the ways in which its effects continue to be felt for generations.

The revised and empirically tested Model of the Differential Impact of Holocaust

Trauma across Three Generations presented at the conclusion of this thesis represents a

further clarification of existing trauma theories as well as the first attempt at

determining the relative importance of both cognitive, interpersonal/interfamilial

interaction processes and demographic variables in post-trauma psychological health

and transmission of traumatic impact.

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Table of Contents

Key words ......................................................................................................................... ii Abstract ............................................................................................................................ iii List of Tables ................................................................................................................. xiii List of Figures ................................................................................................................ xxi Prologue ............................................................................................................................ 1 Section A .......................................................................................................................... 2 Background Literature Review of Psychological Research into the Effects of the Holocaust on Survivors and their Descendants ................................................................ 2 Chapter One – Introduction .............................................................................................. 3

1.1. – The Holocaust as a Unique Trauma of Interest .................................................. 4 1.1.1. – The Structure of a Traumatic Event ............................................................ 5 1.1.2. – Active versus Passive Roles in Traumatic Events ....................................... 5 1.1.3. – The Rationalisation of Traumatic Events .................................................... 6 1.1.4. – The Aftermath of Traumatic Events ............................................................ 7 1.1.5. – Overview of the Assessment of the Holocaust as a Traumatic Experience 8

1.2 – The Nature of Holocaust Trauma ........................................................................ 9 1.2.1. – The Initial Phase: Gradual Removal of Civil Rights ................................... 9 1.2.2. – Phase Two: The Formation of Ghettos ...................................................... 10 1.2.3. – Phase Three: Labour and Concentration Camps ...................................... 11 1.2.4. – Alternatives to Camp Life ......................................................................... 12 1.2.5. – Immediate Aftermath: Displaced Persons Camps .................................... 12

1.3. – Thesis Aims and Rationale ............................................................................... 14 1.3.1 – Stage One: Meta-Analysis ......................................................................... 14 1.3.2. – Stage Two: Empirical Study ..................................................................... 15

1.4. – Thesis Overview ............................................................................................... 16 Chapter Two – The Study of the Impact of the Holocaust on Survivors and their Descendants .................................................................................................................... 17

2.1. – Impact on Survivors ......................................................................................... 17 2.1.1. – History of the Assessment of Holocaust Survivor Mental Health............. 17 2.1.2. – Depression ................................................................................................. 22 2.1.3. – Anxiety ...................................................................................................... 22 2.1.4. – Posttraumatic Stress Disorder Symptoms ................................................. 23 2.1.5. – Paranoia/Fear of Further Persecution ........................................................ 23 2.1.6. – Interpersonal Trust and Intimacy ............................................................... 24 2.1.7 – Factors Affecting the Severity of the Impact of Holocaust Trauma ........... 24

2.1.7.1. – Coping styles and strategies. .............................................................. 24 2.1.7.2. – World assumptions. ............................................................................ 25

2.1.8. – Posttraumatic Growth ................................................................................ 26 2.2. – Impact on Children of Survivors ...................................................................... 27 2.3. – Impact on Grandchildren of Survivors ............................................................. 29 2.4. – Summary of the Impacts of the Holocaust across Three Generations .............. 30 2.5. – Critique of Research regarding Holocaust Survivors and Descendants ........... 31

2.5.1. – Definition of “Holocaust Survivor” and “Child of a Holocaust Survivor”31 2.5.2. – Nature of Control Groups .......................................................................... 32 2.5.3. – Sample Recruitment Methods ................................................................... 34 2.5.4. – Differences between Clinical and Non-clinical Study Results .................. 36 2.5.5. – Assessment of Demographic Differentials ................................................ 38

2.6. – Summary and Conclusions ............................................................................... 40 Chapter Three – The Intergenerational Transmission of Holocaust Trauma ................. 42

3.1. – Parent-Child Attachment .................................................................................. 44 3.1.1. – Survivor Parents’ Insecure Attachment to their Children ......................... 45

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3.1.2 – Negative Effects of Insecure Attachment of Children to Parents ............... 47 3.2. – Family Cohesion ............................................................................................... 50

3.2.1. – Extreme Levels of Cohesion in Survivor Families .................................... 50 3.2.2. – Extreme Family Cohesion as it Relates to the Psychological Health of Children .................................................................................................................. 51

3.3. – Separation-Individuation .................................................................................. 52 3.3.1. – Separation-individuation problems noted among children of survivors ... 52 3.3.2. – Relationship between Separation-individuation Problems and Negative Psychological Outcomes ........................................................................................ 54

3.4. – Communication ................................................................................................ 54 3.5. – Summary and Conclusions ............................................................................... 60

Chapter Four – Demographic and Situational Differentials in the Impact of the Holocaust on Survivors .................................................................................................. 62

4.1. – Age during the Holocaust ................................................................................. 63 4.2. – Time Lapse since the Holocaust ....................................................................... 68 4.3. –Gender ............................................................................................................... 69 4.4. – Country of Origin ............................................................................................. 71 4.5. – Cultural Differences ......................................................................................... 73 4.6. – Reason for Survivor’s Persecution ................................................................... 73 4.7. – Nature of Holocaust Experiences ..................................................................... 75 4.8. – Loss/Survival of Family Members during the Holocaust ................................. 78 4.9. – Post-war Settlement Location ........................................................................... 81

4.9.1. – Europe. ....................................................................................................... 82 4.9.2. – Continents other than Europe. ................................................................... 84 4.9.3. – Israel. ......................................................................................................... 85

4.10. – Amount of Tme before Resettlement ............................................................. 88 4.11. – Summary and Conclusions ............................................................................. 88

Chapter Five – Demographic and Situational Differentials in the Impact of the Holocaust on Descendants of Survivors ......................................................................... 91

5.1. – Children of Holocaust Survivor/s ..................................................................... 91 5.1.1. – Gender ....................................................................................................... 91 5.1.2. – One versus Two Survivor Parents ............................................................. 92 5.1.3. – Birth Order ................................................................................................. 94 5.1.4. – Length of Time between the End of the War and the Birth of Children ... 94 5.1.5. – Birth Before or After Parental Emigration ................................................ 97

5.2. – Grandchildren of Holocaust Survivor/s ............................................................ 98 5.3. – Summary and Conclusions ............................................................................... 98

Section B ...................................................................................................................... 101 Meta-Analyses of Holocaust Survivor and Descendant Research ............................... 101 Chapter Six – Meta-Analysis Methodology ................................................................. 102

6.1. – Justification for Meta-analytic Methodology ................................................. 102 6.2. – Literature Search Methodology ...................................................................... 105

6.2.1. – Citation Sources ....................................................................................... 105 6.2.2. – Process for Identifying Relevant Articles from Search Results .............. 106

6.3. – Criteria for Inclusion of Studies in Meta-analysis .......................................... 107 6.3.1. – Criteria used for Sample Selection .......................................................... 107 6.3.2. – Operationalisation of Variables ............................................................... 108

6.4. – Collection of Relevant Data/information from Individual Studies ................ 108 6.4.1. – Mean Differences between Two Groups ................................................. 109 6.4.2. – Incidence Differences between Two Groups........................................... 110

6.5. – Checks for Duplication of Results .................................................................. 110 6.6. – Calculation Methods for Meta-Analyses ........................................................ 111

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6.6.1. – Mean Differences between Two Groups ................................................. 112 6.6.2. – Incidence Differences between Two Groups........................................... 112

6.7. – Sub-Group Meta-Analyses ............................................................................. 112 6.8. – Meta-Regression: Correlation of Study Effect Sizes with Study Attributes .. 113 6.9. – Criteria for Inclusion of Multiple Results from Single Studies in Meta-Analysis .................................................................................................................................. 114 6.10. – Methods for Dealing with Missing Data ...................................................... 115

6.10.1. – Missing Standard Deviations ................................................................. 115 6.10.2. – Presentation of Significance Tests without Means or Standard Deviations .............................................................................................................................. 115 6.10.3. – Statement of Result without Data or Statistics Reported ...................... 116

6.11. – Interpretation of Meta-Analytic Findings ..................................................... 117 6.11.1. – The File Drawer Question ..................................................................... 117 6.11.2. – Testing the Homogeneity of Effect Size Sets ........................................ 118

6.12. – Overview of Meta-Analysis Section of Thesis ............................................. 119 Chapter Seven – Meta-Analyses of Survivor and Descendant Groups versus Control Groups/General Population .......................................................................................... 120

7.1. – Method ............................................................................................................ 121 7.2. – Holocaust Survivors versus Control Groups .................................................. 121

7.2.1. – Meta-analytic Results .............................................................................. 121 7.2.2. – Studies Excluded from Meta-analyses .................................................... 123

7.3. – Children of Holocaust Survivor/s versus Control Groups .............................. 124 7.3.1. – Meta-analytic Results .............................................................................. 124 7.3.2. – Studies Excluded from Meta-analyses .................................................... 125

7.4. – Grandchildren of Holocaust survivors versus Control Groups ...................... 127 7.4.1. – Meta-analytic Results .............................................................................. 127 7.4.2. – Studies Excluded from Meta-analyses .................................................... 127

7.5. – Summary and Conclusions ............................................................................. 128 Chapter Eight – Meta-Analyses of the Moderating Influence of Demographic Variables among Holocaust Survivors.......................................................................................... 130

8.1. – Method ............................................................................................................ 130 8.2. – Nature of Holocaust Experiences. .................................................................. 130 8.3. – Country of Origin ........................................................................................... 134 8.4. – Loss of Family Members ................................................................................ 135 8.5. – Gender ............................................................................................................ 136

8.5.1. – Meta-analytic Results .............................................................................. 136 8.5.2. – Studies Excluded from Meta-analyses .................................................... 138

8.6. – Age during the Holocaust ............................................................................... 140 8.7. – Time Lapse since the Holocaust ..................................................................... 144 8.8. – Post-war Settlement Location ......................................................................... 146 8.9. – Membership of Survivor Organisations/Support Groups ............................... 149 8.10. – Summary and Conclusions ........................................................................... 149

Chapter Nine – Meta-Analyses of the Moderating Influence of Demographic Variables among Descendants of Holocaust Survivors ................................................................ 151

9.1. – Method ............................................................................................................ 151 9.2. – Demographic Differences within the Children of Holocaust Survivor/s Group .................................................................................................................................. 151

9.2.1. – Number of Survivor parents .................................................................... 152 9.2.2. – Gender of Survivor Parent ....................................................................... 154 9.2.3. – Type of Survivor parent’s Holocaust experiences ................................... 154 9.2.4. – Parental Loss of Family Members ........................................................... 157 9.2.5. – Survivor Parent/s Country of Origin ....................................................... 158

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9.2.6. – Age of Survivor Parent/s during the Holocaust. ...................................... 159 9.2.7. – Length of time between the end of the war and the birth of children...... 161 9.2.8. – Location of post-war settlement. ............................................................. 163 9.2.9. – Gender ..................................................................................................... 165 9.2.10. – Birth Order ............................................................................................. 167 9.2.11. – Membership of Descendants of Survivors Organisations or Support Groups .................................................................................................................. 168

9.3. – Grandchildren of Holocaust Survivors ........................................................... 169 9.3.1. – Gender ..................................................................................................... 169 9.3.2. – Number/Gender of Child of Survivor Parent/s ........................................ 169

9.4. – Summary and Conclusions ............................................................................. 170 Chapter Ten – Refinement of the Model of the Differential Impact of Holocaust Trauma across Three Generations based on Meta-Analyses ..................................................... 171

10.1. – Adequacy of the Assessment of Demographic Differences among Holocaust Survivors and Descendants in the Literature ............................................................ 171

10.1.1. – Adequacy of Demographic Analysis for Holocaust Survivors ............. 171 10.1.2. – Adequacy of Demographic Analysis for Children of Holocaust Survivors .............................................................................................................................. 172 10.1.3. – Adequacy of Demographic Analysis for Grandchildren of Holocaust Survivors ............................................................................................................... 173

10.2. – Intergenerational Differences within the Holocaust Population ................... 174 10.2.1. – Direct Intergenerational Comparisons in the Literature ........................ 174 10.2.2. – Indirect Intergenerational Comparisons via Meta-analysis ................... 177

10.3. – The Need for Further Investigation .............................................................. 178 10.4. – Hypotheses for Empirical Study ................................................................... 178

10.4.1. – Hypotheses Regarding the Relationships between Model Variables .... 178 10.4.1.1. – The impact of influential psychological processes. ........................ 178 10.4.1.2. –The odes of intergenerational trauma transmission. ........................ 179

10.4.2. – Hypotheses Regarding the Influence of Demographic Variables ......... 180 10.4.3. – Hypotheses Relating to Membership of Survivor or Descendant of Survivor Groups ................................................................................................... 182

10.5. – Summary and Conclusions ........................................................................... 183 Section C ...................................................................................................................... 185 Empirical Assessment of the Model of the Differential Impact of Holocaust Trauma across Three Generations.............................................................................................. 185 Chapter Eleven – Empirical Study Rationale and Methodology .................................. 186

11.1. Rationale of the Empirical Study..................................................................... 186 11.2. – Method .......................................................................................................... 187

11.2.1. – Design .................................................................................................... 187 11.2.2. – Sample ................................................................................................... 187 11.2.3. – Procedure ............................................................................................... 188 11.2.4. – Translations ........................................................................................... 190 11.2.5. – Measures ................................................................................................ 191

11.2.5.1. – Depression Anxiety Stress Scales (DASS) ..................................... 192 11.2.5.2. – Impact of Events Scale – Revised (IES-R) ..................................... 192 11.2.5.3. – Post-Traumatic Vulnerability Scale (PTV) .................................... 193 11.2.5.4. – Adult Attachment Scale (AAS) ...................................................... 194 11.2.5.5. – Post-Traumatic Growth Inventory (PTGI) ..................................... 196 11.2.5.6. – COPE – Long Version .................................................................... 197 11.2.5.7. – Benevolence and Meaningfulness of the World sub-scales of the World Assumptions Scale (WAS) .................................................................... 199 11.2.5.8. – Parental Care-giving Style Questionnaire (PCS) ........................... 199

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11.2.5.9. – Parental Fostering of Autonomy Subscale of the Parental Attachment Questionnaire (PAQ-PFA) ............................................................................... 200 11.2.5.10. – Lichtman Holocaust Communication Questionnaire (HCQ) ....... 201 11.2.5.11. – Cohesion and Expressiveness Subscales of the Family Environment Scale (FES) ....................................................................................................... 202 11.2.5.12. – Control questionnaire for historical influences. ........................... 203 11.2.5.13. – Omission of unresolved mourning measure. ................................ 203 11.2.5.14. – Ordering of questionnaires in questionnaire booklets. ................. 204

11.3. – Description of Sample Obtained .................................................................. 205 11.3.1. – Description of Holocaust Survivor Sample ........................................... 205 11.3.2. – Description of Children of Holocaust Survivor Sample ........................ 206 11.3.3. – Description of Grandchildren of Holocaust Survivor Sample ............... 207

11.4. – Statistical Analysis Approach ....................................................................... 208 Chapter Twelve – Empirical Assessment of Influential Psychological Processes and Modes of Intergenerational Transmission Modes among Survivors and Descendants 211

12.1. – The Role of Influential Psychological Processes in Predicting Severity of Psychological Impacts .............................................................................................. 213

12.1.1. – Influence of Coping Strategies .............................................................. 213 12.1.2. – Influence of World Assumptions of Benevolence and Meaningfulness 214 12.1.3. – Summary of the Role of Influential Psychological Processes ............... 215

12.2. – The Relationship between Posttraumatic Growth and Psychological Impact Variables ................................................................................................................... 216 12.3. –The Role of the Proposed Modes of Trauma Transmission/Family Interaction Variables ................................................................................................................... 217

12.3.1. – Influence of Parent-child Attachment Dimensions ............................... 217 12.3.2. – Influence of Family Cohesion ............................................................... 219 12.3.3. – Influence of Parental Encouragement of Independence ........................ 221 12.3.4. – Influence of Level of Family Communication ...................................... 222 12.3.5. – Influence of Communication about the Holocaust ................................ 223 12.3.6. – Summary of the Influence of Family Interaction Variables .................. 224

12.4. – Intergenerational Differences ....................................................................... 228 12.4.1. – Intergenerational Differences on Psychological Impact Variables ....... 228 12.4.2. – Intergenerational Differences on Influential Psychological Processes .. 230 12.3.3. – Intergenerational Differences on Perceptions of Family Interaction ..... 231

12.5. – Summary and Conclusions ........................................................................... 233 Chapter Thirteen – Empirical Assessment of the Moderating Role of Holocaust Survivor Demographic Variables ................................................................................. 239

13.1. – Demographic Variable Inter-relationships ................................................... 241 13.2. – Moderating Influence of Holocaust Survivor Demographics....................... 242

13.2.1. – Holocaust Survivor Gender ................................................................... 243 13.2.1.1 – Influence on survivor and descendant psychological health. .......... 243 13.2.1.2. – Influence on children of survivors’ perception of their parents/family environment. ..................................................................................................... 244

13.2.2. – Holocaust Survivor Age during the Holocaust ...................................... 245 13.2.2.1. – Influence on survivor and descendant psychological health. ......... 245 13.2.2.2. – Influence on children of survivors’ perceptions of their parents/family environment. ............................................................................. 246

13.2.3. – Nature of Holocaust Experiences .......................................................... 247 13.2.3.1. – Influence on survivor and descendant psychological health. ......... 247 13.2.3.2. – Influence on children of survivors’ perception of their parents/family environment. ..................................................................................................... 251

13.2.4. – Loss of Family ....................................................................................... 254

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13.2.4.1. – Influence on survivor and descendant psychological health. ......... 254 13.2.4.2. – Influence on children of survivors’ perceptions of their parents/family environment. ............................................................................. 256

13.2.5. – Holocaust Survivors’ Country of Origin ............................................... 258 13.2.5.1. – Influence on survivor and descendant psychological health. ......... 258 13.2.5.2. – Influence on children of survivors’ perception of their parents/family environment. ..................................................................................................... 260

13.2.6. – Length of Time after 1945 Before Survivor Resettlement .................... 262 13.2.6.1. – Influence on survivor and descendant psychological health. ......... 262 13.2.6.2. – Influence on children of survivor’s perception of their parents/family environment. ..................................................................................................... 263

13.2.7. – Post-war Settlement Location of Survivors ........................................... 264 13.2.7.1. – Influence on survivor and descendant psychological health. ......... 264 13.2.7.2. – Influence on survivor descendants’ perception of their parents/family environment. ..................................................................................................... 266

13.3. – Summary and Conclusions ........................................................................... 268 Chapter Fourteen – Empirical Assessment of the Moderating Role of Descendant Demographic Variables ................................................................................................ 272

14.1. – Demographic Variable Inter-relationships ................................................... 274 14.1.1. – Child of Survivor Demographic Variable Inter-relationships ............... 274 14.1.2. – Grandchild of Survivor Demographic Variable Inter-relationships ...... 275

14.2. – Moderating Influence of Child of Survivor Demographics.......................... 275 14.2.1. – Number of Holocaust Survivor Parents ................................................. 275

14.2.1.1. – Influence on descendant psychological health. .............................. 275 14.2.1.2. – Influence on survivor descendants’ perception of their parents/family environment. ..................................................................................................... 276 14.2.1.3. – Perceptions of survivor versus non-survivor parents. .................... 277

14.2.2. – Time Lapse between the Holocaust and the Birth of Children of Survivors .............................................................................................................................. 278

14.2.2.1. – Influence on descendant psychological health. .............................. 278 14.2.2.2. – Influence on descendants’ perceptions of their parents/family environment. ..................................................................................................... 279

14.2.3. – Child of Survivor Gender ...................................................................... 281 14.2.3.1. – Influence on descendant psychological health. .............................. 281 14.2.3.2. – Influence on descendants’ perceptions of their parents/family environment. ..................................................................................................... 282 14.2.3.3. – Interaction between parent gender and descendant gender. ........... 283

14.2.4. – Child of Survivor Birth Order ............................................................... 285 14.2.4.1. – Influence on children of survivor psychological health. ................ 285 14.2.4.2. – Influence on children of survivors’ perceptions of their parents/family environment. ............................................................................. 286

14.3. – Moderating Influence of Grandchild of Survivor Demographics ................ 287 14.3.1. – Number of Child of Survivor Parents/Survivor Grandparents .............. 287

14.3.1.1. – Influence on descendant psychological health. .............................. 287 14.3.1.2. – Influence on descendants’ perceptions of their family environment.t .......................................................................................................................... 288 14.3.1.3. – Perceptions of child of survivor versus non-child of survivor parents. .......................................................................................................................... 289

14.3.2. – Grandchild of Survivor Gender ............................................................. 290 14.3.2.1. – Influence on descendant psychological health. .............................. 290 14.3.2.2. – Influence on descendants’ perceptions of their parents/family environment. ..................................................................................................... 291

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14.3.2.3. – Interaction between parent gender and descendant gender. ........... 291 14.3.3. – Grandchild of Survivor Birth Order ...................................................... 292

14.3.3.1. – Influence on descendant psychological health. .............................. 292 14.3.3.2. – Influence on descendants’ perceptions of their parents/family environment. ..................................................................................................... 293

14.4. - Differences Related to Sample Characteristics ............................................. 293 14.4.1. – Membership of Survivors Organisations/Support Groups .................... 293 14.4.2. – Participation in Counselling/Therapy .................................................... 296

14.5. – Summary and Conclusions ........................................................................... 298 Chapter Fifteen – Holocaust Survivor and Descendant Case Studies .......................... 304

15.1. – Survivor Case Studies ................................................................................... 304 15.1.1. – “Zosia”- Polish Child Survivor who was in Hiding .............................. 304 15.1 2. – “Siegfried”- German Child Survivor who was in Hiding ..................... 306 15.1.3. – “Greta”- Austrian Camp Survivor ......................................................... 308 15.1.4. – “Laszlo”- Hungarian Camp Survivor .................................................... 310 15.1.5. – “Hans”- German Survivor who Escaped in 1939 .................................. 311 15.1.6. – Conclusions from Survivor Case Studies .............................................. 313

15.2. – Child of Survivor Case Studies .................................................................... 315 15.2.1. – “Lena” – Daughter of two Polish Sole Survivors of the Camps ........... 315 15.2.2. – “Otto” - Son of two Dutch Survivors who were in Hiding ................... 318 15.2.3. – “Mimi” - Daughter of a Female Belgian Child Survivor who was in Hiding ................................................................................................................... 320 15.2.4. – Summary and Conclusions from Child of Survivor Case Studies ........ 322

15.3. – Grandchild of survivor case studies ............................................................. 322 15.3.1. – “Geena” - Grandchild with One Survivor Grandparent ........................ 323 15.3.2. – “Solange” - Grandchild with Four Survivor Grandparents ................... 325 15.3.3. – Summary and Conclusions from Grandchild of Survivor Case Studies 326

15.4. – Summary and Conclusions ........................................................................... 327 Chapter Sixteen – Discussion and Conclusions ........................................................... 328

16.1. – Unique Contribution to the Holocaust Trauma Literature by the Current Thesis ........................................................................................................................ 328 16.2. – Thought-provoking Findings Emerging from the Current Thesis ................ 329

16.2.1. – The Role of Gender ............................................................................... 329 16.2.2. – Country of Origin .................................................................................. 330 16.2.3. – The Impact of Post-war Delay in Child-rearing .................................... 332 16.2.4. – The Compounding Traumatic Impact among Survivor Dyads ............. 333 16.2.5. – The Influence of Post-war Settlement Location on post-Holocaust Symptomatology ................................................................................................... 333 16.2.6. – The Case of the Grandchildren of Holocaust Survivors ........................ 334

16.3. – Revised Model of the Differential Impact of Holocaust Trauma across Three Generations ............................................................................................................... 335 16.4. – Applicability and Adequacy of Existing Trauma Theory in Explaining Post-Holocaust Adaptation among Survivors ................................................................... 339 16.5. – Contributions to Trauma Theory by the Research Presented in the Current Thesis ........................................................................................................................ 344 16.6. – Applicability of Attachment and Family Systems Theory in Understanding the Intergenerational Transmission of Holocaust Trauma ............................................. 346 16.7. – Key Role played by Communication about Holocaust Experiences ............ 347 16.8. – Contemporary Needs .................................................................................... 348 16.9 – Clinical Significance and Applications ......................................................... 350 16.10. – Methodological Issues of the Current Thesis ............................................. 352 16.11. – Future Research Directions ........................................................................ 356

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16.12. – Conclusions ................................................................................................ 358 References .................................................................................................................... 360 Appendix A – Studies included in meta-analyses of Holocaust survivors versus control/comparison groups with meta-regression and subset meta-analysis inclusions383 Appendix B – Studies included in meta-analyses of children of Holocaust survivors versus control/comparison groups with meta-regression and subset meta-analysis inclusions ...................................................................................................................... 395 Appendix C – Studies included in meta-analyses of grandchildren of Holocaust survivors versus control/comparison groups ................................................................ 410 Appendix D – Studies included in meta-analyses of male versus female Holocaust survivors ....................................................................................................................... 413 Appendix E – Studies included in children with one versus two Holocaust survivor parents meta-analyses ................................................................................................... 416 Appendix F – Studies included in male versus female children of Holocaust survivors meta-analyses ............................................................................................................... 418 Appendix G – Studies included in intergenerational comparison meta-analyses ........ 423 Appendix H – Sources of Help in Reaching Potential Study Participants ................... 425 Appendix I – Informed Consent Information Package ................................................. 428 Appendix J – Multi-lingual Introduction to Study ....................................................... 431 Appendix K – Depression Anxiety Stress Scales (S. H. Lovibond & P. F. Lovibond, 1995) ............................................................................................................................. 433 Appendix L – Impact of Events Scale – Revised (D. S. Weiss & Marmar, 1997) ...... 435 Appendix M – Post-Traumatic Vulnerability Scale (Shillace, 1994) ........................... 436 Appendix N – Adult Attachment Scale (Collins & Read, 1990).................................. 437 Appendix O – Post-Traumatic Growth Inventory (Tedeschi & Calhoun, 1996) ......... 438 Appendix P – COPE – Long Version (Carver et al., 1989)......................................... 439 Appendix Q – Correlations between COPE Subscales and Psychological Impact Variables ....................................................................................................................... 441 Appendix R – Benevolence and Meaningfulness Subscales of the World Assumptions Scale (Janoff-Bulman, 1996) ........................................................................................ 443 Appendix S – Parental Care-giving Style Questionnaire (based on Hazan and Shaver, 1986, unpublished, cited in Collins & Read, 1990) ..................................................... 444 Appendix T – Parental Fostering of Autonomy Subscale of the Parental Attachment Questionnaire (Kenny, 1987) ....................................................................................... 445 Appendix U – Holocaust Communication Questionnaire (Lichtman, 1983) ............... 446 Appendix V – Control Questionnaire for Historical Influences ................................... 448 Appendix W – Demographic Questionnaires ............................................................... 450 Appendix X – Intercorrelations between Psychological Impact Variables within the Empirical Study Sample ............................................................................................... 463 Appendix Y – Intercorrelations between Influential Psychological Process Variables within the Empirical Study Sample .............................................................................. 464 Appendix Z – Intercorrelations between Family Interaction/Trauma Transmission Variables within the Empirical Study Sample .............................................................. 467

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List of Tables

Table 6.1. ........................................................................................................................ 110 Example 2x2 contingency table for comparing incidence levels ............................................ 110 Table 7.1. ........................................................................................................................ 122 Summary of meta-analyses of survey/scale studies comparing survivors to control/comparison groups ............................................................................................................................ 122 Table 7.2. ........................................................................................................................ 122 Summary of meta-analyses of incidence/diagnosis studies comparing survivors to control/comparison groups ............................................................................................... 122 Table 7.3. ........................................................................................................................ 124 Summary of meta-analyses of survey/scale studies comparing children of survivors to control/comparison groups ............................................................................................... 124 Table 7.4. ........................................................................................................................ 125 Summary of meta-analyses of incidence/diagnosis studies comparing children of survivors to control/comparison groups ............................................................................................... 125 Table 7.5. ........................................................................................................................ 127 Summary of meta-analyses of survey/scale studies comparing grandchildren of survivors to control/comparison groups ............................................................................................... 127 Table 8.1. ........................................................................................................................ 132 Summary of results from the literature based on the nature/type of Holocaust experiences endured by survivors ........................................................................................................ 132 Table 8.2. ........................................................................................................................ 137 Meta-analysis of survey study results based on survivor gender .......................................... 137 Table 8.3. ........................................................................................................................ 137 Meta-regression of survivor versus control results with the female percentage of the survivor sample ............................................................................................................................ 137 Table 8.4. ........................................................................................................................ 137 Summary of meta-analyses of incidence/diagnosis studies comparing male and female survivors ...................................................................................................................................... 137 Table 8.5. ........................................................................................................................ 138 Meta-regression of incidence rates among survivor with the female percentage of the survivor sample ............................................................................................................................ 138 Table 8.6. ........................................................................................................................ 141 Studies assessing impact of survivor age via correlation/regression analysis ........................ 141 Table 8.7. ........................................................................................................................ 142 Studies assessing the impact of survivor age categorically .................................................. 142 Table 8.8. ........................................................................................................................ 143 Summary of meta-regression findings for average age of survivors in 1945 .......................... 143 Table 8.9. ........................................................................................................................ 145 Summary of meta-regression findings for time lapse since the Holocaust among survey studies ...................................................................................................................................... 145 Table 8.10. ...................................................................................................................... 145 Summary of meta-regression findings for time lapse since the Holocaust among incidence studies ...................................................................................................................................... 145 Table 8.11. ...................................................................................................................... 147 Summary of sub-set meta-analyses of survey studies by post-war settlement location among survivors ......................................................................................................................... 147 Table 8.12. ...................................................................................................................... 147 Summary of sub-set meta-analyses of incidence/diagnosis studies by post-war settlement location among survivors .................................................................................................. 147 Table 8.13. ...................................................................................................................... 149

© Janine Lurie-Beck 2007 xiv

Summary of sub-set meta-analyses of survey studies by sample source for survivors ............ 149 Table 9.1. ........................................................................................................................ 152 Meta-analysis of survey study results based on number of survivor parents .......................... 152 Table 9.2. ........................................................................................................................ 152 Meta-regression of children of survivors versus control results with the percentage of the children of survivor sample with two survivor parents ....................................................................... 152 Table 9.3. ........................................................................................................................ 163 Meta-regression of children of survivor versus control results with average delay between child of survivor birth and 1945 ..................................................................................................... 163 Table 9.4. ........................................................................................................................ 164 Summary of sub-set meta-analyses of survey studies by post-war settlement location for children of survivors ..................................................................................................................... 164 Table 9.5. ........................................................................................................................ 164 Summary of sub-set meta-analyses of incidence/diagnosis studies by post-war settlement location for children of survivors ........................................................................................ 164 Table 9.6. ........................................................................................................................ 165 Meta-analysis of survey study results based on child of survivor gender ............................... 165 Table 9.7. ........................................................................................................................ 166 Meta-regression of children of survivor versus control results with the female percentage of the child of survivor sample .................................................................................................... 166 Table 9.8. ........................................................................................................................ 166 Summary of meta-analyses of incidence/diagnosis studies comparing male and female children of survivors ..................................................................................................................... 166 Table 9.9. ........................................................................................................................ 166 Meta-regression of incidence rates among children of survivors with the female percentage of the child of survivor sample .................................................................................................... 166 Table 9.10. ...................................................................................................................... 168 Summary of sub-set meta-analyses of survey studies by sample source for children of survivors ...................................................................................................................................... 168 Table 10.1. ...................................................................................................................... 172 Summary of the current state of evidence of the impact of survivor demographics on survivor psychological health ......................................................................................................... 172 Table 10.2. ...................................................................................................................... 173 Summary of the current state of evidence of the impact of survivor parent demographics on child of survivor psychological health ......................................................................................... 173 Table 10.3. ...................................................................................................................... 173 Summary of the current state of evidence of impact of child of survivor demographics on child of survivor psychological health ............................................................................................ 173 Table 10.4. ...................................................................................................................... 175 Summary of meta-analyses of survey studies comparing survivors to children of survivors ..... 175 Table 10.5. ...................................................................................................................... 176 Summary of meta-analyses of survey studies comparing children to grandchildren of survivors ...................................................................................................................................... 176 Table 10.6. ...................................................................................................................... 177 Survivor, child of survivor and grandchild of survivor groups versus control groups – Intergenerational comparison of meta-analytic effect sizes .................................................. 177 Table 11.1 ....................................................................................................................... 195 Bartholomew and Horowitz’s (1991) definitions of their four categories of adult attachment .... 195 Table 11.2. ...................................................................................................................... 198 Definitions and categorisations of COPE subscales ............................................................ 198 Table 11.3. ...................................................................................................................... 200 Reliability analysis results for the Parental Care-giving Style questionnaire ........................... 200

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Table 11.4. ...................................................................................................................... 201 Reliability co-efficients for the Holocaust Communication Questionnaire and subscales ......... 201 Table 11.5. ...................................................................................................................... 204 Order and content of questionnaire booklets ...................................................................... 204 Table 12.1. ...................................................................................................................... 214 Correlations between coping strategies and psychological impact variables among Holocaust survivors and their descendants ........................................................................................ 214 Table 12.2. ...................................................................................................................... 215 Correlations between the assumptions of world benevolence and world meaningfulness and psychological impact variables among Holocaust survivors and their descendants ................ 215 Table 12.3. ...................................................................................................................... 216 Relationships between influential psychological processes and psychological impact variables ...................................................................................................................................... 216 Table 12.4. ...................................................................................................................... 217 Relationships between posttraumatic growth and psychological impact variables among survivors (n = 23) ........................................................................................................................... 217 Table 12.5. ...................................................................................................................... 218 Correlations between children of survivor’s scores on psychological impact and influential psychological process variables and their perceptions of their survivor parents (among children with two survivor parents only [n = 51]) .............................................................................. 218 Table 12.6. ...................................................................................................................... 219 Correlations between grandchildren of survivors’ scores on psychological impact and influential psychological process variables and their perceptions of their child of survivor parents (among those with two child of survivor parents only [n = 10]) .......................................................... 219 Table 12.7. ...................................................................................................................... 220 Correlations between children and grandchildren of survivor/s scores on impact and influential process variables and their perceptions of their family of origin cohesion .............................. 220 Table 12.8. ...................................................................................................................... 222 Correlations between child and grandchild of survivor scores on impact and influential process variables and their perceptions of their survivor and child of survivor parent’s facilitation of independence/fostering of autonomy ................................................................................. 222 Table 12.9. ...................................................................................................................... 223 Correlations between children and grandchildren of survivors’ scores on impact and influential psychological process variables and their perceptions of their family of origin expressiveness 223 Table 12.10. .................................................................................................................... 224 Correlations between modes of communication about Holocaust experiences and children with two survivor parents’ (n = 51) scores on psychological impact variables. .............................. 224 Table 12.11. .................................................................................................................... 226 Statistically significant relationships between proposed modes of trauma transmission/family interaction variables and psychological impact variables and influential psychological processes among children of survivors .............................................................................................. 226 Table 12.12. .................................................................................................................... 228 Statistically significant relationships between proposed modes of trauma transmission/family interaction variables and psychological impact variables and influential psychological processes among grandchildren of survivors ...................................................................................... 228 Table 12.13. .................................................................................................................... 229 Intergenerational differences in scores on psychological impact variables (including statistically significant differences)...................................................................................................... 229 Table 12.14. .................................................................................................................... 230 Intergenerational differences in the percentage of samples scoring within normal range of tests ...................................................................................................................................... 230 Table 12.15. .................................................................................................................... 231

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Intergenerational differences in scores on influential psychological process variables (including statistically significant differences) ..................................................................................... 231 Table 12.16. .................................................................................................................... 232 Mean differences in ratings of survivor parents versus child of survivor parents on parent-child attachment dimensions and parental facilitation of independence ......................................... 232 Table 12.17. .................................................................................................................... 232 Mean differences in ratings of survivor versus child of survivor families on family cohesion and expressiveness ................................................................................................................ 232 Table 13.1. ...................................................................................................................... 244 Influence of survivor gender on survivor and children of survivor scores on impact and influential process variables ............................................................................................................. 244 Table 13.2. ...................................................................................................................... 245 Mean differences in ratings of survivor mothers versus survivor fathers among children with two survivor parents (n = 51) on parent-child attachment dimensions and parental facilitation of independence .................................................................................................................. 245 Table 13.3. ...................................................................................................................... 245 Children with a survivor mother versus a survivor father only perceptions of family environment variables ......................................................................................................................... 245 Table 13.4. ...................................................................................................................... 246 Correlations between survivor age in 1945 and impact and influential process variables among survivors and children of survivors ..................................................................................... 246 Table 13.5. ...................................................................................................................... 247 Correlations between Holocaust survivor parent age and children of survivors’ ratings of survivor parents on family interaction variables ............................................................................... 247 Table 13.6. ...................................................................................................................... 248 Holocaust survivor experience group scores on impact and influential process variables ........ 248 Table 13.7. ...................................................................................................................... 250 Children of survivor scores on impact and influential process variables by survivor parent experience groups ........................................................................................................... 250 Table 13.8. ...................................................................................................................... 251 Children of survivors’ scores on impact and influential process variables by survivor parent experience mixture groups ............................................................................................... 251 Table 13.9. ...................................................................................................................... 252 Children of survivors’ scores on family interaction variables by Holocaust experience of survivor parents ........................................................................................................................... 252 Table 13.10. .................................................................................................................... 253 Children of survivors’ scores on family interaction variables by survivor parent experience mixture groups ............................................................................................................................ 253 Table 13.11. .................................................................................................................... 255 Holocaust Survivor scores on impact and influential process variables by loss of family variables ...................................................................................................................................... 255 Table 13.12. .................................................................................................................... 256 Children of survivor’ scores on impact and influential process variables by survivor parents’ loss of family during the Holocaust ........................................................................................... 256 Table 13.13 ..................................................................................................................... 257 Children of survivors’ scores on family interaction variables by sole-survivor status of survivor parents ........................................................................................................................... 257 Table 13.14. .................................................................................................................... 259 Holocaust survivor scores on impact and influential process variables by country of origin ..... 259 Table 13.15. .................................................................................................................... 260 Children of survivors’ scores on impact and influential process variables by survivor mother country of origin ............................................................................................................... 260

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Table 13.16. .................................................................................................................... 260 Children of survivors’ scores on impact and influential process variables by survivor father country of origin .......................................................................................................................... 260 Table 13.17. .................................................................................................................... 261 Children of survivors’ scores on family interaction variables by survivor mother country of origin ...................................................................................................................................... 261 Table 13.18. .................................................................................................................... 261 Children of survivors’ scores on impact and influential process variables by survivor father country of origin .......................................................................................................................... 261 Table 13.19. .................................................................................................................... 263 Correlations between survivor time in Europe before emigration and impact and influential process variables (n = 23) ................................................................................................ 263 Table 13.20. .................................................................................................................... 263 Children of survivors born before their survivor parents’ emigration from Europe versus those born after on impact and influential process variables ......................................................... 263 Table 13.21. .................................................................................................................... 264 Perceptions of children of survivors born before and after their survivor parents’ emigration from Europe on family interaction variables ............................................................................... 264 Table 13.22. .................................................................................................................... 265 Holocaust Survivor post-war settlement group scores on impact and influential process variables ...................................................................................................................................... 265 Table 13.23. .................................................................................................................... 266 Children and grandchildren of survivors’ post-war settlement group scores on impact and influential process variables .............................................................................................. 266 Table 13.24 ..................................................................................................................... 267 Children and grandchildren of survivors’ perceptions of family interaction stratified by survivor post-war settlement location ............................................................................................. 267 Table 13.25 ..................................................................................................................... 270 Average and highest proportions of variance accounted for by survivor demographic variables among survivor and descendant scores on psychological impact and influential psychological process variables. ............................................................................................................ 270 Table 14.1. ...................................................................................................................... 276 Children of one versus two Holocaust survivor parents’ scores on impact and influential process variables ......................................................................................................................... 276 Table 14.2. ...................................................................................................................... 277 Children of one versus two Holocaust survivor parents’ perceptions of family interactions ...... 277 Table 14.3. ...................................................................................................................... 278 Mean differences in ratings of survivor versus non-survivor parents on parent-child attachment dimensions and parental facilitation of independence .......................................................... 278 Table 14.4. ...................................................................................................................... 279 Correlations between children and grandchildren of survivors’ scores on impact and influential process variables with the time lapse between the Holocaust and the birth of children of survivors ...................................................................................................................................... 279 Table 14.5. ...................................................................................................................... 280 Correlations between children and grandchildren of survivors’ scores on family interaction variables with the time lapse between the Holocaust and the birth of children of survivors ...... 280 Table 14.6. .................................................................................................................... 282 Female versus male children of survivors’ scores on impact and influential process variables 282 Table 14.7. ...................................................................................................................... 283 Female versus male child of survivor perceptions of their survivor parent/s on family interaction variables ......................................................................................................................... 283 Table 14.8. ...................................................................................................................... 283

© Janine Lurie-Beck 2007 xviii

Mean differences in ratings of child-of-survivor mothers versus child-of-survivor fathers among grandchildren with two child-of-survivor parents on parent-child attachment dimensions and parental facilitation of autonomy ........................................................................................ 283 Table 14.9. ...................................................................................................................... 284 Statistically significantly different correlations between impact and influential process variables and family interaction variables when stratified by child of survivor gender ............................ 284 Table 14.10. .................................................................................................................... 285 Correlations with child of survivor birth order and differences between children of survivors who are only children and children of survivors with siblings on impact and influential process variables ......................................................................................................................... 285 Table 14.11. .................................................................................................................... 286 Correlations with child of survivor birth order and differences between child of survivor only children and children of survivors with siblings on family interaction variables ....................... 286 Table 14.12. .................................................................................................................... 288 Children of one versus two child of Holocaust survivor parents’ scores on impact and influential process variables ............................................................................................................. 288 Table 14.13. .................................................................................................................... 289 Children of one versus two Child of Holocaust survivor parents scores on impact and influential process variables ............................................................................................................. 289 Table 14.14 ..................................................................................................................... 289 Ratings of child of survivor versus non-child of survivor parents on parent-child attachment dimensions and parental facilitation of independence .......................................................... 289 Table 14.15. .................................................................................................................... 290 Female versus male grandchildren of survivors’ scores on impact and influential process variables ......................................................................................................................... 290 Table 14.16 ..................................................................................................................... 291 Female versus male grandchildren of survivors’ perceptions of their child of survivor parents on family interaction variables ............................................................................................... 291 Table 14.17. .................................................................................................................... 292 Statistically significantly different correlations between impact and influential process variables and family interaction variables when stratified by grandchild of survivor gender ................... 292 Table 14.18 ..................................................................................................................... 292 Correlations with grandchild of survivor birth order and impact and influential process variables (n = 27) ............................................................................................................................... 292 Table 14.19 ..................................................................................................................... 293 Correlations with grandchild of survivor birth order and their perceptions of their child of survivor parents as rated on family interaction variables .................................................................. 293 Table 14.20. .................................................................................................................... 295 Comparison of survivor/descendant group member and non-members among survivors and descendants on impact and influential process variables ..................................................... 295 Table 14.21. .................................................................................................................... 297 Comparison of survivor/descendant therapy history or no therapy history among Holocaust survivors and descendants on impact and influential process variables ................................ 297 Table 14.22 ..................................................................................................................... 301 Average and highest proportions of variance accounted for by descendant demographic variables among descendant scores on psychological impact and influential psychological process variables. ........................................................................................................................ 301 Table 14.23 ..................................................................................................................... 302 Average and highest proportions of variance accounted for by descendant demographic variables among descendant of survivors’ perceptions on family interaction variables .......................... 302 Table 15.1. ...................................................................................................................... 306

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Zosia’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables .................................... 306 Table 15.2. ...................................................................................................................... 308 Siegfried’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables .................................... 308 Table 15.3. ...................................................................................................................... 309 Greta’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables .................................... 309 Table 15.4. ...................................................................................................................... 311 Laszlo’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables .................................... 311 Table 15.5. ...................................................................................................................... 313 “Hans’s” scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables .................................... 313 Table 15.6. ...................................................................................................................... 314 Comparison of survivor case study scores on psychological impact and influential psychological process variables ............................................................................................................. 314 Table 15.7. ...................................................................................................................... 316 Lena’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables .... 316 Table 15.8. ...................................................................................................................... 317 Lena’s perceptions of her survivor father versus her perceptions of her survivor mother on gender specific family interaction variables .................................................................................... 317 Table 15.9. ...................................................................................................................... 318 Lena’s perceptions of family interaction patterns compared to whole survivor sample and relevant survivor subgroups means ................................................................................................ 318 Table 15.10. .................................................................................................................... 319 Otto’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables .... 319 Table 15.11. .................................................................................................................... 319 Otto’s perceptions of his survivor father versus his perceptions of his survivor mother on gender specific family interaction variables .................................................................................... 319 Table 15.12. .................................................................................................................... 320 Otto’s perceptions of family interaction patterns compared to whole child of survivor sample and relevant child of survivor subgroups means ........................................................................ 320 Table 15.13. .................................................................................................................... 321 Mimi’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables .... 321 Table 15.14. .................................................................................................................... 321 Mimi’s perceptions of her survivor mother versus her non-survivor father r on gender specific family interaction variables ............................................................................................... 321 Table 15.15. .................................................................................................................... 322 Mimi’s perceptions of family interaction patterns compared to whole child of survivor sample and relevant child of survivor subgroups means ........................................................................ 322 Table 15.16. .................................................................................................................... 324 Geena’s scores compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means on psychological impact and influential psychological process variables ......................................................................................................................... 324 Table 15.17. .................................................................................................................... 324 Geena’s perceptions of her child of survivor father versus her perceptions of her non-child of survivor mother ................................................................................................................ 324 Table 15.18. .................................................................................................................... 324

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Geena’s perceptions of family interaction patterns compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means .............................................. 324 Table 15.19. .................................................................................................................... 325 Solange’s scores compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means on psychological impact and influential psychological process variables ......................................................................................................................... 325 Table 15.20. .................................................................................................................... 326 Solange’s perceptions of her child of survivor father versus her perceptions of her child of survivor mother ............................................................................................................................ 326 Table 15.21. .................................................................................................................... 326 Solange’s perceptions of family interaction patterns compared to the whole grandchild of survivor sample and relevant grandchild of survivor subgroups means .............................................. 326 Table 16.1. ...................................................................................................................... 336 Status of Hypotheses relating to relationships between model variables ............................... 336 Table 16.2 ....................................................................................................................... 339 Delineation of most and least affected demographic subgroups of survivors ......................... 339 Table 16.3 ....................................................................................................................... 339 Delineation of most and least affected demographic subgroups of children of survivors ......... 339 Table 16.4 ....................................................................................................................... 339 Delineation of most and least affected demographic subgroups of grandchildren of survivors . 339 Table 16.5. ...................................................................................................................... 340 Elements from Green et al.’s (1985) and/or Wilson’s (1989) theories applied to the model of Holocaust trauma developed in the current thesis ............................................................... 340

© Janine Lurie-Beck 2007 xxi

List of Figures Figure 2.1. Preliminary Model of the Differential Impact of Holocaust Trauma on Three Generations ...................................................................................................................... 30 Figure 3.1. Addition of Trauma Transmission modes to the Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations ........................................................ 61 Figure 4.1. Addition of Holocaust survivor demographic variables to the Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations........................................ 90 Figure 5.1. Female Holocaust survivors with their babies born in a displaced persons camp. Florence, 1946. ................................................................................................................. 95 Figure 5.2. Addition of Holocaust Survivor Descendant Demographic Moderators to Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations ................... 100 Figure 8.1. Scatterplots of effect sizes comparing survivor groups to control groups on depression and anxiety surveys and the year studies were conducted ................................................... 145 Figure 10.1. Empirical Study Hypotheses Marked on the Test Version Model of the Differential Impact of Holocaust Trauma on Three Generations ............................................................ 184 Figure 11.1. Identification of Measures of Variables from Model of the Differential Impact of Holocaust Trauma across Three Generations used in the empirical study ............................. 191 Figure 12.1. Section of the Test Model of the Differential Impact of Holocaust Trauma on Three Generations to be tested in this chapter ............................................................................. 212 Figure 12.2. Scatterplots of children of survivor anxiety and depression with child of survivor perceptions of family cohesion .......................................................................................... 221 Figure 12.3. Scatterplot of grandchildren of survivor/s Negative Attachment Dimension/Attachment Anxiety with grandchildren of survivor/s Perceptions of Family Cohesion ...................................................................................................................................... 221 Figure 12.4. Ranking (from most important to least important) of Influential Psychological Processes and Family Interaction Variables/Proposed Modes of Trauma Transmission in terms of their relative importance in predicting scores on Psychological Impact Variables ................... 236 Figure 13.1. Addition of Holocaust Survivor Descendant Demographic Moderators to Testing Model of the differential impact of Holocaust Trauma across Three Generations ................... 240 Figure 13.2. Ranking (from most important to least important) of Influential Psychological Processes, Family Interaction Variables/Proposed Modes of Trauma Transmission and Survivor Demographic Moderators in terms of their relative importance in predicting scores on Psychological Impact Variables ......................................................................................... 271 Figure 14.1. Addition of Holocaust Survivor Descendant Demographic Moderators to the Test Model of the Differential Impact of Holocaust Trauma across Three Generations ................... 273 Figure 14.2. Ranking (from most important to least important) of Influential Psychological Processes, Family Interaction Variables/Proposed Modes of Trauma Transmission and Demographic Moderators (both survivor and descendant) in terms of their relative importance in predicting scores on Psychological Impact Variables .......................................................... 303 Figure 16.1. Revised Model of the Differential Impact of Holocaust Trauma across Three Generations .................................................................................................................... 338 Figure 16.2. Polish prisoners in Dachau toast their liberation from the camp (circa April/May 1945) ...................................................................................................................................... 359

© Janine Lurie-Beck 2007 xxii

The work contained in this thesis has not been previously submitted for a degree or diploma at any other higher education institution. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made.

Signed: Date: ______

© Janine Lurie-Beck 2007 xxiii

Acknowledgements

I would like to thank my supervisors Dr Poppy Liossis and Dr Kathryn Gow for their friendship, support, guidance and advice and my family for their love, support, understanding and patience. I would also like to thank the survivors, children and grandchildren of survivors who have participated in my study and other people’s research, without whom this research would not have been possible and without whom the world would have little conception of the true long-term impact of the Holocaust.

© Janine Lurie-Beck 2007 xxiv

This thesis is dedicated to the memory of the members of the Epstein and Lurie families who did not survive the Holocaust and to the three special members who did and without whom I would not exist – Jozefa Epstein and Abraham Lurie and their son Alec Lurie. In particular, I would like to dedicate this thesis to my Nana Jo, who was proudly waiting for me to submit this thesis, but who sadly passed away before seeing it eventuate.

[In the camp] we used to huddle around and tell stories and I always used to tell them about the little white house with the garden I was going to have when the war was finished. You would probably laugh, women in such a situation… We used to quarrel about the colour of the walls that we were going to paint the house and what kind of furniture we will put in and what kind of pictures will hang on the wall and what colour roses will be in the garden. We have a marvellous time doing all that. You could forget for a few minutes or for a couple of hours and feel as if you were a normal human being again. Well I wasn’t this far out. I have a little house – it is cream not white but I have my roses in the garden all around them. So there! Jozefa Lurie

© Janine Lurie-Beck 2007

1

Prologue

I am the descendant of Holocaust survivors. My grandmother, Jozefa Lurie, was forced

from her home in the Polish city of Łodz into the city’s ghetto, passed through

Auschwitz and spent a number of years in a labour camp in Austria. My father was born

in that camp and also managed to survive.

Upon learning of their experiences in more detail, I began to think about how

well they seemed to have adapted to their experiences. I noticed differences between

my grandmother and some of her friends who I learned had also survived the Holocaust.

I also noticed differences between members of my own family.

I started to speculate as to what factors lead to better adjustment among

survivors and descendants. It was from this starting point that I began a survey of the

literature on Holocaust survivors and their families. My questions were not answered

sufficiently and so it became apparent that I would have to explore further myself to

find answers to my questions.

Janine Beck (nee Lurie)


2

Section A

Background Literature Review of Psychological Research into the Effects of the

Holocaust on Survivors and their Descendants


3

Chapter One – Introduction

It is an unfortunate aspect of the world we live in that there are a myriad of possible

traumatic events that can befall us, from natural disasters to personal assaults, wars and

terrorist attacks. McCann and Pearlman (1990, p. 10) define a traumatic experience as

being: “sudden, unexpected, or non-normative, exceeding the individual’s perceived

ability to meet its demands, and disruptive of the individual’s frame of reference and

other central psychological needs and related schemas.”

Few would disagree that the Nazi Holocaust constituted a “traumatic

experience” for its victims and survivors. Millions of men, women and children were

subjected to unspeakable horrors during this time and those fortunate to survive often

bear psychological scars which have remained with them to this day. Most people will

be at least vaguely aware of the course of events that are referred to as the Holocaust.

Images of ghettos and concentration camps are easily summonsed and have become part

of our historical psyche. While Jews were the most commonly targeted group, others

such as gypsies, homosexuals, communists, trade unionists, people with mental and/or

physical disabilities, petty criminals and many others also became victims of the Nazi

regime (Silverstrim, no date).

While the tragedy of the millions who died during the Holocaust is what lingers

in most people’s minds, it is the millions of survivors who live with the legacy of the

Holocaust that is (or should be) society’s ongoing concern. These survivors had to

piece their lives together as best they could and move on. The extent to which they

were able to do this has been the subject of much research and theoretical discussion

over the last sixty years. As Chodoff (1997) says: “We have a responsibility to

remember their ordeal, and we can still learn from their [Holocaust survivors’]

experiences as a worst-case example to guide us in dealing with the horrible examples

of mass inhumanity that we read of every day (p. 148).”

It is true that the Holocaust occurred more than half a century ago and some may

question why it is still relevant to investigate the impacts of the Holocaust. Quite apart

from the lessons that can be learnt and applied to survivors of more recent state-based

traumas is the fact that survivors and their descendants continue to this day to suffer as a

result of the Holocaust. The majority of survivors are now reaching the end years of

their life. Many are suddenly suffering from an increase of symptoms or the appearance

of symptoms from which they had, until now, been spared. The life review process that

we all face in old age is one filled with traumatic memories for survivors. Recent


4

media coverage has pointed to the difficulties faced by survivors in aged care facilities.

These issues will be addressed in more detail in the thesis but the point needs to be

made that while the Holocaust is rapidly moving into more distant history, its effects are

still very much felt in the present and therefore worthy of continued study within the

psychological literature.

To set the context within a trauma framework, in this introductory chapter, the

Holocaust will be examined on a number of dimensions used in the assessment of

trauma. It will become obvious to the reader that the Holocaust was a unique trauma

and worthy of continued investigation. The overall aims of the current thesis are also

described in this chapter. In addition, a summary of the structure of the thesis is

provided as an overview for the reader.

1.1. – The Holocaust as a Unique Trauma of Interest

Numerous models of reaction to trauma have been developed as tools to help evaluate

the severity of a trauma and potentially predict the severity of its impact on an

individual (for example B. L. Green, 1993; B. L. Green, Wilson, & Lindy, 1985;

Wilson, 1989). In this section, the Holocaust will be discussed in terms of a

combination of factors that were outlined in Green, Wilson and Lindy’s (1985) Working

Model for the Processing of a Traumatic Event and Wilson’s (1989) Person-

Environment Interaction Theory of Traumatic Stress Reactions. These factors include:

structure of the trauma – single or multiple events; duration; role in trauma – active or

passive; personal exposure to intentional or non-intentional risk/threat of death or severe

physical harm; sudden violent loss of loved one/s - exposure to /witnessing death and

violence against others in particular loved ones; natural versus man-made; experienced

alone, with others or community based and; recovery environment – level of support,

societal attitudes, cultural rituals for recovery, displacement from original community.

Another key factor that was not included in either Green, Wilson and Lindy’s (1985) or

Wilson’s (1989) models is the extent to which a trauma victim or survivor can attach a

rational or palatable reason for their experience.

The application of these factors to the Holocaust will be presented in the

following subsections with key factors having lengthier discussion. It is obvious that

Holocaust survivors were personally exposed to physical harm and the threat of death to

both themselves and loved ones and that the Holocaust was a man-made rather than

natural traumatic event. These factors are shared by many other traumas. Examination

of the Holocaust on the key factors of the structure of the traumatic event, a survivor’s


5

role in the trauma, rationalisation of the trauma and recovery environment will outline

its particular uniqueness as a trauma.

1.1.1. – The Structure of a Traumatic Event

In the main, trauma tends to stem from a single event. Natural disasters such as

earthquakes, volcanic eruptions, floods, and cyclones or initiated attacks such as

terrorist attacks, rapes or muggings are over quite quickly. Such events constitute what

Solnit and Kris (1967) refer to as a “shock trauma”. They represent a “sudden peril to

life” which is momentary (Solnit & Kris, 1967). However, there are also forms of

trauma that continue for a more extended period of time. Such events include

participation in the armed forces during wartime, incarceration in a prisoner-of-war

camp or repeated episodes of abuse. Solnit and Kris (1967) introduced the term “strain

trauma” to describe this form of trauma. In other words, the form of trauma continues

for an extended period and places the individual under strain. Survivors of the

Holocaust can certainly fall into this latter category of “strain trauma”.

Strain trauma is viewed as potentially more damaging to the psyche than shock

trauma. Bistritz (1988) argues that even the most harrowing of experiences can be

handled if what is occurring is “predictable and potentially limited in time.” In other

words, if the person can see an end to their suffering they have a heightened capacity to

deal with the trauma as it is occurring because it has a foreseeable end. The nature of

the events of the Holocaust meant that there was a high degree of uncertainty and

unpredictability of what would happen on a daily basis as well as the overall chances of

survival. Bistritz (1988) argues that given this background, survivors were unable to

psychologically defend themselves as much as survivors of forms of shock trauma are

able.

1.1.2. – Active versus Passive Roles in Traumatic Events

There is also the issue of active versus passive roles within traumatic experiences.

Military personnel can be seen to have played an active role in the events leading up to

and within their trauma events. Holocaust survivors on the whole (excepting those

persecuted for resistance) played a passive role. They had not actively participated in

circumstances leading to their ordeals; they were simply forced to obey their

captors/persecutors. This passivity would have also contributed to the

incomprehensibility of their experiences. For example, Sigal and Adler (1976) found

Canadian veterans who had been in Japanese prisoner-of-war camps showed better post-

war adjustment than Jewish concentration camp survivors. He argued that this was


6

partially because the soldiers had played an active fighting role compared to the Jewish

camp survivors who were not interned for anything active.

As Tas (1951/1995) pointed out, soldiers in action were able to relieve pent up

tensions and aggression via combat, an outlet that a Holocaust survivor was missing.

Tas (1951/1995) suggested that because any expression or venting of emotion was a

highly dangerous action for a survivor (because of reprisals for the individual and often

for many surrounding them), their suffering was compounded by the enforced

accumulation of feelings such as anxiety and rage. The mechanism of repressing these

feelings during the Holocaust as a survival strategy would then become a hindrance

when the cathartic release of these emotions was almost impossible for many survivors

in the post-war period (Tas, 1951/1995).

Recent research in Australia has found that playing an active role can minimise

traumatic impact. Parslow (2005) stated that people caught by the Canberra bushfires

who were allowed to play a role in trying to protect their homes and were given more

warning of the need to evacuate suffered fewer post-traumatic symptoms than those

forced to evacuate with minimal notice. Weisaeth (2005) reported that survivors of a

number of industrial accidents in Scandinavia suffered from fewer symptoms if they

had played an active role in trying to rescue fellow workers.

1.1.3. – The Rationalisation of Traumatic Events

It can be argued that while members of the armed forces who participated in combat

and/or were interned in prisoner of war camps certainly endured hardships for years,

they were able to assign a more palatable reason to their suffering than Holocaust

survivors were to their experiences. Military personnel have a clear mission and

ultimate goal which leads them to believe that their actions and their suffering are

justified. They are involved in fighting an “enemy” which perhaps threatens their

country or their way of life in some way. There is a clear cause and effect between their

actions and their experiences. Even for prisoners of war who are not in control of the

events that occur to them as much as they were when in combat can at least understand

the reason for their internment. They can rationalise that they have been captured and

detained because they are enemies of their captors and were fighting against them.

Holocaust survivors in the main were subject to persecutions and incarceration

in camps because of their nationality or ethnicity. They had committed no act that

could be considered an attack against their captors. For Jews and Gypsies their

internment was aimed at the complete destruction of their race based on the opinion that

they were a lesser group in society and not deserving of equal rights or even life. This


7

must have been a very difficult concept to grasp and survivors must have felt a greater

indignation and incomprehension at their detention than prisoners of war.

Support for the notion that a more readily derived rationalisation of a traumatic

event can be protective was discussed by Makhashvili, Beberashvili, Tsiskarishvili,

Kiladze, and Zazashvili (2005). Makhasvili et al. (2005) reported that PTSD rates were

much higher among Georgian civilians displaced during the 1990s due to internal

conflict in Georgia (61%) compared to ex-Chechnyan fighters (11%) and ex-political

prisoners (14%) who were persecuted for support of Georgian ex-president

Gamsakhurdia who was ousted in 1992. In another study from the Baltic states,

Kazlauskas, Gailiene, & Domanskaite-Gota (2005) reported higher levels of anxiety and

depression among deported civilians than ex-political prisoners in Lithuania. The

political prisoners could more readily explain their persecution (active opposition to

their captors) whereas the displaced and deported civilians could not.

1.1.4. – The Aftermath of Traumatic Events

How a survivor is treated and received not only by their immediate friends and families

but by society as a whole has been cited by a number of researchers as a key factor in

determining their post-trauma adjustment (Bower, 1994; de Silva, 1999; Gill, 1994; B.

L. Green, 1993; B. L. Green et al., 1985; Kestenberg & Kestenberg, 1990a, 1990b;

McCann & Pearlman, 1990). Symonds (1980) talks about the notion of “second injury”

that occurs to survivors when they are greeted by unsupportive or blaming reactions

from others. It is suggested that such a reception can be almost as damaging as the

trauma itself. Certainly, it is a widely accepted view that the less than supportive

reception Vietnam veterans received upon their return home did nothing for their

recovery (de Silva, 1999; Lomranz, 1995; McCann & Pearlman, 1990; Z. Solomon,

1995). Sigal and Adler’s (1976) Canadian prisoners-of-war were also theorised to have

adjusted to post-war life because they returned to a homeland that honoured their ordeal.

Reactions to Holocaust survivors were largely dismissive. Brom, Durst and

Aghassy (2002) talk of the horror people experienced when they learned of what

survivors had endured. People did not want to think about what had happened and so

largely shut survivors out rather than reaching out in an effort to support them and help

them recover. Kestenberg and Kestenberg (1990b) note that soon after large scale

natural disasters organised attempts to help people and support them through the initial

aftermath are put into place. Counselling services are often part of this process. While

it cannot be denied that survivors were provided with a degree of material assistance

upon their liberation, an organised attempt to provide psychological help was sadly


8

lacking (Friedman, 1948). A number of researchers have suggested that the availability

of social supports and networks in the survivors’ community are a key factor in

determining their long term recovery (de Silva, 1999; B. L. Green, 1993; B. L. Green et

al., 1985).

While Vietnam veterans may not have had societal support, they were able to

return to family and friends. For a large number of Holocaust survivors there were no

surviving relatives to seek comfort from, no friends, no home and a community

unwillingly to welcome them back with open arms (Eitinger, 1973; Gill, 1994). For a

majority of Holocaust survivors, there was very little to come home to (Rappaport,

1968). Many were the sole survivors of their families, their homes and property had

long been confiscated and in most cases was irretrievable. Returning to such a

“vacuum” compounded the trauma for these survivors (Kestenberg & Kestenberg,

1990b; Zolno & Basch, 2000). As Davidson (1980a) states: “The destruction of the

community and the previous life of the survivor damaged his basic sense of security and

undermined his identity and sense of continuity with the past.” Survivors whose

communities were dismantled or destroyed must have been affected by the resulting

isolation. Indeed, the intactness of the survivor’s community is included in Green et

al.’s (1985) Working Model for the Processing of a Catastrophic Event as an important

aspect of the recovery environment. A person’s sense of connection to their community

has been statistically significantly linked with psychological well-being (for example

W. B. Davidson & Cotter, 1991).

The loss of community was felt so keenly by some survivors that even in the

displaced persons camps, that survivors found themselves in immediately after the war,

they began to form social groups with survivors of the same region or town as their

own. Such groups appeared in much larger numbers when survivors resettled in

countries such as America. Participation in such groups provided at least a small form

of continuity with their destroyed pre-war lives (Zolno & Basch, 2000).

1.1.5. – Overview of the Assessment of the Holocaust as a Traumatic Experience

While there are certainly some traumatic experiences that share some commonalities

with the Holocaust, it is unique in its combination of traumatic elements. The

Holocaust can be defined as a strain trauma of long duration, for which there was no

readily acceptable rationalisation or reason, which was followed by little societal

support for victims and in many cases indifference and which dramatically altered a

survivors’ life course. Not only was the experience itself horrific, but the survivor had

nothing to return to and was forcibly severed from the life course they were on. Similar


9

events have unfortunately occurred not only in Europe (Former Yugoslavia), but in Asia

(Cambodia) and Africa too (Rwanda and Sudan) (Chodoff, 1997). Attempted genocides

are, sadly, not solely the domain of history. Holocaust survivors provide us with the

unique opportunity to examine the long term impacts of attempted genocides as well as

intergenerational effects. As Wieland-Burston (2005) puts it:

Although the Shoah was a unique experience in itself, it nevertheless serves as a prototype for genocide, for massive collective trauma and its long-term effects on a population. In this respect, research on the topic is of vital importance for all who work in the field of psychotherapy, not only for us today, living and dealing with the direct descendants of the Shoah, but also for the future. We cannot suppose that genocide and mass collective trauma are a thing of the past (p. 513).

1.2 – The Nature of Holocaust Trauma

By the end of World War II, roughly eleven million people had died at the hands of

Hitler’s Third Reich (Simon Wiesenthal Centre, n.d.) However, the Nazis were not

successful in completely wiping out the societal groups that they had sought to. By the

end of 1945 there were one and a half to two million displaced persons who had

suffered to some degree at the hands of the Third Reich but had managed to survive.

There are a myriad of texts available for the reader in search of detailed accounts

of what the Jews and other targeted groups went through during World War II. The

current section merely gives a broad overview of the types of experiences these people

had to endure to serve as a context for the understanding of their post-war adjustment.

1.2.1. – The Initial Phase: Gradual Removal of Civil Rights

From the moment Hitler was declared German Chancellor on 30 January 1933,

the gradual removal of rights for German Jews began (Edelheit & Edelheit, 1994).

Initially these were only aimed at causing humiliation but eventually they impacted on

the ability to survive. The long list of humiliations included the boycott of Jewish-

owned businesses, the barring of Jews from government service such as education, the

restriction, and later complete barring, of Jewish children from attending German

schools and universities, playing in playgrounds (1933), followed by removal of

citizenship (1935), the banning of Jews from public streets on certain days, forbidding

Jews to have driver’s licenses or car registration, forcing Jews to sell their businesses,

property, investments and jewellery to the Reich at artificially low prices, forcing them

to carry an identification card (1938), forcing Jews to relinquish radios, cameras and

other electric objects to the police, providing them with restrictive food rations denying

them things such as meat and milk and limiting amount of clothing (1939) (Holocaust


10

time line 1933-1945, n.d.). Edelheit and Edelheit (1994) note that by the beginning of

the war at least 121 laws were passed, each of which denied German Jews a

fundamental right. These restrictions of freedom were extended to the Jews of Austria

after the Anschluss in 1938 and Czechoslovakia in early 1939 (Edelheit & Edelheit,

1994).

As the German Army marched forward into Poland in September 1939, sparking

the beginning of World War II, the Jews of all occupied territories soon joined their

German, Austrian and Czech counterparts in becoming bureaucratically marginalised

members of society. Additional indignities were added such as the freezing of Jewish

back accounts, the introduction of a curfew and compulsory Star of David armbands

(Holocaust time line 1933-1945, n.d.).

Groups that later suffered at the hands of the Third Reich (such as political

prisoners) did not endure these earlier years of incremental rights removals. This

gradual removal of civil rights and erosion of dignity was largely unique to the Jews

(although it was also applicable to Gypsies to a lesser extent) and also lasted for

differing lengths of time depending on the country. German Jews had begun to

experience such changes from six years prior to the onset of war while Jews of other

countries retained such rights until their countries were invaded during the war.

Germany invaded Belgium, Denmark, France, Luxembourg, the Netherlands and

Norway in 1940, Yugoslavia and Greece in 1941 and Hungary only in 1944 after

initially being a German ally (Holocaust time line 1933-1945, n.d.).

1.2.2. – Phase Two: The Formation of Ghettos

In Nazi-occupied Poland, Jewish ghettos were established from 1939 onwards

(Holocaust time line 1933-1945, n.d.). In large cities, such as Warsaw, Lodz and

Krakow, sections of the city were closed off to gentile residents and a walled ghetto was

created to house the cities’ Jewish populations. Often, Jews from surrounding areas

were also moved into the ghettos and, eventually, Jews from other countries occupied

by the Nazis were transported to these ghettos as well.

According to Berenbaum (1993), ghetto life was one of “squalor, hunger,

disease and despair”. Accommodation was very cramped with ten to fifteen people

occupying a space previously used by no more than four. When moving into the ghetto,

people were forced to leave most of their belongings behind and could take only

whatever they could pile onto a wagon. Ever diminishing food rations saw the ghetto

populations gradually starving (Rosenbloom, 1988). Serious public health problems

led to epidemics of diseases such as typhus (Berenbaum, 1993).


11

Despite the dramatic drop in living standards, inhabitants of the ghettos got on

with life as best they could. Adjustments were made to a life of daily struggle for food,

warmth, sanitation, shelter and clothing. Every effort was made to continue cultural life

with clandestine schools created and religious services and entertainment such as music

and theatre productions arranged to create at least a semblance of normal life

(Berenbaum, 1993).

However, ghetto inhabitants lived in constant fear as residents were soon drafted

for ‘labour conscription’ and ‘deportation’. In the European summer of 1942, the

ghettos of Eastern Europe began to be cleared of inhabitants, which in the majority of

cases involved the separation of families. Two years later more than two million Jews

had been transported to concentration camps and there were no ghettos left in Eastern

Europe (Berenbaum, 1993).

1.2.3. – Phase Three: Labour and Concentration Camps

Life in a concentration camp can be described as nothing less than horrific. People only

avoided the gas chambers by being fit to work. Bluhm (1948) explains how people

interned in camps were forced to work sixteen hour days. The work was often back-

breaking and anyone who did not fulfil their quota or was considered to be not pulling

their weight was severely punished by beatings, torture or frequently death (Bistritz,

1988; Bluhm, 1948). Inmates were provided with very little food and often inadequate

clothing with which to sustain themselves in order to do this work (Bluhm, 1948).

People died from starvation or diseases resulting from the unsanitary living conditions

as well as at the hands of the Nazis (Bistritz, 1988). Inmates dealt with death on a daily

basis and often witnessed the deaths of family members, friends and fellow inmates,

often in brutal circumstances (Bistritz, 1988). A number of camp inmates retreated into

a state of “psychological hibernation” because of the extreme shock of camp

incarceration and all that this entailed. They became apathetic and lost the will for self-

preservation and in most cases did not survive for long. Camp inmates who fell victim

to this apathy were often termed “musselmen” (Chodoff, 1997).

Despite all this many were able to survive for many years (Bluhm, 1948),

although a great number tragically died after liberation as a result of the conditions they

endured. They were able to survive largely because they were the most fit and able in

the first place. The very young and the very old as well as anyone with an obvious

illness or physical disability were immediately sent to the gas chamber on arrival.

Bluhm (1948) also notes that conditions differed from camp to camp with the death

rates obviously higher in camps with the worst conditions.


12

1.2.4. – Alternatives to Camp Life

Some of the Jews, and other groups targeted by the Nazis, managed to escape from

ghettos and/or camps and managed to survive in hiding or with an assumed identity.

Some had the opportunity of joining partisan groups and therefore join in the fight

against the Nazis.

Rosenbloom (1988) explains how some were provided with a hiding place such

as a secret compartment in an attic or basement in the home of a sympathetic Christian.

Those lucky enough to secure such a hiding place were sometimes able to survive for

quite extensive periods, even years, which is no mean feat when considering the often

cramped confines of their sanctuary.

Other Jews survived by assuming an “Aryan” identity with the help of forged

papers. The success with which this was done was to some extent dependent on the

person’s ability to fit in with their assumed persona with a convincing accent and role-

appropriate behaviour. Of course, Rosenbloom (1988) points out that there was also a

degree of luck in how long an assumed identity could be maintained. There were many

obstacles to overcome, not the least of which being the willingness of some to inform

authorities of likely impostors for monetary reward (Rosenbloom, 1988).

However, both groups shared the constant fear of discovery which, in

Niederland’s (1968) experience, often led to great levels of post-war anxiety.

Rosenbloom (1988) suggests that “the constant necessity to remain alert and watchful

produced a unique set of psychological stresses”.

The current author would suggest that survivors who joined partisan groups may

well have had a psychological edge as they would have had the satisfaction of fighting

back against the Nazis. While these survivors were also under threat of being

discovered, they were in groups and could therefore look out for each other thereby

dissipating some of the fear of being found. Survivors in hiding were often on their

own with no one to help them feel more secure or protected. Despite these hardships

survival in hiding was much more likely than survival of the camps. Vogel (1994)

quotes data that suggests that between 400,000 and 500,000 Jews survived in hiding,

while no more than 75,000 survived the camps.

1.2.5. – Immediate Aftermath: Displaced Persons Camps

The suffering was not over for all Holocaust survivors once hostilities ceased in 1945.

While survivors from Western European countries such as France, Belgium and

Holland were, on the whole, willing to return home and able to reintegrate into the


13

community with little difficulty, survivors from Eastern Europe were far less willing to

return, and with good reason.

A large number of survivors were met with animosity rather than sympathy and

understanding in their homelands (L. Berger, 1988; Bergmann & Jucovy, 1990; Danieli,

1988; Edelheit & Edelheit, 1994; Johnson, 1995). Bulgarian, Hungarian, Polish and

Romanian Jewish survivors were greeted with widespread anti-semitism which

frequently led to bloodshed. For example, in post-war Poland, during the first seven

months after the war, 350 Jews died as a result of anti-semitic violence (Gilbert, 1987;

Johnson, 1995). Survivors often found it near impossible to reclaim their possessions

and homes from the people who had occupied them after they had been forced to leave

by the Nazis (Kestenberg & Kestenberg, 1990b).

It is therefore understandable that a large proportion of these survivors wanted to

get far away from Europe, to America or to the soon to be established state of Israel. A

massive refugee problem soon developed with hundreds of thousands of displaced

persons wanting to emigrate to countries reluctant to take them in (at least not in large

numbers) (L. Berger, 1988; Gill, 1994; Kestenberg & Kestenberg, 1990b). The

situation for those wanting to emigrate to Palestine/Israel was particularly difficult with

the British Administration very reluctant to allow sizeable refugee shipments to enter

Palestine (until the establishment of the state of Israel on 15 May, 1948). It came to the

stage where the British navy either sent refugee boats back to Germany or Italy or re-

routed them to Cyprus where large numbers of displaced persons (of whom a very large

percentage were Jewish Holocaust survivors) were housed in what was, for all intents

and purposes, another concentration camp: a detention centre opened in August 1946

(L. Berger, 1988; Bergmann & Jucovy, 1990; Edelheit & Edelheit, 1994; Friedman,

1948, 1949; Kestenberg & Kestenberg, 1990b). This was obviously a highly insensitive

method of operation and a potentially further traumatising experience for the survivors

interned there. On his numerous visits to the displaced persons (DP) camps in Cyprus,

Friedman (1948; 1949) noted that “the barbed wire of Cyprus cruelly result[ed] in

bringing back to many of the immigrants, either by association or by the re-stimulation

of ingrained, conditioned responses, some of the behaviour patterns of the

Concentration Camps. Anxieties which were held in abeyance for many years now

erupt[ed] to the surface.” He suggested that:

To attempt to revive the emotional life of people who continue to live in the precarious and threatening atmosphere of the DP camps in Europe or incarcerated on the purgatorial island of Cyprus, hemmed in by barbed wire and armed guards in an ominous re-enactment of the


14

German chapter of their torture, might appear an impossible undertaking. (p. 507)

It took over ten years for some, but finally, the remaining survivors were able to

leave Europe and set up new lives far away from the site of their suffering. The

situation was eased by the establishment of the state of Israel in 1948 and legislation

enacted in the United States Congress shortly afterwards admitting a large number of

displaced persons to America (L. Berger, 1988). There are numerous and varying

estimates of the number of emigrants to the various countries around the world (Krell,

1997a; United States Holocaust Memorial Museum, n.d.). Hass (1996) suggests that

55% of Jewish survivors emigrated to Israel, 25% emigrated to the United States, 10%

emigrated to Canada, Australia, South Africa or Argentina and the remaining 10%

stayed in Europe. The last DP camp closed on 28 February 1957 (Gill, 1994).

1.3. – Thesis Aims and Rationale

The overarching aim of the current thesis is to identify which sub-groups of Holocaust

survivors and their descendants display the most psychological and inter-personal

problems. Who are the most resilient and who are the most vulnerable? To this end,

factors that differentiate between well-adjusted and less-adjusted individuals are of

interest. These factors include many which are demographic and/or situational nature.

To identify these factors, two approaches are utilised. A meta-analytic review of the

literature is undertaken with the aim of devising a model of the differential impact of the

Holocaust. The development of this model is informed by a number of theoretical

frameworks including trauma theory, attachment theory and family systems theory. An

international, transgenerational study is then conducted to test this model and the model

is then revised based on the data obtained from this study.

1.3.1 – Stage One: Meta-Analysis

In the first approach, a detailed review and meta-analytic collation of the psychological

and psychiatric research conducted with survivors and their descendants (up to and

including the year 2006) is undertaken. Within this stage, the extent of existing

empirical support for the factors theorised to differentiate between well- and less-

adjusted survivors and descendants are established. The results of these meta-analyses

are used to revise a preliminary model outlining the impact of the Holocaust on

survivors and their descendants and variables that influence the severity of that impact.

Meta-analysis is also used to determine the size and range of differences

between survivor and descendant samples and control/general population samples. It is

hypothesised that, overall, survivor groups will score higher than the general population


15

on pathological variables, and evidence higher levels of maladaptive familial and

interactional patterns. The aim is to demonstrate that there is a wide range of

differences between survivor groups and the general population (via the measurement of

control groups) which reflects a wide range within the survivor and descendant

populations themselves and that they do not represent a uniform, homogeneous group.

Therefore, research should focus on differences within the survivor population and what

factors explain those differences, rather than finding evidence for the obvious point that

survivors and their descendants differ from the general population (which in fact has

been established over the past six decades).

There is little argument that survivors and descendants differ in terms of their

psychological health and the way in which they relate to others. However, there has

been little focus on identifying the factors that explain these differences and which

factors are the most determinant. As a result of the meta-analyses and literature review

conducted, a draft model of the differential impact of the Holocaust will be constructed

which delineates numerous demographic and situational variables that appear to

moderate the impact of the Holocaust on survivors and descendants.

1.3.2. – Stage Two: Empirical Study

The empirical study conducted for the second phase or stage of the research follows on

from the meta-analyses. It aims to test the veracity of the model developed from the

meta-analyses and literature review. In addition, many variables that have been

theorised to explain differences in post-war adjustment have been inadequately assessed

to date and some have not been assessed at all. Therefore a secondary aim of the study

is to provide some data on these variables in an attempt to clarify their impact. Because

many of the variables included in the meta-analysis were assessed in isolation in the

existing literature, the study conducted for the current thesis represents a unique

opportunity to determine the relative importance of these potential demographic and

situational moderators.

Analysis of the data obtained in this empirical study provides the reader with an

idea of the veracity of the model of the differential impact of the Holocaust. In addition,

it delineates the demographic variables that appear to be the most influential in the

severity of symptoms experienced by survivors and their descendants. To further

illustrate the heterogeneity of the survivor and descendant populations, ten case studies

are also presented.


16

1.4. – Thesis Overview

A summary of the main psychological impacts of the Holocaust on survivors

and their descendants is presented in Section A. Given that the traumatic impact of the

Holocaust is seen to have been transmitted through the generations, the main arguments

as to how Holocaust trauma can be transmitted intergenerationally are also summarised

(Chapter Three). Chapters are also included that summarise current thoughts on the

impact of numerous demographic and situational variables on the three generations as

well as on the transmission processes (Chapters Four and Five).

Section B starts with an explanation of, and justification for, the meta-analytic

methodology used to review the current state of empirical data in the Holocaust

literature (Chapter Six). The first meta-analytic results chapter examines data that

compare Holocaust survivors or their descendants to control/comparison groups in the

literature (Chapter Seven). The next two chapters present meta-analytic and non-meta-

analytic reviews of the current state of the literature with regards to demographic sub-

groups of the Holocaust survivor and descendant populations (Chapters Eight and

Nine). Finally, the last chapter in this section revisits the draft model presented in

Section A and revises it based on the meta-analyses presented in the chapters in Section

B (Chapter Ten).

Section C reports on the empirical study designed to test the revised model from

Section B. Chapter Eleven summarises the rationale and methodology of the study.

Chapter Twelve reports on inter-relationships between model variables, while the next

two chapters (Chapters Thirteen and Fourteen) address the role of demographic factors.

The penultimate chapter presents a number of case studies from the empirical data set

(Chapter Fifteen) The final chapter of Section C and the entire thesis (Chapter Sixteen)

reflects on the results of both the meta-analyses and the empirical study in terms of what

they reveal about the effects of the Holocaust on survivors and descendants. The fully

revised and tested version of the Model of the Differential Impact of Holocaust Trauma

across Three Generations is also presented.


17

Chapter Two – The Study of the Impact of the Holocaust on Survivors and their

Descendants

This chapter summarises the approach to the study of the psychological impact of the

Holocaust on survivors and descendants since the end of World War II. Some

criticisms of this body of research are also presented.

2.1. – Impact on Survivors

The Holocaust is in our blood, in our bones and in our minds. Kellerman (2006b) You simply cannot get rid of that enduring pain – its always with you, day and night. A Holocaust Survivor

2.1.1. – History of the Assessment of Holocaust Survivor Mental Health

Formulations regarding the impact of the Holocaust on the human psyche were being

constructed even before survivors were liberated from their camps (Grubrich-Simitis,

1981; Levav, 1998). Eminent psychiatrists and psychologists such as Bruno Bettelheim

and Victor Frankl found themselves in an unenviable bird’s eye position while

themselves interned in concentration camps. Bettelheim and Frankl were among a

number of survivors who began to document not only their own experiences but

theorise as to the general psychological impact this historical event would have on its

survivors.

The thoughts of mental health workers dispatched to aid survivors in the

displaced persons camps soon appeared in print (for example Friedman, 1948;

Friedman, 1949; Niremberski, 1946). These early impressions paint a picture of initial

numbness and withdrawal, after which survivors appeared to revert back to a “normal”

level of functioning as they started to piece their lives together again (Niremberski,

1946). This appearance of normality may have been related to the happiness and relief

of being liberated. Friedman (1948) noted that untrained observers witnessing such

euphoric behaviour in the survivors they saw in the displaced persons camps mistakenly

saw it as a sign that they were unaffected by their experiences and would make a full

recovery. The assumption was that this post-liberation euphoria would reflect long term

prognosis.

The majority of initial aid efforts, however, were concentrated on survivors’

physical and material requirements (L. Berger, 1988; Bergmann & Jucovy, 1990;

Grubrich-Simitis, 1981). Medical attention was concentrated on organic injuries rather


18

than psychological ones (Eitinger, Krell, & Rieck, 1985; Krell, 1997a, 1997b;

Steinberg, 1989). Attention was focussed on the longitudinal impact of things such as

extreme starvation and infectious diseases such as typhus experienced by camp inmates.

Eitinger, Krell and Rieck (1985) note this was especially true for the publications

coming out of Europe during the 1950s and continued to be the main focus of literature

from Eastern European countries even up to the 1970s.

For almost a decade there was little attention paid to the psychological health of

Holocaust survivors (Gay, Fuchs, & Blittner, 1974). Jucovy (1992) describes this

period as being drawn behind a “curtain of silence”. He argues that it seemed necessary

for survivors and the rest of the world to try to forget and move on (Jucovy, 1992). It

was as if the world wanted to forget about the horrific things that had happened

(Hodgkins & Douglass, 1984) or at least didn’t want to talk about it leading to a

“conspiracy of silence” (Danieli, 1998). Krell (1997a) notes that psychological

interviews were rare in the immediate post-war period, and suggests that interviews at

this time were mainly conducted to gain information for physical assistance, relocation

or for war crime trials.

However, it needs to be remembered that very few survivors sought

psychological help in this period either. The blame for the lack of research in the first

post-war decade cannot therefore be solely placed on a lack of initiative on the part of

the scientific/psychiatric community. The fact that few survivors presented with mental

health issues during this period fed into the belief that to be a survivor you had to be

resilient and would therefore bounce back easily (Friedman, 1948, 1949). Friedman

(1948; 1949) suggested that many held the view that the fact that a survivor had

survived was proof of “physical and psychological superiority” and contends that this

may be why survivors’ psychological health was largely ignored at first. However, as

Grubrich-Simitis (1981) points out, “physical survival was no guarantee for psychic

survival”.

Several reasons abound for why survivors did not seek psychological help in the

initial post-war period. One suggestion is that survivors did not want to acknowledge

any weakness and wanted to appear strong and resilient (Dasberg, 1987). This façade

was not consistent with seeing a therapist. Kellerman (2001a) suggested that any

insinuation that survivors suffered from psychological problems could serve to

stigmatise them even more than they were simply by being identified as a survivor.

A second explanation is that survivors did not in fact suffer any symptoms

during this period and were going through a symptom free phase or latency phase in


19

their post-war adaptation. A number of clinicians have noted that some survivors

experienced a latency period during which they were relatively symptom free (Dasberg,

1987; de Wind, 1968/1995; Kren, 1989). This period lasted anywhere from a number of

months to a number of years (Ryn, 1990). For example Klein, Beersheba, Zellermayer

and Shanan (1963) noted that symptoms only appeared after about three years after

emigration to Israel among approximately 70% of survivors they came into contact with

in clinical practice. Newman (1979) suggested that for some this latency period

continued until the survivors started having children when they were confronted with

issues that reminded them of their experiences during the war such as the loss of loved

ones. For some this period lasted as much as fifteen years (de Wind, 1968/1995)

Friedman (1949) ascribes this period to elation at being liberated from captivity

or having to hide after which a period of symptomatology inevitably follows. A number

of others suggested that the survivors were engrossed in the task of re-establishing their

lives (Dasberg, 1987; Klein et al., 1963; Newman, 1979; Solkoff, 1992b). Another

suggestion has been that this latency period coincided with the time when survivors still

had hope that they would find relatives alive and that it ended with the realisation that

this would never happen (Newman, 1979; Rappaport, 1968; Solkoff, 1992b). Once the

survivors were relatively settled, everyday events, or events related to the Holocaust

such as the Adolf Eichmann trial, would act as reminders of their Holocaust experiences

and trigger the emergence of symptoms (Klein et al., 1963; Solkoff, 1992b).

Ryn (1990) suggested that survivors went through at least four phases of post-

liberation adjustment which can also be used to explain the seemingly symptom-free

period. The first phase is dominated by physical symptoms as it is the time during

which the survivor received medical treatment to aid their recovery from starvation and

any diseases they contracted during their internment (Klein et al., 1963; Kren, 1989).

The second phase begins when this physical recovery is complete. Ryn (1990) argues

that after their physical recovery survivors go through a period during which both

physical/somatic and psychological symptoms are not apparent. After this latency

stage symptoms begin to appear with social problems related to both family and outside

contexts also being noted. During the next phases symptoms such as anxiety and

depression become more ingrained (Ryn, 1990).

The main impetus for the growth of interest in the psychological well being of

Holocaust survivors was the passing of a law by the West German government in 1956

granting restitution to victims of Nazi persecution (L. Berger, 1988; Blumenthal, 1981;

Grubrich-Simitis, 1981; Hodgkins & Douglass, 1984; Jucovy, 1992; Krell, 1997a; Last,


20

1989). The program became known as Wiedergutmachung, meaning “to make good

again” (Bergmann & Jucovy, 1990; Fogelman, 1988). A large number of survivors

began presenting to psychiatrists seeking evidence of a link between their war time

experiences and their post-war psychological problems which was required for a

successful compensation application (L. Berger, 1988; Bergmann & Jucovy, 1990;

Bistritz, 1988; Hodgkins & Douglass, 1984; Jucovy, 1989, 1992; Last, 1989). As a

result, a number of psychiatrists and psycho-analysts began publishing case studies of

Holocaust survivors based on these compensation assessments (Grubrich-Simitis, 1981;

Hodgkins & Douglass, 1984). As the emphasis was on finding evidence of impairment

for compensation claims, the dominant theme arising from these early case studies and

theoretical discourses was a negative one of severe debility.

The early literature regarding the psychological impact of the Holocaust was

therefore based on single case studies or amalgamations of case studies of patients or

compensation applicants (Antonovsky, Maoz, Dowty, & Wijsenbeer, 1971; Dasberg,

1987; E. Harari, 1995; Hodgkins & Douglass, 1984). Thus these early formulations are

based on a small number of, what could be argued, least well adjusted of the survivor

population as a whole since they are based on survivors who were driven to seek

psychiatric help or felt their level of symptoms warranted compensation (Antonovsky et

al., 1971; Dasberg, 1987; Steinberg, 1989).

The study of Holocaust survivors led to a dramatic shift in thinking about the

source of psychological disturbance. Up to this point the dominant theory (in

psychoanalytic circles at least) was that disturbances arose from personality problems

and failure to resolve developmental issues (Krell, 1997b; Z. Solomon, 1995) otherwise

organic brain damage had to be present (Grubrich-Simitis, 1981). That there could be a

lasting psychological impact of trauma was largely unacknowledged (Dasberg, 2001;

Krell, 1997a, 1997b). Unless a trauma caused physical injury and obvious damage to

the brain, even an extremely traumatic experience such as the Holocaust, was assumed

to result in only very temporary emotional problems which would disappear with the

cessation of the trauma itself (Grubrich-Simitis, 1981).

That psychological distress would be temporary is reflected in the terminology

used to describe the initial presenting symptoms of survivors immediately after

liberation such as “refugee neurosis” and “repatriation neurosis” (Grubrich-Simitis,

1981). These terms imply that these symptoms would dissipate once the survivor

became settled into life again.


21

Holocaust survivors presented many examples of clear psychological problems

not associated with obvious organic damage or childhood developmental arrest.

Psychiatrists were forced to acknowledge that psychological distress could be caused by

a traumatic event or series of events such as the Holocaust (Last, 1989). Chodoff

(1963) stated “when one considers the intensity of the stress undergone by these

patients, there seems little necessity to postulate any pre-existing personality

weaknesses or predisposition.” Niremberski (1946) stated “the causal agents of the

concentration camp mentality are of course obvious and entirely due to fear…and the

fight to exist”. This shift in thought led to theorising about a survivor syndrome which

became the forerunner to the post traumatic stress disorder diagnosis.

However the German officials considering the compensation claims remained

sceptical about the idea that psychological impairment could purely be the result of

living through an experience such as the Holocaust. An argument of a link between a

survivor’s symptoms and their Holocaust experience was much more readily accepted if

it could be linked with physical strains such as starvation or some form of physical

injury (Last, 1989). While some survivors were willing to endure the indignity of often

sceptical German officials questioning their claims for compensation, others chose to

ignore any psychological damage to avoid being further stigmatised by being identified

as being mentally ill (Fogelman, 1988).

Literature concerned with psychological impacts began to appear in larger

quantities from Western Europe, Canada and the United States and Israel in the 1960s

and 1970s (Eitinger et al., 1985; Krell, 1997b). Further opportunities to apply for

compensation have arisen in recent years via various European governments as well as

the possible access to Jewish monies from the war period held in Swiss banks (Brandler,

2000). This has led to a second wave of psychological assessments for compensation

applications and has increased interest in survivors’ current well-being (Brandler, 2000).

Clinicians soon noticed a pattern in the symptoms experienced by survivors and

as a result literature referring to a “syndrome” suffered by survivors, whether it was

termed the concentration camp syndrome as first described by Herman and Thyygesen

in 1954 (Brom et al., 2002), or KZ syndrome (Klein et al., 1963) or survivor syndrome

(Niederland, 1981, 1988). These syndromes which came to be applied to all survivors

were based on a clinical minority (Antonovsky et al., 1971). Conn, Clarke and Reekum

(2000) suggest that the creation of the survivor syndrome label had the effect of drawing

more attention to the plight of survivors. Once established as a recognised diagnosis it

also aided many in their efforts to seek compensation from the German government


22

(Conn et al., 2000). However, Berger (1988) suggests that clinicians soon became too

hasty in applying the diagnosis to any patient who was also a Holocaust survivor.

Depression, anxiety and paranoia are commonly listed as part of the

constellation of psychological symptoms seen in Holocaust survivors. In their seminal

work in the trauma field, McCann and Pearlman (1990) state that these three symptoms

are common reactions to many forms of trauma (p. 40).

2.1.2. – Depression

Depression is widely recognised as one of the most common symptoms experienced by

Holocaust survivors in the post-war period (Axelrod, Schnipper, & Rau, 1980; L.

Berger, 1988; Bergmann & Jucovy, 1990; Bistritz, 1988; Bower, 1994; Brom et al.,

2002; Chodoff, 1997; Dasberg, 2001; S. Davidson, 1980a; de Wind, 1968/1995;

Eitinger, 1973; Goldwasser, 1986; Grubrich-Simitis, 1981; Hafner, 1968; Hodgkins &

Douglass, 1984; Kellerman, 2001a; Klein et al., 1963; Krell, 1997b; Krystal, 1995; Last,

1989; Maller, 1964; Nathan, Eitinger, & Winnik, 1963; Niederland, 1981, 1988;

Niremberski, 1946; Porter, 1981; Rosenbloom, 1988; Ryn, 1990; Solkoff, 1981;

Steinberg, 1989). Porter (1981) argues that the severity of depression is strongly related

to the degree of survivor guilt experienced by the survivor. This survivor guilt, he

portends, relates to the loss of loved ones during the Holocaust (Porter, 1981).

Depression has also been considered to be a consequence of unresolved mourning for

the relatives that perished during the Holocaust (Solkoff, 1981; Steinberg, 1989).

According to Niederland (1981) depression is often masked by psychosomatic

symptoms.

2.1.3. – Anxiety

Along with depression, anxiety has been cited as one of the most lasting imprints left by

the Holocaust on a survivor’s psyche (Axelrod et al., 1980; L. Berger, 1988; Bergmann

& Jucovy, 1990; Bistritz, 1988; Bower, 1994; Brom et al., 2002; Chodoff, 1997;

Dasberg, 2001; S. Davidson, 1980a; de Wind, 1968/1995; Eitinger, 1973; Goldwasser,

1986; Grubrich-Simitis, 1981; Hafner, 1968; Hodgkins & Douglass, 1984; Kellerman,

2001a; Krell, 1997b; Krystal, 1995; Last, 1989; Maller, 1964; Nathan et al., 1963;

Niederland, 1981, 1988; Niremberski, 1946; Porter, 1981; Rosenbloom, 1988; Ryn,

1990; Solkoff, 1981). Anxiety displayed by survivors is often associated with the fear

of renewed persecution (Porter, 1981). Maller (1964) asserts that anxiety related to this

fear eventually evolves into a more generalised anxiety about contact with the outside

world. Contact with the outside world becomes a phobic fear to the point that the

survivor becomes almost agoraphobic (Maller, 1964). Niederland (1981) describes


23

how someone knocking on the door or the phone ringing can arouse memories of when

the Gestapo arrived to forcibly remove them from their homes or from the ghetto and

therefore elicit anxiety reactions. Contact with anyone in uniform such as police can

also cause great anxiety (Niederland, 1981). These types of symptoms can be related to

those experienced by Posttraumatic Stress Disorder sufferers.

2.1.4. – Posttraumatic Stress Disorder Symptoms

The diagnosis of Posttraumatic Stress Disorder (PTSD) which first appeared in the

DSM-III (Wilson, 1986) grew out of the aforementioned survivor syndrome

formulations based on Holocaust survivors’ experiences (Ruedenberg-Wright, 1997). A

diagnosis of PTSD is applied when the presence of a threshold combination of three

symptom clusters of intrusion, avoidance and hyperarousal is reported/observed.

Intrusion is defined in the DSM-IV-TR as persistent re-experiencing of the traumatic

event/s such as via dreams, images, thoughts or flashbacks. Avoidance is defined as

persistent avoidance of stimuli associated with the trauma and numbing of general

responsiveness for example avoiding activities, places or people that act as reminders of

the trauma. Hyperarousal is defined as persistent symptoms of increased arousal as

evidenced by symptoms such as difficulties sleeping and/or concentrating,

hypervigilance and exaggerated startle response.

The quintessential PTSD symptoms of intrusion and avoidance have been

recognised among survivors (for example Favaro, Rodella, Colombo, & Santonastaso,

1999; Lavie & Kaminer, 1996; Lev-Wiesel & Amir, 2003; Yehuda, Kahana, Southwick,

& Giller Jr, 1994). Survivors are often plagued by intrusive dreams and flashbacks of

their Holocaust experiences and go to great lengths to avoid contact with things that

may trigger such intrusions. Such symptoms are commonly associated with co-morbid

anxiety and depression problems (McFarlane & Yehuda, 1996) and have been seen to

do so for the Holocaust survivor population as well (Favaro et al., 1999; Yehuda et al.,

1994).

2.1.5. – Paranoia/Fear of Further Persecution

Paranoia is another psychological variable commonly linked with Holocaust survival

(Axelrod et al., 1980; L. Berger, 1988; Bergmann & Jucovy, 1990; Bistritz, 1988;

Bower, 1994; Chodoff, 1997; S. Davidson, 1980a; de Wind, 1968/1995; Goldwasser,

1986; Kellerman, 2001a; Krell, 1997b; Last, 1989; Maller, 1964; Niederland, 1988;

Niremberski, 1946; Solkoff, 1981). This paranoia is said to be an escalation of anxieties

related to the fear of renewed persecution. Those affected appear “chronically

apprehensive and afraid to be alone” (Niederland, 1988). Davidson (1980a) suggests


24

that a tendency towards suspiciousness is sometimes the most obvious symptom

experienced by survivors.

2.1.6. – Interpersonal Trust and Intimacy

Another area of functioning mentioned by a great number of theorists/researchers is

survivors’ ability to develop trust and intimacy in personal relationships. It has been

contended that because of their experiences survivors are impaired in their ability to

form secure attachments (L. Berger, 1988; Brom et al., 2002; E. Cohen, Dekel, &

Solomon, 2002; Dasberg, 2001; S. Davidson, 1980a; Eitinger, 1973; Freyberg, 1980;

Grubrich-Simitis, 1981; Kellerman, 1999, 2001a; Klein et al., 1963; Kren, 1989; Nadler

& Ben-Shushan, 1989; Nathan et al., 1963; Porter, 1981; Rosenbloom, 1988; Ryn,

1990).

It has been suggested that this “insecurity in human relations” developed as a

consequence of Holocaust trauma was the most important and detrimental effect of

survival (de Wind, 1968/1995). This is supposed to have occurred because of the

sudden and often brutal way in which survivors were separated from their parents,

spouses, children and/or other relatives (E. Cohen et al., 2002; Freyberg, 1980; Prot,

2000). Davidson (1980a) suggested that this resulted from the fear of the pain of further

object loss. They had already lost so many loved ones that they dare not allow

themselves to get close to anyone else because it would hurt them too much if they lost

them.

Difficulties in developing trust in relationships is a common reaction to any

traumatic event among all age groups (Macksoud, Dyregrov, & Raundalen, 1993).

McCann and Pearlman (1990) note that damaged trust schemas among people who have

been victimised is a common occurrence (p. 44).

2.1.7 – Factors Affecting the Severity of the Impact of Holocaust Trauma

2.1.7.1. – Coping styles and strategies.

Research into other potentially key psychological factors has been largely lacking. In

particular, coping skills/strategies have been cited as a very important determinant of

post-traumatic adjustment and have been related to symptom levels and attachment

dimensions (for example Aronoff, Stollack, & Sanford, 1998; Carver, Scheier, &

Weintraub, 1989; Fogelman & Savran, 1979; B. L. Green et al., 1985; McFarlane &

Yehuda, 1996; Stone, no date; Wilson, 1989). Coping strategies/resources are included

in both Green et al.’s (1985) Working Model for the Processing of a Catastrophic Event

and Wilson’s (1989) Person-Environment Approach to Traumatic Stress Reactions as

important determinants of psychological impact of traumatic events. There has been


25

limited research into how well survivors cope with subsequent traumas such as a cancer

diagnosis, but little research could be located that simply addressed coping in everyday

life.

2.1.7.2. – World assumptions.

While there has been a reasonable amount of research conducted into

psychopathological symptoms/disorders such as depression and anxiety among

survivors, a potential underlying mechanism for the emergence of these symptoms

among survivors has been under researched. What is referred to here is the concept of

world assumptions as espoused by Janoff-Bulman (1992) in the Theory of Shattered

Assumptions.

The scale and over-whelming nature of the Holocaust meant that for many

survivors their concept of the world changed forever. Janoff-Bulman (1992) argues that

we all have the central beliefs that the world is a relatively fair and just place. Such

beliefs were often shattered by the Holocaust. The extent to which this occurred had

the potential to influence the degree of symptoms experienced by survivors in the post-

war period (McFarlane & Yehuda, 1996; Valent, 1995). McCann and Pearlman (1990,

p. 32) explain how traumatic memories are often completely incongruous with the

survivors’ pre-existing schemas about the world. This incongruity often leads to the

development of symptoms such as depression, anxiety and more specifically PTSD

symptoms such as avoidance (McCann & Pearlman, 1990, p. 51). The shattering of

these assumptions is more marked when the trauma is human-induced as was the case

for the Holocaust – the survivor has to acknowledge that their trauma was caused by

other human beings (Janoff-Bulman, 1992, p 78). A relationship between world

assumptions and symptom levels has been found in at least one study with Holocaust

survivors (Brom et al., 2002). The following quote gives an indication of how a

survivor’s assumptions about the world could be so affected by their Holocaust

experiences.

And when you think of it what a man can do to a man the only way to be sane you have to believe that they were all insane the Germans because if they weren’t insane you wouldn’t want to live in the world would you. Sometimes when the sun is shining and I look around and the birds are singing and the flowers are blooming I think to myself that is not possible, it just didn’t happen, it couldn’t have, it couldn’t have. But it did. But it did. Jozefa Lurie, a Polish Jewish camp survivor


26

2.1.8. – Posttraumatic Growth

Another more recent area of research within the trauma field has been that of post-

traumatic growth. Tedeschi (1999) defines posttraumatic growth as “important changes

in perception of self, philosophy of life, and relationships with others in the aftermath of

events that are considered traumatic in the extreme” (p.321). Living through a

traumatic event can lead to positive changes in a person’s perception of their ability to

deal with difficult circumstances. With the benefit of hindsight, the survivor reflects

that they were quite capable in the way they coped with the traumatic experience which

insight then leads to a more positive perception of their own abilities and may also

positively influence they way they deal with later experiences (Tedeschi & Calhoun,

1996). In terms of philosophical changes, a survivor or victim of trauma may become

more appreciative of life, vow to life live to the fullest and may (after a possible

weakening of beliefs) be left with stronger spiritual and religious beliefs, related to the

knowledge that they faced adversity and lived through it (Tedeschi & Calhoun, 1996).

Finally in the area of relationships with others, Tedeschi and Calhoun (1996) contend

that in their post-trauma life, survivors or victims may value their relationships more,

and also develop deeper and more intimate relationships, partially as a result of

sharing/discussing their traumatic experience with loved ones and friends.

Only one study was located that addressed post-traumatic growth among

survivors. It is therefore of interest to further explore this issue in relation to Holocaust

survivors. Janoff-Bulman (1992, p 136) states that the experience of a traumatic event

as large in scale and effect as the Holocaust often leads the survivor to reassess their

values and beliefs in relation to themselves and what they consider important in life and

in the world.

It would seem intuitive to predict that posttraumatic growth would be inversely

related to negative traumatic impacts but the balance of research in this area tends to

suggest that they co-exist. Both the study conducted with survivors (Lev-Wiesel &

Amir, 2003) as well as others with other population groups such as carers of AIDS

patients (Cadell, Regehr, & Hemsworth, 2003), Israeli adolescents exposed to terror

incidents (Laufer & Solomon, 2006), brain-injury survivors (McGrath & Linley, 2006)

and general population members who have suffered varying traumatic incidents

(Morris, Shakespeare-Finch, Rieck, & Newbery, 2005) obtained positive relationships

between negative symptomatology and posttraumatic growth. The finding of a positive

relationship between posttraumatic growth and pathological symptoms is in contrast to

what is implied in Green et al.’s (1985) trauma model (Processing a Traumatic Event:


27

A Working Model). In their model, Green et al. (1985) denote post-trauma adaptation

as characterised either by growth/restabilisation or pathological outcome. It is granted

that Green et al. (1985) formulated their model before much of the research on

posttraumatic growth was conducted, but it is still interesting to note that they seem to

suggest a mutual exclusivity between pathological symptoms and posttraumatic growth.

The relationship between posttraumatic growth and negative symptomatology is

therefore worthy of further exploration within the context of Holocaust survival and this

is conducted within the current thesis.

2.2. – Impact on Children of Survivors

I can see that my whole adult life has been completely driven by what happened to my family during the Holocaust. A child of survivors The Holocaust is always there in the background. A child of survivors

The first publications regarding the impact of the Holocaust on children of survivors

came from Canada in the mid 1960s (Axelrod et al., 1980; Bergmann & Jucovy, 1990;

Brom, Kfir, & Dasberg, 2001; S. Davidson, 1980a; Grubrich-Simitis, 1981; Last, 1989;

Newman, 1979; Vogel, 1994). This was as a result of a notable increase in the number

of children of survivors presenting for therapy (Brom et al., 2001; S. Davidson, 1980a;

Grubrich-Simitis, 1981; Newman, 1979). Kestenberg and Kestenberg (1990a) add that

it was around this time that a possible connection between symptoms and parents’

survivor status was recognised. Children of survivors had been seen before this but the

fact that their parent or parents were Holocaust survivors had largely been ignored

(Kestenberg & Kestenberg, 1990a).

Researchers and clinicians noted that children of survivors displayed symptoms

reminiscent of those found among survivors (Gay et al., 1974; Grubrich-Simitis, 1981;

Kellerman, 2001a; Rowland-Klein & Dunlop, 1997; Ryn, 1990; Steinberg, 1989;

Zilberfein, 1996). Some noted that the children presented as if they had actually

experienced the Holocaust first hand themselves (Yehuda, Schmeidler, Wainberg,

Binder-Brynes, & Duvdevani, 1998; Zilberfein, 1996).

The 1960s coincided with a time when a large number of children of survivors

were reaching adolescence and young adulthood (S. Davidson, 1980a; Eitinger et al.,

1985; Newman, 1979; Russell, 1982). Adolescence was a particularly common point

of crisis (Newman, 1979). The first paper examining children of survivors, written by


28

Rakoff, Sigal and Epstein (1966) appeared at a time when children born immediately

after the war were on the cusp of adolescence and young adulthood.

Again, depression, anxiety, paranoia and intimacy/trust issues are among the

most common symptoms associated with children of survivors (Zilberfein, 1996).

Problems establishing relationships because of these intimacy/trust issues have been

found to be one of the biggest issues for these children (Barocas & Barocas, 1980; S.

Davidson, 1980a; Fogelman & Savran, 1979; Freyberg, 1980; Kellerman, 1999;

Kuperstein, 1981; Reijzer, 1995; Rieck, 1994; Russell, 1982; Shoshan, 1989; Zilberfein,

1996). In fact it was precisely these relational factors that drove some of this group to

seek psychological assistance (S. Davidson, 1980a; Rieck, 1994).

Elevated anxiety levels have been frequently related to children of survivors.

(Felsen, 1998; Freyberg, 1980; Gay et al., 1974; Grubrich-Simitis, 1981; Kellerman,

1999, 2001a; Kuperstein, 1981; Rowland-Klein & Dunlop, 1997; Solkoff, 1992b;

Steinberg, 1989; Yehuda, Schmeidler, Giller, Siever, & Binder-Brynes, 1998;

Zilberfein, 1996). This anxiety has been related to the pressure of meeting unrealistic

expectations held by survivor parents (for example Kuperstein, 1981). Kuperstein

(1981) notes that these children often suffer from examination anxiety as a result of

pressure to do well in their studies. Anxiety has also been linked to survivor parents’

tendency towards being overprotective and portraying the world as a dangerous place

(Rowland-Klein & Dunlop, 1997). Paranoia has also been listed as a symptom

frequently experienced by children of survivors (S. Davidson, 1980a; Rustin, 1988;

Solkoff, 1992b).

Depression also dominates descriptions of children of survivors

symptomatology (S. Davidson, 1980a; Felsen, 1998; Freyberg, 1980; Gay et al., 1974;

Grubrich-Simitis, 1981; Kellerman, 1999, 2001a; Kuperstein, 1981; Newman, 1979;

Perel & Saul, 1989; Rowland-Klein & Dunlop, 1997; Russell, 1982; Rustin, 1988;

Solkoff, 1992b; Steinberg, 1989; Yehuda, Schmeidler, Giller et al., 1998). It has been

argued that children of survivors’ depression is in actual fact anger turned inwards

(Newman, 1979; Rowland-Klein & Dunlop, 1997). They feel anger towards their

parents but are unable or unwilling to direct it to their parents (Rowland-Klein &

Dunlop, 1997). Depression has also been linked to children’s guilt feelings about

wanting to leave home: another issue associated with adolescence (Grubrich-Simitis,

1981; Russell, 1982). Guilt feelings associated with the knowledge of their parents’

own suffering mean that children feel unable to rebel against their parents or fight the


29

aforementioned unrealistic expectations and so become depressed as a result (Newman,

1979; Perel & Saul, 1989).

As with the literature relating to Holocaust survivors themselves, early clinical

research tended to paint a more pessimistic picture of children of survivors than later

non-clinical research (Solkoff, 1992b; Yehuda, Schmeidler, Giller et al., 1998).

Therefore some literature suggests that children of survivors have higher incidence

levels of psychological symptoms than those with non-survivor parents while other

literature suggests they are no different to the general population.

There is disagreement about the proportion of children of survivors with

emotional problems. Davidson (1980a) states that up to one fifth of the children

referred to child psychiatric and adolescent outpatient services in Israel had at least one

survivor parent. However, he fails to note whether this proportion is actually higher than

the proportion of the Israeli population with survivor parents. Despite this Davidson

(1980a) argues that there is a high incidence of psychological problems among the

children of survivor population. In contrast, Gay et al. (1974) state that children of

survivors did not present to their clinic (also in Israel) in higher proportions than were

found in the population.

2.3. – Impact on Grandchildren of Survivors

Being the granddaughter of survivors has always influenced my identity. A grandchild of survivors I often feel like the Holocaust is not something I remember because someone told me about it, but rather, something I remember because I was there. A grandchild of survivors

Assessment of grandchildren of Holocaust survivors has slowly been building up over

recent years. For a while many have theorised that effects would be evident in this third

generation but it has only been recently that this group have become young adults in

large enough numbers to be more accessible as a research group.

Bistritz (1988) suggested that there was evidence for pathology among the

grandchild of survivor group. Ryn (1990) noted two years later that reports of

disturbances among grandchildren of survivors were beginning to appear.

However, as Chaitin (2003) points out, there is still much to be learned about

grandchildren of survivors. Because of the lack of research to date there are no

conclusive findings as to the mental health of this group, only theoretical conjecture

based largely on anecdotal evidence. However, Ryn (1990) did suggest that there was


30

some evidence of a “sui generis” inheritance of the disturbances suffered by survivors

and their children. In other words, similar types of symptoms seemed to be appearing in

the third generation.

2.4. – Summary of the Impacts of the Holocaust across Three Generations

This chapter so far has summarised the symptomatology suffered by Holocaust

survivors and their descendants. The psychological symptoms and attributes that have

been discussed in this chapter have been evident among survivors and their descendants.

These psychological symptoms and attributes have been presented diagrammatically in

Figure 2.1. Figure 2.1 represents the first stage of a preliminary Model of the

Differential Impact of the Holocaust across Three Generations which will be expanded

on in the coming chapters of this section of the current thesis (Section A). The two

variables of world assumptions (assumptions that the world is a fair and predictable

place) and coping strategies that have been suggested as possible influential factors in

the degree to which the psychological effects are noted in each of the generations have

been placed in this model as influential psychological processes. The degree to which

world assumptions have been affected and the usage (or lack of usage) of negative and

positive coping strategies are suggested as being at least partially predictive of the

severity of psychological impact of the Holocaust. Psychological Impacts of the

Holocaust Influential Psychological

Processes

1st Generation (Survivors)

• Depression • Anxiety • Paranoia • PTSD symptoms • Romantic Attachment

Dimensions • Post-traumatic Growth

• World Assumptions • Coping Strategies

2nd Generation (Children of Survivors)

• Depression • Anxiety • Paranoia • Romantic Attachment

Dimensions


3rd Generation (Grand-children

of Survivors)


Dimensions


Figure 2.1. Preliminary Model of the Differential Impact of Holocaust Trauma on Three Generations


31

2.5. – Critique of Research regarding Holocaust Survivors and Descendants

Methodologies utilised in the study of Holocaust survivors and their descendants to date

have been inadequate on a number of levels. Some of these problems were recognised

many years ago and yet the implementation of recommendations for improved methods

has not been widespread. Problems relate to the definition of what constitutes a

“Holocaust survivor” or a “Child of a Holocaust survivor”, appropriateness of control

groups, differences between results based on clinical and non-clinical samples and lack

of the inclusion of the assessment of demographic factors. Each of these problems will

be addressed below.

2.5.1. – Definition of “Holocaust Survivor” and “Child of a Holocaust Survivor”

Survivors of the Holocaust endured many different types of trauma ranging from

persecution to ghettoisation and concentration camp internment. Researchers differ as

to which of these experiences should be included in a Holocaust survivor categorisation.

Some researchers reserve the term Holocaust survivor solely for those who were

interned in a concentration camp for a period during the war (Lev-Wiesel & Amir,

2000). Others also include those who managed to escape camp internment by living in

hiding and those who survived under the protective umbrella of partisan groups and the

resistance (Felsen, 1998; Hodgkins & Douglass, 1984). Felsen (1998) also located

studies that broaden the definition to include anyone who was domiciled in any region

of Europe under Nazi occupation during the war, with some arguing that anyone who

survived the war in any part of Europe or the USSR ought to be included.

The operationalisation of a “child of Holocaust survivors” has also been fraught

with inconsistencies. Some studies confine this category to those with two survivor

parents while others also include those with only one survivor parent (Felsen, 1998). A

few studies were found which included participants born during the war (for example

Gertz, 1986). Sigal and Weinfeld (1987) and Kestenberg and Kestenberg (1990a)

duly note that any effects noted in these children could have originated from their own

exposure to Holocaust trauma as opposed to influences from their parents.

The differences in definition of Holocaust survivor also comes in to play as

researchers define “child of a Holocaust survivor” by the experiences of the parent.

Therefore inconsistencies in this definition also flow through to studies of the next

generation.

Discrepancies in the definition of the target population obviously have

implications for the comparability of study results. The reader must bear in mind the

criteria used for inclusion in the study group when considering results. In the research


32

discussed in the current thesis, a broad definition of survivors and their descendants is

used, with data collected to identify sub-groups within these populations.

Specifically:

• A survivor is defined as a person who endured some form of persecution by the Nazi

regime. This was dated from January 1933 (when Hitler came to power) until the

end of World War II.

• A child of survivor/s is defined as having at least one parent meeting the survivor

criterion and a birth date after 1945 or after their survivor parent’s persecution had

ended (in the case of survivors who escaped Europe prior to 1945).

• A grandchild is further defined by having at least one grandparent meeting the

survivor criterion and at least one parent meeting the child of survivor/s criteria (and

neither parent meeting the survivor criteria).

2.5.2. – Nature of Control Groups

The predominant control group used in studies of Holocaust survivors is made up of

people who emigrated from Europe (specifically countries that were under Nazi

occupation) before the war (i.e., pre 1939). Other studies merely used people native to

the country the study was conducted in as a control group. There are also a number of

studies which fail to even specify the nature of their control group at all (Lomranz,

1995).

The argument that aspects of Holocaust survivors post-war adjustment (and also

their children’s well being) could be related to the experience of migrating to a new

country, rather than their traumatic war experiences, gained currency in the last two

decades (Baranowsky, Young, Johnson-Douglas, Williams-Keeler, & McCarrey, 1998;

Halik, Rosenthal, & Pattison, 1990; Kuperstein, 1981; Solkoff, 1992b; E. Weiss,

O'Connell, & Siiter, 1986). In light of this, the use of native born subjects as a control

group (or as a sole control group) has fallen from favour. The vast majority of studies

examined for this thesis used pre-war immigrants as their control group.

However, the use of pre-war immigrants as a control group also potentially

introduces confounds to research. Shmotkin and Lomranz (1998) assert that there are

two issues that have rarely been acknowledged by researchers utilising this type of

control group. Probably the vast majority of these pre-war immigrants left behind some

family members in Europe. These family members could potentially have died during

the Holocaust. As a case in point, in a study by Bistritz (1988) 40% of the group

considered to be a control group had lost family members in the Holocaust. Therefore,

while they did not endure the Holocaust themselves they had to mourn the loss of


33

family members who did (Kahana, Harel, & Kahana, 1989). The impact of losing

family members in such tragic circumstances has been suggested as one of, if not the,

most traumatising aspects of Holocaust survival (see Chapter Four for more details).

Illustrating this point is Nathan, Eitinger and Winnik’s (1964) finding that pre-war

immigrants whose parents died in the Holocaust had similar levels of psychological

symptoms to a survivor group, while both groups evidenced more symptoms than a pre-

war immigrant group whose parents had not died during the Holocaust. These people

can hardly be considered untouched by the Holocaust as is assumed by their inclusion in

a “control group”.

The second point raised by Shmotkin and Lomranz (1998) is that while the use

of pre-war immigrants as a control group is meant to control for the immigration effect

noted earlier, the nature of the pre- and post-war immigration experiences differed

markedly. Post-war immigrants often had to endure extended stays in displaced persons

camps before their chosen settlement country allowed them to emigrate. Competition

for such placements was much fiercer in the post-war period as there were so many

more people wanting to emigrate.

Kahana et al. (1989) have suggested that the best control group to use, which

eliminates the aforementioned problems with differences in pre and post war

immigration experiences, is one consisting of people who lived in Europe during the

war but experienced minimal if any persecution. They suggest the ideal group would be

post-war Romanian immigrants as Romania remained relatively untouched until the

very late stages of the war.

Kahana et al. (1989) also suggested that multiple control groups might be used

in order to eliminate/control for any potential confounding variables that have been

discussed. Only two studies that utilised more than one control group were found by

the current author in her literature search for this current thesis. Joffe, Brodaty,

Luscombe and Ehrlich (2003) had a pre-war immigrant control group as well as an

Australian or English born control group in their study conducted in Sydney. The

inclusion of both groups allowed an examination of the potential immigrant effect. The

pre-war immigrant group was found to score higher on both depression measures than

the native born control group providing support for the immigration effect. In fact, the

pre-war immigrant group scored statistically significantly higher on the measure of

severe depression (t (98) = 2.60, p < 0.05). However, both control groups obtained a

mean of 0.80 on the measure of anxiety used (Anxiety and Insomnia scale on the

General Health Questionnaire); a result that does not lend support to the idea that


34

immigrant status increases psychopathology symptoms. Shmotkin, Blumstein and

Modan (2003) had both a pre-war and a post-war immigrant control group. This

allowed an assessment of the impact of differential immigrant experiences with post-

war immigrants presumably experiencing similar immigrant experiences to the

Holocaust survivors themselves. The two immigrant groups scored almost identically

on the depression measure used.

Carmil and Carel (1986) suggest that studies conducted with survivors who live

in Israel should include a control group from another country. They argue that given

the various wars that Israel has been involved in since its inception in 1948 the

population as a whole, irrespective of survivor status, may have a higher level of

psychological distress.

In the current thesis, the nature of control groups used is elucidated and

discussed. The potential immigration effect is also examined in the empirical study

where comparisons are made between children of survivors born before and after their

survivor parents’ emigration.

2.5.3. – Sample Recruitment Methods

While some researchers seek volunteers via appeals to the general public, the majority

make contact with potential subjects via membership lists of organisations. Such

organisations are either generic Jewish organisations which may include both survivor

and non-survivor members (Felsen, 1998) or organisations specifically for survivors.

The use of member lists such as these prompts the question of whether members are

different to non-members. Using membership lists from Jewish organisations could be

seen as the preferable option as it may include survivors who don’t necessarily want to

broadcast their survivor status and would therefore be less likely to join a survivor

group. However, bias is still present as only people who more strongly identify with

their Jewish identity and heritage are likely to join such groups (Levav, 1998). As

Levav (1998) argues, not all potential respondents will be contactable via such a group.

This method will also only derive Jewish survivors and will miss out on contacting non-

Jewish survivors.

The derivation of samples via appeals to survivor group members however is

even more limiting. This method only contacts survivors who have joined such groups

and therefore were willing to identify themselves as a survivor. Differences between

members and non-members of survivor groups as well as the reasons why a survivor or

child of a survivor may want to join a support group of this nature have been discussed

by a number of researchers. Some argue that membership is beneficial for the


35

psychological well-being of survivors while others contend that they are a magnet for

the less well-adjusted among the survivor group.

Fogelman and Savran (1979), referring to children of survivors, argue that those

who don’t feel they have been particularly impacted upon by their parent/s experiences

are far less likely to join a group. In their experience, it is the children who are

struggling to come to terms with their parent/s experiences and what they mean to them

that join such groups in an attempt to resolve such issues. This would mean that

samples derived from such groups are starting off from a more affected sub-group of the

population.

Baron, Reznikoff and Glenwick (1993) contend that the literature they examined

suggests that participation in such support groups has a positive influence and leads to a

decrease in level of symptoms experienced. The survivor derives comfort from the idea

that they are not unique and that others share similar experiences. Kahana and Kahana

(2001) state that the group serves as a substitute extended family for the survivor and

the presence of this extra support network therefore reduced the need for more formal

psychological intervention. As mentioned in Chapter One, Section 1.1.4, survivor

groups based around survivor’s pre-war region or town served to ameliorate some of the

negative feelings associated with the abrupt removal from pre-war communities (Zolno

& Basch, 2000)

Gertz’s (1986) qualitative appraisal of reasons for membership among a group

of children of survivors revealed that issues of identity were central. Members stated

that they joined a survivor group because they strongly identified with their role as the

child of a survivor and wanted to acknowledge that. They further developed this

identity by contact with others in the same position which they met through the group.

For many children of survivors, group membership serves to provide a surrogate

extended family that was not available to them within their own family because of the

death of grandparents during the Holocaust. Learning that other children of survivors

had similar experiences with their survivor parents as they were growing up also adds to

the strong sense of camaraderie that develops in such groups (Zolno & Basch, 2000).

Robinson, Rapaport-Bar-Sever and Rapaport (1994) found that membership of

survivor organisations among survivors themselves is related to demographic variables

such as age of the survivor and the nature of their Holocaust experiences. They found

that survivors who had spent time in hiding were less likely to have joined this type of

support group than survivors who had been in a camp. They also found that the

likelihood of joining a group increased with age. That is, the older the survivor was


36

when their persecution began the more likely they were to be a member of a survivor

support group.

Clearly, the issue of sampling recruitment methods is one which must be

considered when evaluating any research study involving Holocaust survivors or their

descendants. Unfortunately, readers are denied the opportunity to deem for themselves

the effectiveness of sampling techniques when examining a fair number of publications

of survivor research. Solkoff, who has conducted several reviews of the literature in

this area (Solkoff, 1981, 1992a) found that samples are often not properly described in

terms of the sampling methods used to obtain them (Solkoff, 1992b). The current

author also found that a sizeable proportion of studies fail to give enough detail to

enable exact replication of sampling.

2.5.4. – Differences between Clinical and Non-clinical Study Results

While it is clear that some survivors have suffered a great deal in the post-war period

from a number of symptoms, others have managed to adapt quite well. Studies

examining the incidence levels of symptoms do not find that 100% of those surveyed

suffer from these symptoms. For example, while Szymusik’s (1964 (in Polish), cited in

Ryn, 1990) assessment of a group of former camp inmates in Poland found that 60%

were considered to have some psychological problems this leaves 40% who did not.

Helweg-Larsen et al. (1949 (in Danish), cited in Nathan et al., 1964) found 75% of a

group of 130 camp survivors in Denmark displayed neurotic symptoms of varying

degrees of severity, leaving 25% relatively symptom free. Later studies have also found

a percentage of survivors citing no psychological distress; for example 26% of a sample

studied by Carmil and Carel (1986) and 39% of a sample studied by Chaitin (2002).

Further evidence that some survivors have adapted better than others comes

from inconsistencies in the literature between clinical and the non-clinical studies which

began to appear from the 1970s. Research based on non-clinical groups of Holocaust

survivors often find no or little difference between them and control groups whereas

clinical research tends to paint a bleaker picture (L. Berger, 1988; Gross, 1988; Rustin,

1988). The most parsimonious explanation for this is that clinical samples are made up

of survivors whose symptoms were debilitating enough for them to seek some form of

psychological help which presupposes that their post-war adjustment was not as good as

participants in non-clinical studies who mostly did not seek such help. Antonovsky et

al. (1971) suggest that it is inevitable that clinical samples will be found to evidence a

degree of psychopathology since “by definition, patients are maladaptive.” That such

results cannot, and should not, be applied to the entire Holocaust survivor population


37

(which includes a large number who did not find the need to seek psychiatric or

psychological help) is a moot point. Clinical sub-samples of the Holocaust survivor

population cannot be considered representative of the survivor population as a whole

(Dasberg, 1987; Whiteman, 1993; Yehuda, Schmeidler, Giller et al., 1998). There are

also some survivors who perhaps did suffer symptoms to a degree that might warrant

intervention or compensation but did not seek any. In a 1947 to 1951 study of 1,300

Danes who had been in camps about 75% stated they had had or still had neurotic

symptoms of varying degrees of severity (Eitinger, 1961). Very few of them had sought

psychiatric help. Therefore, on a number of levels, clinical studies cannot even be

considered representative of the clinical sub-population of survivors.

Berger (1988) suggests that because there are differences in results within the

literature (between studies based on clinical and non-clinical samples) “at least some of

(and possibly all) of the results are inaccurate”. This seems to the current author to be

the most illogical argument of all since it fails to take into account the notion that results

may differ purely because they are based on different samples of survivors who have

differing levels of symptomatology. As Krell, Suedfeld and Soriano (2004, p 505) put it

It is important not to use the lives of well-adjusted survivors as a basis for neglecting the severe long-term effects of the Holocaust on some and equally important not to commit the error of over-generalising from those who seek therapy or other help to the entire population of survivors.

Gross (1988) makes a valid point in regard to this issue that few seemed to have

thought about before. Initial publications in relation to post-war adaptation of survivors

were based on summaries of clinical case notes of survivors who had either sought

psychiatric assessment in order to apply for compensation or had sought therapy. Non-

clinical survey research emerged in later years. The clinical literature tends to present a

more negative picture than the later community research. Gross (1988) points out that

the very fact that the clinical literature appeared earlier than the survey research could

be the key to why they differ in their conclusions. Non-clinical survey research was

conducted with survivors when a longer amount of time had passed between the

Holocaust and the study participation. Clinical case studies were published at a time

that was more contemporaneous. Therefore what we may be seeing here is merely an

alleviation of symptoms over time (Gross, 1988). Whiteman (1993) states that many of

the early formulations of the impact of the Holocaust on survivors continue to be taken

for granted today even though they are clearly based on evaluations conducted when

survivors were “at their lowest ebb”. This has led to a tendency towards


38

“syndromisation” of survivors which has also been found to occur with children of

survivors as well (Steinberg, 1989).

When reviewing the literature many authors have suggested that there is no

overall difference between survivors (or their descendants) and the general population

because a large number of non-clinical studies find no statistically significant

differences between them and control groups. However, a vast majority of these studies

do find that survivor groups score higher on measures of mental health even if it is not

statistically significantly higher. The clinical groups have statistically significantly

higher levels psychopathological symptoms/disorders while the non-clinical groups

have non-statistically significantly higher levels than control groups/the general

population.

Felsen (1998) suggests that the term complex rather than syndrome be used to

reflect that the differences between survivor groups and controls are there to some

degree. The term syndrome implies that symptoms are present to a clinically significant

level while the term complex, Felsen (1998) argues, can be used to merely identify a

differing psychological profile with mild, but not necessarily pathological, levels of

certain symptoms. Felsen (1998) applied this argument to children of survivors,

however it could be used to apply to any non-clinical group of children of survivors or

survivors themselves. So the key issue should be why some survivors end up being

classified as clinical and others non-clinical. What factors lead to these different levels

of post-war adjustment? Many of these factors will be demographic in nature.

2.5.5. – Assessment of Demographic Differentials

Perhaps the biggest criticism that can be levelled at research conducted with survivors

and their descendants, which also represents an unfortunate missed opportunity, is the

lack of assessment of demographic differences within the survivor population and their

descendants. The vast majority of research with this population has concentrated on

differences between this group as a whole compared to control groups (Kahana &

Kahana, 2001). As Fogelman and Savran (1979) noted, what was missing was an

indication of the range and degree to which symptoms were present in this population.

In other words how the levels of adaptation differed within the survivor group among

different demographic subgroups.

While efforts have been increasing in recent years, very few researchers have

examined differences between sub-groups as readily assessable as gender and age

(Solkoff, 1992b). What makes this fact even more puzzling is the fact that

heterogeneity among the Holocaust survivors and their descendants has been argued


39

within theoretical discourses from the very beginning (Blank, 1996; Eitinger, 1969;

Niremberski, 1946; Yehuda, Schmeidler, Giller et al., 1998) despite some arguing that

heterogeneity was only recognised much later (Steinberg, 1989).

Only a very small minority of community survey studies conducted sub-group

analysis to check for these potential differences. Some studies fail to even provide a

description of the demographic characteristics of their sample (Solkoff, 1992a), let

alone using them as variables for further statistical analysis. Others have noted how

important it is to look for within group differences but then fail to report information

about this issue in relation to their own study (for example Blank, 1996).

In his reviews of the literature in this field Solkoff (1992b) points out the lack of

investigation of issues such as religious/ethnic backgrounds (he gives the example of

comparing Polish Jewish survivors to Polish Catholic survivors), nature of Holocaust

experiences (i.e., camp incarceration versus living in hiding), and country of post-war

settlement (for example Israel versus America or Australia versus remaining in Europe).

While a number of articles that examined the impact of differing Holocaust experiences

were found, the issues of ethnicity/religion and post-war settlement location were

ignored by the majority of researchers. Only one study was located that explicitly

assessed the impact of being Jewish. Rose (1983) had both Jewish and non-Jewish

children of survivor groups and Jewish and non-Jewish control groups in her study.

Okner and Flaherty (1988) were the only researchers comparing an American group of

children of survivors to an Israeli group.

As is outlined more fully in Chapter Four, the nature and duration of persecution

endured by survivors was highly dependent on the country in which they were

domiciled both before and during the war. It would therefore seem prudent to check for

differences between survivors of different countries of origin. The only study located

by the current author to have cross referenced results with country of origin was

Schleuderer (1990). Schluederer’s (1990) study examined children of survivors but he

cross-referenced their results with both their mother ‘s and their father’s country of

origin. No studies were located that examined this issue with the survivor generation

itself which is difficult to understand.

There is evidence for heterogeneity within the Holocaust survivor groups

assessed in the studies examined for this project. For example, the Holocaust survivor

groups assessed by Finer-Greenberg (1987) and Yehuda, Kahana, Southwick and Giller

Jr. (1994) both recorded standard deviations in depression scores twice as high as those

noted for their respective control groups. While it is not possible to assess the


40

source/reason for this difference, it is possible to state that there was much more

individual variation in the Holocaust survivor groups compared to the control groups.

Perhaps if these groups were broken into demographic subgroups of some kind some

light could have been shed on the exact nature of these differences.

One possible explanation for Finer-Greenberg’s (1987) results is age

differences. The age range of her Holocaust survivor sample was 17 years.

Specifically, participants ranged in age from 55 to 72 years. Those aged 55 would have

only been 7 years old when the war started in 1939, while those aged 72 would have

been 24 years old and already adults. Shmotkin and Lomranz’s (1998) sample of

Holocaust survivors had an even wider age range of 48 years, representing another lost

opportunity to ascertain the impact of age. Terno, Barak, Hadjez, Elizur and Szor’s

(1998) comparison of incidence levels of affective disorder among clinical groups of

survivors and controls is also called into question when one notes the age range of 38

years of their subjects.

While a lot of possible demographic moderating variables have been left

unexamined, some researchers have embarked on the assessment of differences between

survivors with and without a diagnosis of Posttraumatic Stress Disorder (for example

Trappler, Braunstein, Moskowitz, & Friedman, 2002; Yehuda et al., 1994; Yehuda,

Schmeidler, Giller et al., 1998). That any person diagnosed with PTSD would score

higher on measures of psychopathological symptoms such as depression, anxiety and

paranoia than persons without such a diagnosis seems to be a fairly logical assumption –

given the co-morbidity rates of these disorders. Research into differences between these

two groups does not add to our knowledge of what leads to differing levels of

adjustment within this population.

Many researchers have suggested various demographic factors which may have

influenced the degree to which a survivor (and their descendants) were able to adjust to

life after the Holocaust. These factors and the theories behind them will be explored

more thoroughly in Chapter Four.

2.6. – Summary and Conclusions

This chapter has provided a summary of the research and theories as to the impact of the

Holocaust on survivors and their descendants. As was discussed early in the chapter,

initial research focussed on the survivors themselves and then moved on to their

children as they started to seek treatment in the mid 1960s. The most commonly

referred to symptoms and effects of the Holocaust seen among survivors themselves are

depression, anxiety, paranoia, PTSD symptoms and difficulties with trust and intimacy.


41

Similar symptoms were seen among children of survivors in levels higher than the

general population.

If descendants of survivors also show elevated levels of psychological

symptoms then this begs the question of how did the effects of the Holocaust transfer to

subsequent generations. Chapter Three discusses numerous variables that have been

postulated as potential transmission modes. At the end of this chapter the preliminary

Model of the Differential Impact of Holocaust Trauma across Three Generations which

was presented in Section 2.4 will be expanded to include these proposed modes of

intergenerational trauma transmission.


42

Chapter Three – The Intergenerational Transmission of Holocaust Trauma

Surviving carries baggage that lasts for generations. A child of survivors

Chapter Two cited many sources that suggest that the impact of the Holocaust can be

seen not only in those who directly endured the suffering of the period but in their

descendants as well. Related to this is the fact that the well-established finding that

higher rates of psychopathology are found among the children of people with

psychopathological symptoms or disorders has been replicated within the survivor

population as well (Keinan, Mikulincer, & Rybnicki, 1988; Major, 1990; Schwartz,

Dohrenwend, & Levav, 1994; Yehuda, Halligan, & Bierer, 2001). But it is not enough

to merely note that the greater prevalence of psychological symptoms noted amongst

survivors can be seen in their descendants. It is necessary to investigate the

mechanisms that allow this to occur. Perhaps if these mechanisms can be identified

then it may be possible to nullify or minimise their effects and by so doing decrease the

symptom levels of the children.

This line of thought brings the issue of transmission of trauma across

generations, or intergenerational transmission of trauma to the fore. Intergenerational

transmission implies that children of trauma survivors can be exposed to or become

subject to “residues” of parental traumas without direct exposure to the trauma

(Weingarten, 2004). If it is accepted that descendants of survivors develop symptoms as

a result of their parents’ war time experiences, the next question is by what process or

processes does this occur?

Family systems theory applies to the case of symptomatology experienced by

descendants of Holocaust survivors quite readily. The family systems approach states

that as a part of an organised family system, an individual is never truly independent

and can only be understood within the context of that family system (P. Minuchin,

1985). A family systems approach to the study of psychopathology holds that an

individual’s symptoms are an expression of some form of dysfunction within the family

system which needs to be explored as much as the individual clients themselves (Bitter

& Corey, 1996). Certainly the nature of their survivor parents’ Holocaust experiences,

and the ways in which these impacted on their interactions with their children, are

highly relevant when considering the presenting symptomatology of children of

survivors. As Kellerman (2001d) argued “whatever the diagnosis, it is assumed that

children have absorbed some of the terrors of their parents and that any psychological


43

evaluation of the child must include some inquiry into the Holocaust history of the

parents as well as their particular style of child-rearing behaviour (p. 2).”

A number of hypotheses about survivor family environment have been posited

to explain why children of Holocaust survivors may have higher levels of symptoms

than the general population. These hypotheses fall into two camps. The first proposes a

direct form of transmission whereby the children of survivors develop symptoms via

modelling their parents’ maladaptive behaviours as might be espoused by theorists such

as Bandura (Kellerman, 2001a, 2001e; Major, 1990; Mazor & Tal, 1996; Schwartz et

al., 1994). The second suggests a more indirect route in which survivor’s parenting

behaviour is affected by their symptoms and the children subsequently develop

symptoms as a result of this “flawed” parenting (Felsen, 1998; Goldwasser, 1986;

Kellerman, 2001a; Schwartz et al., 1994; J.J. Sigal, 1973). In this second proposed

pathway interactions and communication within the family are seen as mediating

processes for the transmission of survivors’ psychological problems to their children

(Kellerman, 2001a). It is inevitable that survivors of any form of massive trauma such

as the Holocaust unwittingly incorporate their process of coping with that trauma into

their family life (Bistritz, 1988; Brom et al., 2001; Chaitin, 2002). Last (1989) notes that

this process was termed “toxic parental impact” within psychodynamic circles. The fact

that Holocaust survivors were seen to have difficulty in interpersonal relations after the

war has already been discussed in Chapter Two. It follows that these difficulties would

translate into their relationships with their post-war children and families. In other

words, the trauma does not only affect the individual survivor but also by affecting the

way the individual survivor interacts within the family unit it also affects the

functioning of the family unit, as would be espoused by family systems theory (P.

Minuchin, 1985). However, it should also be noted that, as Newman (1979) points out,

not all survivors developed problematic relationships with their children just as not all

survivors developed debilitating psychiatric problems in the post-war period.

Harkness (1993) described the family life cycle in a way that captures the reason

why the Holocaust can have such a long lasting and devastating impact on a family. He

said that “the family life cycle is characterised by the making and breaking of emotional

bonds”. Bar-On (1995) further elaborates by stating that families are unique systems

that can only be joined through birth or marriage and left through death or divorce.

Wardi (1994) adds that the “experience of loss and separation accompanies us

throughout our lives” and that “the ability to pass through life’s stages in a relatively

easy manner derives from the ability to experience separation in an optimal manner, as


44

conflict free as possible”. It is fair to say that survivors were not able to experience the

separation from their loved ones that perished during the Holocaust in a smooth and

conflict free way. Wardi (1994) contends that as a result of this, developmental

separations and losses are especially difficult for Holocaust survivors to cope with.

Kellerman (2001b) further asserts that it is specifically in the area of making and

breaking emotional bonds that Holocaust survivor families often struggle. In his

Person-Environment Approach to Traumatic Stress Reactions, Wilson (1989) cites

“intensification of developmental stages” as being part of life-course development in a

post-trauma environment.

From the outset survivors had difficulty establishing bonds after the Holocaust

and they subsequently ran into difficulty when those bonds had to be severed. This

corresponds to difficulty in establishing parent-child attachment and more generally to

cohesion within the family and the children’s separation-individuation phase

corresponds to the breaking of bonds. Parent child attachment, family cohesion and

separation-individuation have been mentioned many times in the literature as

particularly difficult for survivors and their families. Additionally, communication

within the survivor family, particularly in relation to the Holocaust experiences of the

survivor, has been presented often as another mediating influence on the psychological

adjustment of children of survivors.

This chapter considers the four factors of parent-child attachment, family

cohesion, separation-individuation and communication, in turn in terms of their nature

within survivor families and their impact on the well-being of the children in these

families. In so doing this chapter serves to incorporate a broad family systems approach

to the assessment of transmission of Holocaust trauma incorporating attachment theory

and the 3-D Circumplex Model of Family Functioning (cohesion and communication).

Finally, the preliminary Model of the Differential Impact of Holocaust Trauma across

Three Generations presented in Chapter Two, Section 2.4, will be amended to

incorporate these proposed intergenerational transmission variables.

3.1. – Parent-Child Attachment

Chapter Two highlighted the fact that many survivors experienced problems in relating

to others after the war (for example Freyberg, 1980). Sigal, Silver, Rakoff and Ellin

(1973) explain how this deficit among survivors lead to difficulties in forming healthy

relationships with their children. There has been an increasing emphasis in the literature

on the impact of traumas such as the Holocaust on attachments (Wiseman et al., 2002)


45

and the use of attachment as a useful framework in the explanation and treatment of

traumatic impact (for example M. F. Solomon & Siegel, 2003).

The study of attachment focuses on the infant as an individual “in formation”

within the family system (P. Minuchin, 1985). A very basic definition of attachment is

that it is the emotional bond that forms between an infant and a parent/adult that leads

the child to seek out that adult in times of distress, be highly receptive to being cared for

by them and to display anxiety if separated from them (Reber, 1985). The child can

either develop a secure or insecure attachment to their parent or caregiver depending on

the nature of the adults’ responses to the child. If the parent or caregiver responds

promptly and consistently to the child’s needs then a secure attachment will form. If the

parent or caregiver is slow to respond, inconsistent in their response or non-responsive

then an insecure attachment will form. Inconsistency of response will lead to an

ambivalent attachment while non-responsiveness will lead to avoidant attachment (the

work of Mary Ainsworth as summarised by Hazan & Shaver, 1987). A child’s

attachment to their parent/s is very important as it teaches the child emotional

regulation. This role makes it clear how attachments in formative years can be linked to

emotional problems in later life (Sroufe, Duggal, Weinfeld, & Carlson, 2000).

The role that the parent-child relationship may play in the mental health of the

children is also a basic tenet of Kohut’s Self-Psychology theory. Kohut argued that the

failure of parents to demonstrate sufficient empathy towards a child is a key element in

the development of psychopathology (the work of Heinz Kohut as summarised by

Baker & Baker, 1987). A lack of responsiveness or inconsistent responsiveness,

mentioned in the context of attachment theory above, also relates to the self-

psychological concept of parental mirroring. Adequate/appropriate responsiveness or

mirroring is an important resource for the development and maintenance of self-esteem

in the child, and when it is inadequate there is a much higher likelihood of the child

having psychological problems in adulthood (the work of Heinz Kohut as summarised

by Baker & Baker, 1987).

3.1.1. – Survivor Parents’ Insecure Attachment to their Children

The psychological symptoms experienced by survivors in the post-war period often had

negative implications for the way in which they could relate to their children. In

particular problems with unresolved mourning and anxiety have been linked to

problematic parenting and attachments. Unresolved mourning in mothers has been

linked with disorganised infant-mother attachments (van Ijzendoorn, 1995). Parents


46

pre-occupied with their grief over lost relatives were often emotionally unavailable to

their children (Barocas & Barocas, 1980).

Depressed and anxious parents have also been seen to be withdrawn and lacking

in warmth towards their children which has implications for the parent-child

relationship (Kendler, Sham, & MacLean, 1997). An anxious parent is limited in their

ability to inspire trust in their children (Lipkowitz, 1973).

As noted in Chapter Two, anxiety is commonly found among survivors and

survivors have often been described as over-anxious parents (Axelrod et al., 1980; Halik

et al., 1990; Kellerman, 2001b; Newman, 1979; Rustin, 1988). Davidson (1980a)

describes how this over-anxiety was played out in the mother-child relationship from

the very beginning with survivor mothers overfeeding their babies for fear they would

starve, constantly checking on babies’ breathing throughout the night with extreme over

reactions to any minor sign of ill health. Sonnenberg (1974) explains that survivors

were driven by a great desire to protect their children from having to endure any

suffering and Halik et al. (1990) add that their fear that harm would come to their

children was often inappropriately extreme.

Children of survivors often note that their parents were hyper-vigilant and

protective (Freyberg, 1980). It is not surprising that such behaviour was found to

inspire fear, mistrust, wariness and suspicion in children of survivors (Rowland-Klein &

Dunlop, 1997). While this level of anxiety may have been appropriate for conditions

during the Holocaust it is considered inappropriately extreme for peacetime conditions.

For example, Barocas and Barocas (1980) write that survivors often gave the impression

of extreme and imminent danger though its source may have seemed fairly vague

(Kellerman, 2001a). They made general statements such as “be careful” and “don’t

trust anybody” (Kellerman, 2001e). Kellerman (2001a) suggests that some survivors

continued with their hyper-vigilant survival strategies which may well have been key to

their survival in a concentration camp but are viewed as paranoid in a peacetime

environment.

Survivors often have a retrospectively insecure view of their relationship to their

own parents. This is not because the nature of the parent-child attachment was insecure

but because the intervening circumstances of the Holocaust altered their assessment.

Research has found that attachment can change over time and can be considered

unstable (Baldwin & Fehr, 1995). Therefore it can be argued that a traumatic event and

how a parent is seen to deal with that event can alter the nature of the attachment that

the child has with their parent. For example, child survivors’ images of protecting and


47

loving parents were undermined when they witnessed their parents’ inability to protect

themselves or their children from Nazi atrocities (Chaitin & Bar-On, 2002; Kestenberg

& Kestenberg, 1980). Thus the traumas of the Holocaust induce an insecure attachment

to survivors’ parents which may not have existed prior to these events (Auerhahn &

Lamb, 1998).

Some survivors were able to maintain their image of their pre-war

relationship/attachment to their parents as a model for their later child-rearing.

Survivors who were able to hold on to these memories were more likely to be able to

foster secure attachment in their children as they had a model of security they could

convey to their children (Chaitin & Bar-On, 2002). Survivors who did not have such an

internalised model often had difficulties in this regard (Freyberg, 1980).

However, van Ijzendoorn, Bakermans-Kranenburg, and Sagi-Schwartz (2003)

disagree that survivors retrospectively altered their view of their attachment to their

parents. They argue that while they certainly saw evidence of their parents’ inability to

protect them, survivors were able to recognise that the fault for this lay with the Nazi

war machine and not with any parental weakness. They argue that survivors attachment

to their parents and basic trust should not have been undermined by their Holocaust

experiences (van Ijzendoorn et al., 2003).

Whatever the argued origin, be it unresolved mourning, over-anxiety or

retrospective alterations of attachments based on Holocaust experiences, it has been

argued by many that the parent-child attachment between survivors and their children is

more often insecure than secure.

3.1.2 – Negative Effects of Insecure Attachment of Children to Parents

Insecure modes of attachment between parents and children have been linked to

increased symptomatology in the children such as depression, anxiety, paranoia and

adult attachment insecurities (Crowell & Treboux, 1995; Hesse, Main, Yost Abrams, &

Rifkin, 2003). In a recent study, Costa and Weems (2005) found that attachment to

mother mediated the relationship between child and maternal anxiety. In other words,

the apparent relationship between maternal and child anxiety was reflecting the

relationship between maternal anxiety and her attachment to her child and the child’s

attachment to their mother and their level of anxiety. This mediation relationship was

also found by Han (2005) with a sample of children of South East Asian refugees who

had been traumatised by war experiences. She suggested that because the refugee

parents had a reduced capacity to develop secure attachment with their children (in

much the same way that the current author and the other authors have argued is the case


48

for Holocaust survivors) that therefore parent-child attachment can be considered a

pathway for trauma transmission (Han, 2005).

Having an anxious or depressed parent has been linked to children’s insecure

attachment to those parents. For example, Radke-Yarrow (1991) found the incidence of

secure attachment to be lower among children of depressed mothers than of mothers

with no diagnosis (53% versus 62%). Shoshan (1989) notes that some children of

survivors felt their parents minimised the importance of any problems they were having

for example at school and so felt that they could not turn to their parents for comfort and

support in these instances. Such behaviours are linked to insecure attachment modes

(van Ijzendoorn, 1995). Survivor parents have often been described in this way (Chaitin

& Bar-On, 2002; Freyberg, 1980; Lipkowitz, 1973).

Bar-On et al. (1998) argue for the application of the categorisation of attachment

between survivor parents and their children as the insecure-ambivalent attachment

orientation. Main (1990) stated that this form of attachment is the predictable response

of a child to the inconsistency of emotional responsiveness of the survivor parent.

Survivors have been described as clinging tightly to their loved ones for fear of losing

them on the one hand and at the same time seeming to distance themselves so that they

would not be so hurt if they did lose them (Brom et al., 2001). The children in this

situation are then conflicted by their desire for emotional proximity which they often

felt denied. However they also strove for autonomy in reaction to the stifling nature of

their parent’s over-anxiety and protectiveness. This description melds neatly with the

insecure-ambivalent attachment style. Ryn (1990) notes that relationships between

survivors and their children have been described as ambivalent in Polish research. The

attachment between survivors and their children has been described as symbiotic by

many writers (Barocas & Barocas, 1980; L. Berger, 1988; Halik et al., 1990; Kellerman,

2001c; Rowland-Klein & Dunlop, 1997; Rustin, 1988).

The contrasting model of Fraley, Davis and Shaver (1998) which explains the

rise of a dismissing/avoidant attachment style can also be applied in some survivor

families. In their model, Fraley et al. (1998) note how a rejecting caregiver who is

“unavailable” to their children leads their children to feel they cannot rely on others and

not to become too close or dependent on others. This model in particular would apply

in survivor families where survivors remained emotionally distant to their children

because of a fear of pain caused by further separations. The theory being that if they

tried to remain detached they would not be hurt so much when the inevitable separation

occurred.


49

These problematic parent-child relationships can then be linked to symptoms in

the children such as depression (J.J. Sigal et al., 1973). Feeney and Noller (1996) state

that quality of parent-child attachment has been found to relate to emotional well-being

of children with lower anxiety and depression associated with secure attachment and

higher anxiety and depression associated with insecure forms of attachment It has been

argued that the children of over-anxious parents have higher incidence levels of

depression, paranoid ideation, phobias and psychoses (Rustin, 1988; Trossman, 1968).

The findings of a study by Vivona (2000) further attest to this relationship with

adolescents reporting insecure attachments to their parents evidencing higher levels of

depression and anxiety. Sroufe, Duggal, Weinfeld and Carlson (2000) assert in their

review that the relationship between insecure parent-child attachment and emotional

problems among the grown up children is firmly established. However they temper this

by saying that this relationship is not deterministic but rather probabilistic. Emotional

or psychopathological problems are more likely when insecure-parent child attachment

is present but are not a certainty.

The insecure attachment that children of survivors developed towards their

parents is also related to attachment problems in later life (Crowell & Treboux, 1995).

Some theorists argue that adult attachment is a natural progression or evolution of

attachments to parents in childhood and that the only thing that changes is the object of

that attachment, that is from the parents to the romantic partner (Levy, Blatt, & Shaver,

1998; R. S. Weiss, 1991). Bowlby (1988) contended that the attachment that a child

forms with its mother or other primary care giver acts as a model for subsequent

relationships with romantic attachment figures. Davidson (1980a) argues that children

of survivors often have difficulties establishing intimate relationships because of lack of

security and warmth they felt as a child. This may be because they were lacking a

secure attachment model (E. Cohen et al., 2002). Numerous studies have found

evidence of a relationship between insecure parent-child attachment and insecure

romantic attachment among grown children (Collins & Read, 1990; Levy et al., 1998;

Shaver, Hazan, & Bradshaw, 1988). Sagi-Schwartz et al. (2003), Woolrich (2005) and

Berger (2003) obtained further support for this relationship within the survivor

population.

Not only are children of survivors’ adult attachments potentially affected, but

also their subsequent attachments to their own children. Thus attachment becomes a

self-perpetuating transmission mode (Chaitin & Bar-On, 2002; van Ijzendoorn, 1995).

In a meta-analysis of parent-child attachment van Ijzendoorn (1995) found that in 75%


50

of cases, the nature of parent-child attachment was predicted by the parent’s view of

their own childhood attachment. If they viewed their own childhood attachment as

insecure then their attachment with their children is also likely to be insecure. Since

insecure attachment has already been linked to the increased likelihood of psychological

problems such as anxiety and depression Sigal and Rakoff (1971) note that there is

every possibility that children generations removed from the Holocaust will still be

suffering from its psychological aftermath.

3.2. – Family Cohesion

Family cohesion can be defined as the degree of emotional bonding or closeness

between family members (Bray, 1995; Olson, 1993). In other words, how close or

distant family members feel to each other (Bray, 1995). According to Olson’s (1993)

Circumplex model of marital and family systems, the four levels of cohesion are

enmeshed (very high), connected (moderate to high), separated (low to moderate) and

disengaged (very low). The two extremes of this spectrum are considered maladaptive

while the two central dimensions are considered normal (Olson, 1993).

3.2.1. – Extreme Levels of Cohesion in Survivor Families

Family cohesion has been heavily implicated in theories of trauma transmission

(Baranowsky et al., 1998). For example, Leydic Harkness (1993) notes that families of

Vietnam veterans have been categorised at the extreme (maladaptive) ends of the

cohesion dimension, that is enmeshed or disengaged. The extreme ends of this

dimension have been linked to psychological problems such as depression in the

children of these families (Franklin & Streeter, 1993).

Holocaust survivor families are commonly described as being enmeshed or

disengaged, though enmeshed is the more common description (for example Almagor &

Leon, 1989; Felsen, 1998; Halik et al., 1990; Kellerman, 2001b, 2001c; Newman, 1979;

Perel & Saul, 1989; J.J. Sigal & Weinfeld, 1989). Kellerman (1999) notes that survivor

families are often infused with over-dependency between family members or

exaggerated independence. In a later article he notes that while survivor families differ

the more pathological ones can be considered enmeshed (Kellerman, 2001e).

According to Olson (1993) disengaged families are characterised by a lack of

emotional closeness, with members generally unable to turn to each other for support.

Family members see themselves as quite separate and have a high degree of

independence with little attachment to the family. The emotional closeness lacking in

the disengaged family system is omnipresent in the enmeshed family. Dependency

between family members is very high and family members have very little identity as a


51

separate person. Minuchin (1974) contended that the parents in enmeshed families are

often overcontrolling and intrusive when relating to their children.

Holocaust survivor parents have often been characterised as over controlling and

specifically over protective of their offspring (Axelrod et al., 1980; Bar-On et al., 1998;

Chodoff, 1997; B. B. Cohen, 1991; Felsen, 1998; Fogelman & Savran, 1979; Halik et

al., 1990; Hass, 1990; Kellerman, 2001b; Kuperstein, 1981; Newman, 1979; Oliner,

1990; Rowland-Klein & Dunlop, 1997). In fact, in his discussions with children of

survivors, Hass (1990) found that over-protectiveness was the most common trait

mentioned when asked how they believed their parents’ Holocaust experiences had

affected the way they raised them. Hogman (1998) asserts that over-protectiveness

towards children was also noted among survivors of the Armenian genocide.

It is worthy of mention that while enmeshment is generally viewed as a negative

influence, Fogelman and Savran (1979) note that children of survivors do derive some

positives out of it. They note that while the children of survivors they have come into

contact with often express anger and frustration over their parents’ over-protectiveness

they also see it as evidence of their parents’ deep love for them (Fogelman & Savran,

1979). Because of the extent of their losses in the Holocaust, survivors value their

family members to a great extent and this cannot be but obvious to their children

(Fogelman & Savran, 1979).

3.2.2. – Extreme Family Cohesion as it Relates to the Psychological Health of Children

Over-protection on the part of parents has been linked to depression among their

children in the general population (Feeney & Noller, 1996). Rustin (1988) posits that

over-protection on the part of survivor parents has been linked to depression and

paranoid ideation in children of survivors. Sachs (1988 (in Hebrew), cited in Z.

Solomon, 1998) found that extreme cohesion (either enmeshment or disengagement)

was related to higher levels of anxiety and depression among children of survivors.

As Almagor and Leon (1989) and Felsen (1998) note, the lack of boundaries

both between the parents and intergenerationally between the parents and the children

inevitably lead to difficulties in the establishment of self-identity in the children of these

families. Ackerman (1956, cited in Almagor & Leon, 1989) suggested that this blurring

of boundaries leads to “interlocking of family pathology as well as its generational

transmission.”

While high and low cohesion have been linked to psychopathology symptoms in

the children of affected family systems it is the decreased level of independence

associated with high cohesion that is more often discussed in relation to children of


52

Holocaust survivors. When cohesion is too high, or a family is considered enmeshed,

family members have minimal independence (Olson, 1993). This lack of independence

can cause problems when children enter the separation-individuation phase during

adolescence (Felsen, 1998). Specifically the children have problems establishing

autonomy and independence (Felsen, 1998; J.J. Sigal & Weinfeld, 1987). These

difficulties are discussed in the next section.

3.3. – Separation-Individuation

According to Mazor and Tal (1996), separation-individuation refers to the development

of an autonomous, responsible adult identity separate from the family of origin able to

take on adult responsibilities. This occurs gradually as the balance between autonomy

and independence and dependence on parents is adjusted in age-appropriate stages

(Mazor & Tal, 1996). The end result is commonly physically demonstrated by the child

moving out of the family home in adolescence or young adulthood (Auerhahn & Lamb,

1998).

Emotional fusion is the polar opposite of individuation and is characterised by

unresolved attachment to the family of origin (Bray, 1995). Bray (1995) explains that

children at this end of the spectrum feel undue responsibility for others (that is, their

parents) and may also avoid taking responsibility for themselves by maintaining such

strong ties to their parents. Such fusion is linked to higher stress levels, poorer health,

and higher incidence of psychological problems (Bray, 1995; Brom et al., 2001).

3.3.1. – Separation-individuation problems noted among children of survivors

Many researchers have noted that children of survivors have extreme difficulty

establishing an independent and autonomous self (Chaitin & Bar-On, 2002; Gay et al.,

1974; Newman, 1979; Perel & Saul, 1989). In fact, Perel and Saul (1989) state that

stages of family development that involve assertion of autonomy and independence,

especially when children reach adolescence, leave home and marry, are particular crisis

points for the survivor family. However Wardi (1994) opined that survivor mothers are

incapable of encouraging independence even in their infant children. With the blurring

of boundaries outlined in previous sections in the form of symbiotic attachments and

family enmeshment it is no wonder that individuation presents difficulties for survivors

and their children and that fusion is prevalent (Bar-On et al., 1998; Barocas & Barocas,

1980; Brom et al., 2001; Felsen, 1998; Fogelman & Savran, 1979; Freyberg, 1980;

Goldwasser, 1986; Halik et al., 1990; Hass, 1990; Jucovy, 1992; Kellerman, 2001b,

2001e; Kuperstein, 1981; Mazor & Tal, 1996; Perel & Saul, 1989; Rosenbloom, 1988;

Rowland-Klein & Dunlop, 1997; Shoshan, 1989; Steinberg, 1989; Wardi, 1994).


53

The root cause of separation-individuation problems in the children of survivors

is their parents’ intense reaction at the thought of separation from them. This is thought

to result from the losses experienced by survivors during the Holocaust, particularly of

their parents (Halik et al., 1990; Kellerman, 2001e; Mazor & Tal, 1996). It is not the

fact that they were separated from their parents but that the separation was so abrupt and

violent that leads to difficulties (Last, 1989; Perel & Saul, 1989). Children were often

dragged away from their parents kicking and screaming or witnessed their parents being

killed (Chaitin & Bar-On, 2002). Having been separated from their parents in such an

unnatural way, many survivors are lacking a parental model for dealing with the normal

process of individuation (S. Davidson, 1980a). They interpret separations as loss

(Freyberg, 1980) since in their experiences separations between parents and children

were permanent. Also having lost so many relatives as well as the collective loss of

communities, many survivors feel incapable of dealing with any further loss (Kahana et

al., 1989; Rowland-Klein & Dunlop, 1997).

Hass (1990) states that some survivors explicitly told their children that they

could not endure another separation, even the normal developmental separation of

young adults from their family of origin. Some go so far as to block their children’s

attempts at establishing relationships with people outside the family unit, to move out of

the family home or any other attempts at individuation (Barocas & Barocas, 1980; S.

Davidson, 1980a; Freyberg, 1980; Hass, 1990). When this occurred the children often

developed an ambivalent relationship with their parents due to the resentment they felt

from their parent’s clinginess and their interpretation of their attempts at individuation

as acts of abandonment and betrayal (Bistritz, 1988).

Children of survivors develop “separation guilt” as a result of their desire to

differentiate themselves from their parents (Grubrich-Simitis, 1981; Kuperstein, 1981;

Rowland-Klein & Dunlop, 1997). Children of survivors are torn between wanting to

establish relationships outside the family and establish a degree of autonomy and

independence yet at the same time wanting to maintain the comfortable dependency on

their family of origin (Russell, 1982). They are aware of how much their parents have

already suffered and lost and so wish to protect them from further separations

(Freyberg, 1980; Mazor & Tal, 1996; Rowland-Klein & Dunlop, 1997). Many children

of survivors therefore remain at home long after many of their cohort have moved out

on their own (Fogelman & Savran, 1979) thereby maintaining their symbiotic,

enmeshed relationship with their family of origin to the detriment of their own

autonomy (Rowland-Klein & Dunlop, 1997). Thus just as it was argued earlier in this


54

chapter that survivors are overly protective of their children, so too are children of

survivors of their parents (Kellerman, 2001e).

3.3.2. – Relationship between Separation-individuation Problems and Negative

Psychological Outcomes

It has been stated that the difficulties experienced in this stage are the main cause of

symptoms in the children of survivor population (Grubrich-Simitis, 1981). Separation-

individuation is a major goal of the adolescent period (Kuperstein, 1981) and it was at

this life stage that children of survivors started to seek psychological help in greater

numbers (S. Davidson, 1980a; Kuperstein, 1981; Russell, 1982).

Problems with separation-individuation and the aforementioned guilt that

children experience have been associated with a number of psychopathological

symptoms such as depression, anxiety and paranoia (Barocas & Barocas, 1980; Bistritz,

1988; S. Davidson, 1980a; Okner & Flaherty, 1988; Rustin, 1988; Steinberg, 1989).

Kenny and Donaldson (1991) report statistically significant positive relationships

between children’s symptom levels and parental over-involvement and parental fear of

separation from their children, while a negative relationship was noted between

children’s symptoms and the degree to which parents encouraged their autonomy.

Mazor and Tal (1996) note that the capacity to develop intimacy with a romantic

partner is also related to the degree to which an individual is differentiated from their

family of origin. Along with Steinberg (1989) and Barocas and Barocas (1980), they

note that when attachments to family of origin have not been sufficiently processed and

resolved via the separation-individuation process, this style of symbiotic attachment

may then be played out in future attachment relationships both romantic and parental.

3.4. – Communication

Survivors’ ability to talk about their Holocaust experiences varies greatly. Of specific

interest for this project is the way in which survivors chose to communicate their

Holocaust experiences to their children. Variations in the communication of Holocaust

experiences can have implications for the psychological well-being of survivors’

children (Axelrod et al., 1980; Baranowsky et al., 1998; Bistritz, 1988; Okner &

Flaherty, 1988; Wiseman et al., 2002). The influence of the style of communication

used by other trauma victims such as Vietnam veterans and ex-prisoners-of-war has also

been found to impact on their descendants. Kellerman (2001e) states that parental

communication style has been implicated as “a crucial determinant in the adaptation of

families beset by catastrophe.” Bray (1995) contends that “communication deviance”

has been linked with disorders such as schizophrenia.


55

Open communication in general is linked to the more functional family systems

while dysfunctional families commonly have communication problems (Bray, 1995).

Family communication patterns can be seen as symptomatic of a family’s level of

cohesion. Bray (1995) posits that families with high cohesion, or enmeshment, display

excessive emotional responsiveness when relating to family members, while families

with low cohesion, or disengaged families, may have problems with a lack of

communication. For example, Rodick, Henggler and Hanson (1986) found that

interaction between mothers and adolescents characterised as balanced was associated

with statistically significantly higher rates of supportive and open communication

expressed with positive affect than those located at the extremes. In fact Olsen (1993),

includes family communication as a facilitating dimension in his Circumplex Model of

Family Systems, which aids in movement along the two dimensions of family cohesion

and adaptability.

Communication between survivors and their children about the Holocaust has

varied between complete and (too) detailed accounts to absolute silence (Baranowsky et

al., 1998; Chaitin & Bar-On, 2002; Danieli, 1988; Fogelman & Savran, 1979; Gay et al.,

1974; Gertz, 1986; Jucovy, 1992; Jurkowitz, 1996; Kellerman, 2001a, 2001c, 2001e;

Obermeyer, 1988; Okner & Flaherty, 1988; Perel & Saul, 1989; Rowland-Klein &

Dunlop, 1997). Communication in one of these extreme forms has been linked to the

least adjusted of the children of survivor population (S. Davidson, 1980a; Jucovy, 1992;

Kellerman, 2001a; Rieck, 1994).

While open communication is seen as favourable, it has been argued that

tempering of accounts is required so as not to traumatise the listener with horrific detail

when discussing the Holocaust. Obsessive talk/preoccupation about the Holocaust does

not take into account the listener’s ability to absorb and can be traumatic for the listener

(Bar-On, 1995; Baranowsky et al., 1998; Kellerman, 2001c; Perel & Saul, 1989).

Schwarz (1986) found a curvilinear relationship between children’s depression and the

level of parental communication about their Holocaust experiences. Children forced to

continuously listen to detailed accounts of their parent’s suffering often become

depressed or develop a strong sense of guilt over not having suffered like their parents

(S. Davidson, 1980a; Kuperstein, 1981; Trossman, 1968). Okner and Flaherty (1988)

and Major (1990) note that the age at which children of survivors are told about their

parents’ experiences is also of importance. This point ties into the aforementioned idea

that the listener’s ability to absorb what is being told is important. If children are told at

a very young age when they are not ready to optimally process the information it can


56

have a negative impact on their psychological health (Major, 1990; Okner & Flaherty,

1988). Major (1990) notes that among children of Norwegian survivors who

incessantly spoke about their Holocaust experiences when the children were very young

depression and nightmares were common. She suggests this is because the children

were unable to keep a healthy distance from the experiences they learnt about from their

fathers’ Holocaust stories (Major, 1990).

The conspiracy of silence that was quite pervasive for around a decade (as

discussed in Chapter Two) meant that a lot of survivors had no one to talk to about their

experiences (Danieli, 1982; Kellerman, 2001e; Wiseman et al., 2002). Therefore the

survivors’ children became the only sounding boards available for a lot of survivors

(Gordon, 1990). This factor contributed to survivors seemingly obsessive re-telling of

Holocaust stories (Gordon, 1990). For many survivors the telling or witnessing of their

Holocaust experiences was a necessary form of catharsis (Danieli, 1982) as it presented

a way of releasing pent up grief (Okner & Flaherty, 1988). Because survivors often felt

they could not or did not want to seek any form of psychological help the children were

counted on for emotional support as well (Fogelman, 1998). For all of these reasons the

children in these circumstances were understandably affected.

Silence on the topic can also be harmful (S. Davidson, 1980a). Many survivors

remained silent about their experiences in the belief that their children would be

traumatised if they told them about it (Baranowsky et al., 1998; Danieli, 1988; Jucovy,

1992; D. Weiss, 1988; Wiseman et al., 2002). In fact Finkelstein and Levy (2006) state

that 22% of their survivor sample (n = 50) cited “fear of audience harm” as a reason for

their reluctance to talk about their Holocaust experiences. However, when the children

are not told anything about their parents’ experiences they often play out fantasies in

their head of what they think might have happened (S. Davidson, 1980a; Major, 1990).

These fantasies may be more horrific than the truth (Baranowsky et al., 1998; L. Berger,

1988; S. Davidson, 1980a; Jucovy, 1992; Steinberg, 1989). Therefore their parents’

silence indirectly had the opposite effect to that desired, namely to cause psychological

distress (Kellerman, 2001a; van Ijzendoorn et al., 2003) such as increased depression

(Major, 1990; Trossman, 1968). Goldwasser (1986) notes that an important part of

therapy for children of survivors is to learn to differentiate between the reality of their

parents’ experiences and the fantasies they created. It seems that “the efforts by

survivor parents to protect their children from knowing the grotesque experiences they

had witnessed and endured ultimately failed in light of the child’s urge to know (Krell et

al., 2004, p 507).” Indeed a study by Wiseman et al. (2002) found that children of


57

survivors who had largely remained silent about their experiences were more anxious

than children of survivors who had openly discussed their experiences. Similarly,

Goodman (1978) found that a clinical group of children of survivors reported less

communication about the Holocaust by their parents than a group of children of

survivors classified as non-clinical.

Despite their parents’ silence on the topic of the Holocaust most children could

sense their parents’ suffering and were left confused and inexplicably guilt ridden about

it (Danieli, 1988). For example, from a very early age, perhaps from birth, children of

survivors can be ultra sensitive to non-verbal signals such as facial expressions which

belie the suffering hidden under the surface (S. Davidson, 1980a; Fogelman, 1989;

Kellerman, 2001e; Shoshan, 1989; Steinberg, 1989). Fogelman (1989) contends that it

is via these intense non-verbal messages teamed with small bits of information gathered

from various sources that a lot of children find out or piece together their parent’s

Holocaust story rather than via direct story telling. The following quote illustrates the

point:

Because silence transmits its own messages, it is impossible not to communicate. Meanings are constructed. Snippets of text and fragments of allusion are calibrated against context and sense is haltingly induced. I grew up apprenticed in the skills of inference and versed in the language of the oblique. I became literate in the grammar of silence. Wajnryb (2001, p. xi), a child of survivors

Children of survivors in this situation often don’t press their parents for details

as they sense that it would cause pain for their parents to discuss their experiences

(Wiseman et al., 2002). Bar-On et al. (1995) and Wiseman et al. (2002) refer to this

situation as a “double wall” in which parents do not tell and children do not ask.

Children are also often conflicted about whether they want to know the details of their

parents’ Holocaust experiences (Fogelman & Savran, 1979). Fogelman and Savran

(1979) reported that when this issue came up in children of survivor group sessions

some intimated that they wanted to know how their parents survived but at the same

time did not know how they would cope with the knowledge once they got it. Or as

Wajnryb (2001, p. xii) put it: “there has been a struggle of competing interests: the

yearning to understand has vied uncomfortably with the urge not to know.” Janice

Friebaum’s poetry also portrays similar themes.


58

You were mute to free our spirits You kept secrets to spare us grief Yet we were tethered to your pain and mourned for your losses. How could you know your eyes spoke volumes And your silence painted pictures? In perfect step we moved: Not-too-close, not-too-much, Not-so-soon, please don’t push.

If you think we didn’t care We thought you didn’t either. If you thought we didn’t need your burdens We thought we wouldn’t trouble you with ours. You thought, we thought, You assumed, and so did we. All to keep us safe, all to keep you unhurt. Excerpts from Silent Conversation by Janice Friebaum © (a child of survivors)

Lang (1995) notes that survivor parents who tell little of their Holocaust

experiences are often also relatively silent on their pre-Holocaust life. Therefore the

children of these survivors not only live in a state of confusion over their parents’

Holocaust experiences they also have an increased sense of isolation from the lack of

family history available to them. Weiss (1988) argues that many children of survivors

interpreted their parents’ reluctance to discuss their experiences as a lack of closeness

and warmth which understandably impacted upon the quality of the parent-child

attachment.

It is the children of survivors who were able to be balanced in their

communication about the Holocaust (that is open but not in excessive detail until the

listener is ready to cope) that evidence the least psychological impact (S. Davidson,

1980a; Perel & Saul, 1989). Goldwasser (1986) notes how many authors in the field

stress that Holocaust experiences should be communicated to children in “an

appropriate and non-frightening way”.

It has been suggested that the degree to which a survivor is able to discuss their

experiences with their children is related to the survivor’s progress in working through

or coming to terms with their experiences themselves (S. Davidson, 1980a; Russell,

1982). A survivor who has largely processed and reconciled their experiences is in a

better position to discuss the Holocaust in a healthy way with their children (S.

Davidson, 1980a). For these reasons Rowland-Klein and Dunlop (1997) suggest that

survivors feel more capable of telling their stories to their children when they have

grown up and with the added benefit of the passage of time. Survivors are then better

able to tell their stories and the children are mature enough to cope with them. It is also

worthy of note that many survivors who constantly verbalised their Holocaust

experiences were responding to a “need to talk” that Janoff-Bulman (1992) likened to


59

intrusive recall (akin to the PTSD symptom of intrusion). Janoff-Bulman (1992)

suggests that persistent discussion of the Holocaust most likely points to incomplete

processing of the traumas by the survivor.

The ability to disclose details of experiences and be expressive has also been

linked to psychological well-being (Finkelstein & Levy, 2006; Gordon, 1990; Russell,

1982; Tedeschi, 1999) as well as the development of a feeling of security and trust

(Axelrod et al., 1980). Gordon (1990) postulated that a survivor’s ability to articulate

their Holocaust experiences is the mediating variable between the actual trauma and

their psychological well-being. Furthermore the ability to clearly articulate one’s

experiences becomes a mode of intergenerational transmission for interpersonal

difficulties with such factors as intimacy. Gordon (1990) argued that children of

survivors use their parents’ method of expression as a model for their own and if their

parents have difficulty articulating or acknowledging their experiences so will their

children. She goes on to state that this ability is related to the development of intimacy

in relationships and it therefore is reasonable to expect that children of survivors will

therefore have difficulties in this regard (Gordon, 1990).

The fact that survivors sometimes have trouble clearly articulating their

Holocaust experiences leads them to ambiguous communication about this period to

their children (Kellerman, 2001e). Bray (1995) defines healthy communication as being

clear and direct and so this form of communication, which he would categorise as

indirect and masked, is considered dysfunctional Rowland-Klein and Dunlop (1997)

note that communication about the Holocaust can therefore be subtle and somewhat

coded. Gordon (1990) gives a good example of this and the negative impact it can have.

A Holocaust survivor may react negatively to the colour yellow because of its

association with the Star of David armband that Jews were forced to wear during the

war. If the survivor is able to clearly explain this connection to the child they learn that

it is this link to the armband that makes yellow distasteful to the survivor and are able to

clearly understand this connection. If the survivor is unable to clearly articulate this

connection and responds in a fearful manner to a vast number of things that are yellow

or to various sounds and smells the child may take on this sense of a more globalised,

objectless fear or paranoia without understanding its source. Gordon (1990) argues that

it is not the automatic fear reaction witnessed by the child that is the important

transmitting factor but the survivors’ ability to explain it that is the key. When the

explanation is present, the necessary condition of healthy communication, that is shared


60

meaning, is also present (Bray, 1995). Lack of shared meanings is a feature of

dysfunctional communication (Bray, 1995).

However it is not simply a matter of being open or the extent to which a survivor

is open about their experiences that impacts on the psychological well-being of the

children of survivor population. The way in which survivors communicate their

experiences can be very important. Goldwasser (1986) explains how the parent’s ability

to openly describe their experiences without being excessively emotive or alternatively

being too deadpan (blunting of affect) is of vital importance. Jucovy (1992) states it is

“the way in which communication between the generations takes place rather than the

concrete content which is being imparted” that is the influential factor.

Bray (1995) refers to the concept of emotional expression which applies here.

Bray (1995) notes that affect or emotion that is tied to verbal communications via things

such as tone of voice can impact on the way the message conveyed is interpreted. He

notes that strong negative emotions, termed expressed emotion when teamed with

verbal communication, have been seen in families of schizophrenic, depressed and bi-

polar patients and have been associated with increased depression and anxiety. He also

notes that strong negative emotional statements outweigh positive emotional statements

in terms of their impact on family life. Guilt-inducing communication has frequently

been noted within Holocaust survivor families (for example Kellerman, 2001e;

Lichtman, 1983; Porter, 1981). Porter (1981) notes that depression often results in

children of survivors as a result of this, while Keller (1988) noted that extreme family

cohesion (either enmeshment or disengagement) were associated with guilt-inducing

communication as well.

It is clear that communication within the families of survivors both about the

Holocaust and in general is a potential pathway for the transmission of trauma.

Dysfunctional methods of communication such as obsessive retelling of events,

complete silence, indirect, ambiguous communication as well as communication laced

with negative emotions that can be seen as guilt inducing have all been linked to

psychological problems in the children of survivors.


The model presented at the end of Chapter Two has been expanded to

incorporate these family interaction variables. They have been bolded in the revised

version of the model presented overleaf in Figure 3.1. In contrast to the influential

psychological process variables, which are thought to influence the severity of

symptoms experienced, the family interaction/possible modes of transmission variables


61

are argued to mediate the relationships between ancestor and descendant variables. For

example, the relationship between Holocaust survivor scores on psychological impact

variables and child of survivor scores on psychological impact variables is hypothesised

to be mediated by the family interaction variables.

While the majority of literature on transmission of Holocaust trauma refers to

the transmission from survivors to their children, it is important to also remember

grandchildren of survivors. Numerous authors have argued it is important to include

assessments of grandchildren of survivors so that the parenting of the children of

survivors can be evaluated (Bar-On, 1995; Bar-On & Gilad, 1994; Mazor & Tal, 1996;

D. Weiss, 1988). Indications of transmission from children of survivors to the

grandchildren have begun to appear in the literature (Bistritz, 1988; Brom et al., 2001;

Chaitin & Bar-On, 2002; Ryn, 1990) but research is still lacking (Chaitin, 2003).

Psychological Impacts of

the Holocaust Influential

Psychological Processes

Modes of Intergenerational Transmission

of Trauma

1st G

ener

atio

n (S

urviv

ors)




2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)


Dimensions


• Parent-Child Attachment • Family Cohesion • Encouragement of

Independence • General Family

Communication • Communication about

Holocaust experiences

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Su

rvivo

rs)


Dimensions




Communication Figure 3.1. Addition of Trauma Transmission modes to the Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations


62

Chapter Four – Demographic and Situational Differentials in the Impact of the

Holocaust on Survivors

I was 18 years old when everyone I loved was taken from me: my home, my belief in people, my nationality, everything. I don’t believe I ever recovered from these. I live under the shadow of the Holocaust. Of course I have happy occasions, but even these times I felt sad because my family was not with me. A Holocaust Survivor

Chapter Two introduced the idea that there is evidence of differential post-Holocaust

adaptation relating to various demographic variables. Some of these have been directly

assessed by research and others have been left unexamined though the potential to

evaluate their impact has been present on many occasions.

The idea that there may be differences in adjustment among the Holocaust

survivor population (both in terms of their own psychological health and the way in

which they interact with their children) has been espoused by a number of researchers in

the field (Eitinger, 1969; Grubrich-Simitis, 1981; Halik et al., 1990; Kellerman, 1999).

Grubrich-Simitis (1981) notes that “there is no obligatory correlation between having

survived the concentration camps and the emergence of belated psychic aftereffects.”

While some survivors remain/ed deeply affected by their experiences many adjusted to

post-Holocaust life very well and lead productive lives (Halik et al., 1990). Bistritz

(1988) suggests that a continuum of adjustment exists among survivors with varying

levels of adjustment possible although she doesn’t suggest what factors influence a

survivor’s position on this continuum.

McCann and Pearlman (1990) argue that the exploration of individual

differences in response to massive traumas, such as the Holocaust, should be an

important area of research within the trauma field. The suggestion that reasons for

differential adjustment should be explored within the Holocaust survivor population

was made as much as thirty years ago (for example Antonovsky et al., 1971) but largely

ignored. There has been an acknowledgement that the tendency of the majority of

research to treat Holocaust survivors as a homogenous group is limiting (L. Berger,

1988; Bistritz, 1988; Blank, 1996; Danieli, 1998; Kahana & Kahana, 2001; Marcus &

Rosenberg, 1988; McCann & Pearlman, 1990; Shmotkin & Lomranz, 1998). This

chapter seeks to delineate potential moderating demographic variables (and interactions

between them) and incorporate them into the proposed model of the differential impact


63

and transmission of Holocaust trauma which has been gradually built up over previous

chapters.

The specific Holocaust survivor demographic and situational variables to be

considered in this chapter are age during the Holocaust, time lapse since the Holocaust,

gender, country of origin, cultural differences, reason for persecution, nature of

Holocaust experiences, loss of family members, post-war settlement location and post-

war resettlement issues. While these variables have been applied to the specific case of

the Nazi Holocaust, the majority of them appear in some form in either or both of the

two trauma models that have been used as a reference point for the current thesis:

namely Green et al.’s (1985) Working Model for the Processing of a Catastrophic Event

and Wilson’s (1989) Person-Environment Approach to Traumatic Stress Reactions.

Both theories refer to demographic characteristics, specific elements of the trauma itself

as well as aspects of the “recovery environment” as being influential in the severity of

traumatic reaction experienced by a victim/survivor.

4.1. – Age during the Holocaust

That there is, or at least might be, a difference in adjustment level among survivors of

differing ages was first raised very early on. For example, Niremberski (1946) noted

that children’s psychological well-being differed from that of adults in displaced

persons camps. Since then numerous researchers have argued for the influence of a

survivor’s age during the Holocaust on their subsequent adaptation (Brom et al., 2002;

Chaitin, 2003; Dasberg, 2001; Kahana & Kahana, 2001; Kellerman, 1999, 2001a,

2001b; Kuperstein, 1981; Matussek, 1975; Ornstein, 1981; Reijzer, 1995; Ryn, 1990;

Shanan, 1989; Steinberg, 1989; Suleiman, 2002; Tuteur, 1966).

Theorists have differed in their opinions as to the most vulnerable age group.

Most argue that a negative relationship between age and psychological symptomatology

exists in the Holocaust survivor population (Auerhahn & Laub, 1987; Baron et al.,

1993; Bower, 1994; Brom et al., 2002; Budick, 1985; M. Cohen, Brom, & Dasberg,

2001; Dasberg, 1987; Kahana & Kahana, 2001; Kellerman, 2001a; Mazor, Gampel,

Enright, & Orenstein, 1990; J.J. Sigal, 1998), while others argue for a positive

relationship (Kestenberg, 1990, 1993). Still a third group argues that adolescents were

the worst off with those younger and older in better psychological shape (Bower, 1994;

Budick, 1985; Felsen, 1998; Kuperstein, 1981; Marcus & Rosenberg, 1988; Suleiman,

2002). The arguments presented by these three camps will be addressed in turn.

Krell’s (1985) comments précis the main argument for why the youngest among

survivors would be most severely scarred by their experiences. These young survivors


64

were “too young to have partaken of a foundation for life, too traumatised to experience

a childhood and too preoccupied with survival to reflect on its impact.”

Firstly, in terms of foundations, Rustin (1988) suggests that the degree to which

Holocaust survivors were able to develop an empathic relationship with their parents

before being separated from them had implications for their own child-rearing

capabilities. Specifically, if the survivor was lacking a model of empathic parenting

from their parents they would be unable to respond appropriately to their own children

as they went through the “normative crises of childhood and adolescence”. The key

point here is that the younger the survivor was during the Holocaust, the less of a

chance they had to develop the empathic relationship with their parents. Therefore

younger survivors are envisaged to have had less empathy and greater difficulties with

their children at these crises points. However, some young survivors may have been

provided with a model of empathy from surrogate parental figures during the Holocaust.

Therefore this rule may not universally apply (Rustin, 1988).

Memories of pre-war family life were of great comfort to many while enduring

the traumas of the Holocaust (Rustin, 1988). According to Valent (1998), children from

as young as four years of age are able to maintain an image of their parents, fleshed out

by memories of their last moments together which they can remember forever. These

images are required for the development of a secure self (Kestenberg, 1985) or as

Moskowitz (1983) suggests are the nucleus of identity. Survivors old enough to clearly

remember this period and who had developed their own identity to some degree are

described as feeling more centred and self-reliant than younger survivors (Rustin,

1988).

In a qualitative assessment of a group of well-adjusted Holocaust survivors, Lee

(1988) had the following to say on the positive influence of positive childhood

memories:

The capacity to survive was grounded at least in part on early experiences of a positive nurturing environment. Apparently, having received love, warmth and respect from their parents had facilitated their enduring of a terrible ordeal and their going on to living meaningful lives in spite of the severe trauma they had experienced. The child brought up in a home with warmth and nurturance with experiences of love and security will have a reservoir of strength upon which he or she can draw in times of need (p.76).

That the Holocaust afforded very little opportunity for normal childhood

activities is an obvious point. As Dasberg (2001) puts it “children were exploited and

deprived of normal patterns of schooling, games, friendships with other children, and


65

hope for the future.” More specifically the situation their parents found themselves in

precluded them from establishing an adequately safe and trusting environment that

children rely on them to provide (Dasberg, 2001; Macksoud et al., 1993; Rustin, 1988).

This is quite apart from the physical requirements of adequate shelter, nutrition and

hygiene which were also largely lacking (Dasberg, 2001). Macksoud et al. (1993)

contend that the fear/anxiety felt by children when their parents are unable to protect

them from harm can be very intense. The Nazis success in degrading their parents in

front of their children destroyed their image of protecting and loving caregivers

(Kestenberg & Kestenberg, 1990b)

Auerhahn and Laub (1987) argue that the nature of familial losses a younger

survivor experienced are more damaging in the long-term than the losses of older

survivors. Specifically they suggest that survivors who were children or adolescents

lost their family of origin which they argue has more serious implications for

attachments and parenting ability than adult survivors who lost their children. It is

assumed the underlying logic of this argument is that these younger survivors lost initial

and primary attachment figures. However, older survivors were likely to have lost their

parents and their children during the Holocaust which it could be argued would be

potentially more traumatising. People old enough to have grown up children were often

killed as they were considered too old to work and where therefore of no use (Chaitin &

Bar-On, 2002).

Having summarised arguments for a negative relationship between age and

symptomatology (i.e., that younger survivors are/were worse off than older survivors)

attention can now turn to points made for the opposing theory. The main stance among

theorists espousing this view is that youth brings with it the ability to recover quickly.

Kestenberg (1993) argued that once the child survivors went through the initial

physical recovery they were essentially better able to “bounce back” than adults. She

suggests that the knowledge that their whole life was ahead of them was a positive

influence on them. For adults, on the other hand, the treatment endured in the camps

was more psychologically damaging as it led to regression back to earlier stages of

development. Adults regressed back to pregenital phases (within a Freudian

framework) because they were treated as if they were children. According to

Kestenberg (1993) this additional regression factor meant that adults could not so

readily readjust to normal conditions.

Children may be viewed as more vulnerable but are also viewed as more

adaptable. Kellerman (2001a) stated that “children are at the same time more


66

vulnerable and more malleable than adults.” In the immediate post war period

Niremberski (1946) remarked that children under eight years appeared to show no

symptoms of fear or anxiety and that while such symptoms were seen in the older

cohort of eight to sixteen year olds, their “readjustment was reasonably fast.” Matussek

(1975) noted that younger survivors were more socially integrated in their post-war

lives than older survivors.

Further support for the notion that younger survivors had better post-war

adjustment is found in a study by Eitinger (1973). A quick examination of the age

profile of the groups in this study reveals that the average age of survivors seemingly

well adjusted and in the workforce is noticeably younger than that of groups who had

come to the attention of health services. A later study conducted by Eaton, Sigal and

Weinfeld (1982) found the incidence levels of symptoms such as depression and anxiety

to increase with age in a group of male survivors.

The final viewpoint in relation to the impact of age on the impact of the

Holocaust is that adolescents represent the most vulnerable subgroup of survivors.

Budick (1985) explains that adolescents as a group could be considered more vulnerable

to Holocaust traumata because of the nature of the adolescent period. Even without the

backdrop of the Holocaust, adolescence is a period of emotional upheaval and

sensitivity which makes them more vulnerable to environmental changes than people

who have already successfully passed through this developmental stage (Budick, 1985).

Suleiman’s (2002) argument is couched in terms of cognitive development.

Specifically he separates child survivors into three basic groups based on their ability to

comprehend and deal with their situation. The first group aged up to 3 years he

considers too young to remember and unlikely to be affected to any large degree. The

second group, aged between approximately four and ten years are old enough to

remember but too young to understand. The third group, aged in the early adolescent

years of approximately 11 to 14 are considered the most vulnerable because they are old

enough to understand but too young to be responsible. By this age they have the

cognitive ability to understand the implications of their situation (Macksoud et al.,

1993). This age group were often forced to take on responsibilities and make choices at

a much younger age than they normally would have. In other words, they were forced

to take on adult roles and responsibilities prematurely (Macksoud et al., 1993;

Suleiman, 2002). The stress of this role for this age group is seen to have further

compounded their already traumatic situation (Suleiman, 2002).


67

It is worth noting that age had a significant influence on the likelihood of

survival in the first place. Many authors have noted that the young and old were often

sent to their deaths in the gas chambers immediately upon their arrival at concentration

camps (Chaitin & Bar-On, 2002; Nathan et al., 1964; Sternberg & Rosenbloom, 2000;

Sugar, 1999). Adolescents and younger adults were kept alive in order to perform

physical labour (Sugar, 1999). Survival of young children did occur but was the

exception rather than the rule (Sternberg & Rosenbloom, 2000). Therefore the majority

of survivors would have been in their teens or twenties (Brody, 1999; Krell, 1997a;

Nathan et al., 1964; Ornstein, 1981)

Camp survivors are also mainly made up of those who came to the camps

towards the end of the war as very few survived for lengthy periods of time (i.e., years)

in camps. Young children had a better chance of surviving the war if they were in

hiding (Brody, 1999). This point therefore raises a potential confound between age and

the nature of Holocaust experiences. Support for this argument comes from a study

conducted with Bosnian refugees persecuted by Serbians in the 1990s. Weine et al.

(1995) found that, among a group of 20 Bosnian refugees, a positive relationship

between age and negative symptoms was no longer statistically significant when

traumatic exposure was partialled out. In other words, it was the amount of traumatic

exposure that varied with age and this was the variable impacting on number and

severity of symptoms.

In contrast to theoretical discourse concentrating on the relationship between age

and degree of psychological impact, there is also a sizeable amount of literature

referring to the relationship between age and the nature of psychological impact. For

example, Bensheim (1960 (in German), cited in Hafner, 1968) describes three very

different symptom patterns based on age during incarceration in concentration camps.

Survivors interned in camps between the ages of six and twelve were described as

suffering from “paroxymal affective reactions”, and displaying a fear and mistrust of the

environment. Survivors in their adolescent years (twelve to sixteen) also displayed fear,

however psychosomatic symptoms were dominant. Chronic depression appeared to be

the main symptom seen in survivors over 30 years of age (Bensheim (in German), 1960,

cited in Hafner, 1968).

Some symptoms are viewed as universally apparent irrespective of the age of the

survivor during the Holocaust while others display a clear relationship with age. For

example, consistent with Bensheim’s (1960 (in German), cited in Hafner, 1968)


68

idea that depression was a dominant symptom in survivors who were over 30, Hafner

(1968) notes that depression appeared to be more common among older survivors than

younger survivors, both from appraisal of his own sample and review of earlier

literature. In contrast, anxiety and paranoia levels seem to be more independent of age

(Hafner, 1968). In their study of child survivors of the Holocaust, Keilson and

Sarphatie (1992) found that children aged up to 4 years during the Holocaust suffered

from what they termed “neurotic character development”, while those aged 11 to 14

when liberated commonly experienced anxiety and older teens more commonly

experienced depression.

Differences in relational factors are also postulated. Steinberg (1989) relates

differences in parenting experiences among survivors of varying ages. For example,

older survivors who lost their partner and perhaps children of their own are described as

becoming over-invested in their post war families while younger survivors who lost

their parents rather than children were more focussed on fears of abandonment

(Steinberg, 1989). Survivors who experienced the Holocaust in their adolescent years

were often seen to have difficulties relating to their children when they reached this

developmental phase (Kestenberg, 1985).

4.2. – Time Lapse since the Holocaust

Another issue of import is the impact of aging on survivor’s mental health. A number

of researchers have suggested that survivors’ symptomatology worsens with age (e.g.,

Dasberg, 1987; Joffe et al., 2003). In particular, some suggest that the process of life

review, that is dealt with as a person reaches their later years, is a negative process for

survivors as they have to review their Holocaust experiences as well as other life

experiences (Lomranz, 1995). The revision of these experiences brings the anguish of

the period and its losses back to the fore. The survivors are then confronted with the

resurfacing of issues related to incomplete mourning (Dasberg, 1987).

It has been suggested that there may be a curvilinear relationship between time

lapse since the Holocaust and intensity of symptoms. In other words, with time, the

symptoms gradually decrease in severity but then increase again when the life review

process occurs (Dasberg, 1987). Joffe et al. (2003) state that, in their clinical

experience, symptoms suffered by Holocaust survivors appear to worsen with age.

Terno, Barak, Hadjez, Elizur and Szor (1998) note that exacerbation of symptoms such

as suicidal ideation and depression, appearance of paranoia and chronicity of

schizophrenia are often present in aging Holocaust survivors they have encountered.

Dasberg (1987) cites results of an unpublished survey at the Jerusalem Clinic for


69

Psychiatry of the Elderly in which 25% of new referrals between 1983 and 1986 were

Holocaust survivors. He notes that the majority of these new clients were experiencing

symptoms that appeared to be related to their Holocaust experiences (Dasberg, 1987).

Terno et al. (1998) also note a disproportionate number of Holocaust survivors among

their geriatric psychiatric patients than would be expected by their proportion in the

Israeli population (60% compared to 40%).

4.3. –Gender

Apart from age, gender is one of the most frequently mentioned demographic variables

in the Holocaust survivor research (Kahana & Kahana, 2001; Matussek, 1975; Tuteur,

1966) and the possible differential impact of gender was recognised very early

(Niremberski, 1946). While conflicting theories regarding the impact of gender of

adaptation to Holocaust trauma were found, on the whole it is thought that females are

affected more than males by their experiences. However it is worth considering

arguments on both sides.

Baumel (1999) and Danieli (1982) have espoused two different reasons as to

why male survivors may appear to be worse off than females. Baumel’s (1999)

argument relates to the way females developed bonds with fellow inmates during their

incarceration in camps while Danieli’s (1982) focus is on what could be described as the

“wounded pride of the patriarch”.

Danieli (1982) suggested that males see themselves as “protector and provider”.

She argues that the way survivors were treated in concentration camps led to feelings of

complete helplessness which seriously challenged this male self-image. Males not only

had to deal with the experiences themselves but with the knowledge that they were also

unable to “protect and provide” for their family. In a similar vein a number of other

authors have suggested that children of survivor fathers might be less well adjusted than

those with survivor mothers because knowing that one’s father was a Holocaust victim

might destroy the individual’s image of the powerful father figure. It has been argued

that the image of the demeaned mother is less threatening than the image of the

victimised, defenceless father (Baron et al., 1993; Kestenberg, 1980). However, it was

countered by Pines (1986) that children of survivor mothers should be more affected

because if the mother has been traumatised she is unable to provide a secure foundation

for her children right from infancy.

An alternative view which also espouses greater male vulnerability relates to the

relative safety of both genders among those in hiding. Several researchers have noted

that males/boys in hiding during the war were more at risk than females/girls because of


70

the Jewish custom of circumcision (Rosenbloom, 1988; Sternberg & Rosenbloom,

2000; Valent, 1998). In Europe, only Jewish males were circumcised (Rosenbloom,

1988; Sternberg & Rosenbloom, 2000). Thus the Jewishness of a captured male could

be established easily by the Nazis. Because of this, people were less willing to help a

male hide than a female (Reijzer, 1995; J.J. Sigal, 1998). Females had more chance of

convincing the Nazis that they were not Jewish than males and therefore of escaping

capture. Therefore among survivors who spent time in hiding, it could be argued that

the males were in a more anxiety provoking situation than the females. However, there

is also the point that males were more likely to be considered fit and strong enough for

slave labour than females which led to the survival of more males than females from the

camps (J.J. Sigal, 1998).

Baumel’s (1999) view point is based largely on the idea that women

incarcerated in camps actively sought to bond with their fellow camp inmates to form

substitute families and support networks to a greater extent than men. Baumel (1999)

contends that constructing these networks came easier for the women. Within these

relationships the women found comfort and nurturing that theoretically helped them to

deal with their surroundings (Baumel, 1999). Ainsworth (1991) explains that this

tendency may have a genetic/evolutionary basis. As the “physically weaker sex”,

females required support and protection from others more than the physically strong and

independent males.

Gilligan (1984) suggested that women had more of a need to establish these

relationships. Gilligan (1984) argued that for men mature relationships reinforce the

idea of separation and independence while women continue to value attachment to

others. This is seen as another reason why women forged stronger bonds more rapidly

in the camp environment. This notion is further reinforced by Matussek’s (1975)

findings that in the immediate post-war period female survivors were much more likely

to marry in haste than male survivors. The male survivors were more likely to try to re-

establish themselves via work while females sought to do so by establishing a family.

However, this theorised need for attachment among women could also lead to more

negative psychological impacts when separations from families or surrogate families

occurred.

However, as stated at the start of this section, the predominant view is that

female survivors suffer more from post-Holocaust effects than males. Dasberg (1987),

Kahana and Kahana (2001) and Matussek (1975) have all argued that females are more

deeply affected.


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A number of studies considering the incidence of mental health symptoms in

survivors found higher incidences of various symptoms and disorders among the

females in their samples. For example, Sigal and Weinfeld (1989), found that 65% of

the females in their sample (as opposed to 36% of the males) showed some evidence of

psychiatric impairment. Eaton, Sigal and Weinfeld (1982) found that 64% of females

suffered from four or more symptoms compared to 36% of males in their sample. In

their longitudinal health study, conducted in a neighbourhood of Jerusalem since 1969,

Levav and Abramson (1984) found that 73% of female camp survivors versus 57% of

male camp survivors suffered from some emotional distress.

It is also noteworthy that in the Levav and Abramson (1984) study, incidence of

emotional distress was higher among females in the control group. However, the

criteria for inclusion in this control group will have included many who suffered some

degree of Nazi persecution and who may have lost family members in the Holocaust.

Despite this control group contamination it begs the question of whether higher

incidence or greater severity of symptoms among females is unique to the survivor

population or is true of the general population as well. A study conducted by Yehuda,

Halligan and Bierer (2001) found a much higher incidence of anxiety among control

females than males in their community study adding further support to this notion. It

would appear that females are generally more likely to experience emotional distress

and that this is also reflected in the survivor population and is not unique to it (for

example Oltmanns & Emery, 1995).

4.4. – Country of Origin

The survivors’ country of origin has rarely been studied as a potential moderating factor

despite the fact that the nature and duration of a survivor’s experiences could vary

greatly depending on this (Brom et al., 2002; Kellerman, 2001b; Suleiman, 2002).

Persecution began as far back as 1933 for German nationals (Edelheit & Edelheit,

1994), with Austria and Czechoslovakia following just before the war started and other

countries added to the list as the German army advanced.

For this reason some survivors endured over 10 years of gradual worsening of

conditions, while others endured a much more rapid decline in conditions which lasted

for around 3 years (Shanan, 1989). Bower (1994) notes that Polish subjects in his study

were persecuted for an average of five and a half years compared to only one or two

years for Czechoslovakian and Hungarian subjects. Eitinger (1973) notes similar

differences between his group of Norwegian survivors and his other group originating

from Eastern European countries such as Poland, Hungary and Czechoslovakia.


72

Moreover, some countries were viewed more negatively by the Nazis than others and

therefore their citizens were subject to different levels of respect. For example, the

Germans had a much more negative view of the Poles than of the French or the Dutch.

Eitinger (1981) notes that although Denmark was invaded in 1940, the Danish

government largely maintained control and so persecution of Jews only began in 1943

when the Germans took over political as well as military power. Countries occupied by

German allies rather than by Germany itself also enjoyed some initial respite. For

example, much of Greece was occupied by the Italians and the Bulgarians and the

Jewish communities there were largely safe until mid 1943 (Sugar, 1999).

Factor (1995) provides a detailed definition of a Holocaust survivor which

includes the dating of when persecution of Jews occurred in a number of countries. He

dates persecution as beginning when each country was occupied by the Nazis or when a

complicit government began enacting anti-semitic laws and pogroms on their behalf.

Specifically the dates are: from 1933 for Germany, from March 1938 for Austria, from

October 1938 for Czechoslovakia, from September 1939 for Poland, from April/May

1940 for Denmark, Norway, Belgium, the Netherlands, Luxembourg and France, and

from April 1941 for Bulgaria, Rumania, Hungary, Yugoslavia, Greece and

countries/areas formally part of the USSR.

While it would be natural to assume that greater traumatisation/traumatic

reactions would be seen among survivors from countries with longer durations of

persecution, Davidson (1980b) would argue that this is not necessarily the case.

Davidson (1980b) believed that ghettoisation was a “strengthening process” which

made ghetto survivors better able to adjust to concentration camp life than survivors

who went straight to the camps (as often occurred in countries invaded in later stages of

the war). Davidson (1980b) cites the example of the Greek Jews who he argues faired

far worse in terms of mortality rates in the camp system. This argument is akin to the

scientific anecdote of throwing a frog into cold water and gradually heating the water as

opposed to throwing the frog into boiling water from the beginning – the process of

acclimatisation may well have gone a long way in determining survival and post-war

psychological adjustment.

A survivor’s country of origin also determined their post-war settlement location

to some extent. As was discussed in Chapter Two, some countries were easier and/or

more palatable or safe to return to than others. This point more specifically applies to

Jewish survivors.


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4.5. – Cultural Differences

Quite apart from the differing historical timelines that go with separate countries, a

related but equally as important a variable is that of cultural differences (Brom et al.,

2002). There is evidence of ethnic/cultural differences in the variables of interest

outlined in the model being developed for the current thesis. Cultural differences exist

in family cohesion, separation-individuation and communication styles which may well

explain discrepancies between survivor and control groups (Aleksandrowicz, 1973;

Almagor & Leon, 1989; Felsen, 1998; Porter, 1981; Rosen & Weltman, 1996).

Matching survivor and control groups on country of origin controls this potential

confound, however there has been insufficient examination of cultural differences as a

factor which may influence responses and adaptation to Holocaust trauma.

A comparison of survivors from different countries or regions of Europe would

be advantageous in addressing this issue. While many studies have been found to cite

the countries of origin of their Holocaust survivor subjects, few conduct a comparison

of survivor sub-groups based on this variable. This represents a missed opportunity to

explore the impact of country of origin on survivor well-being that could easily have

been performed.

Jewish families, and particularly Eastern European Jewish families, are viewed

as generally more enmeshed than other groups, with parents, particularly mothers, seen

as over-protective (Aleksandrowicz, 1973; Felsen, 1998; Porter, 1981; Rosen &

Weltman, 1996). Guilt-inducing communication is also a characteristic of the

stereotype of the Yiddishe Mammeh (Giordano & McGoldrick, 1996; Kellerman,

2001b). Therefore, non-survivor Jews might be seen to experience similar family

environments to descriptions of survivor families (D. Weiss, 1988). However it has

been argued that the Holocaust may have served to intensify the already over-protective

and enmeshed family environment (Felsen, 1998; Kellerman, 2001b; Porter, 1981).

Kellerman (2001d) suggests the stereotypic statements of the Yiddishe Mammeh, for

example those concerning eating enough food, take on “more desperate and anxious

overtones.”

4.6. – Reason for Survivor’s Persecution

While most people are aware that Jews were a major target group of the Nazis, there

were others who suffered at the hands of the Germans. While alienation, via the

removal of civil rights and ghettoisation, was unique to the Jews and Gypsies, people

could be interned in concentration camps for a number of reasons (Favaro et al., 1999).

Camp populations were made up of targeted ethnic groups such as Jews and Gypsies as


74

well as political prisoners (mainly of left wing persuasion such as communists and

socialists), criminals, homosexuals and members of religious groups such as the

Jehovah’s Witnesses and those opposed to the Nazi regime on religious grounds

(Schmolling, 1984; J.J. Sigal & Weinfeld, 1989).

The experiences of inmates (and also therefore chances of survival) could differ

a great deal depending on their reason for persecution (Kren, 1989). Jews and Gypsies

received the worst treatment by far and were among the first killed or “exterminated” in

large numbers (Hodgkins & Douglass, 1984). While all inmates suffered, those who

were considered Aryan, or captured members of the armed forces, for example, were

given larger portions of food and were not subject to discipline as harsh as that

experienced by Jews and Gypsies (Bluhm, 1948). In addition, as some were targeted as

individuals for individual acts, they were able to return to an intact family and home

upon liberation (Eitinger, 1969; Favaro et al., 1999). As a case in point among a group

of Italian political prisoners who participated in a study conducted by Favaro et al.

(1999) all had returned to their homes after liberation and only a very small number had

lost any family members.

Survivors targeted because of their race or religion often endured many years of

persecution before being sent to camps. By contrast, political and other survivors were

sent to a camp as a form of punishment for a “crime” or act against the Nazi regime

(Favaro et al., 1999). As well as experiencing differential treatment and post-war

outcomes, camp inmates imprisoned for acts against the Nazi regime or for “crimes”

were in a better position to rationalise their imprisonment than those targeted solely for

their ethnic group or race (Favaro et al., 1999).

The vast majority of research conducted with Holocaust survivors has

concentrated on the Jewish survivor subgroup (Favaro et al., 1999). While this group is

no doubt the largest segment of the survivor population, it is clear there are other groups

that merit research attention as well. The few research studies that have considered the

reason for persecution have found that it may well have a differential impact on post-

war adjustment (Favaro et al., 1999; Matussek, 1975). For example, Matussek (1975)

found survivors persecuted because of their race (i.e., Jewish survivors) more frequently

exhibited symptoms such as depression and anxiety and were less trusting than

survivors identified as political prisoners. Favaro et al. (1999) concluded that political

prisoners had experienced far less traumatic effects of their experiences than those

incarcerated because of their race or ethnicity.


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4.7. – Nature of Holocaust Experiences

Every survivor’s experience of the Holocaust was different. Holocaust survival does

not just encompass enduring internment in a concentration camp (Brom et al., 2002;

Friedman, 1948). There were the preceding years of increasing persecution and

isolation from community and ghettoisation, which should not be ignored as

traumatising events/circumstances (Shanan, 1989). Beyond that, while many went to

camps, some managed to survive in hiding, which may have involved living in a

confined hiding space with or without the aid of others to provide food, or living in the

guise of an Aryan with false papers. Others managed to escape into forests and

survived with partisan and resistance groups. Many survivors experienced a

combination of these. That there may have been a differential impact based on the

nature of the Holocaust traumas experienced has been acknowledged by many in theory

but assessed by relatively few empirically.

The general consensus has been that camp survivors are the most detrimentally

affected of all survivors (Baranowsky et al., 1998; Eaton et al., 1982; Favaro et al.,

1999; Friedman, 1948; Jucovy, 1989; Kahana & Kahana, 2001; Nathan et al., 1964).

Diagnoses of post-traumatic stress disorder are noted as higher among this subgroup of

survivors (Baranowsky et al., 1998; Favaro et al., 1999; Kahana & Kahana, 2001).

Further support for this notion is Finkelstein and Levy’s (2006) finding of a negative

relationship between amount of camp experience and comfort with disclosure, given

that comfort with disclosure is generally negatively related to symptomatology.

The duration of camp internment has also been cited as a potential influencing

factor on post-war adjustment (Antonovsky et al., 1971; Kahana & Kahana, 2001; Last,

1989). It is hypothesised that survivors who spent time with partisan and resistance

groups were aided psychologically by the knowledge that they were actively trying to

undermine the regime trying to persecute them (Favaro et al., 1999; Jucovy, 1992;

Matussek, 1975; Okner & Flaherty, 1988; Porter, 1981; Steinberg, 1989)

There are also a number of authors who contend that survivors who spent time

in hiding are, if nothing else, at least more anxious than survivors with other Holocaust

experiences (Rosenbloom, 1988; Yehuda, Schmeidler, Siever, Binder-Brynes, & Elkin,

1997). The constant threat of discovery and the necessary high degree of vigilance for

self-preservation were certainly highly anxiety provoking circumstances. Sleep

deprivation was often also necessary, feeding into a circular anxiety provoking situation

(Maller, 1964). For those hiding in solitary confinement, isolation was another factor

(Baron et al., 1993). In one study, a group of survivors who had spent the war in hiding


76

had a much higher incidence of depression and anxiety than other groups of survivors,

although small samples sizes mean generalisation is not yet possible (Eaton et al.,

1982).

Amir and Lev-Wiesel (2001) raised the related issue of the impact of forgotten

identity. Many child survivors were placed in hiding by parents or loved ones at such

an early age that they cannot remember their original family and identity. Most were

given new identities (especially Christian identities for Jewish children). Amir and Lev-

Wiesel (2001) found that survivors who have not been able to uncover their original

identity are plagued by symptoms of greater severity and/or frequency than those who

can remember their identity.

Despite all the evidence to the contrary, some are still of the opinion that the

nature of Holocaust experiences has no bearing on survivors’ post-war psychological

well-being (Dasberg, 1987; Terno et al., 1998). These researchers tend to lean on the

argument that when the traumatic experiences are so extreme and extensive there is

little value in trying to sub-categorise the forms of trauma endured (Grubrich-Simitis,

1981; Kahana et al., 1989; Kahana & Kahana, 2001).

The assessment of the impact of the nature of Holocaust experiences has been

conducted in one of two ways. One way has been to group survivors according to their

experiences and check for differences between the resultant groups. Traditional

groupings include camp survivors, those who spent at least some of the war in hiding

and members of resistance/partisan groups (Felsen, 1998). The second way has been to

assign a severity of trauma rating to each survivor research participant based on their

experiences. The derivation of such scores requires the researcher to make largely

subjective judgements as to which experiences can be considered more traumatic than

others. Felsen (1998) notes that, to date, there has been no agreement in relation to the

definitive quantification of the relative traumatisation that occurred as a result of these

differing experiences.

A number of examples were found of studies where attempts to construct a

hierarchy of traumatic experiences were made. In general, camp incarceration is viewed

as the most traumatic of experiences. For the most part, researchers cite no justification

for their reasoning.

Last and Klein (1984) gave the following severity ratings in relation to

Holocaust trauma: a weight of 1 was given to those living under Nazi occupation in

Europe, a weight of 2 to those confined in a ghetto, a weight of 3 assigned to being a

camp inmate and a weight of 4 denoted experiencing both ghetto and camp life. Bower


77

(1994) also used a rank ordering of severity although this was said to be based on

survivors’ views of the severity of the experiences. They ranked survival of an

extermination or concentration camp as the most traumatic, followed by ghetto living

and finally by what he termed “illegal living”.

Lev-Wiesel and Amir (2000) recognised that research has tended to

automatically assume camp experience to be the worst of the possible predicaments that

a survivor may have found themselves in. In fact they note that a large amount of

research has followed an unwritten rule that only those who spent some time in a camp

should be referred to as survivors. Robinson et al. (1990) also espouse the view that

greater psychological impact was felt by those who survived a camp as opposed to those

who were in hiding or had joined the partisans. Further illustrating this point, Carmil

and Carel (1986) suggest that emotional distress within their sample of Holocaust

survivors would have been greater had they limited their sample to camp survivors to

the exclusion of those who endured other experiences such as hiding. This statement

implies that they assumed the camp survivors would have higher symptom levels than

survivors with other non-camp experiences.

The predominant explanation as to why survivors who were interned in camps

may not have fared as well as others relates to how active a role the survivor played in

their situation. For example, Lev-Wiesel and Amir (2000) suggest that survivors who

spent the war in hiding or as partisans felt more in control of their lives because they

were doing something active toward the goal of self-preservation. They argue that

doing something active to counter the continuous life threats experienced enabled them

to somewhat preserve their “self-confidence, self-control and self-appreciation” (Felsen,

1998). The nature of the survivor’s role in their traumatic experience (active versus

passive) is seen as one of the key determinants of post-traumatic recovery (B. L. Green,

1993) and is noted in both Green et al’s (1985) Working Model for the Processing of a

Catastrophic Event and Wilson’s (1989) Person-Environment Approach to Traumatic

Stress Reactions.

This active-passive dichotomy can be operationalised in one way within the

survivor population in terms of resistance fighters versus camp inmates. Resistance

fighters are the ultimate example of people who played an active role in their war-time

experiences while camp inmates are often described as having passively conformed

with the processes laid out which led them eventually to the camps. This active-passive

dichotomy may well be acted out within the parenting styles of these survivors. Danieli

(1982) suggested that camp survivors taught their children to mistrust others and


78

discouraged their attempts to establish autonomy while ex-resistance fighters

encouraged their children to “take charge” with their children struggling to live up to

their “parent-hero image.” In a separate study, Bauman (2003) found that children of

camp survivors perceived their parents (particularly their mother) as more mistrustful

than children of survivors with other non-camp Holocaust experiences.

4.8. – Loss/Survival of Family Members during the Holocaust

They told her to go to the left and us to go to the right. And when mama started crying they said oh it is only for the night we segregated the young from the old. And they said you are going to have a shower and be put into the barracks, you will see your children in the morning and in the morning there was the smoke going in the crematorium that was the morning. I don’t want to cry again… When I come home and nobody was there and nothing was there and all I wanted was a photo, just one photo of my parents and my sister and I couldn’t get it anywhere, which to this day hurts me very much. Jozefa Lurie, a Polish Jewish camp survivor who was the sole surviving member of her family

The extent of familial losses experienced by a Holocaust survivor has been

hypothesised as one of, if not the most important predictor of post-war well-being of

survivors and their children (Axelrod et al., 1980; L. Berger, 1988; Chodoff, 1963;

Fogelman & Savran, 1979; Hafner, 1968; Kuperstein, 1981; Matussek, 1975). Degree

of bereavement is also listed in both Green et al’s (1985) Working Model for the

Processing of a Catastrophic Event and Wilson’s (1989) Person-Environment Approach

to Traumatic Stress Reactions as an important factor in determining the impact of a

traumatic event. Axelrod et al. (1980) suggest a negative relationship between the

number of surviving relatives of a survivor and the severity of symptoms experienced

by their children. The loss of family members in such horrific and violent circumstances

is something that often lead to “survivor guilt” and great difficulties with mourning

(Hafner, 1968) and has been said to be at the centre of the survivors’ trauma (Shanan,

1989; Valent, 1995). The death of family members was noted as causing the most

severe pain among a group of 36 survivors of the Armenian Genocide (Kalayjian,

Shahinian, Gergerian, & Saraydarian, 1996). To lose children via a violent death during

the Holocaust is seen as the most traumatising event that could have occurred to a

survivor. The death of a child before its parents is unnatural and difficult to come to

terms with, the death of a child in violent circumstances almost insurmountable (Felsen,

1998; Grubrich-Simitis, 1981; Shanan, 1989).

Some perspective on the impact of this issue can be gained by a quick survey of

some research studies in which the number of relatives lost during the Holocaust is


79

noted. Among a sample of 157 concentration camp survivors Matussek (1975) reports

that close to 80% had lost at least one family member and that 70% had lost practically

all their family members. In Nathan et al’s (1964) group of 157 camp survivors, only

13% could say they had not lost any family member during the Holocaust. In Hafner’s

(1968) sample of 86 survivors, 72% lost both their parents, 41% lost all their siblings

and of the those who had been married 48% lost their spouse and among the parents

57% had lost their children. Bistritz (1988) found that 72% of 32 camp survivors and

65% of 26 survivors who had lived underground had lost all their family members.

As Kestenberg and Kestenberg (1990b) so evocatively put it: “By separating

parents from children, husbands from wives, and siblings from each other, the Nazis

systematically re-created conditions comparable to those of an infant abandoned by his

mother.” Green (1993) lists the nature and number of familial losses as a key aspect of

trauma experiences in determining how well a survivor recovers from their experience.

More specifically if a person endured their traumatic experiences with another family

member such as a parent or sibling it is predicted that they will have more positive

psychological outcomes (Dasberg, 1987; Kestenberg, 1990). For example Kinzie,

Sack, Angell, Manson and Rath (1986) found that child survivors of the Cambodian

genocide were less likely to evidence post-traumatic stress disorder symptoms when

they had been with a family member during their traumatisation. Wilson (1989)

included both level of bereavement and whether the survivor/victim endured the trauma

alone or with others as variables of import in his Person-Environment Approach to

Traumatic Stress Reactions.

Anna Freud and Burlingham (1943) found children (exposed to trauma in World

War II) in the care of their own mothers or a familiar mother substitute were not

psychologically devastated by wartime experiences, principally because parents could

maintain day-to-day care routines and project high morale. Prot (2000) adds to this

argument by stating that survivors often told her that they felt much safer when their

mother was with them. Survivors who had family members with them did not have to

contend with loneliness on top of everything else (Prot, 2000). Finally, referring

specifically to children, Macksoud et al. (1993) cite evidence that suggests that children

fare better if they remain with their families, even if they will endure or witness more

traumatic events. However, children who had lost parents and families were also likely

to be taken under the wing of other adults (Bar-On et al., 1998). Therefore the

“buffering” provided by parents was also often provided by substitute caregivers. The

younger the child the more likely this was to occur (Bar-On et al., 1998).


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The impact of these losses was lessened to some extent among those who were

able to establish close bonds with fellow survivors and establish surrogate families.

That such ties would be sought is no surprise. As Ainsworth (1991) notes: “That

affectional bonds are especially likely to be formed under conditions of danger is only

to be expected since the attachment and caregiving systems are concerned with needing

and providing protection.”

Such support has often been cited by survivors as an invaluable aid to their

coping during the Holocaust (Kahana & Kahana, 2001; Rustin, 1988; Schmolling, 1984;

Shanan, 1989). Among a group of 219 former camp inmates, 20% cited camaraderie

with fellow inmates as contributing to their survival (Matussek, 1975). Another study

(n = 143) found 63% attributed survival to social support within the camp and 39% to

help from their family (Suedfeld, 2003).

Involvement in this type of surrogate family provided a degree of normalcy to

the survivors’ day to day lives. These groups provided survivors with a forum in which

it was safe to express their feelings, let out frustrations and find support and

encouragement (Ornstein, 1981). Such opportunities were not available to the isolated

survivor. A degree of familiarity with home was an additional feature that made such

groups such a therapeutic force. Having people from the same home town or

neighbourhood around enabled the maintenance of links to pre-war life (Ornstein,

1981).

However, Terno et al. (1998) provide a hypothesis for why a sole survivor may

have had far more difficulties adjusting to post-Holocaust life than those for whom

some family members survived. They argue that the relationship between Holocaust

experiences and psychopathology might not be a direct one but an indirect one. They

suggest that it may not be the Holocaust experiences per se that lead to

psychopathological symptoms but the lack of support available to sole survivors in the

post-war period that did the most damage. In other words, when their symptoms

emerged after the Holocaust they were limited in the support they had to help deal with

them (Terno et al., 1998).

The loss of family members during the Holocaust is a trauma that is keenly felt

for the rest of the survivors’ life as well as that of their children and possibly even

grandchildren. This is because the death of so many family members means the loss of

ones’ extended family, the loss of the survivors’ childrens’ ability to relate and be with

their grandparents and possibly aunts and uncles and cousins and learn valuable

information about their heritage and ancestry (Chaitin, 2002; Goldwasser, 1986;


81

Grubrich-Simitis, 1981; Russell, 1982). “It wiped out the possibility of a full life cycle

of multigenerational families where daughters learn how to be mothers from their own

mothers, where grandchildren hear stories and get a sense of continuity from their

grandparents (Bar-On, 1995).” With no extended family, the survivors and their

children had to rely on each other which, while often resulting in a close-knit family

group, often led to extreme family enmeshment (Fogelman, 1998). It means that the

survivors often missed out on having a model of growing old before they grew old

themselves since they were robbed of the opportunity to see their parent’s age

Of course I have the picture in my mind but I would love to at least have pictures to show my children that they did have grandparents and an aunt but they had nobody and I had nobody. Do you realise that I didn’t even have any body to write a letter and send a photo to say I have nice children and they are nice looking and they are nice for someone to be happy that I have children. There was no-one in the world. That is why my husband meant so much to me because he was all I had. He was everything to me, he was the mother and the father and lover and the father of my children and my husband and the friend and the protector – everything. Jozefa Lurie, a sole survivor of her family

4.9. – Post-war Settlement Location

Holocaust survivors are scattered all over the world. While some survivors remained in

Europe, most survivors emigrated from Europe to Israel or to far away

countries/continents such as the United States, Canada, Australia, South Africa and

various countries in South America (Bistritz, 1988; Danieli, 1988). Obviously these

locations differ in many ways and some have argued that differences in adjustment

levels may relate to the choice of post-war settlement location (L. Berger, 1988;

Chodoff, 1963; Danieli, 1988; Felsen, 1998; van Ijzendoorn et al., 2003). Porter (1981)

suggested that the motivation to emigrate or remain in one’s own country was probably

related to the severity of initial symptomatology experienced by the survivor.

The locations chosen by survivors for their post-war settlement can be broken up

into three main categories. These categories are those who chose to remain in Europe,

those who chose to immigrate to Israel and those who chose to immigrate to other

continents such as North America or Australia. For those who chose to emigrate,

immigration experiences and difficulties assimilating into new societies and cultures

(often having to learn a new language) were interwoven with their long term recovery

process (de Silva, 1999; Solkoff, 1981; van Ijzendoorn et al., 2003).

It is also important to consider which survivors were more likely to return to

their own country or remain in Europe or move to Israel or to a completely different


82

continent. This is related to a number of factors including whether they had anyone to

return to and also the reception they received from their communities. Political

prisoners were more likely to have families to return to than Jewish prisoners for

example.

A survivor’s choice of post-war settlement location had the ability to greatly

affect their recovery and psychological well being after the Holocaust. Markedly

different experiences and receptions awaited survivors depending on where they chose

to settle after the war. Due to the differing nature of these post-war environments it is

not unreasonable to hypothesise that recovery processes may have differed by location.

Green (1993) argues that the way a survivor of trauma is treated by society after the fact

is of vital importance to their long term prognosis. The possible importance of this

issue in relation to Holocaust survivors has been recognised by several researchers as an

area requiring further assessment (Baron et al., 1993; L. Berger, 1988; Chodoff, 1963;

Danieli, 1988; Felsen, 1998; Kestenberg, 1990; Kestenberg & Kestenberg, 1990a; J.J.

Sigal & Weinfeld, 1989; van Ijzendoorn et al., 2003). Sigal and Weinfeld (1989)

recommended 18 years ago that a meta-analysis be conducted to determine if

differences in adaptation occurred as a result of post-war settlement location. Baron,

Reznikoff and Glenwick (1993) suggested a comparison of survivors who settled in

America versus those who settled in Israel is warranted.

Any differences found between survivors living in Israel versus those in Europe

or those in America or Australia cannot be automatically linked to differences in these

societies and the receptions they provided to the newly arrived survivor refugees. It

needs to be acknowledged that different types of survivors with different types of

experiences chose different post-war settlement locations and this potential confound

cannot be ruled out. For example is a survivor in Australia more anxious than a

survivor in Israel because of how they were received when they first emigrated and how

they continue to be treated or is it a function of how anxious they were in the first place

about a re-occurrence of the Holocaust that they chose to settle in a country so very far

away? However, the pros and cons of each post-war settlement location are many and

varied. Each will be considered in turn in the following sub-sections.

4.9.1. – Europe.

Survivors who settled in Europe remained in the area/region in which they suffered their

trauma (Fogelman, 1988). These survivors either returned to their country of origin or

settled in another European country but remained within relatively close proximity to

the region of their suffering. It should be noted that most camp survivors felt they could


83

not return to their homeland (Kren, 1989). However, by returning to their native areas,

these survivors did not have to go through the acculturation process that those who

decided to emigrate were forced to (Jucovy, 1989).

This group of survivors often lived in the midst of their former persecutors or at

least in the midst of bystanders who did nothing to ease their plight during the war

(Fogelman, 1988; Kahana & Kahana, 2001). Survivors residing in countries such as

Poland and Hungary also had to deal with the emergence of communism (Kahana &

Kahana, 2001).

In Germany, Fogelman (1988) argues that the government’s decision to pay

compensation to survivors increased anti-semitic and anti-survivor feelings in a country

concerned about getting its economy into a healthy state in the post-war period.

Survivors in Germany were acutely aware of this societal sentiment and this led many

to keep their problems hidden (Fogelman, 1988)

The decision to remain in Europe was dictated to some extent by the survivors’

country of origin and their belief in their ability to stay on. Survivors from some

countries were more readily accepted than others with anti-semitic feelings rife in some,

especially Eastern, European countries. Many Jewish survivors returned home to find

non-Jews living in their homes and unwilling to relinquish their ill-gotten gains to their

rightful owners (Reijzer, 1995).

The thought that a return to their homeland was possible was a buoying

influence recognised by Niremberski (1946) in his visits to displaced persons camps.

He noted that psychological symptoms appeared to be diminishing among those who

felt they would be able to return home and that there would be something to return

home to. He notes that this was least likely to be the case for Poles and Jewish

survivors who, for the most part, had lost all possessions and all or most of their family

members (Niremberski, 1946).

Survivors from these regions who decided to return to their homelands

maintained a very insular life. According to Orwid, Domagalska-Kurdziel, and

Pietruszewski (1995), who studied a group of survivors who returned to their Polish

homeland, most married out of the Jewish faith and maintained strict secrecy about their

Holocaust experiences. They note that these survivors also kept their Jewish origins a

secret. Similar descriptions of survivors in Poland were presented by Prot (2000).

Haesler (1994) suggests that for many survivors who remained in Europe,

particularly in Germany, this was more of a chance event than a deliberate decision.

Many survivors wanting to emigrate to other continents waited a very long time in order


84

to obtain the necessary paperwork and permissions to do so. In the meantime, these

survivors had to find a way to support themselves while they waited and in so doing

often set themselves up in such a favourable working situation that it seemed better to

remain than to leave. It was rare for a survivor to make the decision to settle in

Germany with all of the negative feelings that this would bring to the surface. For some

however, the knowledge that they were re-establishing a Jewish community in Germany

was a powerful motivator in their decision to stay permanently (Haesler, 1994).

4.9.2. – Continents other than Europe.

A second group consists of survivors who made a concerted effort to move far away

from Europe and chose to immigrate to completely different continents. The most

common studies of these survivors are conducted in America, however studies

conducted with survivors who moved to Canada and Australia can also be included in

this group.

Unfortunately many of these survivors who ventured far afield to re-establish

their lives were not always received with open arms. Many found that people did not

want to hear about their Holocaust experiences. As a result they kept to themselves and

mainly socialised with other survivors (Bistritz, 1988). The reception awaiting

survivors once successful in their emigration efforts differed greatly. In many countries

survivors were shunned – people did not want to hear about their experiences. The

thought of what had happened to survivors was too much to bear, they did not want to

be reminded of it (Danieli, 1988). Alternatively, people did not ask survivors about

their experiences for fear of bringing up hurtful memories for them (Danieli, 1988).

In discussions about Jewish survivors there is a distinction made between

survivors who settled in Israel and those who settled elsewhere, or the Diaspora

(Kaslow, 1995). Survivors in the Diaspora were much more likely to experience

alienation based on their survivor status and so often chose to remain silent so as not to

antagonise people and risk the success of their assimilation (Goldwasser, 1986; Kaslow,

1995). This became known as the “conspiracy of silence” (Danieli, 1988) and it further

compounded survivors sense of isolation and loneliness and their mistrust of society

(Danieli, 1988).

Fogelman (1998) argues that many Jewish survivors in America were rejected

by the American Jewish community who felt guilt over their perceived lack of, or

inadequate amount, of help they were able to provide to save Jews during the war.

Fogelman (1998) also notes that there was a notable degree of anti-semitism in America

in the immediate post-war period. This kind of cultural milieu was certainly not


85

conducive to a smooth transition period for the survivors. Many settled in close

proximity to other survivors and soon survivor enclaves were apparent in many cities

such as Pittsburgh and New York and Montreal in Canada (Fogelman, 1998). A similar

phenomenon was seen in Melbourne in Australia.

A key factor for survivors who moved to these English speaking countries was

the immigration experience and all that it encompassed. This included not only having

to get used to the new surroundings and very different cultural settings but also for

many learning to speak English (Bar-On, 1995; Jucovy, 1989). The move from Europe

to the Americas or Australia was a dramatic one and for many represented sudden and

permanent severing from their European homelands.

4.9.3. – Israel.

The third group consists of survivors, specifically Jewish survivors, who chose to

immigrate to Israel. These survivors made a decision to move to a location

fundamentally associated with the religious/cultural group that made them targets

during the war. They therefore were fostering a very strong link to their Judaism. In

addition to this, these survivors have lived in an environment of continued warfare,

which continues to this day with hostilities between Israelis and Palestinians.

Immigration to Israel has been considered both a help and a hindrance to post-

war adjustment among survivors. Arguments for the former position centre around the

benefits of feeling part of the emerging Israeli state. The later position draws on factors

such as continued warfare and the Sabra myth (van Ijzendoorn et al., 2003). Each of

these positions will be addressed in turn.

An important point to note is that Jewish survivors in Israel suddenly found

themselves to be part of the majority group rather than a marginalised minority group

(Hodgkins & Douglass, 1984; J.J. Sigal & Weinfeld, 1989; Z. Solomon, 1998). This is

something unique to Israel, the Jewish state. Jews in every other country in the world

are in the minority rather than majority (Kaslow, 1995). Jews in Israel could therefore

recognise that anti-semitism was less likely to take place given their majority status

(Hodgkins & Douglass, 1984) and easily fit in (Newman, 1979; van Ijzendoorn et al.,

2003). The sheer number of survivors who settled in Israel also meant that survivors

were surrounded by others who had gone through similar circumstances and with whom

they had some camaraderie (Goldwasser, 1986; Kaslow, 1995).

Survivors in Israel have the opportunity to take part in collective mourning

rituals such as Yom Hoshoah (a national day of mourning for those who died in the

Holocaust) (Aleksandrowicz, 1973; Bergmann & Jucovy, 1990; Goldwasser, 1986;


86

Newman, 1979; Steinberg, 1989). Yom Hoshoah (Day of the Holocaust) was

introduced by David Ben Gurion, Israel’s first Prime Minister (Fogelman, 1988).

Bergmann and Jucovy (1990) suggest that such events provided survivors and their

families with a forum in which it was safe to work through negative emotions

associated with the Holocaust – something that might otherwise have remained

unvented. The public acknowledgement of their traumatic experiences provides the

survivors with additional validation and support. It also provides them with a further

opportunity to memorialise their friends and loved ones who died in the Holocaust and

to some degree may satisfy the need to witness that some survivors experience (Krell,

1993). Wilson (1989) specifically cites the availability of cultural rituals for recovery as

an important factor of the post-trauma milieu in his Person-Environment Approach to

Traumatic Stress Reactions.

It is precisely because of the increased level of public awareness and

commemoration of the Holocaust in Israel that children of survivors who settled in

Israel may be more educated about the Holocaust than children of survivors who settled

elsewhere. There is a strong emphasis in Israeli education about the Holocaust and the

role of survivors in the context of the establishment of the Jewish state. Israeli children

take part in school trips to Holocaust memorials and museums (with the impressive and

comprehensive Yad Vashem museum and archive based in Jerusalem). Therefore

children of survivors in Israel are educated to a great extent about the Holocaust and are

therefore not solely dependent on their survivor parents for this knowledge (Okner &

Flaherty, 1988).

It is intuitive to suggest that survivors who settled in Israel may be worse off

than survivors who settled elsewhere in a more peaceful country (Antonovsky et al.,

1971; Dasberg, 1987). However, some have theorised that despite the background of

hostilities survivors who settled in Israel were provided with opportunities to mourn and

release anger not afforded to those in other countries (Antonovsky et al., 1971).

Researchers such as Bistritz (1988) and Hass (1996) suggest that the numerous

wars with surrounding Arab nations provided survivors with an outlet for pent up anger

via participation in the military with victories in these conflicts providing the boost that

can only be provided by being on the winning side (Hass, 1996; Porter, 1981). In

addition, the establishment of Israel as a Jewish state represented the failure of the Nazi

goal to wipe out the Jews completely (Newman, 1979; Z. Solomon, 1998). However,

Hass (1996) is quick to point out that the possible negative effect of continuing to live at

war must not be ignored.


87

Participating in the establishment and growth of the state of Israel (Hass, 1996;

Silverman, 1987) afforded survivors an opportunity to develop positive self-images as

pioneers building a homeland and refuge for Jews (Goldwasser, 1986). They were able

to identify their own rebirth and rehabilitation with the rebirth and growth of the state

(Z. Solomon, 1998). As Bistritz (1988) says “the transition from victim to contributor

was greatly enhanced in Israel.”

The Israeli ‘kibbutz’ communal style of living is also seen as critical to the

prevention of survivors’ alienation (Bistritz, 1988; Goldwasser, 1986). Nadler and Ben-

Shushan’s (1989) study findings tend to support this notion with survivors living in a

kibbutz found to be more emotionally stable, less tense, insecure and suspicious.

Survivors were more likely to receive much needed support and guidance with things

such as parenting in such a setting. However, Hass (1996) suggests that kibbutz living

may have actually been detrimental, arguing that it may be likened to ghettoisation.

There are numerous relatively convincing arguments that settlement in Israel

was more negative than positive for survivors. Holocaust survivors were sometimes

viewed as passively allowing themselves to be tortured and murdered by the Nazis

rather than attempting to fight (Bar-On, 1995; Bar-On et al., 1998; van Ijzendoorn et al.,

2003). This notion is inconsistent with the heroic Sabra ideal of strength and courage in

the face of adversity (Bar-On et al., 1998; Chaitin, 2002; Kellerman, 2006a). Post-

traumatic weakness was also inconsistent with the Sabra and seen as detrimental to the

establishment of a strong state of Israel (Z. Solomon, 1998). That this ideal was quite

ingrained is supported by the publication of a pamphlet by the Israeli Ministry of

Education in the 1950s entitled “Like Sheep to Slaughter” which presented such

arguments in print (Bar-On, 1995). It is not surprising therefore that initially only those

who had actively fought in partisan groups or who had participated in ghetto uprisings

were seen worthy of commemoration.

The most obvious negative point is the amount of conflicts between Israel and

its Arab neighbours in the post-war period. First there was the War of Independence,

followed by the Sinai War, the Six Day War, the Yom Kippur War, war and terrorism

associated with conflict with Lebanon and numerous intafadas with the Palestinians

(Lomranz, 1995). While the political and military instability of Israel has been used as

a positive target for pent up anger over Holocaust experiences, it is doubtful whether

this argument can be stretched for the length of time that such circumstances have

existed in the Middle East.


88

Apart from the continued conflict in the area, there are other potential negative

impacts. The climate in Israel is quite hot at times (Matussek, 1975) and certainly much

less comfortable than a European climate. Also, as a newly established state, Israel was

poor in resources and economic stability (Matussek, 1975).

4.10. – Amount of Tme before Resettlement

It is important to reflect on the immediate post-war period during which time many

survivors spent extended periods of time in displaced persons camps awaiting a chance

to emigrate. It has been suggested that this period further compounded their

traumatisation (Porter, 1981; Solkoff, 1981) as they “were made to feel over and over

again that they were unwanted – they were unwanted when they tried to return home

and unwanted when they tried to emigrate to a new country (Matussek, 1975).” Terry

(1984) added that despair stemmed from the disappointment with the way they were

received after their liberation. Jewish survivors found it very difficult to immigrate to

Israel prior to 1948 when the region was under British control. Countries all over the

world maintained tight restrictions on the number of refugees/displaced persons they

took in. Friedman (1948) noted that survivors who were able to gain relatively quick

access to these countries were able to re-establish a normal life quite quickly and

regained “their balance and health” whereas those who were left to languish in the

displaced persons camps suffered from increasing anxiety and aggression. Part of the

reason for this is that many displaced persons camps were quite regimented and were

experienced by many survivors as a return to the concentration camp lifestyle

(Friedman, 1948, 1949).


This chapter has summarised the main arguments for the moderating impact of

demographic and situational variables on the impact of the Holocaust on its survivors.

While there is general agreement on the impact of some (for example gender), for the

most part there is disagreement as to the impact or direction of influence of most of the

variables discussed. Obviously, more clarity in the literature as to the impact of these

variables and their relative importance would be beneficial. This is one of the key

things the current thesis aims to address.

The preliminary Model of Differential Impact of Holocaust Trauma across

Three Generations is further augmented in Figure 4.1 to take into account the

demographic variables discussed in this chapter. The survivor demographic variables

added to the model have been presented in bolded typeface. They have been included

with reference both to the survivor generation as well as descendant generations. It is


89

felt that differences among survivors related to these demographic variables will

reverberate through the generations by virtue of differences in not only symptom levels

but parenting and familial patterns. Chapter Five goes on to discuss demographic

variables that are intrinsic to the descendant generations which may lead to differential

symptom levels/trauma transmission among survivor descendants.


90

Psychological Impacts of the Holocaust

Influential Psychological Processes

Modes of Intergenerational Transmission of Trauma

Demographic Moderators

Holocaust Survivor Generation

1st G

ener

atio

n (S

urviv

ors)




• Age during the Holocaust • Time lapse since the Holocaust • Gender • Type/nature of Holocaust experiences • Reason for persecution • Loss of family • Country of origin • Post-war settlement location • Length of time before resettlement/time spent in displaced

persons camps

2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)


Dimensions



persons camps

•

• Parent-Child Attachment • Family Cohesion • Encouragement of Independence • General Family Communication • Communication about Holocaust experiences

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)


Dimensions



persons camps

• Parent-Child Attachment • Family Cohesion • Encouragement of Independence • General Family Communication

Figure 4.1. Addition of Holocaust survivor demographic variables to the Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations


91

Chapter Five – Demographic and Situational Differentials in the Impact of the Holocaust

on Descendants of Survivors

The current chapter summarises the demographic and situational variables that may have

influenced the nature of symptom presentation among descendants of survivors. It should

be noted that all the demographic and situational variables that apply to survivors are also

argued to impact on subsequent generations. In other words, demographic subgroups of

survivors who are the most affected by their Holocaust experiences will most likely have

children who display the most or highest levels of symptoms also (Goldwasser, 1986;

Grubrich-Simitis, 1981; M. Weiss & Weiss, 2000; Yehuda, Schmeidler, Giller et al., 1998).

This is because the most traumatised survivors will have been the most ill-equipped for the

parenting role and the transmission processes discussed in Chapter Three will have been

highly present when raising their children. For the sake of brevity it was considered

unnecessary to revisit each survivor demographic variable discussed in Chapter Four with

regards to its continuing influence on the descendants of survivors in this chapter.

Therefore this chapter summarises the additional demographic variables that apply uniquely

to children and grandchildren of survivors with the understanding that survivor

demographics also play a role in determining the psychological health of their descendants.

5.1. – Children of Holocaust Survivor/s

Among children of survivors there are several demographic variables that are argued to

impact their psychological and inter-personal well-being in adulthood. These are: the delay

between the end of the war and their birth, whether they were born before or after their

survivor parents’ emigration from Europe (if this occurred), whether they have one or two

survivor parents, their gender and their birth order.

5.1.1. – Gender

The existence of potential gender differences within the children of survivor population has

been posited by a number of researchers. Male and female children are said to react

differentially to their survivor parents and their experiences (Solkoff, 1992b). Sons and

daughters of survivors may also interpret their survivor parents’ communication differently

(Felsen, 1998; Kellerman, 2001b; Rieck, n.d.-b).

In general, as with survivors, it is females that are said to evidence higher levels of

vicarious traumatisation or are considered more vulnerable to it occurring (Vogel, 1994).

Vogel (1994) argues that females are more vulnerable because the development of their


92

sense of self or identity is strongly related to their ability to “connect and feel alike” to

there care-givers (predominantly their mothers) while for males the focus is more on

creating differentiating, as opposed to osmotic, boundaries.

There is also discussion of gender differences in nature as well as severity of

symptoms or reactions to survivor parents’ trauma. For example, Felsen (1998) found that

sons of survivors react to stressful family environments with “introjective characteristics”

while daughters evidence more “anaclictic traits”.

Given that gender is such a readily assessable variable, it is striking to note that in

his review of the literature, Solkoff (1992a) found few examples of statistical analysis of

gender differences in children of survivor research. This is despite the fact that the majority

of studies were conducted with mixed gender samples and so the opportunity for such

analysis was clearly available.

5.1.2. – One versus Two Survivor Parents

It is commonly held that children with two survivor parents will have more psychological

problems than children with only one survivor parent (Grubrich-Simitis, 1981). However,

while the majority of conjecture has concurred with this assertion, there have been a small

number who have argued for the opposite, that having one survivor parent and one non-

survivor parent is more detrimental to psychological health.

The arguments for greater negative outcomes for children whose parents are both

survivors are numerous. Davidson (1980a) suggests that a “dyadic victim unit” forms in

which each survivors’ fears and anxieties are reinforced by the similarly held fears and

anxieties of their survivor partner. Therefore, the whole may be more than the sum of the

parts. While having one survivor parent may relate to some dysfunctional or maladaptive

family interactional patterns (as compared to families with no survivor parents), it has been

argued that the non-survivor parent helps to mitigate these negative effects to a certain

degree (Gay et al., 1974; J.J. Sigal & Weinfeld, 1987).

Survivor “dyads” often formed very shortly after the end of the war, in many cases

whilst the survivors where still in displaced persons camps. Many felt that only a partner

who had also experienced the horrors of the Holocaust would be able to understand them

(Niederland, 1988). In such cases, often their survivorship was the only thing these

survivor couples had in common, the realisation of which then led to unhappiness within

the marriage (S. Davidson, 1980a). However, just as a sense of loneliness and isolation had

often led to such hasty unions, the fear of this loneliness and isolation frequently led to an


93

unwillingness to separate (Bistritz, 1988; S. Davidson, 1980a). Growing up in an

environment of an unhappy marriage is not overly conducive to the happiness of the

children of these marriages.

However, the argument for why having both survivor parents may actually be better

for children of survivors also uses the common background of survivorship as part of its

supporting evidence. Gay, Fuchs and Blittner (1974) contend that families created as the

result of a marriage between two survivors may be characterised by more harmony and

stability and less hostility because of an understanding of survivor partners’ backgrounds.

They argue on the basis of marital harmony literature that for couples made up of two

people from very different backgrounds (as would likely be the case in a survivor-non-

survivor union), their differences serve to create a potentially ever-widening gap which

creates family unit weakness and discordance. Given such an argument, children of

survivors would be more likely to live in an unhappy family environment if only one parent

was/is a survivor.

Van Ijzendoorn, Bakermans-Kranenburg and Sag-Schwartz (2003) found support

for the notion that having two survivor parents is worse than having just one in a meta-

analysis of 32 studies conducted with studies assessing psychological well-being of

children of survivors. An effect size of 0.57 was obtained from the 13 studies in the two

survivor parent category compared to 0.09 from the 19 studies in the one survivor parent

category. However their assessment of this issue was not as valid as it could have been.

Studies were placed in the two survivor parent category if more than 75% of the sample had

two survivor parents with the remaining studies placed in the one survivor parent category.

This is by no means a pure comparison of the impact of having two versus one survivor

parent. A preferable method would have been to conduct a correlation between study effect

sizes and the percentage of the sample with two survivor parents. Merely dividing the

studies based on the 75% cut-off criteria meant that some studies in the two survivor parent

category would have included participants with only one survivor parent while large

proportions of study samples included in the one survivor parent category could have had

two survivor parents (indeed up to 74% of those samples). The more methodologically

sound approach of correlating study effect sizes with the percentage of the sample with two

survivor parents is used in the current thesis (see Chapter Nine, Section 9.2.1).


94

5.1.3. – Birth Order

First born and only children are viewed as being the most vulnerable of the children of

survivor group when considering birth order (S. Davidson, 1980a; Grubrich-Simitis, 1981;

Newman, 1979; Porter, 1981). It is thought that the only child with survivor parents is

particularly susceptible as they are the sole repository of the transmitted traumas of their

parents (Newman, 1979). Children in other birth-order positions are exposed to these to a

lesser extent because there are more children to mitigate the effect (Baron et al., 1993).

First born children are a physical representation of the recreation of families so

desired by Holocaust survivors (Porter, 1981). These children may be seen as resurrections

of lost loved ones, or so-called “memorial candles.” All the survivor’s hopes for the future

are concentrated on this child more so, it is argued, than subsequent children (Porter, 1981).

This leads to a large amount of pressure on this child to succeed compared to subsequent

children (Porter, 1981).

Other results/research on first-born children of survivors showed that these children

were more seriously affected by parents having been survivors than children in other birth-

order positions because of the nature of the relationship between parents and first-born

children, namely, greater time spent alone with their parents, which would increase the

exposure to the survivor syndrome (Baron et al., 1993).

Arguments for the vulnerability of first born or early birth order children often

touch on a separate but related issue – that of the time lapse between the end of the war and

the birth of the children of survivors. As Grubrich-Simitis (1981) so aptly puts it: “This

enhanced vulnerability of firstborn children applies especially to those born very soon after

liberation, that is, where the birth of a new child was part of a manic attempt by the parents

to reconstitute the lost family and where this occurred before a certain level of psychic

reintegration – especially in the mother – could possibly have been reached (p. 431).” This

issue of the time lapse between the end of the war or survivor parent liberation and its

influence on the psychological health of children borne to survivors is discussed in the next

section.

5.1.4. – Length of Time between the End of the War and the Birth of Children

In Davidson’s (1980a) experiences with clients in Israel, an obvious relationship emerged

between the symptom severity of children of survivors and when they were born. He noted

that the majority of children of survivors, whom he saw in treatment, were born in the

immediate post-war period. While children born after a longer delay were also


95

encountered, Davidson (1980a) describes their presentation as “less severe and of a more

subtle psychological nature.” Russell (1982) concurred with Davidson’s (1980a)

experiences stating that these later born children evidenced “much less damaging after-

effects or were symptom-free.” Oliner (1990) observed that a notable proportion of

children of survivors seeking help from mental health professionals were born in 1946. In

other words, directly after the war and often while the survivor parents were still in

displaced persons camps (Oliner, 1990). Many children were born in these camps, with

survivors conceiving as soon as their physical recovery allowed (Danieli, 1988). While the

general consensus has been that children born in the immediate post-war years are the most

vulnerable subgroup, there have been differing views. For example, Mazor and Tal (1996)

state that, in their experience, similar symptoms and interpersonal behaviour patterns were

seen both in children born soon after the war and those born much later.

In the immediate post-war period many survivors found themselves essentially

alone. Understandably, many survivors married and set up families in haste to ease the

loneliness they felt (Barocas & Barocas, 1980; Bistritz, 1988; S. Davidson, 1980a;

Grubrich-Simitis, 1981; Newman, 1979; Oliner, 1990; Porter, 1981; Shoshan, 1989).

Danieli (1988) has referred to such marriages as “marriages of despair” where the dominant

motivation for marriage was mutual loneliness and shared suffering (Freyberg, 1980).

Children were born soon after to further ease the loneliness and to replace lost family

members (Grubrich-Simitis, 1981): as so evocatively demonstrated in Figure 5.1.

Figure 5.1. Female Holocaust survivors with their babies born in a displaced persons camp. Florence, 1946. Reprinted by permission from Elaine Zaks, whose mother is on the far right holding her brother as a baby.


96

The suggestion that improvement with delay is actually reflective of the degree to

which survivor parents had processed or resolved their mourning and integrated their

trauma has been made by many (S. Davidson, 1980a; Grubrich-Simitis, 1981; Oliner, 1990;

Russell, 1982). The psychodynamic viewpoint is that when insufficient time was allowed

for the survivor parents to resolve these issues, their working through process was played

out in their interactions and relationships with their children (S. Davidson, 1980a;

Grubrich-Simitis, 1981; Oliner, 1990). Bar-On et al. (1998) were quick to point out that it

is the lack of resolution, or mourning, that is the problematic issue not the loss or trauma

itself. In fact, if the parent has successfully resolved these issues prior to child-rearing,

often minimal effect has been noted. Rubin (1983 (conference presentation), cited in

Hogman, 1985) stated that when mourning is resolved, memories of the lost loved one can

act as a source of warmth and happiness, whereas unresolved mourning brings negative

emotions with it. Further support for this notion can be found in the results of Ainsworth

and Eichberg’s (1991) study of the influence of maternal unresolved mourning on

children’s attachment with a non-Holocaust related sample. They compared children of

mothers who had lost a significant attachment figure and had resolved their mourning and

those who had not resolved their mourning. Ainsworth and Eichberg (1991) found that the

children with mothers who had resolved their mourning did not differ statistically

significantly in incidence of insecure attachment from a control group of children whose

mothers had not experienced the death of a loved one. However, the children of mothers

with unresolved mourning had a much higher incidence of insecure attachment types. This

finding serves to further highlight the message that it is not necessarily the experience of

the death of a loved one that is influential but the success with which this knowledge is

coped, or has been dealt with, that is key.

Unresolved grief and mourning have been commonly associated with the

experiences of Holocaust survivors. Many survivors lost not just one but many relatives in

horrific circumstances. Moreover, the circumstances in which they found themselves at the

time (for example in a concentration camp), precluded involvement in traditional aids and

rituals associated with mourning such as funerals and open expressions of grief (Barocas &

Barocas, 1980; B. B. Cohen, 1991; Freyberg, 1980). A number of authors have suggested

that the process of mourning was therefore suspended among survivors until after the war

ended. However, some survivors were not able to resolve their grief even in the post war

period. During the war, they were preoccupied with their mere survival, and then, in the


97

immediate post war years, they were preoccupied with re-establishing some semblance of a

normal life, finding employment and often learning new languages (Danieli, 1988;

Freyberg, 1980).

It is acknowledged that when children are born before the mourning process is

finished or resolved, it can have significant effects on the way the children are brought up

(S. Davidson, 1980a; Kuperstein, 1981). Indeed, the memories of the unmourned relatives

cast a shadow on the new family (S. Davidson, 1980a). In fact, some have argued that

rather than having a positive impact on their recovery, interactions with their children may

have further re-opened wounds in relation to past losses (Newman, 1979).

Ornstein (1981) validly queried if “to consider parenting as a potentially restorative

is risky, for at what price to the children does such recovery in the parents occur?” (p. 146).

Barocas and Barocas (1980) suggested that, while the majority of children of survivors born

in this early period were taken care of quite well in a physical sense, they can be described

as emotionally deprived. “There was considerable emotional deprivation due to the greatly

limited and restrictive affective resources, the impaired object relations and the grief-

stricken pre-occupation of the parents” (Barocas & Barocas, 1980, p. 8). Parents, pre-

occupied with their grief over lost relatives, were often emotionally unavailable to their

children (Barocas & Barocas, 1980) or emotionally absent (Barocas & Barocas, 1980;

Chayes, 1987; Kuperstein, 1981).

Children born to parents who had achieved insufficient resolution and integration of

their Holocaust experiences have been seen as more vulnerable to emotional problems

(Grubrich-Simitis, 1981; Oliner, 1990). According to Davidson (1980a), children born in

the immediate aftermath of the Holocaust became “intensely involved by their parents in

their early attempts at recovery.” (p. 20). Children born after longer delays did not get

caught up in their parents’ working through process, as their parents had “achieved a

greater degree of integration of the massive trauma” in the intervening years.

5.1.5. – Birth Before or After Parental Emigration

There is a second potential explanation for the seemingly increased levels of emotional

disturbance in children born soon after the cessation of hostilities. As Fogelman (1998)

pointed out, the experiences of these children were not only affected by their immediate

family, but also by the social climate in which they grew up. The children born

immediately after the war were often born in displaced persons or transit camps and in

addition they may have experienced many moves between these camps. They may also


98

have accompanied their survivor parents on heart-breakingly fruitless searches for

surviving relatives (B. B. Cohen, 1991). Furthermore, their parents may well have still

been recovering physically from their ordeals and so may have been plagued by ill health

(Freyberg, 1980).

Beyond these experiences was the huge upheaval of migration to new countries. In

these new countries, their parents had to start again in establishing their lives, and their

adjustment was further complicated by the need to learn a new language and attempts at

assimilating into a culture/society different from what they had known (Fogelman, 1998;

Freyberg, 1980). The early experiences of children born in these circumstances compared

to those born after their parents had established themselves were clearly quite different

(Krell et al., 2004; Levav, Kohn, & Schwartz, 1998; Shoshan, 1989). Levav, Kohn and

Schwartz (1998) suggested that given this disparity, children of survivors born in these two

different periods should be differentiated in research.

5.2. – Grandchildren of Holocaust Survivor/s

Just as the children of the most affected survivors are expected to be the most affected

themselves, so too are the grandchildren of those most affected. Again differences in

psychological well-being are expected based on gender and the number of Holocaust

survivor relatives.

As with the children of survivors (and for the same reasons noted above), gender

and birth order are hypothesised to be influential variables in the psychological well-being

of grandchildren of survivors. Research into grandchildren of survivors is a very recent

addition to the literature on the inter-generational impacts of the Holocaust. A handful of

studies have considered demographic variations in this population but more research is

needed into this issue.


The model of differential impact of Holocaust trauma across three generations which has

been gradually forming over the previous three chapters is further amended here (see

Figure 5.2) to take into account the demographic variables considered in this chapter. As

can be seen child of survivor demographic variables have been listed against both the child

of survivor and grandchild of survivor generations. As with the survivor generation

demographic variables, it is argued that these demographic variables potentially influence

not only the child of survivor generation themselves but also their children (the grandchild


99

of survivor generation). Once again the variables added to the model in this chapter have

been presented in bold typeface.

The addition of the descendant demographic variables completes the preliminary

version of the Model of the Differential Impact of Holocaust Trauma across Three

Generations that has been built based on a review of the theoretical and anecdotal

literature. With the preliminary model built it is necessary to test it in some way. It was

decided that a systematic review of the existing empirical data in the literature regarding

Holocaust survivors and descendants would be cross-referenced with this model to

determine which if any areas of the model have already been adequately assessed by

previous research. In order to obtain a more objective synthesis of the existing data than

might be afforded by a traditional narrative review it was decided to use meta-analytic

techniques. This meta-analytic investigation is reported in Section B of this thesis. The

meta-analytic techniques used in this process are described in detail in Chapter Six,

including a more detailed justification for the use of meta-analysis. Chapters Seven to Nine

report the results of the meta-analyses conducted. The final chapter in Section B, Chapter

Ten, revisits the model in light of the evidence obtained from the meta-analyses.


100

Psychological Impacts of the

Holocaust

Influential Psychological

Processes


of Trauma



Children of Survivor Generation

Grandchildren of Survivor Generation

1st G

ener

atio

n (S

urviv

ors)

• Depression • Anxiety • Paranoia • PTSD symptoms • Romantic

Attachment Dimensions

• Post-traumatic Growth

• World

Assumptions • Coping Strategies

• Age during the Holocaust • Time lapse since the Holocaust • Gender • Type/nature of Holocaust experiences • Reason for persecution • Loss of family • Country of origin • Post-war settlement location • Length of time before resettlement/time spent in

displaced persons camps

2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)

• Depression • Anxiety • Paranoia • Romantic


• World Assumptions

• Coping Strategies



• Number of survivor parents

• Delay between the end of the war and their birth

• Birth before or after survivor parent/s emigration

• Birth order • Gender

•


Independence • General Family Communication • Communication about

Holocaust experiences

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)



• World Assumptions

• Coping Strategies







• Number of child of survivor parents




Communication

Figure 5.2. Addition of Holocaust Survivor Descendant Demographic Moderators to Preliminary Model of the Differential Impact of Holocaust Trauma across Three Generations


101

Section B

Meta-Analyses of Holocaust Survivor and Descendant Research


102

Chapter Six – Meta-Analysis Methodology

Chapters Two to Five of this thesis have provided a review of the theoretical and anecdotal

literature with regards to the impacts of the Holocaust on survivors as well as the

transmission of this impact to subsequent generations. In the process of this review, a

Preliminary Model of the Differential Impact of Holocaust Trauma across Three

Generations was developed. It is necessary to attempt to establish the veracity of this

preliminary model. To this end, it was decided that a detailed and objective assessment of

the existing empirical data be conducted before embarking on a new empirical study. A

meta-analytic review of the empirical assessment of the key variables noted in the

theoretical and anecdotal literature was undertaken. The current chapter explains the

methodological approach to these meta-analyses. Chapters Seven to Ten report on the

findings of this meta-analytic review process.

This chapter provides a detailed explanation of the methodology used for the meta-

analytic review of the literature pertaining to Holocaust survivors and their descendants.

Firstly, justifications for the use of meta-analytic techniques as opposed to a traditional

literature review are presented. Following this, various aspects of the meta-analytic

approach of the thesis are explained. The literature search is described including the

process for identifying relevant research. Various inclusion criteria for analysis are then

described. The nature of the data collected is explained. The meta-analysis calculation

techniques utilised are introduced followed by an explanation of how the results were

interpreted. The approaches used to counter problems arising from missing data are

clarified, and finally, an explanation of how the results of the analyses conducted have been

presented is provided.

6.1. – Justification for Meta-analytic Methodology

The aim of the first stage of the current thesis was to bring some synthesis to the research

conducted to date with Holocaust survivors, their children and their grandchildren in

relation to demographic variables. A traditional literature review is generally qualitative/

narrative in nature or perhaps utilises a rudimentary quantitative method such as ‘vote-

counting’ (Egger & Davey Smith, 1997). These methods are open to criticism in relation to

the validity of their conclusions.

‘Vote-counting’ involves producing a simple tally of statistically significant results

and non-statistically significant results. Often non-statistically significant results are


103

simply quoted as being non-statistically significant and no information is given as to the

direction of the result. By merely reporting the proportion of statistically significant to

non-statistically significant results the reader of such a review is robbed of vital information

about the relationship in question, such as, an indication of the direction of non-statistically

significant findings and the magnitude of the relationship. A group of individual studies

which may all have non-statistically significant results can lead to the conclusion that there

is a statistically significant difference overall if most of the mean differences are in the

same direction. Such results would lead to the conclusion that no relationship exists in a

‘vote-counting’ exercise (Cook & Leviton, 1980). The conclusions of such exercises

should clearly be viewed with great scepticism (Cooper, 1984; Egger & Davey Smith,

1997; B. F. Green & Hall, 1984).

Reviews of the same literature can lead to differing conclusions. For example

reviewers may disagree as to which studies to include in their review (Egger & Davey

Smith, 1997). They can also differ in how they choose to weigh the importance of each

study result since this is done in a subjective manner by the reviewer (Egger & Davey

Smith, 1997). Vote-counting usually ignores sample size and so the relatively unbiased

method of weighting the results based on sample size is not utilised (Egger & Davey Smith,

1997).

It has been argued that the same scientific rigor be applied to research literature

reviews as to the individual empirically designed studies. In other words reviews should be

“more technical and statistical than narrative” (Glass, McGaw, & Smith, 1981).

Appropriately applied statistics will enhance the validity of review conclusions (Cooper,

1984). In an interview with Hoffert (1997), Harris Cooper commented that “meta-analysis

gives greater credence to the review because it is an application of a scientific method to a

formerly subjective pursuit.” Hoffert (1997) defines meta-analysis as “a statistical method

of quantitatively combining and synthesizing results from individual studies.”

Meta-analytic reviews have the advantage of taking the magnitude and direction of

each result into account irrespective of their statistical significance level, thus making up

for the shortfall in this area by more traditional review methods. They allow more

objective appraisal of a body of research which eliminates the problem of differing

opinions when more subjective methods are used (Egger & Davey Smith, 1997).

In addition, meta-analytic reviewers can test hypotheses that were never tested in

individual studies, and, by so doing, add new insight to the area of research. For example


104

differences between sub-groups of the population or other sources of heterogeneity in

results can be explored via meta-analysis (Egger & Davey Smith, 1997). Thus, meta-

analysis should therefore, to some extent at least, reduce the need for new research (B. F.

Green & Hall, 1984).

Meta-analysis involves treating the results of individual studies as a data set for

analysis, the findings of an original study replace the individual as the unit of analysis

(Egger & Davey Smith, 1997; Glass et al., 1981). If thought of in this way, seemingly

contradictory study results can be reconciled very easily. Each study can be viewed as

deriving an estimate of the true population effect by obtaining a result based on a sample

from this population. It is therefore reasonable to assume that study results may differ

purely as a result of sampling from different parts of the population distribution (Lyon, n.d.;

Taveggia, 1974). Taveggia (1974) goes so far as to say that individual study results are

therefore meaningless because they may have occurred by chance. They are only

meaningful once observed within a distribution of findings. By accumulating results

across studies, one can gain a more accurate representation of the population relationship

than is provided by individual studies (Lyon, n.d.).

Numerous reviews have been conducted with regard to impacts of the Holocaust on

the survivors themselves and their children and the interaction between these generations.

An up to date review is required to enable inclusion of more recent research that has not

been incorporated in earlier reviews. The main problem with the majority of reviews to

date is that they have been narrative reviews rather than meta-analytic reviews (for example

Felsen, 1998; Kellerman, 2001c; Solkoff, 1992a). A number of researchers have suggested

meta-analysis of research relating to Holocaust survivors and their descendants (for

example J.J. Sigal & Weinfeld, 1989) however only one meta-analysis was located by the

current author. Van Ijzendoorn et al. (2003) conducted a meta-analysis relating to

psychological well-being among children of survivors. This meta-analysis only addresses

children of survivors and not three generations as is conducted for the current thesis,

however, several demographic variables of interest were examined. For example, the

impact of having one versus two survivor parents is addressed as well as post-war

settlement location (van Ijzendoorn et al., 2003). However there is one major fault with

their methodology that casts a shadow over their findings.

The research team state that unpublished studies and studies only reported at

meetings or conferences were excluded from the meta-analysis (van Ijzendoorn et al.,


105

2003). No explanation as to why this is a justified course of action is provided which is of

great concern considering the now established and much discussed bias towards the

publication of statistically significant results (Cook & Leviton, 1980; Cooper, 1984; Egger

& Davey Smith, 1998; B. F. Green & Hall, 1984; Hedges & Olkin, 1985; Hoffert, 1997;

Wolf, 1986). The fact that this approach was used has negative implications for the validity

of their meta-analysis results. Even among the narrative reviews only one review article

that incorporated unpublished theses was located (Felsen, 1998), however, this review only

included studies conducted in America.

The superiority of meta-analytic review methods over traditional narrative or vote-

counting reviews has been established. When unpublished studies are also included to

counter publication bias, meta-analysis provides the most objective means of reviewing

research on a given topic and has the added bonus of providing a quantified overall

measure of the relationships assessed in the research. Therefore, meta-analysis has been

used in the current thesis to examine the empirical support for theories relating to

demographic differentials in the psychological adjustment of Holocaust survivors and their

descendants. The remainder of this chapter details the statistical methodologies used to

conduct the meta-analyses presented in the current thesis.

6.2. – Literature Search Methodology

6.2.1. – Citation Sources

A literature search was performed in order to identify studies conducted with Holocaust

survivors, children of Holocaust survivors and grandchildren of Holocaust survivors

between 1945 and 2006. The search term “Holocaust Survivors” was entered into the

PsycINFO, ProQuest Psychology Journals and Psychology Journals online database

citation databases. Separate searches were conducted with the search term “Concentration

Camp” to check for any articles not using the word Holocaust but studying the same

populations. Translations of works published in languages other than English were sought

and mostly found.

As was discussed earlier, in an exercise such as this, it is vital to include both

published and unpublished research to control, as much as possible, for the much discussed

publication bias towards statistically significant findings (Cook & Leviton, 1980; Cooper,

1984; Egger & Davey Smith, 1998; B. F. Green & Hall, 1984; Hedges & Olkin, 1985;

Hoffert, 1997; Wolf, 1986). PsycINFO incorporates the Dissertation Abstracts

International database so that both published and unpublished sources were perused. An


106

additional search was conducted with the WorldCat Dissertations and Theses service (via

OCLC FirstSearch) to ensure adequate search coverage of unpublished research from

around the world.

In addition to computer database searches, search results were cross-referenced with

the comprehensive Holocaust research bibliography, established in 1979 by the late Leo

Eitinger (who conducted some of the earliest research on Holocaust survivors) (Rieck, n.d.-

a). The most recent print edition produced by Krell and Sherman (1997) was perused.

Miriam Rieck – who helped compile the previous incarnation of the bibliography including

research up to 1985 (Eitinger et al., 1985) – maintains an electronic version of the

bibliography which can be found on the internet (http://research-

faculty.haifa.ac.il/arch/index.asp) and this resource was used to check post-1997 references

added to the bibliography (last checked in December 2006).

6.2.2. – Process for Identifying Relevant Articles from Search Results

An initial perusal of books and review articles on the effects of the Holocaust and the

transmission of trauma to subsequent generations identified variables of interest for the

study. These variables were discussed in detail in Chapter Two and were incorporated into

the preliminary Model of the Differential Impact of Holocaust Trauma across Three

Generations. To refresh the reader’s mind, the variables of interest were psychopathology

(specifically anxiety, depression, paranoia and post-traumatic stress disorder symptoms),

post-traumatic growth, world assumptions, coping styles, and romantic adult attachment.

These are labelled as psychological impact variables and influential psychological process

variables in the preliminary versions of the model presented. The search results obtained

for the more detailed meta-analytic investigations were searched for measurements of these

variables.

The results of searches were reviewed via their title and/or abstract. If the title of

the article mentioned a variable of interest it was ear-marked for inclusion. If a title of an

article was too general as to reveal the particular variables assessed in the article, the

abstract was then scanned. Articles with mention of the variables of interest in the abstract

were also then ear-marked. If, after examination of both the title and abstract, it was still

unclear as to whether the particular article was of relevance, the article itself was viewed,

where possible, in an effort to ensure no relevant article was overlooked.

In some instances, a variable of interest was not mentioned specifically but the

study encompassed a broader concept which could encapsulate a variable of interest. In

http://research-faculty.haifa.ac.il/arch/index.asp

http://research-faculty.haifa.ac.il/arch/index.asp


107

particular this refers to articles utilising personality or psychopathology questionnaires

which may include subscales assessing variables of interest. Examples of such measures

include the Minnesota Multiphasic Personality Inventory (MMPI) and the Symptom

Checklist (SCL-90 or SCL-90-R) both of which have subscales measuring depression,

anxiety and paranoia – all variables of interest. If any such broad measures were mentioned

every effort was made to determine the nature of subscales to check if any assessed

variables of interest. If any such measures were mentioned then the study was checked to

see if sub-scale scores were quoted as well as overall scores.

6.3. – Criteria for Inclusion of Studies in Meta-analysis

A number of factors were considered when deciding which studies to include in meta-

analyses. These factors include criteria used by researchers when deriving their samples,

the operationalisation of variables measured and methodological quality of studies.

6.3.1. – Criteria used for Sample Selection

The criteria for inclusion in Holocaust survivor, children of Holocaust survivor and

grandchildren of Holocaust survivor groups varies from study to study. The following

broad and inclusive criteria were used in the meta-analyses presented in the current thesis:

• A Holocaust survivor was defined as any person domiciled in a country occupied by the

Nazis and who suffered some form of persecution. This definition is not confined to

those who were interned in concentration camps. It includes people who survived the

war in hiding or in some other way. While many researchers have considered only camp

survivors to be within this category (Felsen, 1998; Hodgkins & Douglass, 1984), the

inclusion of survivors with other experiences allows the analysis of differences between

these groups.

• A child of a Holocaust survivor had to have at least one parent who met the above

criteria for a Holocaust survivor. They could have either one or two Holocaust survivor

parents. They had to be born after the cessation of hostilities. A few studies were found

which included participants born during the war (for example Gertz, 1986): this author

agrees with the argument that these people should be considered survivors themselves

rather than children of survivors (Kestenberg & Kestenberg, 1990a). Sigal and Weinfeld

(1987) duly note that any effects noted in these children could have originated from their

own exposure to Holocaust trauma as opposed to influences from their parents.

Therefore studies of children of survivors including any born pre-1945 were not

included in meta-analytic calculations, but are discussed in the text.


108

• A grandchild of a Holocaust survivor had to have at least one grandparent meeting the

criteria outlined above for Holocaust survivor and also a parent meeting the criteria for

child of a Holocaust survivor as outlined in the second dot point above, but no parent

meeting the criteria for a survivor (as outlined in the first dot point above).

6.3.2. – Operationalisation of Variables

Only studies including specific operationalisation of a variable being meta-analysed were

included. For example, the psychopathological variables of depression, anxiety and

paranoia have been subject to such analysis. Only studies including specific depression,

anxiety and/or paranoia measures were included in these analyses. Studies using general

psychopathology/well-being measures or only quoting overall scores for measures

including subscales measuring these variables were not included as meta-analyses were

only conducted for the specific symptoms identified.

6.4. – Collection of Relevant Data/information from Individual Studies

Means, standard deviations, percentages and/or correlation co-efficients as well as sample

sizes were obtained from the articles and dissertations along with the results of significance

testing where conducted. In addition to this statistical information, detailed demographic

characteristics of samples (for example, mean age, age range, gender breakdown, nature of

experiences, religious affiliation), methods utilised to derive the samples and the country

where the study was conducted, were also noted (where reported) so that their influence

could be assessed.

The above described data and information from each study was entered into

Microsoft Excel spreadsheets set up by the current author to conduct significance testing

and the meta-analytic calculations. Significance tests were automatically conducted for all

data entered into the spreadsheet and thus served as a calculation check when such tests had

already been conducted by the original researcher/s. Calculation checks of the original

researcher/s’ significance testing is a practice advocated by Cooper (1984) as a preliminary

process to meta-analysis. All significance tests quoted in the body of the current thesis are

derived from these calculations as opposed to those quoted by the original authors. This

ensures a degree of consistency as the same formula is used to conduct all tests.


109

6.4.1. – Mean Differences between Two Groups

The following formulae for independent groups t-tests as detailed by Tilley’s (1999)

undergraduate statistics text was used to conduct significance tests for between group mean

differences for each individual study/result:

2

22

1

21

21

~~

NN

XXt

σσ+

−= where

1~

22

−= ∑

Nx

σ

Meta-analytic texts consulted (Cook & Leviton, 1980; Cooper, 1984; B. F. Green &

Hall, 1984; Hunter & Schmidt, 1990, 2004; Schwarzer, 1996; Wolf, 1986) suggest the

calculation of an effect size for each group difference be incorporated in a meta-analysis.

An effect size reflects the magnitude or strength of a relationship which a significance test

cannot do with its significant/not significant dichotomy (American Psychological

Association, 2001).

These effect sizes are used for meta-analysis, rather than ts, because they give a

reflection of effect size unfettered by the influence of sample size. That is, when

calculating a t, the larger the sample size, the larger the t will be with the same original

difference between means. While it is necessary to temper a t-test result with the sample

size when conducting one study, it is unnecessary in a meta-analysis. This is because the

meta-analytic process weights each result in a way that reflects its precision as an estimate

of the population effect. In addition to this mathematical argument, Hunter and Schmidt

(2004) argue that because the effect size is unaltered by sample size, it is a better reflection

of the population effect size which is defined without reference to sample size.

The effect size, Hedges g, is calculated by dividing the difference between the two

group means by the pooled standard deviation or within-group standard deviation (that is

the weighted [by the degrees of freedom] mean of the two variances square rooted)

(Riopelle, 2000). In formulaic notation:

pooledSDXX

g 21 −= where )(

)()(

21

2221

21

dfdfdfSDdfSD

SD pooled +×+×

=

Hedge’s g is a positively biased estimate of the population effect size ( δ ) when

calculated with small samples. To counter this, Hedges and Olkin (1985, p. 81) provided


110

the following adjustment formula which was utilised for the meta-analyses reported in the

current thesis:

gN

)94

31(ˆ−

−=δ

6.4.2. – Incidence Differences between Two Groups

Studies reporting percentages or incidence levels often did not test for statistical

significance. After an examination of a number of statistical texts it was decided that these

would be tested with the use of odds ratio calculations. The odds ratio was viewed as more

applicable to the analyses required for this project than chi-square, because it is not unduly

affected by uneven sample sizes (Smithson, 2000). In addition, it has become identified

with assessing the significance of differences in incidence levels of symptoms in two

populations (Smithson, 2000) as would be set out in a 2x2 contingency table such as Table

6.1. Table 6.1. Example 2x2 contingency table for comparing incidence levels (Y) Symptom

(X) Group Yes No Survivor N11 N12 Control N21 N22

The odds ratio of having the symptom, if in the survivor group, versus the control

group is:

( )( )21

11====

=ΩXYOddsXYOdds

where ( )12

1111NNXYOdds === and ( )

22

2121NNXYOdds ===

In other words 2221

1211

//NNNN

=Ω

6.5. – Checks for Duplication of Results

Upon examination it became obvious that findings from studies have often been published

more than once. For example the results of a study conducted by Moshe Almagor and

Gloria Leon in 1978/1979 were published in a journal article in 1981 and then in a book

chapter in 1989 (Almagor & Leon, 1989; Leon, Butcher, Kleinman, Goldberg, & Almagor,

1981). In another example, Sophie Venaki, Arie Nadler and Hadas Gershoni’s findings

were published in the International Journal of Social Psychiatry in 1983 and then in

Family Process in 1985 (Venaki, Nadler, & Gershoni, 1983, 1985). In yet another


111

example, the results presented in Cohen, Brom and Dasberg (2001) are re-reported with

additional data in Brom, Durst and Aghassy (2002).

Egger and Davey Smith (1998) identify this “multiple publication bias” as of great

concern for meta-analysts. They note that multiple publication bias can further compound

the problem of publication bias because not only are statistically significant results more

likely to be published in the first place, they are also more likely to be published more than

once (Egger & Davey Smith, 1998). If the duplication of data is not recognised, this can

lead to an over-estimation of the meta-analytic effect size. Therefore, special care was

taken to cross-reference study results with at least one common author to ensure (as much

as possible) that duplication of data did not occur in the current project.

The issue of possible duplication of data also arose when looking at dissertations

and theses which were later published as journal articles or book chapters, as was the case

for the work of Helen Lichtman, Susan Rose and Felice Zilberfein (Lichtman, 1983, 1984;

Rose, 1983; Rose & Garske, 1987; Zilberfein, 1994, 1996). All dissertations and theses

obtained were cross-referenced with the published material to ensure data was not

duplicated. Dissertations are a useful resource, as they contain more detailed presentation

of results than journal articles do and so were often consulted in the search for missing data.

6.6. – Calculation Methods for Meta-Analyses

Meta-analyses were conducted on two types of statistics. These are the examination of

mean differences between two groups as would be analysed by an independent groups t-test

and the examination of differences in incidence levels between two groups as would be

analysed by an odds ratio. It should be noted that the calculation methods used were cross-

checked by running representative meta-analyses on a number of recognised meta-analytic

computer programs such as Comprehensive Meta-Analysis, Meta-Stat and Stats Direct.

Excel calculation spreadsheets were developed by the author and used for the meta-

analyses in this thesis, in preference to the use of meta-analytic computer programs, to be

certain that the inner calculations were being conducted correctly. Also not all of the

analysis tools required for the desired analyses for this thesis were available in any given

program located.


112

6.6.1. – Mean Differences between Two Groups

Meta-analytic or weighted average effect sizes were derived by weighting each effect size

by the inverse of its variance as advocated by Hedges and Olkin (1985). The individual

effect size variance was calculated with the following Hedges and Olkin (1985) formula:

+

=

21

22

2

ˆ

nnN

dfSDg

δ

The meta-analytic effect size was then calculated as follows:

)1(

)1ˆ(

2

2

g

g

SD

SDg

Σ

×Σ

=

δ

6.6.2. – Incidence Differences between Two Groups

Meta-analytic odds ratios were calculated by simply producing a sum of all frequencies in

each cell for all the relevant individual odds ratios (the formula for which is presented in

Section 6.4.2) and then calculating an overall meta-analytic odds ratio based on the total

population of people included in all studies.

In other words, ∑ 11N , ∑ 12N , ∑ 21N and ∑ 22N were derived and then these

figures were entered into the odds ratio formula as follows:

∑∑∑∑=Ω

2221

1211

//

NNNN

6.7. – Sub-Group Meta-Analyses

In addition to overall meta-analyses, meta-analyses of subgroups were also conducted

where viable. Sub-groups were either location groups or other demographic variables such

as gender.

As has already been discussed, a large majority of studies have treated Holocaust

survivors, children of Holocaust survivors and grandchildren of Holocaust survivors as

homogenous groups and have compared their entire sample’s combined scores to control

groups. A lot of these studies, however, quote data relating to subgroups within their study

groups (for example males versus female groups, children of one versus two survivors).

While some have checked for statistically significant differences between these subgroups,


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others have not conducted significance testing at all, citing means and standard deviations,

often in an appendix. Consequently there were many opportunities to assess differences

between subgroups that the original researchers left unrealised or perhaps just unreported.

As was discussed in Chapter Four, markedly different post-Holocaust experiences

may have been encountered by survivors depending on where they chose to settle after the

war. Three distinct locations/location groups were considered for possible meta-analysis.

These fall roughly into one of three post-war settlement groups of those who stayed in

Europe, those who went to Israel and those who immigrated to other continents such as

America. It is possible to examine this issue via sub-group meta-analyses by grouping

studies based on the country or region they were conducted in.

One of the main aims of this research project was to examine demographic

differences within groups of survivors, children of survivors and grandchildren of

survivors. Therefore, where sufficient results were obtained, separate meta-analyses were

conducted to assess such differences. These most commonly related to gender and one

versus two survivor parents for children of survivors, although in some instances other

demographic variables could be meta-analysed. However, it is noteworthy that such

analysis could only be conducted if the original author quoted data for these subgroups, or

their entire sample was from the subgroup. Davey Smith and Egger (1998) point out that

the decision to include sub-group data may have been dependent on the statistical

significance of the results. This should be borne in mind when interpreting these results.

6.8. – Meta-Regression: Correlation of Study Effect Sizes with Study Attributes

Meta-regression was also used to examine the relationship between the strength of an effect

and variables such as age and time lapse since the Holocaust. This involved correlation of

effect sizes with the demographic characteristics of age, gender (for example female

percentage of the sample), number of Holocaust survivor parents (for example percentage

of the sample with two survivor parents), time between the study and the Holocaust, and

time between the Holocaust and the birth of children of Holocaust survivors. Davey Smith,

Egger and Phillips (1997) describe how meta-regression can be used to look at the

“gradient in .. effects”. They state that:

Such a gradient allows for a more powerful examination of differences in outcomes, as a statistical test for trend can be performed.… Attributes of study groups such as age and length of follow-up can readily be analysed in this way.


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Meta-regression analyses were conducted using SPSS. The effect size and

demographic data used from each study were weighted by the survivor or descendant

sample size, so that studies with larger sample sizes were given more weight in the

analysis.

The formula followed by SPSS for this calculation is equivalent to the formula for

Pearson’s correlation co-efficient as presented in Tilley (1999) with the added element of

weighting by sample sizes:

∑∑=

Hgroup

HGroupYXmeta N

NZZr

))((

Scatterplots were viewed before each analysis was conducted to ensure there was no

evidence of a curvilinear (as opposed to linear) relationship and that Pearson’s correlation

co-efficient was an appropriate statistic to apply to the data.

Not all researchers reported the data required for these meta-regressions (for

example the average age of their subjects or the gender breakdown) which means that not

all studies could be included in meta-regressions. This factor must be kept in mind when

interpreting the results of the meta-regression. Where this occurs, a note is made informing

the reader so that the results can be interpreted in an informed manner.

6.9. – Criteria for Inclusion of Multiple Results from Single Studies in Meta-Analysis

Hunter and Schmidt (1990; 2004) identify several conditions where it is statistically valid

to include multiple results from one study in meta-analytic calculations. These are when

the study essentially incorporates a “fully replicated design” or when “conceptual

replication” occurs.

A fully replicated design occurs when the same measure or condition is used with

independent groups. Examples relevant to the current research would be measures

conducted with two groups of Holocaust survivors or other generations sourced from two

different locations or different sample sources such as survivor groups versus clinical

settings, or with demographic subgroups such as males and females or differing age groups.

The key determinant is that the groups are independent and that no participant is included

in both groups.

Conceptual replication is present when there is replicated measurement of a

particular variable. For example, Finer-Greenberg (1987) uses both the Symptom Check

List-90-Revised (SCL-90-R) and the Cognitive Checklist to measure depression and


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anxiety levels in Holocaust survivors. This means that for each Holocaust survivor there

are two scores for depression and two scores for anxiety. Including each separate

conceptual replication violates the assumption of independence (Hunter & Schmidt, 1990,

2004). This assumption states that each result included in the meta-analysis must be

independent from the other results included. Therefore, effect sizes representing

conceptual replications were averaged so that the independence assumption was not

breached. This also ensured that each study participant contributed to the meta-analytic

result once.

6.10. – Methods for Dealing with Missing Data

A common problem faced by meta-analysts is missing/unreported data or statistics (Cooper,

1984). Thankfully, there were very few instances of missing data in the research included in

the meta-analyses for this project. For the rare instances where these problems occurred an

effort was made to calculate a replacement value where the missing data would impact on

the meta-analytic calculations. Wherever this practice was conducted a note is made in the

text so that the reader is aware and can interpret analysis results in the light of this. The

following sections outline the types of missing information that were confronted and how

they were dealt with.

6.10.1. – Missing Standard Deviations

A weighted average of the standard deviations of all groups in all other comparisons using

the same questionnaire was used as a replacement standard deviation. This was obtained

by calculating the average weighted variance and then square rooting this figure to derive

the weighted average standard deviation. It was not necessary to calculate a replacement

standard deviation, if the results of significance testing were reported. A replacement value

was only calculated, if it was required to derive an effect size for the meta-analysis.

6.10.2. – Presentation of Significance Tests without Means or Standard Deviations

A formula quoted by several authors has been developed in order to calculate a g-value, for

use in a meta-analysis, when only a t-value is reported without the means and standard

deviations of the groups involved. The following formula (Cooper, 1984; Lyon, n.d.) was

utilised to convert t-values to g-values when this circumstance arose:

dftg 2

=


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When only a p-value was quoted, the TINV function in Microsoft Excel was used as

it returns the t-value when given the p-value and the degrees of freedom for a particular

significance test. The method stated in the previous paragraph was then used to derive an

effect size from this derived t-value.

6.10.3. – Statement of Result without Data or Statistics Reported

Sometimes authors merely cited whether they obtained a statistically significant result

without reporting any descriptive statistics at all. In these instances, the most unbiased

estimate of a t-value was inserted into the analysis.

The most problematic situation occurred where an author obtained a non-

statistically significant result. It is not uncommon in such circumstances for no data to be

reported and a sentence such as “There was no statistically significant difference between

the survivor group and the control group on the XXX measure” included in the text.

However, it is obviously important for the integrity of the meta-analytic process for null

results to be included as well as statistically significant results, so that an accurate overall

effect is calculated. Unless this is stated in the article, it is also often impossible to know in

which direction the non-statistically significant result was obtained.

Because of the difficulties just described, the most commonly suggested solution is

to assume a t or effect size of zero (Cooper, 1984). Given the lack of information, this is

the only unbiased replacement value that can be inserted. It is important to note, however,

that an effect size of zero is rare and that the non-statistically significant result will have

almost certainly been in a certain direction. Given this, it must be borne in mind that using

zero as a replacement value will have the effect of making the overall effect size, or g ,

closer to zero than it might actually be (Cooper, 1984).

It was less common for a researcher to state that a statistically significant difference

was found between the two study groups without citing any descriptive statistics or test

results. In these instances, the minimum t-value required to derive a statistically significant

result at a significance level of 0.05 for a two-tailed test (given the sample size/degrees of

freedom) was inserted into the analysis. Again, while this is by no means a perfect

solution, it does not impact upon the analysis as much as missing information regarding a

non-statistically significant result which can vary much more markedly in terms of

direction and degree (that is, between the negative and positive values of the cut-off t -value

required for significance).


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6.11. – Interpretation of Meta-Analytic Findings

With weighted overall effect sizes and odds ratios calculated it was necessary to have a

framework for interpreting the meaning of the results. In addition to determining statistical

significance, two supplementary interpretation methods were used. “Fail Safe N” was

calculated to address possible reader concerns relating to studies which may have been

inadvertently left out of the analysis for various reasons. The issue of homogeneity of effect

sizes was also addressed.

6.11.1. – The File Drawer Question

When conducting meta-analysis it is desirable, but often impossible, to include every piece

of research conducted to date on the issue of interest. It is possible that there are a number

of studies that are left uncovered because they remain unpublished or unobtainable or do

not show up in database searches because they have not been added to them or do not come

up with the search terms used. This relates back to the idea that there is a publication bias

towards statistically significant results which implies that there may well be studies with

non-statistically significant results that were rejected for publication because of this. It

should be noted again that for the meta-analyses outlined in the current thesis every effort

was made to include unpublished data as well as published data. However, it needs to be

acknowledged that the chances of obtaining the data from every single unpublished study

ever conducted are very low, despite the most fervent of efforts by a meta-analyst. In light

of this, a formula has been developed which estimates the number of opposite results

needed to produce a non-statistically significant overall effect. This has also been called

the “Fail Safe N” (Cooper, 1984; Hunter & Schmidt, 1990, 2004; Rudner, Glass, Evartt, &

Emery, 2002).

The formulae used for this project are based on that presented by Hunter and

Schmidt (1990; 2004) and Orwin (1983). The maximum meta-analytic effect size, or

criticalg required so that its 95% confidence interval would encompass zero (and therefore be

considered non-significant) is determined. The following formula then calculates how

many additional non-statistically significant or opposing results would be required to

reduce g to that level.

c

critical

gggkk )(

0−

=

where k0 is the additional number of opposite results required and k is the number of

comparisons included in the analysis.


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6.11.2. – Testing the Homogeneity of Effect Size Sets

The main premise of conducting a meta-analysis is the hope of creating the most precise

estimate of the true size of a population effect. Related to this premise is the question of

whether it is valid to assume that the collection of effect sizes/study results being

aggregated in a meta-analysis are a homogeneous set, related to a single population effect

size or whether they are actually a heterogeneous set, reflective of a number of different

populations which should be considered separately. A statistical test designed to assess

whether a set of effect sizes is homogeneous is the Q Homogeneity Test. The formula

(Hedges & Olkin, 1985, p. 153; Kline, 2004, p. 260) for this test is:

∑ −= 2

2)(

gSDggQ where the 2

gSD formula is given in Section 6.6.1

The result of this test is assessed via the 2χ distribution with k – 1 (k = number of

studies/results) degrees of freedom.

The assumption of a single population effect size is implicit in a “fixed-effects”

meta-analytic model. When this assumption has been breached, as evidenced by a

statistically significant Q Homogeneity Test result, it must be assumed that the set of effect

sizes/study results represent a heterogeneous group. The courses of action available to the

researcher are either to conduct meta-analyses using a “random-effects” model (which does

not assume a single population effect size) or to conduct sub-set meta-analyses (Kline,

2004, p. 260).

One of the main objects of the current thesis is to identify the demographic sub-

groups of survivors and their descendants that differ statistically significantly from each

other. Therefore, the use of a “random-effects” meta-analysis model is not of relevance

here. It was not the aim of the study to acknowledge but not explore the sources of

heterogeneity. The aim of the meta-analytic review of the literature was to establish

statistically the presence of heterogeneity and then to attempt to uncover the reasons for it.

To test for heterogeneity it is necessary to use a meta-analytic tool designed to test whether

a set of study results are homogeneous in the hopes that the results of such a test would be

negative. Therefore the Q Homogeneity Test is an important tool in answering the

questions raised by the literature review of survivor research. Beyond establishing the

heterogeneity of results, the methodology required to examine demographic differences is

the use of sub-set meta-analyses.


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6.12. – Overview of Meta-Analysis Section of Thesis

This chapter has summarised and explained the meta-analytic methods used in Stage One

of this thesis. The rest of this section contains the results of literature reviews in which

these methods were used. Chapter Seven reports the results of studies which compare

Holocaust survivors, children of survivors and grandchildren of survivors to

control/comparison groups. Chapter Eight presents meta-analytic and non-meta-analytic

reviews of demographic differences within the Holocaust survivor group. Chapter Nine

addresses demographic differences among the descendants of Holocaust survivors, namely

their children and grandchildren. The reader should note that all studies included in the

meta-analyses/review of the literature will be discussed in past tense while the results of

meta-analyses will be discussed in present tense. This will aid the reader in differentiating

between results of studies in the literature and results of the meta-analyses conducted for

the current thesis. In Chapter Ten the model of the differential impact of Holocaust trauma

is revised in light of the meta-analytic and non-meta-analytic review findings. The results

of this process are examined to determine which areas have convincing evidence and which

are more ambiguous and require further study. This review and reappraisal process informs

Stage Two of the thesis which entails an empirical assessment of the revised model.


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Chapter Seven – Meta-Analyses of Survivor and Descendant Groups versus Control

Groups/General Population

Opinions have been divided as to the extent Holocaust survivors and their descendants

differ from the general population in terms of psychological health and functioning. An

examination of the literature clearly reveals a range of results with some studies finding

statistically significant differences between survivors (or their descendants) and the general

population (as represented by control groups) and others finding negligible differences or

no differences at all. While arguments such as differing sample sources are put forward as

reasons for the heterogeneity of findings, the point that perhaps results differ so widely

because groups of survivors may differ widely in their level of post-Holocaust adjustment

has rarely if ever been put.

This chapter provides a quantitative synthesis (via meta-analyses) of findings to

date which compare Holocaust survivors or descendant groups to control groups/the

general population on a number of psychological variables. In so doing it aims to establish

the current state of evidence in relation to differences between Holocaust survivors and

descendants and the general population. The specific meta-analysis hypotheses (MAH) are

that:

MAH1: Survivors, children and grandchildren will, overall, have statistically

significantly higher scores on negative psychological variables and statistically

significantly lower scores on positive psychological variables than control groups/the

general population when the currently available data in the literature is synthesised via

meta-analyses. In other words, overall differences BETWEEN survivor and descendant

groups and control groups will be statistically significant.

MAH2: The individual effect sizes and odds ratios included in the meta-analyses will

have large ranges and the Q test of homogeneity of meta-analytic effect sizes will be

statistically significant. These results will suggest that survivors and descendants differ

statistically significantly from the general population, but the size of this difference

varies substantially from study to study - a finding suggestive of the fact that the

survivor and descendant population is a heterogeneous rather than homogenous group

which warrants WITHIN group/sub-group comparisons.


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7.1. – Method

Studies comparing Holocaust survivors or descendants to control groups were collated for

meta-analyses. The psychological variables addressed by these meta-analyses are

depression, anxiety, paranoia, world assumptions of benevolence and meaningfulness and

positive and negative romantic attachment and intimacy dimensions. Because the range of

measures used to assess attachment and interpersonal trust and intimacy were so varied,

studies/results were grouped under the broad headings of positive or negative dimensions.

The studies included report results based on surveys or questionnaires (where mean

ratings are provided) or on diagnoses or categorisations (where percentages of samples

qualifying for a given diagnosis or category are provided). Separate meta-analyses are

conducted for sets of studies reporting on survey means versus those reporting on

percentages qualifying for diagnoses. Meta-analytic statistics reported include effect sizes,

odds ratios, Fail Safe Ns and Homogeneity Q tests (refer to Chapter Six for detailed

explanations of these analyses).

To be included in the analyses studies had to include a survivor or descendant group

and a control group that were measured at the same time. Because of potential confounds

due to historical and geographical factors the few studies that compared survivor or

descendant groups to normative data or data sourced from a separate study, to serve as a

control group, were not included in the meta-analyses but are discussed in the text. The

studies that included survey ratings of participants by third parties were also not included so

that all analyses only include self-rating on surveys.

7.2. – Holocaust Survivors versus Control Groups

7.2.1. – Meta-analytic Results

In this section the results of studies comparing Holocaust survivors to control groups are

combined meta-analytically and discussed. Table 7.1 presents the results of meta-analyses

of survey studies comparing Holocaust survivors to control groups. Table 7.2 presents the

results of meta-analyses of incidence or diagnosis studies. The individual studies/results

that were included in each of these analyses can be found tabulated in Appendix A.


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Table 7.1. Summary of meta-analyses of survey/scale studies comparing survivors to control/comparison groups Variable Number of

results where survivors scored higher than comparison group

g 95% confidence limits for g

Fail Safe N

Highest individual result effect size (g)

Survivor group sample size

Control group sample size

Q Homogeneity test

Depression 29/30 0.32 * 0.26 to 0.39 123 1.96 2,000 1,880 114.41 * Anxiety 12/13 0.57 * 0.47 to 0.67 62 1.41 907 649 175.53 * Paranoia 10/12 0.45 * 0.34 to 0.56 37 0.99 660 645 29.43 * Assume World is Benevolent

3/9 - 0.28 * - 0.16 to - 0.40 31 -0.50 316 470 24.64 *

Assume World is Meaningful

3/9 - 0.11 - 0.23 to 0.00 18 -0.53 316 470 25.73 *

Positive Attachment/Intimacy Variables

0/3 - 0.26 * - 0.02 to - 0.51 6 -0.64 130 85 4.79

Negative Attachment/Intimacy Variables

2/3 0.28 * 0.03 to 0.52 <1 0.84 130 85 14.70 *

Note. A positive effect size ( g ) indicates that survivors scored higher on a variable than control groups while a negative effect size indicates that survivors scored lower on a variable than control groups. * p < 0.05 Table 7.2. Summary of meta-analyses of incidence/diagnosis studies comparing survivors to control/comparison groups Variable Number of

results with higher incidence for survivor group

Ω 95% confidence

limits for Ω

Average incidence among survivors

Survivor incidence range


Average incidence among controls/ comparisons

Control incidence range


Depression 5/5 1.27 * 1.11 to 1.46 33% 18% to 61% 3,488 28% 13% to 46% 1,561 Anxiety 4/4 1.44 * 1.27 to 1.63 48% 8% to 64% 3,470 44% 20% to 50% 1,570 Paranoia 2/2 1.24 0.99 to 1.55 13% 12% to 54% 2,353 9% to 50% 1,190 Insecure Attachment

1/1 2.87 * 1.20 to 6.86 77% -

48 54% - 48

Note. The average incidences for depression and anxiety include the findings of Eitinger (1972) and Matussek (1975) while the average incidence for paranoia also includes the findings of Matussek (1975). These two studies did not include comparisons to control groups and so could not be included in the odds ratio analysis.

Ω meta-analytic odds ratio * p < 0.05

Overall, Holocaust survivors score statistically significantly higher on negative

psychological variables and statistically significantly lower on positive psychological

variables than control groups. Meta-analytic effect sizes based on survey studies range

between 0.28 and 0.57 for negative variables and -0.11 and -0.28 for positive variables.

When the mode of measurement is incidence or diagnosis rather than survey scores,

survivors also have a higher incidence of negative psychological symptoms or disorders

than control groups. The odds of survivors being categorised as depressed, anxious or

paranoid are between 1.24 and 1.44 times higher than for members of control groups with

the odds of being categorised with an insecure attachment being 2.87 times higher.


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However, there is also a large range in effect sizes and incidence levels. This

suggests that even though, when all the data is collated, survivors differ statistically

significantly from the general population, there is substantial variation within the survivor

population as to the size of that disparity. For example, while survivors included in the

data in the meta-analysis of depression survey results scored an average of 0.32 of a

standard deviation higher than their control group, the most extreme difference between a

survivor group and a control group for depression was 1.96 standard deviations (see Table

7.1). This large variation is further evidenced by the predominantly statistically significant

Homogeneity Q tests which suggest that the set of effect sizes are heterogeneous and do not

represent a homogeneous population.

7.2.2. – Studies Excluded from Meta-analyses

Three studies asked children of survivors to rate their survivor parents on psychological

variables (Major, 1996; Podietz et al., 1984; Woolrich, 2005). Podietz et al. (1984) asked a

group of children of survivors to rate their survivor parents in terms of how fearful they

perceived them to be. The researchers did not cite the descriptive data of the groups but did

cite the statistically significant t test results. Children of survivors rated their mothers and

their fathers as statistically significantly more fearful than control mothers and fathers were

rated (t (216) = 3.63, p < 0.001 and t (216) = 2.58, p < 0.05 respectively). In Major’s

(1996) study, participants rated the extent to which they believed their parents were

suspicious of others. There were no differences in how children of survivors and children

whose parents were not survivors rated their parents on this variable. Survivor mothers

were rated identically to mothers who had not survived the Holocaust (M = 2.50 for both

groups) while survivor fathers were rated only slightly lower than comparison fathers (M =

2.40 versus M = 2.50). No standard deviations were reported but results of t-tests were and

there were no statistically significant differences in ratings here. In the most recent of the

studies to report children of survivor’s ratings of their parents, Woolrich (2005) reported

the percentage of participants who considered their parents general mood to be

characterised by anxiety or depression. Survivor mothers were more likely to viewed as

anxious (29% of 59 versus 19% of 59) than comparison mothers but were equally likely to

be viewed as depressed (27% for both groups). Survivor fathers were more likely to be

viewed as anxious (21% of 69 versus 12% of 59) and depressed (26% versus 12%) than

fathers who had not survived the Holocaust. When analysed via odds ratio, none of these

differences reached significance. The findings of these three studies do not contradict the


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overall finding that in general Holocaust survivors score higher or have a higher incidence

of negative psychological dimensions and score lower or have a lower incidence of positive

psychological dimensions.

7.3. – Children of Holocaust Survivor/s versus Control Groups


This section summarises and meta-analyses the results of studies comparing children of

survivors to control groups. Table 7.3 summarises the findings of meta-analyses of survey

studies while Table 7.4 presents the findings of odds ratio analysis of incidence studies.

Information regarding the individual studies/results included in these meta-analyses is

presented in Appendix B.

Similar to the findings pertaining to survivors, children of survivors are seen to

overall evidence higher levels/incidence of negative psychological symptoms and lower

levels of positive psychological dimensions. The effect sizes are smaller than those

obtained for the survivor analyses suggesting less disparity with the general population one

generation removed from the trauma.

While there is a sizeable range of effect sizes in the survey study meta-analyses,

none of the Q homogeneity tests are statistically significant. However it is notable that a

number of them are very close to the significance threshold. This may suggest less

heterogeneity in the children of survivor population than the survivor population. Table 7.3. Summary of meta-analyses of survey/scale studies comparing children of survivors to control/comparison groups Variable Number of results

where children of survivors scored higher than comparison group


Fail Safe N


Children of survivor group sample size


Q Homogeneity test

Depression 17/26 0.10 * 0.01 to 0.19 3 0.56 1,087 770 28.06 Anxiety 13/17 0.18 * 0.06 to 0.29 9 1.02 613 482 19.52 Paranoia 7/12 0.21 * 0.04 to 0.39 3 0.78 298 164 19.93 Assume World is Benevolent

1/1 0.00 - 0.33 to 0.34 - - 67 70 -

Assume World is Meaningful

0/1 - - - 67 70 -

Positive Attachment/Intimacy Variables

3/8 - 0.09 - 0.22 to 0.04 - - 0.43 418 379 14.57


6/13 0.02 - 0.08 to 0.13 - 0.35 658 510 15.78

Note. A positive effect size ( g ) indicates that children of survivors scored higher on a variable than control groups while a negative effect size indicates that children of survivors scored lower on a variable than control groups. * p < 0.05


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Table 7.4. Summary of meta-analyses of incidence/diagnosis studies comparing children of survivors to control/comparison groups Variable Number of

results with higher incidence for child of survivor group

Ω 95% confidence

limits for Ω

Average incidence among children of survivors

Children of survivor incidence range

Child of survivor group sample size

Average incidence among controls/ comparisons

Control incidence range


Depression 3/4 6.70 * 4.24 to 10.58 25% 3% to 56% 399 5% 2% to 12% 580 Anxiety 4/4 3.14 * 2.08 to 4.76 24% 7% to 70% 399 7% 5% to 10% 580 Insecure Attachment

1/1 2.99 * 1.23 to 7.25 68% - 48 42% - 50

Note. Both average incidences also include the findings of Zajde (1998). Zajde (1998) did not compare her results to a control group and so her data could not be included in the odds ratio analysis. * p < 0.05 7.3.2. – Studies Excluded from Meta-analyses

Five studies were omitted from the meta-analyses comparing children of survivors to

control groups because of design flaws. Three of these included participants in their

children of survivor group that do not meet the criteria for “child of survivor” as outlined in

the meta-analysis methodology chapter of the current thesis (specifically birth post-1945).

The remaining two studies had problems surrounding their “control” groups.

Stein’s (1997) child of survivor group included participants who were born as far

back as 1922. Clearly such participants could be classified as survivors themselves, despite

technically also being the children of Holocaust survivors. Because the definition of a child

of survivors for the current thesis is a person who was born after their parents’ persecution

had ended and who had not directly experienced the Holocaust themselves this sample was

considered contaminated. However, it is worthy to note that Stein’s (1997) results provide

further support for the trend of higher scores among children of survivors on negative

psychological variables. Stein (1997) conducted a study assessing anger expression before

and after a mood-inducing condition. He also assessed sadness levels before and after the

induction. The sadness levels of children of survivors and the control group prior to the

induction can be seen as another measure of depression in this group. Scores were

averaged over the induction groups to provide total group scores for the child of survivor

and the control group. It was the children of survivors who were statistically significantly

sadder than the control group (M = 50.27, SD = 12.49, n = 52 versus M = 44.12, SD = 4.88,

n = 51). This difference was statistically significant (t (101) = 3.27, p < 0.01).

Gertz’s (1986) study comparing 111 children of survivors to 53 controls could not

be included in the meta-analysis because of the sample criteria used. Subjects aged up to

43 at the time of the study were included despite the fact that they must have been born no


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later than 1943: clearly before the end of the war. The daughters of survivors scored higher

on the Beck Depression Inventory than female controls (M = 8.28, SD = 6.39, n = 60 versus

M = 6.65, SD = 5.67, n =32). A similar pattern of results was noted for the males (sons of

survivors M = 7.82, SD = 9.35, n =51 versus controls M = 5.04, SD = 4.55, n = 21). On the

Spielberger Trait Anxiety Scale both child of survivor groups also scored higher than their

respective control groups (Female M = 42.35, SD = 10.29 versus M = 40.43, SD = 9.95;

Male M = 40.34, SD = 12.35 versus M = 38.70, SD = 9.79). None of these differences

reached statistical significance but were all in the same direction.

In the third study excluded because of sample contamination, Rubenstein (1981)

examined differences in depression between children of survivors and a control group.

This study also included participants born before 1945 and was thus conducted with a

contaminated sample. Despite the problems with Rubenstein’s (1981) study, his findings do

add further support to the idea that children of survivors show higher levels or greater

severity of psychological symptoms than control groups or the general population.

Rubenstein (1981) divided his child of survivor sample into children with one survivor

parent and children with two survivor parents. Both child of survivor groups scored

statistically significantly higher on the Depression scale of the Mini-Mult (an abbreviated

version of the MMPI) than the control group (children with one survivor parent M = 20.75,

SD = 4.52, n = 48, children with two survivor parents M = 22.40, SD = 4.88, n = 30, control

M = 18.41, SD = 3.02, n = 24; t (70) = 2.57, p < 0.05; t (52) = 3.62, p < 0.001).

Utilising the SCL-90-R, Chayes (1987) compared depression, anxiety, phobic

anxiety and paranoia levels of a sample of children of survivors to non-patient normative

data. Normative data is not the same as a contemporaneous and geographically proximate

control group. In addition, the large sample used to derive the normative data (n = 974)

was so large that it was having a significant impact on the meta-analytic results, and so the

study was left out of the analysis. Chayes’ (1987) children of survivors had lower levels of

depression (M = 0.28, SD = 0.56, n = 25 versus M = 0.36, SD = 0.44, n = 974), paranoia (M

= 0.24, SD = 0.64; M = 0.34, SD = 0.44) and anxiety (M = 0.21, SD = 0.51; M = 0.30, SD =

0.37) than the normative data. The children of survivors scored higher than the normative

data on phobic anxiety (M = 0.17, SD = 0.61; M = 0.13, SD = 0.31). None of these

differences reached statistical significance however.

Finally, Berger (2003) compared the results of her sample of 109 children of

survivors to a sample of college students (derived from another study) on the Experiences


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of Close Relationships Scale which yields scores on the attachment scales of avoidance and

anxiety. No statistically significant differences were found but the children of survivors

scored slightly higher on both scales (Avoidance M = 49.43, SD = 23.29 versus M = 47.63,

SD = 18.59; Anxiety M = 64.72, SD = 25.92 versus M = 63.06, SD = 21.26).

7.4. – Grandchildren of Holocaust survivors versus Control Groups


This section summarises the meta-analyses of results comparing grandchildren of survivor

to control groups. There were no studies looking at the incidence of symptoms or

diagnoses so the results here only pertain to survey studies and are presented in Table 7.5.

Table 7.5. Summary of meta-analyses of survey/scale studies comparing grandchildren of survivors to control/comparison groups Variable Number of results

where grandchildren of survivors scored higher than comparison group


Fail Safe N


Grandchild of survivor group sample size


Q Homogeneity test

Depression 1/2 0.41 * 0.07 to 0.76 < 1 0.84 70 64 6.68 * Anxiety 3/4 0.43 * 0.15 to 0.72 2 0.96 109 76 7.99 Paranoia 0/1 - 0.23 - 0.74 to 0.27 - - 30 30 - Positive Attachment/Intimacy Variables

0/3 - 0.43 * - 0.81 to - 0.04

5 - 0.49 53 45 0.32


2/2 0.46 - 0.22 to 1.13 - 0.84 11 15 0.84

Note. A positive effect size ( g ) indicates that grandchildren of survivors scored higher on a variable than control groups while a negative effect size indicates that grandchildren of survivors scored lower on a variable than control groups. * p < 0.05 As was the case for the survivors and the children of survivors, grandchildren of

survivors score statistically significantly higher on negative variables and statistically

significantly lower on positive variables than control groups. Interestingly the effect sizes

found here are higher than those found for the children of survivors and are not consistent

with the suggestion of a dissipation of effect with each generational removal. However it is

not clear if this is a genuine effect or perhaps due to the small number of studies and

grandchildren of survivors included in these analyses. Certainly the findings for survivors

and children of survivors can be considered more robust because of the larger sample sizes

they are based on.

7.4.2. – Studies Excluded from Meta-analyses

Two studies presented ratings by third parties of grandchildren of survivor versus control

groups and were therefore excluded from the meta-analyses. Rubenstein (1981) reported

teacher ratings of primary school aged grandchildren of survivors while Sigal and Weinfeld


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(1989) asked parents and teachers to rate their grandchildren of survivor sample. Sigal and

Weinfeld (1989) had two groups of grandchildren of survivors: one group with at least one

Holocaust survivor grandparent (n = 58) and one group with at least one survivor parent

and one survivor grandparent (n = 11). Two control groups were also used: one group with

native born grandparents (n = 30) and one group with at least one pre-war immigrant

grandparent (n = 28). The percentages of parents and teachers who considered the children

were sad often or very often were: 23% of grandchildren of native born, 30% of

grandchildren of pre-war immigrants, 21% of grandchildren of survivors and 57% of

children/grandchildren of survivors. While the sample size was very small it is interesting

to note that the subjects with a parent and a grandparent who survived the Holocaust were

rated as sad often or very often much more frequently than the other groups. The

percentages for often or very often fearful or anxious were: 11% of grandchildren of native

born, 19% of grandchildren of pre-war immigrants, 34% of grandchildren of survivors and

40% of children/grandchildren of survivors. In addition to self-ratings which were

included in the meta-analysis, the grandchildren in Rubenstein’s (1981) study were rated on

anxiety on the School Behaviour Checklist by their school teachers. Children with survivor

grandparents scored higher than the control group but not statistically significantly so (two

survivor grandparents M = 51.92, SD = 10.64, n = 15; one survivor grandparent M = 46.72,

SD = 9.03, n = 24; control M = 45.09, SD = 7.62, n = 11). These findings further add to

overall finding that grandchildren of survivors evidence higher symptom levels than the

general population.


This chapter has presented the findings of meta-analyses comparing Holocaust survivor and

descendant groups to control groups. The aims of this exercise were: 1) to establish the

extent to which survivors and their descendants differ to the general population (as

represented by control groups) on a number of psychological variables and; 2) to determine

if the size of this difference between survivor and descendant groups and the general

population is homogeneous (suggesting that survivors and their descendants are a

homogenous group).

The summation of results from studies comparing survivor and descendant groups

to control groups does support the argument that OVERALL survivors and their

descendants differ statistically significantly from the general population on psychological

variables. However, the large variation in effect sizes as well as the number of statistically


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significant heterogeneity tests (Q homogeneity tests) suggest that differences BETWEEN

survivors and their descendants to the general population are not uniform. These findings

are suggestive of the notion that there is a large amount of heterogeneity WITHIN the

survivor and descendant populations.

The existing data pertaining to potential sources of this heterogeneity are examined

in Chapters Eight and Nine. These chapters report the findings of meta-analytic

investigations into demographic sub-groups of the Holocaust survivor and descendant

populations.


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Chapter Eight – Meta-Analyses of the Moderating Influence of Demographic Variables

among Holocaust Survivors

Chapter Four discussed numerous demographic variables which have been mentioned in

the literature as potential influences on Holocaust survivors’ post-war adjustment. This

chapter summarises the existing data pertaining to demographic differences within the

Holocaust survivor population with meta-analytic techniques being applied where possible.

Specifically, the demographic variables for which empirical assessment has been conducted

to date among the Holocaust survivor population, which are considered in this chapter are

the nature of Holocaust experiences, loss of family, gender, age during the Holocaust and

post-war settlement location. Meta-analysis techniques are used to provide additional and

in some cases new/first analyses of issues such as age during the Holocaust, post-war

settlement location, time lapse since the Holocaust and membership of survivor

organisations.

8.1. – Method

Direct and indirect assessment of demographic variables and their impact on Holocaust

survivors’ post-war adjustment are presented in this chapter. Direct assessments of

demographic variables in the literature are summarised and meta-analysed where possible.

Indirect assessment, (where meta-analytic techniques are used to test variables not tested in

the individual studies included in the meta-analysis) is also possible for some variables

thereby filling some of the gaps in the literature.

Demographic variables are assessed indirectly via meta-analytic techniques such as

sub-set meta-analyses and meta-regressions. Sub-set meta-analyses provide insight into

demographic variables such as post-war settlement location via meta-analyses of studies in

sets determined by the country of study. Meta-regressions are also used to explore

relationships between continuously-scaled variables and study effect sizes. Examples of

such continuous linear variables include the average age of study participants, and the

proportion of samples that meet particular criteria (such as the percentage of a sample that

is female).

8.2. – Nature of Holocaust Experiences.

Twenty studies were located that considered the influence of the nature or type of

Holocaust experiences on the presence or severity of post-war psychological symptoms.

The approaches used by researchers in the assessment of nature of Holocaust experiences


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were so varied that it is impossible to conduct any valid meta-analyses. The dominant

operationalisation of this variable in the literature was categorical, but categories used are

not uniform across studies. A number of studies use a camp versus non-camp

categorisation but the nature of these groups across studies differs widely. Some studies

use a severity rating which is subjectively determined and is also not consistent across

studies. The studies located which assessed the role of the nature of Holocaust experiences

are summarised in Table 8.1 with findings and trends outlined. While there are a few

exceptions to the rule, overall it appears that survivors with some form of camp experience

have suffered more detrimental effects than survivors with other experiences. It is clear

however that there are also differences depending on the kind of camp in which a survivor

was incarcerated (labour versus concentration versus death) and that conditions differed

between camps.


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Table 8.1. Summary of results from the literature based on the nature/type of Holocaust experiences endured by survivors Study Operationalisation of Nature of

Experiences Findings Trend

Amir and Lev-Wiesel (2001)

Survivors who had been in hiding during the war who could remember their pre-war identity (n = 23) and those who could not (n = 23)

Depression and Anxiety scales of SCL-90 Depression – Could remember M = 0.72, Couldn’t remember M = 1.08. This result narrowly missed achieving statistical significance (t (44) = -1.91, p = 0.062). Anxiety – Could remember M = 0.61, Couldn’t remember M = 0.93

Survivors who could not remember their pre-war identity more depressed and more anxious

Ben-Zur and Zimmerman (2005)

30 concentration camp (CC) survivors versus 30 survivors with other Holocaust experience (includes labour camps)

Negative Affect Scale CC 3.26 versus Other 2.92 Statistically significant difference

Concentration Camp survivors more depressed than non camp survivors and labour camp survivors

Brody (1999) Camp (CC) versus non-camp (NC) and also correlation with length of imprisonment for camp group

Geriatric Depression Scale, SCID-Depression, PTSD Checklist for Civilians Intrusion, Avoidance and Hyperarousal Subscales GDS = CC 7.00, NC 6.67 SCID-D = CC 6.40, NC 6.13 Overall PTSD Severity = CC 32.60 NC 30.73 Intrusion = CC 1.73, NC 1.40 Avoidance = CC 1.47, NC 1.00 Hyperarousal = CC 1.47, NC 1.07 Positive correlation of r = 0.31 between PTSD symptom severity and length of imprisonment for the camp group. This correlation just missed out on statistical significance (p < 0.06). Some of the symptoms have higher incidence levels in the non-camp group. Specifically these are flashbacks (20% versus 7%), loss of interest in pleasurable activities (20% versus 13%), emotional detachment (13% versus 7%), foreshortened future (27% versus 13%), hypervigilance (27% versus 20%) and exaggerated startle (30% versus 27%).

Camp survivors have higher depression and PTSD symptoms scores but some individual symptoms are more common among the non-camp group with higher levels of symptoms such as hypervigilance and exaggerated startle potentially explained by extended periods in hiding

Clarke, Colantonio, Rhodes, Conn, Heslegrave, Links and van Reekum (2006)

47 concentration camp survivors (CC) 52 work camp, ghetto or hiding survivors (WGH) 76 resistance fighters or other Holocaust experience survivors (OT)

Geriatric Depression Scale, PTSD diagnosis GDS = CC 18.2, WGH 18.9, OT 19.9 % with PTSD = CC 35%, WGH 27%, OT 13.2% (significant)

Camp survivors have higher PTSD diagnosis but no significant difference in depression severity

Cohen, Dekel, Solomon and Lavie (2003)

26 camp survivors (C) 65 survivors who had been in hiding (H)

Current PTSD symptom levels using the PTSD Inventory Fear of Close Personal Relationships Questionnaire PSTD symptom levels = C 7.65, H 5.95 Statistically significant difference FCPRQ – No statistically significant differences and no descriptive data reported.

Camp survivors suffer more from PTSD symptoms than survivors who were in hiding. No trends can be noted about relationship issues.

Cordell (1980) Correlations with length of confinement in concentration camp among 20 Holocaust survivors

No statistically significant correlations between length of confinement and paranoia and depression as measured by Heimler Scale of Social Functioning. Correlation co-efficients not quoted.

No trend can be noted due to lack of data

Favaro, Rodella, Colombo and Santonastaso (1999)

Italian political prisoners who had been interned in a camp (n = 51) (C) Former partisans (n = 47) (P)

Incidence of major depressive disorder, depressed mood, PTSD diagnosis, intrusion, avoidance and hyperarousal Major depressive disorder = C 33%, P 4% Depressed mood = C 55%, P 6% PTSD Diagnosis = C 13%, P 2% Intrusion = C 48%, P 28% Avoidance = C 15%, P 6% Hyperarousal = C 37%, P 28% All differences are statistically significant using odds ratio analysis Among these symptom categories, the symptoms that yielded the largest group differences were (in descending order of significance) intense distress over reminders, physiological reactivity over reminders and recurrent nightmares (intrusion), avoidance of activities and situations, avoidance of thoughts and feelings (avoidance) and hypervigilance and exaggerated startle response (hyperarousal)

Political camp prisoners more depressed and more likely to suffer from PTSD symptoms than former partisans


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Study Operationalisation of Nature of Experiences

Findings Trend

Hafner (1968) An examination of restitution claim files. Discrimination (experienced effects of economic and social laws imposed but emigrated before enduring more extreme experiences) = n = 95 (D) Illegal residence (survivors in hiding or using assumed identity) = n = 70 (IR) Ghetto = n = 54 (G) Concentration camp = n = 158 (CC)

Incidence of Chronic depressive reactions and chronic anxiety neurosis Chronic depressive reactions = D 22%, IR 31%, G 19%, CC 30% Chronic anxiety neurosis = D 19%, IR 41%, G 52%, CC 34%

Illegal residence and camp highest on depression and Illegal residence and ghetto highest on anxiety

Joffe, Brodaty, Luscombe and Ehrlich (2003)

Mild experience group - generally removed from high risk situations such as living anonymously in the countryside or with non-Jewish families or living on Aryan papers (n = 15) Moderate group - usually in ghettos or labour camps but not in death camps, had some freedom and were able to forage for food (n = 39) Severe group - in concentration or death camps or in inhumane conditions hidden for months and often years, at constant risk of being discovered or killed. (n = 46) Subjectively determined by the authors.

Severe Depression scale of the General Health Questionnaire (SD-GHQ) Withdrawn Depression scale of the Brief Psychiatric Rating Scale (WD-BPRS) Anxiety and Insomnia scale from the General Health Questionnaire (AI-GHQ) SD-GHQ = Mild 0.70, Mod 0.80, Sev 1.70 WD-BPRS = Mild 2.00, Mod 2.90, Sev 4.80 AI-GHQ = Mild 1.40, Mod 2.10, Sev 4.10 There are statistically significant differences for all three scales.

Hiding survivors less anxious and depressed than labour camp or ghetto survivors who are also less anxious and depressed than concentration/death camp survivors.

Kuch and Cox (1992)

Review of 123 compensation files. They delineated their sample into concentration camp (n = 78) and non-concentration camp (labour camps or hidden) survivors (n = 45) and further divided their camp sample into tattooed (Auschwitz) (n = 20) and non-tattooed camp survivors (n = 58).

PTSD diagnosis: 47% of the total sample met the criteria for diagnosis, 51% of the concentration camp sample 65% of the tattooed group. The tattooed camp survivor group had a statistically significantly higher number of PTSD symptoms as well (M = 9.40 versus M = 6.70). A list of each of the PTSD symptoms is also provided and the tattooed camp survivor group always had a higher incidence for each symptom than the non-tattooed group.

Implication of differences in PTSD rates depending on severity of camp conditions

Kuch, Rector and Szacun-Shimizu (2005)

Review of 350 compensation files. Ghetto versus tattooed camp survivors

Hamilton Depression and Anxiety Scales Tattooed Auschwitz survivors did not score statistically significantly differently from ghetto survivors on either scale. No descriptive data was reported

No statistically significant difference between ghetto and camp survivors but no trend can be noted due to lack of data.

Leon, Butcher, Kleinman, Goldberg and Almagor (1981)

Camp survivors (n = 27) versus other (n = 15)

MMPI Depression and Paranoia Scales Depression = CC 61.89, Other 64.13 Paranoia = CC 57.74, Other 55.87 NB – Means here were averaged across gender groups by the current author to aid brevity

Survivors with non-camp experiences such as hiding have higher depression and lower paranoia than camp survivors

Letzter-Pouw and Werner (2005)

N = 96 Survivors of labour camps (LC), concentration camps (CC) and hiding (H) compared but no sub-sample sizes reported

Impact of Events Scale – avoidance and intrusion subscales Intrusion = LC 2.88, CC 3.82, H 3.05 (significant difference) Avoidance = no significant difference and no means quoted

Concentration camp experience associated with highest intrusion levels

Lev-Wiesel and Amir (2000)

Child survivors - average 12 years old in 1945. Survivors who were in a concentration camp (n = 35) (CC) In hiding (n = 46) (H) Adopted by a Christian family (n= 52) (A) Cared for in a Christian orphanage or monastery (n = 37) (OM)

Depression, Anxiety, Phobic Anxiety and Paranoia scales of SCL-90 PTSD Scale - Intrusion and Full or Partial PTSD (%) Depression = CC 0.59, H 0.59, A 1.07, OM 0.78 Anxiety = CC 0.51, H 0.50, A 0.89, OM 0.76 Phobic Anxiety = CC 0.51, H 0.21, A 0.41, OM 0.27 Paranoia = CC 0.34, H 0.53, A 0.72, OM 0.77 Intrusion = CC 3.86, H 2.88, A 3.75, OM 4.38 Full or Partial PTSD Diagnosis = CC 49%, H 48%, A 50%, OM 19% All scale scores differ statistically significantly across the groups

Survivors adopted or cared for in a Christian institution have higher levels of depression, anxiety and paranoia than survivors who hid or were in camps. Survivors in institutions have notably lower level of PTSD diagnosis but have highest intrusion rate.


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Study Operationalisation of Nature of Experiences

Findings Trend

Nathan, Eitinger and Winnik (1964)

Sorted through Jerusalem’s Talbieh Psychiatric Hospital’s patient records for the period 1949 to 1959 and found the files of 157 concentration camp survivors and 120 survivors who had spent most of the war in exile in the Soviet Union.

Incidence of major depressive disorder, dysphoria, depressive signs, anxiety attacks, free floating anxiety, paranoid manifestations and paranoid diagnosis MDD = C 13%, E 10% Dysphoria = C 45%, E 21% Statistically significant difference Depressive signs = C 49%, E 37% Statistically significant difference Anxiety attacks = C 3%, E 1% Free floating anxiety = C 15%, E 5% Statistically significant difference Paranoid manifestations = C 41%, E 43% Paranoid Diagnosis = C 9%, E 8% The reader should bear in mind however that the camp group appear to have a slightly older age profile than the exile group, meaning age could be a possible confound in this study.

Camp survivors have higher incidence of depression, anxiety and paranoia than people who spent time in exile in the USSR

Robinson, Rapaport, Durst, Rapaport, Rosca, Metzer and Zilberman (1990)

49 death camp survivors (C) versus 37 non-camp survivors (NC)

Depression and anxiety diagnoses Depression diagnosis = C 55%, NC 24% Anxiety diagnosis = C 55%, NC 27% Both differences are statistically significant when analysed via odds ratio analysis

Camp survivors more likely to be diagnosed with depression or anxiety than non-camp survivors

Robinson, Rapaport-Bar-Sever and Rapaport (1994)

Child survivors who had been in camps (n = 43) versus those who had been in hiding (n = 44)

Depression Diagnosis Camp group 48% Hiding group 31% Not statistically significant

Camp group more likely to be diagnosed with depression than hiding group.

Rozen (1983) Concentration camp group (n = 47) (C) versus hiding group (n = 53) (H)

Beck Depression Inventory and Spielberger Trait-Anxiety Scale. BDI = CC M = 10.02, H = 11.45 STAS = CC M = 41.64, H = 43.66

Hiding group more depressed and anxious than camp group.

Schreiber, Soskolne, Kozohovitch and Deviri (2004)

Camp survivors (n = 25) (C) Ghetto/hiding survivors (n = 25) (GH) Evacuated before experiencing the whole gamut of possible traumas (n = 13) (E)

Impact of Events Scale Based on a study whose main interest was differences before and after open heart surgery among a group of Holocaust survivors. The before surgery scores are reported here. These results are of course affected by the heart problems obviously being experienced by the survivor sample. Total PTSD score = C 17.00, GH 16.40, E 17.40 Intrusion = C 9.60, GH 8.60, E 12.90 Statistically significant difference between GH and E Avoidance = C 6.80, GH 8.40, E 4.50 Statistically significant difference between GH and E

Seemingly incongruous result that survivors who only experienced early persecution phase are more affected by PTSD symptoms but this study is affected by sample with heart problems awaiting surgery

Silow (1993) Correlations with length of confinement in ghettos and/or camps (whole sample n = 38) Auschwitz survivors (n = 25) (A) Survivors of other camps/ghettoes (n = 13) (C/G)

Impact of Events Scale Correlations between avoidance and intrusion symptoms and length of confinement in ghettos and/or camps. Minimal relationship between these variables was found with the highest correlation being 0.19 between avoidance and number of months confined in camps. Intrusion = A 25.72, C/G 27.39 Avoidance = A 16.00, C/G 14.54

Varied results for each PTSD symptom cluster when comparing Auschwitz to other survivors

Yehuda, Schmeidler, Siever, Binder-Brynes and Elkin (1997)

Camp (n = 70) versus hiding (n = 30)

None of the 17 symptoms listed on the Clinician Administered PTSD Scale statistically significantly differentiated between their sample of survivors who had been in hiding and camp survivors. No descriptive data were reported.

No trend can be noted due to lack of data

8.3. – Country of Origin

Only one study was located that addressed the potential influence of a survivor’s country of

origin on their symptom levels. Letzter-Pouw and Werner (2005) report that survivors who

were born in Eastern Europe reported significantly higher levels of intrusion (M = 3.54, n =

78) than survivors born in Western Europe (M = 2.43, n = 18, F (1,85) = 15.9, p < 0.01).


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Note that no standard deviations were reported. Avoidance symptoms were also recorded

but no details were reported as no significant difference was found.

8.4. – Loss of Family Members

Four studies were located that considered the effect of the loss of family members during

the Holocaust. Each of these studies operationalised their analysis in a different way and so

meta-analytic methods could not be applied with this demographic variable.

Hafner (1968) cross-referenced survivors who were diagnosed with depression,

anxiety or paranoia with those who had lost members of their immediate family during the

war. The incidence of recurrent depression was slightly higher among those who had lost

family members than among those who had not. However, contrary to what would be

expected, chronic depression was markedly higher among those who had not lost family

members. This data was provided only in a chart without exact numbers quoted however it

is possible to state that approximately 18% of survivors without loss (n = 107) were

diagnosed with recurrent depression compared to approximately 24% who did (n = 106)

and approximately 26% of survivors with loss were diagnosed with chronic depression

compared to approximately 38% of those who did not lose family members. The incidence

of free floating anxiety was higher among those who had not lost family members than

among those who had. Approximately 40% of survivors without loss (n = 107) were

diagnosed with free floating anxiety compared to approximately 28% who did (n = 106).

Though it came close, this difference did not reach statistical significance when assessed

using odds ratio analysis. Hafner (1968) theorised that the higher level of anxiety and

depression among survivors who did not lose family members may be due to interaction

with family members also traumatised which may be stronger than the impact of losing

family members. Hafner (1968) also compared paranoid reactions among survivors who

had not lost any family members to those who had lost both their parents and other

members of their immediate family. Among the survivors with no loss, only one had a

paranoid reaction. Among those who had lost family members, 4 or 4% had evident

paranoid reactions. The odds ratio, as calculated by the current author, is 4.16 (in favour of

survivors who had lost family members) but does not reach statistical significance because

of the small proportions involved.

In his thesis, Silow (1993) divided his sample of 38 Jewish Holocaust survivors into

three groups based on the number of family members they had lost during the war. The

three groups were: 1) Sole survivors, 2) Survivors with 2-3 surviving relatives (including


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self) and 3) Survivors with 4-18 surviving relatives. Two one-way ANOVAs were

conducted to assess the differences between these three groups on intrusion and avoidance.

Neither statistical test reached significance. Unfortunately no means or standard deviations

were quoted in order to note even a small trend in any direction.

In another unpublished thesis, Brody (1999) ran a correlation analysis between the

number of family members who were killed during the Holocaust and severity of PTSD

symptoms. She included her control group within this analysis too. These were

participants who had not directly experienced the Holocaust but who nonetheless did lose

relatives in the Holocaust. She obtained a statistically significant positive correlation of r =

0.35 (p < 0.03) between severity of PTSD symptoms and the number of family members

killed during the Holocaust for the total sample of 40 participants (including 10 control

participants).

Finally, in another unpublished thesis, Cordell (1980) asserts she found no

statistically significant difference in depression or paranoia between survivors who were

alone and survivors who had family with them while in a concentration camp.

Unfortunately, she quotes no means so that not even a slight trend can be discerned from

her results.

Results relating to the impact of loss of family members are certainly difficult to

interpret. Unreported descriptive data and contaminated samples make it difficult to truly

gauge the impact of this variable in three of the four studies. The findings from Hafner’s

(1968) study seem counterintuitive. This variable has not yet been analysed adequately to

make any firm statements about its true influence.

8.5. – Gender

The influence of gender on a survivor’s post-war adjustment is analysed a number of ways.

Firstly, results that directly compared male and female survivors are meta-analytically

combined in effect size and odds ratio meta-analyses. In addition, an indirect method is

used in which studies comparing survivors to control groups are analysed according to the

female percentage of their sample. Studies included in this meta-regression are delineated

in Appendix A. A comparison of male versus control and female versus control is also

provided (see Appendix D for details of studies included).


An examination of the meta-analytic findings presented in Tables 8.2, 8.3 and 8.4 indicate

that overall it is female Holocaust survivors who appear more negatively affected by


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Holocaust trauma than male survivors. In addition, there is tentative support for the idea

that not only are females more affected than males but that female survivors differ more

widely from female controls than male survivors do from male controls. Given that

females in general have been found to suffer from higher rates of psychological symptoms

such as those tested here, (for example Oltmanns & Emery, 1995) these results hint that the

gender differences in the survivor population are over and above the gender differences one

might expect in the general population. Table 8.2. Meta-analysis of survey study results based on survivor gender

Variable Effect size for male versus female results Effect size for male versus control male results

Effect size for Females versus control female results

Number of results where

females scored higher

than males

g 95% confidence

limits for g

Total N

g 95% confidence

limits for g

Survivor N

g 95% confidence

limits for g

Survivor N

Depression 3/5 - 0.39 * - 0.63 to - 0.15 324 0.18 - 0.15 to 0.51 76 0.32 - 0.03 to 0.67 57 Anxiety 1/1 - 0.65 * - 1.05 to - 0.24 100 No results located 0.30 - 0.10 to 0.70 48

Paranoia 2/2 - 0.53 - 1.16 to 0.11 42 0.65 - 0.05 to 1.34 17 0.73 * 0.15 to 1.32 25 Intrusion 1/1 - 0.16 - 0.80 to 0.48 38 No results located No results located

Avoidance 0/1 0.08 - 0.56 to 0.72 38 No results located No results located Notes. A negative effect size indicates that females scored higher than males. Results for paranoia versus controls based on 1 study with 2 male and female samples. Results for anxiety females versus controls based on 1 study with 2 measures of anxiety (averaged effect size). Results for depression versus controls based on 3 results from 2 studies. * p < 0.05 Table 8.3. Meta-regression of survivor versus control results with the female percentage of the survivor sample Variable Number of results for which

gender breakdown was provided

metar 2metar


Depression 24/30 0.23 *** 0.05 1,480 Anxiety 8/13 - 0.30 *** 0.09 378 Paranoia 8/12 0.12 0.01 160 Assumption that the World is Benevolent 3/9 - 0.86 *** 0.75 178 Assumption that the World is Meaningful 3/9 0.77 *** 0.59 178 Positive Attachment Dimensions 3/3 - 0.98 *** 0.95 130 Negative Attachment Dimensions 3/3 0.97 *** 0.95 130 Note. Study results included in meta-regressions are weighted in the analyses by their associated survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. *** p < 0.001 Table 8.4. Summary of meta-analyses of incidence/diagnosis studies comparing male and female survivors Variable Number of results where

females had higher incidence than males

Ω 95% confidence

limits for Ω

Average incidence

among females

Average incidence among males


Depression 2/2 3.17 * 2.65 to 3.81 49% 23% 2,303 Anxiety 2/2 2.52 * 2.11 to 3.01 68% 45% 2,302 Paranoia 1/1 2.90 * 2.21 to 3.82 18% 7% 2,159 PTSD # 0/1 1.61 0.56 to 4.64 19% 27% 91 Note. The odds ratio reported for PTSD is in reference to males rather than females. In other words the odds of males having PTSD in this study sample are 1.61 times higher than the odds for the females in the sample. All other odds ratios reported here indicate a higher incidence for females. Ω meta-analytic odds ratio * p < 0.05


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Table 8.5. Meta-regression of incidence rates among survivor with the female percentage of the survivor sample Variable Number of results for

which gender breakdown was provided

metar between incidence and female % of

sample

2metar


Depression 5/5 0.25 *** 0.06 2,462 Anxiety 4/4 0.67 *** 0.45 2,418 Paranoia 2/2 1.00 *** 1.00 2,209 Note. Study results included in meta-regressions are weighted in the analyses by their associated survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. *** p < 0.001 8.5.2. – Studies Excluded from Meta-analyses

Children of Holocaust survivors provided ratings of their male and female survivor parents

in three studies. Because they are ratings by third parties and not self-ratings they are not

included in the meta-analyses.

Podietz et al. (1984) asked a group of children of survivors to rate their survivor

parents in terms of how fearful they perceived them to be. The researchers did not cite

group means and standard deviations but do report that children of survivors rated their

mothers and their fathers as statistically significantly more fearful than control mothers and

fathers were rated (t (216) = 3.63, p < 0.001 and t (216) = 2.58, p < 0.05 respectively). The

difference between the groups was more marked for ratings of mothers, however because of

lack of information the difference between how survivor mothers and fathers were rated

could not be directly assessed. The raw data would have been required to conduct a

repeated measures t-test to discover if children of survivors rated their mother statistically

significantly higher than their fathers.

On the anxious/nervous scale of the Adjective Checklist a group of 73 children of

survivors rated their survivor mothers statistically significantly higher than their survivor

fathers in a study by Leventhal and Ontell (1989). Survivor mothers were given a mean

rating of 3.79 (SD = 1.11) compared to 3.39 (SD = 1.30) given to fathers. This difference

was statistically significant at the 0.05 level (t (144) = -1.99, p < 0.05). Major (1996) asked

some children of survivors and a control group to rate their parent’s on a variable they

termed suspiciousness. Both groups rated their mothers and fathers very similarly (in fact

the mean ratings assigned ranged only between 2.4 and 2.5. Obviously such differences did

not reach statistical significance. The control group (n = 37) rated both their mother and

their father as 2.5 on this questionnaire while survivors’ children (n = 19) rated their fathers

as 2.4 and mothers at 2.5.


139

In the third study to present the perceptions of Holocaust survivors held by their

children, Woolrich (2005) reported the percentage of survivors’ children who considered

their survivor parents to be anxious or depressed. Of the 59 participants with a survivor

mother, 27% considered her depressed and 29% considered her anxious. Of the 69 with a

survivor father, 26% rated their father as depressed and 21% considered him to be anxious.

While the differences in perceived depression were slight, survivor mothers were more

likely to be considered anxious than survivor fathers.

A number of studies searched for gender differences in their combined data set of

Holocaust survivors and control participants. There is of course no way of telling whether

the findings obtained would have been stronger or weaker had the survivor sample been

partitioned out but it is still interesting to note their results. In a study by Prager and

Solomon (1995) a regression analysis was undertaken with a number of variables including

gender. Gender was found to be a statistically significant predictor for the meaningfulness

of the world subscale in the combined Holocaust survivor and control participant sample.

Specifically, females scored lower than males on this subscale. No descriptive statistics

were provided by gender to allow for significance testing of gender within the Holocaust

survivor sample. Another study which considered gender differences on world assumptions

was that by Breslau (2002). Again, it is unfortunate that the analysis was based on control

and survivor groups pooled together, however her results are similar to those obtained by

Prager and Solomon (1995). Specifically she found no specific gender differences for the

Self-Worth or Benevolence of the World subscales but found that females scored

statistically significantly lower than males on the Meaningfulness of the World subscale.

The mean score for females was 36.93 compared to 39.75 for males (F (1,251) = 6.80, p <

0.01). Finally, via multiple regression analysis in which gender was a predictor, Brody

(1999) asserted that it was females who suffered statistically significantly more from both

intrusion and avoidance than males in her combined survivor and control sample. While

the results from all three studies were tainted by the use of the combined control group and

survivor sample, it is worthy of note that overall their findings do support the prevailing

trend of females being worse off than males.

Two additional studies to consider gender differences could not be included in

meta-analyses because of insufficient data. Yehuda et al. (1997) found statistically

significant differences between two symptoms within the avoidance cluster. The non-

statistically significant gender differences on all other symptoms were not reported so no


140

general trend can be ascertained. They also did not report on overall avoidance or

intrusion results and so this study could not be included in the meta-analysis of PTSD

symptoms. In terms of the two statistically significant differences, female survivors (n =

67) scored statistically significantly higher than male survivors (n = 33) on psychogenic

amnesia (M = 2.55, SD = 2.63 versus M = 0.85, SD = 1.64, t (98) = 3.37, p < 0.001) and

foreshortened future (M = 1.73, SD = 2.30 versus M = 0.82, SD = 0.88, t (98) = 1.76, p <

0.05). Gender was a non-statistically significant predictor of post-traumatic growth in Lev-

Wiesel and Amir’s (2003) study. Unfortunately, no means were reported by gender and so

no trends can be described.

8.6. – Age during the Holocaust

The influence of a survivor’s age during the Holocaust on their post-war psychological

health was assessed by thirteen studies and also indirectly by the current author via meta-

regression. Studies directly assessing age, operationalised it either as a continuous variable

or as a categorical variable with various age cut-offs. The results of these studies are

summarised in Tables 8.6 and 8.7. Across the studies there are a few findings that are

ambiguous, however, overall, there is a trend towards negative effects increasing rather

than decreasing with age.


141

Table 8.6. Studies assessing impact of survivor age via correlation/regression analysis Study Findings Trend Brody (1999) The information provided on the impact of age on PTSD

symptoms was only calculated for the entire sample (including both survivors and controls). A correlation of r = 0.05 between age and PTSD severity was obtained. It is reported (without associated descriptive statistics) that older subjects suffered more from intrusion and avoidance (as opposed to hyperarousal) than younger subjects. Again this was not delineated by group. It cannot be determined whether a stronger correlation would have been derived if just based on the survivor sample.

Mixed/unreliable findings

Cohen, Dekel, Solomon and Lavie (2003)

There was a small (not-significant) negative correlation of -0.23 between age in 1939 and fear of intimacy for 43 treated survivors, with a null-result of 0.04 for 48 non-treated survivors. The correlation between age and current PTSD symptoms was r = 0.20 for the treated group r = 0.32 (p < 0 .05) for the non-treated group.

PTSD symptoms increase with age

Cordell (1980)

No statistically significant correlation between either the depression or paranoia subscales of the Heimler Scale of Social Functioning and survivor age during the Holocaust in a group of 20 Holocaust survivors.

No effect.

Lev-Wiesel and Amir (2003)

Survivors’ age was a statistically significant predictor of overall post-traumatic growth. The beta weight quoted was a positive number (β = 0.24) suggesting that that the older the survivor the higher their post-traumatic growth score.

Post-traumatic growth higher for older survivors

Prager and Solomon (1995)

Age was not statistically significantly correlated with any of the three subscales of the World Assumptions Scale. No co-efficients were cited.

No effect

Schreiber et al. (2004)

The main focus of study was on PTSD levels before and after heart surgery. A statistically significant negative correlation was found between pre-surgery avoidance scores and age (r = -0.30, p < 0.05) among the Holocaust survivor group.

PTSD avoidance decreases with age but biased data

Yehuda at al (1997)

Derived a positive correlation between overall PTSD symptom levels and age among their sample of 100 survivors (r = 0.61, p < 0.001). When the symptoms were examined individually it was found that this effect was not uniform. Specifically, negative correlations with age were found for the PTSD symptoms of hypervigilance (p = 0.001), psychogenic amnesia (p = 0.008) and emotional detachment (p = 0.046). Distressing intrusive thoughts was the only individual symptom to have a statistically significant positive correlation (p = 0.013). Correlation co-efficients were not reported for these individual symptoms. Clearly the majority of the remaining symptoms all had relationships in the positive direction to create the overall statistically significant positive effect.

Overall PTSD symptoms increase with age but a few specific symptoms decrease with age


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Table 8.7. Studies assessing the impact of survivor age categorically Study Nature of Age Categories Findings Trend Bower (1994) Comparison of survivors aged 16 or

younger (n = 100) during the Holocaust to survivors aged 20 years or over (n = 100)

Aged 16 or younger group = 66% depression, 55% anxiety, 29% ‘contact abnormalities’ which includes paranoid ideation. Aged 20 years or over = 76% depression, 52% anxiety, 10% ‘contact abnormalities’ which includes paranoid ideation. The difference between the groups on contact abnormalities is statistically significant (odds ratio = 3.68, 95% CI = 1.68 to 8.05)

Depression increasing with age No effect for anxiety Paranoia decreasing with age (statistically significant result)

Brom, Durst and Aghassy (2002)

Clients of AMCHA (an organisation aimed at providing psychological help to Holocaust survivors). AMCHA adult group (n = 60) = average age of 75 at the time of the study and were therefore aged 21 on average at the end of the war AMCHA child group (n = 28) = average age of 64 and therefore were aged 10 on average at the end of the war.

Child group = Total IES Score (M = 33.60, SD = 14.30), Avoidance (M = 13.90, SD = 10.00), Intrusion (M = 19.10, SD = 10.80), lower on benevolence and meaningfulness scales of the World Assumptions scale (rescaled from the 8 sub-scale version) Adult group = Total IES Score (M = 31.00, SD = 13.20), Avoidance (M = 10.30, SD = 7.30), Intrusion (M = 20.70, SD = 10.20), higher on benevolence and meaningfulness scales of the World Assumptions scale (rescaled from the 8 sub-scale version) No statistically significant differences.

PTSD score decreasing with age World Assumptions more positive with increasing age

Hafner (1968) Differing categories for each analysis. Aged 13 at start of persecution (n = 37) = 9% chronic depression diagnosis, 60% anxiety neurosis and other neurotic reactions diagnosis, and 6% paranoid reactions Aged 14 to 21 (n = 104) = 24%, 59%, and 1% Aged 22 to 30 (n = 98) = 26%, 59% and 1% Aged 31 to 50 (n = 92) = 40%, 49% and 1% Aged 51 and over (n = 4) = 50%, 50% and 0% Approximations from a graph (specific data not cited) Aged 0 to 8 years (n = 12) = 15% symptom of depression, 31% symptom of free floating anxiety Aged 9 to 13 years (n = 26) = 26% and 39% Aged 14 to 16 years (n = 33) = 31% and 19% Aged 17 to 21 years (n = 68) = 35% and 39% Aged 22 to 30 years (n = 93) = 40% and 25% Aged 31 to 50 years (n = 88) = 39% and 38% Aged 51 and over (n = 4) = 50% and 50%

Depression increasing with age Mixed results for anxiety Paranoia incidence too low to note a pattern

Keilson and Sarphatie (1992)

Age when separated from mother during the Holocaust. 0 to 18 months (n = 30) 13 months to 4 years (n = 41) 4 to 6 years (n = 24) 6 to 11 years (n = 42) 11 to 14 years (n = 26) 14 to 18 years (n = 41)

0 to 18 months = 7% chronic-reactive depression diagnosis, 13% anxiety-neurotic development diagnosis 13 months to 4 years = 12% and 27% 4 to 6 years = 8% and 25% 6 to 11 years = 19% and 12% 11 to 14 years = 12% and 39% 14 to 18 years = 32% and 20%.

Mixed findings for anxiety and depression

Matussek (1975)

Review of compensation files of 63 survivors aged under 30 at the start of their incarceration in a camp versus 81 survivors who were over 30 at the time

Aged under 30 = 32% depressive mood, 33% permanent anxiety state Aged over 30 = 30% and 38% Neither of these differences were statistically significant using odds ratio analysis.

Little difference for depression Anxiety increasing with age

Robinson, Rapaport, Durst, Rappaport, Rosca, Metzer, and Zilberman (1990) and Robinson, Rapaport-Bar-Sever and Rapaport (1994)

Two studies deriving sample from the same source (Yad Vashem records) 1994 study group restricted to survivors aged less than 13 (n = 103) when persecution began 1990 study group contained adult survivors (n = 86)

Younger group = 42% depression, 43% anxiety Older group = 42% depression, 44% anxiety No statistically significant differences.

No effect

Meta-regressions are conducted using the effect sizes calculated for studies

comparing Holocaust survivors to control groups (as presented and summarised in Chapter

Seven) and the survivor samples’ average age in 1945. The mean age of each study group


143

in 1945 is calculated by subtracting the mean age from the study year to determine the

mean birth year and then subtracting this from 1945. Not every study provided the average

age of their sample and so the complete set of studies/results cannot be included in the

meta-regressions. The proportion of results that can be included in these analyses is

outlined in Table 8.8 below. The details of all studies included in the meta-regression and

the studies that could not be included can be seen in Appendix A. Table 8.8. Summary of meta-regression findings for average age of survivors in 1945 Variable Number of results with age

data provided which could be included in the meta-

regression

metar 2metar


Depression 16/30 - 0.54 *** 0.29 1,313 Anxiety 8/13 0.26 *** 0.07 376 Paranoia 2/12 -1.00 *** 1.00 53 Assumption that World is Benevolent 3/9 - 0.89 *** 0.80 178 Assumption that World is Meaningful 3/9 0.58 *** 0.33 178 Positive Attachment Dimensions 3/3 0.65 *** 0.42 130 Negative Attachment Dimensions 3/3 - 0.25 ** 0.06 130 Note. Study results included in meta-regressions are weighted in the analyses by their associated survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. ** p < 0.01, *** p < 0.001 The results from the meta-regressions provide some contrasting findings. The data

pertaining to depression, world meaningfulness and negative and positive attachment

dimensions suggest that negative effects decrease with age. The results for anxiety and

world benevolence are more consistent with the overall pattern from the studies that

directly assessed age, namely that older survivors suffered more ill-effects. Obviously the

result for paranoia is remarkable but its perfect magnitude is likely a statistical aberration.

The findings of the one study found that reports on children of survivors’ perception

of their parents, suggested ill-effects increasing with survivor age. Sigal and Weinfeld

(2001) had Canadian children of Holocaust survivors rate their parents on a number of

psychopathological measures including depression. These children were separated into

four groups based on their parents’ age at the cessation of World War II. These groups

consisted of children of survivors aged 2-9 years (n = 47), 10-13 years (n = 54), 14-18

years (n = 114) or 19-24 years (n = 137) at the end of the war. In general, older survivors

were perceived to have higher depression and paranoia levels than younger survivors by

their children. Survivors aged 2-9 years during the war were rated as the least depressed

(M = 2.35, SD = 1.87), followed by those aged 10-13 years (M = 2.63, SD = 2.29) with the

14-18 and 19-24 year olds being almost equivalent (M = 3.64, SD = 2.53 and M = 3.63, SD


144

= 2.66, respectively). The two older age groups were rated statistically significantly higher

than the two younger age groups by their children. Survivors 2-9 years were rated as the

least paranoid (M = 1.16, SD = 1.54), followed by those aged 10-13 years (M = 1.43, SD =

1.61), 14-18 years (M = 1.96, SD = 1.86), and finally 19-24 year olds (M = 2.27, SD =

1.78). Children of survivors who were 2-9 years old during the war rated their parents’

paranoia as statistically significantly lower than those whose parents were 14-24 years old.

In addition, children whose parents were 10-13 years also rated their parents’ paranoia as

statistically significantly lower than the 19-24 years group.

The findings in relation to survivors’ age during the Holocaust are far from clear. It

is not discernible whether conflicting results are due to differing methodology or analysis

approaches or some other reason. Further analysis of the impact of age is certainly

warranted, preferably with age measured on a continuous scale rather than as a categorical

variable.

8.7. – Time Lapse since the Holocaust

Two meta-regression sets are calculated to determine the relationship between the time that

has elapsed since the Holocaust and survivors scores on and incidence levels of depression,

anxiety and paranoia (as compared to control groups). Effect sizes and incidence rates are

correlated with the time that had elapsed between 1945 and when each study was

conducted. Studies included in this meta-regression can be seen in Appendix A. No

studies were excluded.

Table 8.9 reports the results of the meta-regressions based on the survey studies.

The results for depression and anxiety are statistically significant quadratic correlations

which means they reflect curvilinear rather than linear relationships. These curvilinear

relationships can be seen more clearly in Figure 8.1. As can be seen, these analyses suggest

that depression and anxiety symptoms have shown an upward trend in more recent years

after having subsided somewhat. The linear meta-regression correlation for paranoia is also

statistically significant but differences between linear and curvilinear analyses are not

significant. It is not clear whether there is truly a linear relationship between time lapse and

paranoia or whether there is a curvilinear relationship that has been left uncovered because

of smaller sample sizes.


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Table 8.9. Summary of meta-regression findings for time lapse since the Holocaust among survey studies Variable Number of results included

in meta-regression metar (linear) 2metar (linear) metar (quadratic) 2

metar (quadratic) Survivor group sample

size

Depression 30 0.39 *** 0.16 0.57 *** 0.33 2,000 Anxiety 13 0.50 *** 0.25 0.51 ** 0.26 907 Paranoia 12 0.37 *** 0.14 0.37 0.14 360 Notes. Study results included in meta-regressions are weighted in the analyses by their associated survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. *** p < 0.001

1980.00 1985.00 1990.00 1995.00 2000.00 2005.00

Year of Study

-0.50

0.00

0.50

1.00

1.50

2.00

Effe

ct S

ize

for D

epre

ssio

n

1975.00 1980.00 1985.00 1990.00 1995.00 2000.00 2005.00

Year of Study

-0.50

0.00

0.50

1.00

1.50

Effe

ct S

ize

for A

nxie

ty

Figure 8.1. Scatterplots of effect sizes comparing survivor groups to control groups on depression and anxiety surveys and the year studies were conducted Note. Each study is weighted in the analysis by its survivor sample size. This weighting is denoted by the size of the data points in the Scatterplot. Table 8.10 reports the meta-regressions for incidences of depression, anxiety and

paranoia among survivors reported and time lapse since the war. There appears to be a

decrease in depression and paranoia diagnosis but an increase in anxiety diagnosis with the

passage of time. However it is unclear whether these statistically significant linear

relationships actually hide curvilinear relationships that would be more apparent with larger

study sets.

Table 8.10. Summary of meta-regression findings for time lapse since the Holocaust among incidence studies Variable Number of results included in

meta-regression metar 2metar


Depression 6 -0.71 *** 0.50 2,606 Anxiety 6 0.66 *** 0.44 3,444 Paranoia 3 -0.85 *** 0.72 2,353 Notes. Study results included in meta-regressions are weighted in the analyses by their associated survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. It was not possible to validly and reliably test for quadratic/curvilinear relationships due to the small study sets involved. *** p < 0.001


146

Two studies conducted by Robinson with various colleagues also provide data

pertinent to this issue by providing incidence of depression and anxiety as at the time of

study and also retrospectively immediately after the war (Robinson et al., 1994; Robinson

et al., 1990). In the earlier study 55% of the 86 survivors suffered from depression

immediately after liberation compared to 42% in 1989 when the data was collected. They

further note that 38% had suffered with depression for the entire time since liberation, 17%

endured it only after the war but not currently but 4% said they only suffer from depression

currently and didn’t suffer from it after the war. In terms of anxiety, 47% said they had

suffered from anxiety in the post-war period and 44% said they suffer from anxiety

currently. Over a third (35%) said they had suffered from anxiety continuously to the

present day since the Holocaust while one in ten (11%) said they did suffer from anxiety in

the immediate post-war period but no longer suffer from it. Interestingly though just under

one in ten (8%) said that they did not suffer from anxiety in immediate aftermath of the war

but were experiencing symptoms at the time of the study. On a positive note, the authors

note that close to half of the sample surveyed (46%) said that they have not experience

anxiety at all (either immediately after the war or since (Robinson et al., 1990).

In the later study conducted with child survivors (aged less than 13 when

persecution began) the incidence of depression was higher when the data was collected than

after the war (31% versus 42% of 103 survivors). A higher proportion of those surveyed

indicated that they suffer from chronic anxiety today than said that they experienced such

anxiety after the war (43% versus 37% of 103). This would suggest that there is a group of

survivors within that sample who did not experience anxiety in the post-war period but later

developed it.

8.8. – Post-war Settlement Location

A survivors’ post-war settlement location had/has the potential to affect and be affected by

a survivors’ post-war adjustment. The way survivors were received by society differed by

country but also the reasons a survivor had for choosing to settle in a particular country also

differed. Survivors who were the most affected by their Holocaust experiences may have

been the ones who chose to settle the furthest away from Europe. Differential results

dependent on post-war settlement location are presented in this sub-section. Only two

studies that addressed this issue directly could be found. Sub-set meta-analyses of studies

grouped together by study location provide an indirect measure of this variable. The results


147

of meta-analytic sub-set analysis of survey and incidence/diagnosis studies are presented in

Tables 8.11 and 8.12. Details of the studies included can be found in Appendix A. Table 8.11. Summary of sub-set meta-analyses of survey studies by post-war settlement location among survivors Israel America, Australia or Canada Number of

results based on data

collected in Israel

Survivor group

sample size

g 95% confidence

limits for g

Number of results based on data

collected in America, Australia or Canada

Survivor group

sample size

g 95% confidence

limits for g

Anxiety 7 329 0.62 * 0.39 to 0.85 6 501 0.53 * 0.39 to 0.68 Depression 14 1,197 0.29 * 0.21 to 0.37 16 803 0.37 * 0.27 to 0.47 Paranoia 4 249 0.33 * 0.15 to 0.51 8 411 0.52 * 0.38 to 0.66 Assume world is benevolent

6 249 -0.28 * - 0.41 to - 0.15 1 67 -0.30 - 0.63 to 0.04

Assume world is meaningful

6 249 -0.09 - 0.22 to 0.03 1 67 -0.25 - 0.58 to 0.09

* p < 0.05 Table 8.12. Summary of sub-set meta-analyses of incidence/diagnosis studies by post-war settlement location among survivors

Israel Canada Variable Number

of results based on

data collected in Israel

Ω 95%

confidence limits for

Ω

Average Incidence

Survivor Group

Sample Size

Number of results based on

data collected

in Canada

Ω 95%


Ω

Average Canada

Incidence

Survivor Group

Sample Size

Anxiety 3 1.41 * 1.24 to 1.62 55% 2,286 1 1.35 0.78 to 2.32 30% 135 Depression 4 1.24 * 1.07 to 1.43 34% 2,327 1 1.40 0.72 to 2.72 18% 135

Ω meta-analytic odds ratio * p < 0.05 The meta-analytic results based on incidence studies suggest higher incidence of

both anxiety and depression among survivors who settled in Israel compared to survivors

who settled in Canada (see Table 8.12). The results from the sub-set meta-analyses of

survey studies are in the main inconsistent with the incidence study results with larger

effects noted for American samples for depression, paranoia and the two world assumptions

of benevolence and meaningfulness and larger effects for Israeli samples only for anxiety

(see Table 8.11).

The results of Eitinger’s (1972) examination of anxiety and depression levels

among groups of survivors in Israel and Norway afford the first of two direct assessments

of post-war settlement location found by the current author. The data reveal a 34%

incidence of periods of depression among the 328 Norwegian survivors, with 31% of the

554 Israeli survivors evidencing the same symptoms. Marked symptoms of anxiety were

noted in 36% of the Norwegian sample and 39% of the Israeli sample. Neither of these

differences are statistically significant when analysed by the current author.


148

The recent study by Kahana, Harel and Kahana (2005) provides the second direct

assessment of post-war settlement location. In this study an American group and an Israeli

group of Holocaust survivors completed the SCL-90 thus providing measures of anxiety,

depression and paranoia. The American survivors (n = 150) scored statistically

significantly higher than the Israeli survivors (n = 150) on all three variables (Anxiety –

American M = 18.69, SD = 8.61 versus Israeli M = 16.67, SD = 6.98, t (298) = 2.22, p <

0.05; Depression – American M = 25.82, SD = 10.67 versus Israeli M = 21.71, SD = 8.94,

t(298) = 3.60, p < 0.001; Paranoia – American M = 9.45, SD = 3.24 versus Israeli M =

8.64, SD = 3.70, t (298) = 2.01, p < 0.05). The findings here in relation to depression and

paranoia are consistent with the meta-analysis of survey study subsets in Table 8.11 with

American survivors worse off than Israeli survivors. However while this pattern is again

mirrored for anxiety in Kahana, Harel and Kahana (2005), the opposite result is obtained in

the meta-analyses (with Israeli survivors appearing to be worse off than American

survivors).

The findings of Nadler and Ben-Shushan (1989) suggest that the depression levels

of survivors in Israel depends greatly on the nature of the community in which they live.

For example, they found that survivors living within a kibbutz (a very close knit

community group) had statistically significantly lower levels of anxious and low energy

depression than survivors living in the city. No specific statistics can be quoted as they

were not presented by the authors.

Another potentially important influence is the degree to which survivors

successfully integrated into the society and community of the country that they moved to

after the war. This issue was addressed in a study by Hafner (1968). Hafner (1968)

compared a group of survivors whom he considered had integrated well into their new

homeland (“good integration group”) to a group who appeared to have assimilated and

established themselves less well (“bad integration group”). Among the good social

integration group (n = 102), approximately 18% were found to suffer from recurrent

depression, 32% from chronic depression and 33% from free floating anxiety. Of those

considered to have bad/poor social integration (n = 84), approximately 23% were

diagnosed with recurrent depression, 49% were diagnosed with chronic depression and

40% with free floating anxiety.

Clearly the issue of post-war settlement location warrants further direct

investigation involving direct comparison of survivors stratified by their post-war


149

settlement location. Issues such as the nature of the community within a country that

survivors settled in as well as the success of their integration into that country need to be

considered. Results from meta-analytic sub-set analysis are inconsistent and there are only

two studies that have considered post-war settlement directly.

8.9. – Membership of Survivor Organisations/Support Groups

Differences in survivor psychological health that relate to membership of a survivor support

group or organisation are examined via sub-set meta-analyses. Studies based on samples

derived from such groups are combined in a separate meta-analysis to those whose samples

were derived from the general community by some other means. Table 8.13 presents the

results of this exercise (see Appendix A for study details).

Apart from the results for paranoia, larger meta-analytic effect sizes are derived

from the studies using a survivor group sample as opposed to the studies using a non-

survivor group sample. This suggests that survivors who are members of survivor groups

have higher levels of negative symptoms than survivors who are not members of such

groups. This finding is consistent with the argument that the more affected survivors are

more likely to join such groups than less affected survivors (see Chapter Two, Section

2.5.3). Table 8.13. Summary of sub-set meta-analyses of survey studies by sample source for survivors Survivor Groups General Community Number of

results whose survivor

sample was recruited from

survivor groups

Survivor group

sample size

g 95% confidence

limits for g

Number of results whose

survivor sample was

recruited from the general population

Survivor group

sample size


Anxiety 3 103 0.63 * 0.36 to 0.89 9 771 0.56 * 0.45 to 0.67 Depression 4 123 0.46 * 0.20 to 0.72 24 1,734 0.33 * 0.25 to 0.41 Paranoia 2 51 0.39 * 0.04 to 0.75 9 576 0.44 * 0.32 to 0.56 Positive Attachment/Intimacy Variables

2 91 -0.38 * - 0.68 to - 0.09 1 39 0.00 # Cannot compute


2 91 0.34 * 0.04 to 0.64 1 39 0.14 - 0.30 to 0.57

Note. An effect size of zero is reported for the study assessing positive attachment dimensions within the general community because no descriptive data was reported because no statistically significant difference between the survivor and control groups were found. However, despite the fact that it is highly unlikely that both groups scored exactly the same, the only unbiased estimate of effect size that can be made in this circumstance is zero. * p < 0.05


This chapter has presented the findings of meta-analyses and reviews of the literature

addressing demographic differences among Holocaust survivors on a number of


150

psychological variables. While the results pertaining to gender are relatively consistent, the

data relating to other variables is ambiguous or lacking. While 20 studies were located that

assessed types of Holocaust experiences, there was hardly a consensus on its

operationalisation. Given how much conjecture and anecdotal evidence there is regarding

the influence of the survivors’ loss of family during the Holocaust, with many suggesting it

is the most traumatising element, it is a shame that this has not translated into a more

substantial body of empirical assessment.

Existing data pertaining to the influence of gender, age during the Holocaust, time

lapse since the Holocaust and post-war settlement location were supplemented with meta-

analyses by the current author. While these analyses did not always help reach a definitive

conclusion about the role of these variables, it should be noted that these analyses add to

the knowledge already gleaned from the existing data.


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Chapter Nine – Meta-Analyses of the Moderating Influence of Demographic Variables

among Descendants of Holocaust Survivors

In Chapter Eight, the influence of numerous demographic variables on the psychological

health of Holocaust survivors was discussed. In this chapter, the influence of demographic

variables on the psychological health of two generations of descendants of Holocaust

survivors is discussed. Both aspects of their survivor parent/grandparents’ experiences

during the Holocaust as well as demographic variables that relate to the children and

grandchildren generations are examined.

9.1. – Method

Direct and indirect assessment of demographic variables and their impact on Holocaust

survivor descendants’ psychological health are presented in this chapter. Direct

assessments of demographic variables in the literature are summarised and are meta-

analysed where possible. Indirect assessment is also possible for some variables.

Demographic variables are assessed indirectly via meta-analytic techniques such as

sub-set meta-analyses and meta-regressions. Sub-set meta-analyses provide insight into

demographic variables such as post-war settlement location via meta-analyses of studies in

sets determined by the country of study. Meta-regressions are also used to explore

relationships between linear/continuous variables and study effect sizes. Examples of such

continuous variables within the descendants of survivor groups are post war delay in birth,

and the proportion within samples that meet particular criteria (such as the percentage of a

sample that is female or that has two Holocaust survivor parents compared to only one).

By correlating study effect sizes with methodological aspects such as sample criteria,

further analysis of demographic variables is possible using the data already available in the

literature. This is one of the key advantages of a meta-analytic approach to literature

review.

9.2. – Demographic Differences within the Children of Holocaust Survivor/s Group

In this section, the current status of research evidence pertaining to the moderating

influence of demographic variables on the psychological health of children of Holocaust

survivors is established. Demographic variables considered include those relating to their

Holocaust survivor parents (such as the nature of their Holocaust experiences or their age

during the Holocaust) as well as variables that are intrinsic to the children themselves such

as their gender and birth order.


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9.2.1. – Number of Survivor parents

Whether a person is the child of one or two Holocaust survivors has the potential to affect

the severity of symptoms they experience, or the degree of trauma transference. The

impact of number of survivor parents is assessed in a number of ways. Results that directly

compared children with one versus two survivor parents are combined meta-analytically

(see Appendix E for study details). In addition to this direct method, studies comparing

children of survivors to control groups are analysed according to the percentage of the

children of survivor sample with two survivor parents (see Appendix B for study details).

This approach is identical to that used to look at the female percentage of study samples for

Holocaust survivors in the previous chapter and children of survivors in this chapter. A

comparison of children of one survivor versus controls and children of two survivors versus

controls is also provided. The results of these analyses are presented in Tables 9.1 and 9.2. Table 9.1. Meta-analysis of survey study results based on number of survivor parents

Variable Effect size for children with one versus two survivor parents

Effect size for one survivor parent versus control results

Effect size for two survivor parents versus control results

Number of results where children

with two survivor parents scored higher than with

one survivor parent

g 95% confidence

limits for g

Total N

g 95% confidence

limits for g

Child of Survivor Group

Sample Size

g 95% confidence

limits for g

Child of Survivor Group

Sample Size

Depression 4/5 - 0.19 - 0.43 to 0.06

257 -0.01 - 0.30 to 0.28

74 0.10 - 0.16 to 0.35

117

Anxiety 2/4 - 0.01 - 0.29 to 0.27

191 0.03 - 0.27 to 0.32

74 0.05 - 0.23 to 0.34

117

Paranoia 1/4 0.09 - 0.19 to 0.37

191 0.49 * 0.19 to 0.79

74 0.38 * 0.09 to 0.67

117

Negative Attachment Dimensions

1/1 - 0.06 - 0.46 to 0.36

98 -0.08 - 0.39 to 0.24

36 -0.01 - 0.29 to 0.27

62

Notes. A negative effect size indicates that children with two survivor parents scored higher than children with only one survivor parent. * p < 0.05 Table 9.2. Meta-regression of children of survivors versus control results with the percentage of the children of survivor sample with two survivor parents Variable Number of results for which

parental breakdown was provided and could be included

in meta-regression

metar 2metar

Child of survivor sample size

Depression 13/26 0.02 0.00 547 Anxiety 10/17 -0.09 0.01 382 Paranoia 5/12 -0.30 ** 0.09 128 Positive Attachment Dimensions 4/8 0.12 0.01 247 Negative Attachment Dimensions 11/13 0.22 *** 0.05 595 Note. Study results included in meta-regressions are weighted in the analyses by their associated child of survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. ** p < 0.01, *** p < 0.001


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The results of the meta-analyses are not as strong as anticipated. None of the meta-

analyses of results that directly compared children of one to children of two survivor

parents reach statistical significance. In addition the meta-analytic effect sizes for

children with one survivor parent versus controls are not uniformly weaker than the meta-

analytic effect sizes for children with two survivor parents versus controls as would be

intuitively predicted. The results for depression are the only ones that are in the pattern that

would be predicted though none are large enough to reach significance.

It is interesting to note that the results for paranoia uniformly suggest children with

one survivor are more paranoid than children with two survivor parents. This is evidenced

by the larger effect size for children with one survivor parent versus controls than the effect

size for children with two survivor parents versus controls. In addition the meta-regression

which correlates children of survivor versus control effect sizes with the percentage of the

child of survivor sample with two survivor parents is negative suggesting that effect sizes

are lower when the proportion of the sample with two survivor parents is higher. The

children with one survivor parent versus controls meta-analytic effect size, children with

two survivor parents versus controls meta-analytic effect size and the meta-regression with

the percentage of the child of survivor sample with two survivor parents are all statistically

significant for paranoia. The only other statistically significant result from these analyses is

the statistically significant positive correlation between the percentage of the child of

survivor sample with two survivor parents and effect sizes comparing children of survivors

to controls on negative attachment dimensions. This result suggests that children of

survivors score much higher than controls on negative attachment dimensions when they

have two survivor parents than if they only have one survivor parent.

One study had to be left out of meta-analytic calculations due to sample

contamination. Rubenstein (1981) also attempted to examine differences in depression

between children of one survivor and children of two survivors. This study included

subjects born before 1945 which, for the purposes of this study, are not considered to be

members of the children of survivor population but rather are survivors themselves. It is

worthy of note that, despite the problems with Rubenstein’s (1981) study, his findings do

add further support to the idea that children of two survivor parents show higher levels or

greater severity of psychological symptoms. Using the Depression scale of the Mini-Mult

(an abbreviated version of the MMPI), Rubenstein’s (1981) study found that children with

two survivor parents had higher depression scores than children with one survivor parent


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(M = 22.40, SD = 4.88, n = 48 and M = 20.75, SD = 4.52, n = 30 respectively). However,

this difference did not reach statistical significance.

9.2.2. – Gender of Survivor Parent

Despite the many opportunities to examine the influence of survivor parent gender in

studies with children of survivors (particularly those that delineated children with one and

two survivor parents) only one study was located that directly assessed this variable.

Schleuderer (1990) not only noted whether participants had one or two Holocaust survivor

parents, but, unlike other researchers who obviously had the same opportunity, he also

noted the gender of the Holocaust survivor parent for those with only one survivor parent.

On both measures of depression used in his study (the Dysthymic and Major Depressive

subscales of the Millon Clinical Multiaxial Inventory II), children with Holocaust survivor

fathers had higher levels of depression than those whose mother was the survivor. On the

Dysthymic subscale, children of survivor fathers were given a rating of 9.84 (SD = 11.39, n

= 25) while children of survivor mothers were given a rating of 7.92 (SD = 9.61, n =12).

On the Major Depression subscale, children of survivor fathers were rated at 6.64 (SD =

8.26) and children of survivor mothers were rated at 5.50 (SD = 6.17). Children with

survivor fathers also had the higher levels of anxiety (M = 5.48, SD = 7.17 versus M = 4.33,

SD = 4.29) and paranoia (M = 25.20, SD = 12.23 versus M = 24.08, SD = 15.12) compared

to those with survivor mothers. None of these differences reached statistical significance

but it is interesting to note the consistency of results with children of survivor fathers

scoring less favourably on all measures.

9.2.3. – Type of Survivor parent’s Holocaust experiences

Only five studies were found to have considered the impact of survivor parents’ type of

Holocaust experiences on their children. Because of the different categories and analysis

methods used by these studies, meta-analytic synthesis of the results is not possible.

However each study is discussed in turn in this section.

In the first study, Lichtman (1983; 1984) divided her sample into children with one

parent who had spent time in a concentration camp, two parents who had been in a camp,

one or two parents who had been in hiding and one or two parents who had escaped. As

measured by the MMPI depression subscale, children with one parent who had been in a

camp had the lowest depression scores (M = 20.58, SD = 7.20, n = 21), followed by

children of two camp survivors (M = 21.01, SD = 4.46, n = 21), children of one or two

survivors who escaped (M = 22.10, SD = 5.05, n = 13) and children of one or two survivors


155

who were in hiding (M = 23.10, SD = 7.52, n = 9). On the MMPI anxiety subscale,

children with both parents as camp survivors had the lowest anxiety (M = 11.21, SD = 7.87,

n = 21), with increasing levels of anxiety among children of one camp survivor (M = 13.46,

SD = 8.60, n =21), children of one or two survivors who escaped (M = 14.89, SD = 6.55, n

= 13) and children of one or two survivors who were in hiding (M = 20.96, SD = 13.30, n =

9). On the MMPI paranoia subscale, children of one or two survivors who escaped (M =

8.46, SD = 3.33, n = 13) had the lowest paranoia, followed by children with both parents as

camp survivors (M = 9.67, SD = 3.50, n = 21), children of one camp survivor (M = 9.81, SD

= 4.17, n = 21) and children of one or two survivors who were in hiding (M = 11.89, SD =

4.01, n = 9). None of the differences between these subgroups were statistically significant.

It is interesting to note that for both anxiety and depression it was the children of camp

survivors who had the lowest levels of symptoms compared to children of survivors who

were in hiding and survivors who escaped at some point. The pattern is not exactly

replicated for paranoia but it is notable that children of survivors who were in hiding were

also the ones with the highest paranoia levels. However, it is also duly noted that these

results were based on very small sample sizes and this paired with the lack of significance

means that no firm assertions can be made based on this study.

Lichtman (1983; 1984) also examined the impact of parental Holocaust experience

on children of survivors in another less direct way. Subjects were asked to rate the severity

of their survivor parent’s Holocaust experiences (as they perceived them). Factors

incorporated into this questionnaire included descriptions of parental war experiences on a

scale from fortunate to catastrophic, an assessment of the effect the Nazi occupation had on

parental lifestyle from enhancing to devastating and the nature of conditions lived under

during the war from pleasant to unbearable. The correlation between rating of parental

trauma and depression among children with two survivor parents was 0.10 (n = 52). The

correlation between rating of parental trauma and anxiety among children with two survivor

parents was 0.07 (n = 52). Neither of these correlations were statistically significant. The

correlation between rating of parental trauma and paranoia among children with two

survivor parents was 0.26 (n = 52). This correlation narrowly missed the statistically

significant cut off (p = 0.06). These results are not exactly earth shattering either and the

measure of parental trauma is not pure as it includes perceptions of the children and is not

objectively based on the details of the survivor parents experiences but on the perception of

the impact of those experiences.


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In the second of the five studies to be discussed in this section, Leon, Butcher,

Kleinman, Goldberg and Almagor (1981) looked at how different parental Holocaust

experiences influences children’s depression and paranoia levels. They separated their

group into children of survivors who had been interned in a concentration camp and those

who had other Holocaust experiences. Interestingly there was a differential effect by

gender with daughters of survivors with camp experience more depressed than those of

survivors with other experience (M = 56.69, SD = 9.67, n = 16 versus M = 52.60, SD =

8.32, n = 5), but the opposite effect for sons (M = 59.93, SD = 12.16, n = 16 for sons of

camp survivors versus M = 62.25, SD = 16.76, n = 4 for sons of non-camp survivors). Leon

et al. (1981) also assessed how different Holocaust experiences of parents may affect

children’s paranoia levels. A slightly different interaction effect was noted for paranoia

with female children of camp survivors and non-camp survivors roughly equivalent in their

paranoia levels (M = 53.75, SD = 8.23, n = 16 and M = 54.20, SD = 8.90, n = 5

respectively) and a non-statistically significant but much more marked difference among

male children with those with camp survivor parents more effected (M = 58.06, SD = 7.69,

n = 16 versus M = 51.25, SD = 5.31, n = 4). As with Lichtman’s (1983; 1984) findings,

these results were based on very small sample sizes and therefore should be interpreted

with caution.

In the third study, using a crude measurement of differential Holocaust

traumatisation, Schleuderer (1990) conducted a correlation between subject’s rating of

parental Holocaust trauma and measures of psychological symptoms. Participants gave a

rating between 1 (minimal) and 5 (extreme) regarding their impression of the traumatic

level of their mother and father’s Holocaust experiences. The correlations between their

rating of paternal trauma (n = 100) and dysthymia was -0.02, major depression 0.06,

anxiety 0.12, and paranoia – 0.11. For maternal trauma (n = 100) the correlations were:

dysthymia 0.04 (n = 100), major depression 0.01, anxiety 0.17, and paranoia 0.04. None

of these correlations were statistically significant and all are of negligible strength.

In the fourth study, Brom, Kfir and Dasberg (2001) calculated a severity of

Holocaust experience score for the parents of their daughters of survivors group. The score

was derived by the research team by taking into account the survivor parents’ experiences

during the war such as the kind of persecution they experienced, their age and the number

of family members they lost. This severity of Holocaust experience score was then

correlated with the daughters’ depression scores. The correlation between these two


157

variables was 0.23 (n = 31) which was not statistically significant. Again this measure of

parental trauma is not ideal and there is no indication of how the survivor’s age was taken

into account in the trauma measure – was it assumed that age was positively or negatively

associated with severity of symptoms?

In the last study located that considered the impact of the type of Holocaust

experiences endured by a survivor on the psychological health of their children, Bauman

(2003) looked at children with survivor mothers and fathers separately depending on

whether their survivor parent had been in a camp or had other Holocaust experiences.

Participants completed the neuroticism subscale of the NEO Five Factor Inventory which

measures predisposition to anxiety, hostility, depression, self-consciousness, impulsivity

and vulnerability. Among the children of Holocaust survivor mothers there was very little

difference relating to whether the survivor mother had been in a camp (M = 3.60, SD =

1.23, n = 68) or had other experiences (M = 3.57, SD = 1.25, n =82). There was a larger

gap between the scores of children with a Holocaust survivor father who had been in a

camp (M = 3.46, SD = 1.24, n = 40) compared to children whose father had other

Holocaust experiences (M = 3.60, SD = 1.21, n = 108), however neither difference reached

statistical significance. It is interesting to note though that the results relating to survivor

father here seem to mirror those of Lichtman (1983; 1984) in that the children of non-camp

survivors score higher than children of camp survivors.

While there is some tentative evidence here to suggest that children of non-camp

survivors may evidence higher levels or severity of symptoms it is by no means

indisputable. For the most part, this issue has been examined with inadequate

operationalisation or small samples. Given the strong evidence for differential impact

based on type of experience on survivors themselves it is reasonable to assume that there

are discernible differences among descendants that are dependent on the Holocaust

narrative of their ancestors. However, the exact translation to the child of survivor

generation has not been clearly delineated to date.

9.2.4. – Parental Loss of Family Members

Theoretical discourse and other empirical findings discussed in earlier chapters would

suggest that children of survivors who lost family members during the Holocaust would be

more adversely affected in psychological functioning than children of survivors whose

families stayed in tact. Only two studies were located that considered the impact of a

survivor’s loss of family members on the subsequent psychological health or functioning of


158

their children. Both point to more negative affects among children of survivors being

associated with more familial loss on the part of their survivor parents.

Schwarz (1986) gathered data on the number of children that female survivors lost

during the war and levels of phobic anxiety among children born to the female survivors in

the post-war period. The correlation co-efficient derived was 0.40 (n = 67) which was

statistically significant (p < 0.001). In other words, the more children lost by a female

survivor during the war, the higher the anxiety level experienced by her children born in the

post-war period.

Gertler (1986) measured the degree to which achieving intimacy is difficult among

children of survivors who lost a spouse or a child/children during the war compared to

children of survivors who did not lose a spouse or child during the war. While this

difference did not reach statistical significance the children of survivors who lost family

members scored higher on the Hard to be Intimate scale than children of survivors whose

families escaped death (M = 1.01, SD = 0.72, n = 26 versus M = 0.86, SD = 0.55, n = 72).

There is a consistency between these two findings that suggest greater familial

losses by Holocaust survivors may well be associated with more negative outcomes for

their children. However, two studies provides inadequate assessment of this issue and

further data is required here.

9.2.5. – Survivor Parent/s Country of Origin

Two studies were located that analysed the level/severity of symptoms among children of

survivors depending on their survivor parents’ country of origin. As outlined in Chapter

Four, a survivor’s country of origin has implications for the nature and duration of their

persecution during the Holocaust which in turn relates to the degree of traumatisation they

evidenced in the post-war period. This variable therefore also has the potential to impact

the severity of transmission of trauma to the next generation.

Schleuderer (1990) cross-referenced his children of survivor sample with the

country of origin of their survivor mothers and/or fathers. While sample sizes were quite

small with all but one of the nine countries listed having samples less than 10, there were

notable differences in dysthymia, major depression, anxiety and paranoia scores. Listing all

the means and standard deviations for all the groups would be tedious and largely

meaningless given the sample sizes and lack of statistical significance but they certainly

pointed to potential statistically significant effects if larger sample sizes had been used.


159

Berger (2003) examined the impact of survivor parents country of origin on their

children’s romantic attachment style. However, because she included children of non-

survivors in the analysis it is not clear whether some of the parents born in European

countries were not survivors. In addition, she did not specify the sample sizes of each of

the country sub-groups. Statistically significant differences were obtained on both the

avoidance and attachment anxiety dimensions when considering mother’s country of origin

and a statistically significant result was also obtained when considering the impact of

father’s country of origin on avoidance. In relation to mother’s country of birth, children of

Romanian-born mothers had the highest scores on avoidance (M = 74.86), followed by

German (M = 57.11), American (M = 48.25), Polish (M = 44.13) and finally Hungarian (M

= 39.22). According to ANOVA analysis, these differences are statistically significant (p <

0.01). Interestingly, some marked differences in rank were noted when looking at

attachment anxiety, particularly for children of Hungarian-born mothers: Romanian (M =

80.29), Hungarian (M = 79.33), American (M = 73.98), German (M = 57.83), and finally

Polish (M = 56.05). These differences also reached significance in an ANOVA analysis (p

< 0.05). Turning to father’s country of origin, the results for avoidance followed a similar

pattern to that found in relation to mother’s country of origin. Again, children of

Romanian-born father’s were highest on the list (M = 71.00), followed by German (M =

53.43), Polish (M = 49.46), American (M = 47.17), Czech (M = 40.30) and finally

Hungarian (M = 31.56). These results were statistically significantly different when

analysed via ANOVA (p < 0.05). On the attachment anxiety dimension, children of

Romanian fathers were rated the highest (M = 74.40), followed by Hungarian (M = 66.44),

American (M = 65.00), German (M = 64.79), Czech (M = 63.25) and Polish (M = 61.74).

None of these differences reached statistical significance.

While this evidence is by no means overwhelming, it is suggestive of the reasoning

that children of survivors’ may have experienced differential rates of trauma transmission

depending on their survivor parents’ country of origin. The influence of survivor’s country

of origin has been inadequately assessed for both the survivor and child of survivor

generations.

9.2.6. – Age of Survivor Parent/s during the Holocaust.

Four studies directly assessed the impact of survivors’ age during the Holocaust on the

psychological health and/or functioning of their children. Because the age categories used


160

by each study differed widely it was not possible to combine these results meta-

analytically.

Budick (1985) compared children of survivors who were teenagers between 1939

and 1945 (aged 13 to 18) and those who were adults (aged 19 and over). The children of

the older survivors had the higher level of depression, as measured by the depression

subscale of the Basic Personality Inventory, (M = 3.56, SD = 3.22, n = 16 versus M = 2.50,

SD = 2.25, n = 16). This pattern was matched on the anxiety subscale of the Jackson

Personality Inventory (M = 10.93, SD = 4.01 versus M = 10.37, SD = 3.12); Interpersonal

Affect (M = 13.18, SD = 3.89, n = 16 versus M = 12.31, SD = 4.73, n = 16) and Succorance

(M = 9.25, SD = 4.78, n = 16 versus M = 7.88, SD = 3.84, n = 16). None of these

differences reached statistical significance but that is unsurprising given the sample sizes

involved. Budick (1985) controlled for the possible confounding variable of the time lapse

between the children’s birth and the end of the war. Both groups of children had a similar

age range (children of teenage survivors ranging from 21 to 36 and children of adult

survivors ranging from 24 to 37).

In the second study, Eskin (1996) calculated a correlation between children of

survivors’ depression scores and their parent’s age. This provided another indirect measure

of the impact of survivors’ age during the Holocaust and depression in their children. The

correlation between these two variables was -0.18 (n = 49) and was not statistically

significant. However, although quite weak this result suggested that in this sample of

children of survivors, depression was higher the younger their parents were (and therefore

the younger they must have been during the Holocaust).

Thirdly, Berger (2003) analysed children of survivors’ scores on attachment-related

avoidance and anxiety in relation to their mother and father’s age during the Holocaust.

Survivor parents’ age during the Holocaust was operationalised categorically as “child”,

“adolescent” and “adult”. No age definitions were provided for these categories. Another

problem is that some mothers and fathers were not survivors but it is not clearly stated that

children with non-survivor parents were removed from the analyses. Therefore it is not at

all certain if this is a pure assessment of this variable; however in the interests of

completeness, it is interesting to consider the results even if very cautiously. In relation to

mother’s age first, children whose mothers were adolescents during the war scored the

highest on avoidance (M = 52.76, SD = 22.42), followed by those whose mothers were

adults (M = 49.37, SD = 23.72) and finally those whose mothers were children (M = 45.31,


161

SD = 23.84). No statistically significant difference was found. In terms of anxiety a more

linear (though again, non significant) relationship was found with children of adults

mothers most anxious (M = 69.23, SD = 23.21), followed by adolescents (M = 63.32, SD =

27.70) and children (M = 60.86, SD = 26.83). The impact of father’s age during the war on

avoidance was similar to that of mothers in pattern and non-significance (child M = 47.17,

SD = 26.66, adolescent M = 45.08, SD = 22.81, adult M = 50.51, SD = 23.05). The children

of fathers who were children during the war scored the highest on attachment anxiety (M =

74.75, SD = 32.40) followed by those whose fathers were adults (M = 65.45, SD = 26.09)

and finally adolescents (M = 58.00, SD = 23.45).

Finally, Bauman (2003) compared children of survivors scores on neuroticism

depending on whether their survivor mother or father was a child or adolescent during the

war or if they were an adult. Again, similar to Berger (2003) the age ranges of these

categories was not provided. Children of survivor mothers who were children or

adolescents during the war scored higher on neuroticism than children of survivor mothers

who were adults during the war (M = 3.65, SD = 1.27, n = 95 versus M = 3.34, SD = 1.10,

n = 55). A much smaller and negligible difference was noted among children of survivor

fathers (Child/Adolescent M = 3.47, SD = 1.19, n = 38 versus Adult M = 3.55, SD = 1.20,

n = 110). Neither of these differences reached significance.

There are mixed findings here with some results suggesting children of survivors’

symptoms increasing with their survivor parents’ age during the war and others suggesting

they decrease. It is noted though that the one study finding children of older survivors to be

more affected had very small samples. This section has highlighted yet another variable

that requires further clarification.

9.2.7. – Length of time between the end of the war and the birth of children.

This issue has never been addressed directly in a study with children of Holocaust

survivors. Three studies were located that consider the impact of a child of survivor’s age

which provides an indirect measure of this issue (E. Berger, 2003; Eskin, 1996; Gertler,

1986). The results of these three studies are summarised first and then meta-regressions

conducted by the current author are presented.

The correlation presented by Eskin (1996) between depression among children of

survivors and their age provided an indirect measure of this relationship for depression.

The older they children of survivors are the shorter the time delay between the end of the

war and their birth. The correlation was - 0.11 (n = 49). While not statistically significant


162

this suggested a weak negative relationship where the older the subjects were the less

depressed they were.

In the second study, Gertler (1986) allowed an examination of this issue by dividing

his children of survivor group into age groups based on their age at the time of the study.

These age group boundaries can be used to determine a range in the length of time between

their birth and the end of the war. The three age groups were 25 to 30, 31 to 35 and 36 to

40 in 1986. So the group aged between 36 to 40 were born between 1946 and 1950, those

aged 31 to 35 were born between 1951 and 1955 and those aged 25 and 30 were born

between 1956 and 1961. These correspond to a post-war delay in birth of 1 to 5 years, 6 to

10 years and 11 to 15 years respectively. As was mentioned before, these groups were also

segmented by number of survivor parents. In both array cases, it was the children born

with the shortest time delay after the war who scored the highest on the Hard to be Intimate

scale. No statistically significant differences were found but this is not surprising given the

small cell numbers. Among the children with one survivor parent, children born with a 1 to

5 year delay scored 1.11 (SD = 1.01, n =3), a 6 to 10 year delay scored 0.78 (SD = 0.79, n =

18) and 11 to 15 year delay 0.79 (SD = 0.54, n = 15). Among the children with two

survivor parents, the 1 to 5 year delay group scored 1.07 (SD = 0.75, n = 25), a 6 to 10 year

delay scored 0.86 (SD = 0.53, n = 24) and 11 to 15 year delay 0.92 (SD = 0.49, n = 13).

Finally, the correlation between children of survivor’s age and their scores on

attachment related avoidance and anxiety presented in Berger (2003) provides another

indirect measure of the impact of post-war delay in birth. She obtained a correlation of

0.11 between children of survivor’s age and avoidance and 0.01 between age and anxiety.

This correlation is no stronger that that found by Eskin (1996) and the two results together

suggest that perhaps post-war delay in birth is not a very influential variable.

Meta-regressions have been conducted by the current author between children of

survivors versus control results and the average delay in between 1945 and the children of

survivor sample’s birth. Average delay in birth is calculated using the average age of the

children of survivor samples as cited by researchers and the study year. Working

backwards, the average year of birth is determined and from this the average delay between

1945 and the average year of birth. The results of these analyses are presented in Table 9.3.

Details of the studies included in this meta-regression can be found in Appendix B.


163

Table 9.3. Meta-regression of children of survivor versus control results with average delay between child of survivor birth and 1945 Variable Number of results with age

data provided which could be included in the meta-

regression

metar 2metar


Depression 17/26 -0.47 *** 0.22 774 Anxiety 14/17 -0.38 *** 0.15 492 Paranoia 7/12 0.53 *** 0.28 213 Positive Attachment Dimensions 2/8 1.00 *** 1.00 70 Negative Attachment Dimensions 3/13 0.24 ** 0.06 124 Note. Study results included in meta-regressions are weighted in the analyses by their associated child of survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. ** p < 0.01, *** p < 0.001 The meta-regressions for depression and anxiety are in the direction that is

consistent with theoretical conjecture in the literature. Both of these analyses suggest

higher levels of depression and anxiety (or greater disparity between children of survivors

and control groups) among children of survivors with a shorter delay between the end of

the war and their birth. The result for paranoia is in the opposite direction, suggesting

higher paranoia with longer post-war delays in birth.

The results for negative and positive attachment dimensions are more ambiguous.

The perfect correlation of 1.00 for positive attachment dimensions is in the desirable

direction but is clearly a statistical aberration given the small number of results involved in

the analysis. The meta-regression for negative attachment dimensions repeats the pattern

found for paranoia in that it is in the opposite direction to what would be predicted.

However, again there are sample size and result number issues here and so very little

meaning can be attached to this result.

9.2.8. – Location of post-war settlement.

Differences in psychological health and functioning among children of survivors that relate

to their survivor parent/s post-war settlement location have only been directly assessed by

one study (Okner & Flaherty, 1988). However this issue can also be examined indirectly

via a meta-analytic comparison of studies conducted in different countries/regions.

Okner and Flaherty (1988) compared children of Holocaust survivors who had

grown up in Israel to those who had grown up in America on measures of depression and

anxiety. While there were no statistically significant differences between the two groups, it

was the American group who scored higher on both the depression and anxiety measures

than their Israeli counterparts (Depression M = 12.60, SD = 11.30, n = 138 versus M =

11.90, SD = 10.10, n = 52; Anxiety M = 13.30, SD = 8.00 versus M = 12.60, SD = 8.10)


164

Two meta-analytic exercises have been carried out by the current author with post-

war settlement location. Sub-set meta-analyses for survey studies and sub-set meta-

analyses for incidence studies provide an additional assessment of the influence of this

variable and are reported in Tables 9.4 and 9.5. Studies included in these sub-set meta-

analyses can be found in Appendix B. Table 9.4. Summary of sub-set meta-analyses of survey studies by post-war settlement location for children of survivors

Israel America Number of results

based on data collected in Israel

Child of survivor

sample size

g 95% confidence

limits for g

Number of results based on data collected in

America

Child of survivor

sample size

g 95% confidence

limits for g

Anxiety 2 95 0.00 Not able to compute

15 518 0.21 * 0.09 to 0.34

Depression 2 75 0.15 - 0.17 to 0.47 24 1,012 0.10 * 0.00 to 0.19 Positive


1 70 - 0.37 * - 0.73 to - 0.00 7 348 - 0.05 - 0.19 to 0.09

Notes. Both results for anxiety stated there were no statistically significant differences but did not quote descriptive data. Therefore a null result (or mean difference of zero) was entered into the analysis for both studies. It is highly likely that the groups did differ in some direction, though not statistically significantly and it cannot be determined what the true effect size would have been. * p < 0.05 Table 9.5. Summary of sub-set meta-analyses of incidence/diagnosis studies by post-war settlement location for children of survivors Variable America Europe Number of

studies conducted in America

Ω 95% confidence

limits for Ω

Average Incidence

Child of Survivor Sample

Size

Number of studies conducte

d in Europe

Ω 95%


Ω

Average Incidence


Size

Anxiety 3 3.16 * 2.07 to 4.82 19% 340 1 3.19 0.30 to 33.89

53%% 59

Depression 3 6.96 * 4.30 to 11.26 23% 340 1 3.64 0.78 to 16.93

34% 59

Variable Israel Number of

studies conducted in

Israel

Ω 95%

confidence

limits for Ω

Average Incidence


Size Anxiety 1 1.00 0.48 to 2.06 7% 147 Depression 1 0.83 0.26 to 2.65 3% 147 Note. European studies conducted in Norway and France. Both average Europe incidences include the findings of Zajde’s (1998) study conducted in France. Zajde (1998) did not compare her results to a control group and so her data could not be included in the odds ratio analysis. Ω meta-analytic odds ratio * p < 0.05 From a perusal of the sub-set meta-analysis of survey results (Table 9.4) it appears

that children of survivors in Israel have faired worse than their counterparts in America.

However, looking at the meta-analysis of incidence studies it is the children of survivors

based in Israel who have much lower incidence of both anxiety and depression (though this


165

is based on only one study). The survey results meta-analysis finding that Israeli children

of survivors score worse than American children of survivors contradicts the direct

assessment of this issue by Okner and Flaherty (1988), however the incidence study meta-

analysis is clearly supportive of their findings. It seems there is still too much

inconsistency in the available date pertaining to post-war settlement and its influence on

children of survivors to be able to make a firm conclusion.

9.2.9. – Gender

Gender differences in the psychological well-being of children of survivors are analysed in

a similar fashion to analyses conducted for Holocaust survivors in Chapter Eight. Firstly,

results that directly compared male and female survivors are meta-analytically combined in

effect size and odds ratio meta-analyses (see Appendix F for studies included). In addition,

an indirect method is used in which studies comparing survivors to control groups re

analysed according to the female percentage of their sample (see Appendix B). A

comparison of male versus control and female versus control is also provided (see

Appendix B). The results of these analyses are presented in Tables 9.6, 9.7, 9.8 and 9.9. Table 9.6. Meta-analysis of survey study results based on child of survivor gender

Variable Effect size for male versus female results Effect size for male versus control male results

Effect size for Females versus control female results

Number of results where

females scored higher

than males

g 95% confidence

limits for g

Total N

g 95% confidence

limits for g

Child of Survivor

N

g 95% confidence

limits for g

Child of Survivor

N

Depression 12/18 - 0.22 * - 0.38 to - 0.05 749 0.03 - 0.13 to 0.20 373 0.17 * 0.02 to 0.31 371 Anxiety 9/12 - 0.20 - 0.41 to 0.02 427 0.19 - 0.07 to 0.45 125 0.21 - 0.00 to 0.43 180 Paranoia 6/10 0.17 - 0.06 to 0.40 324 0.03 - 0.27 to 0.33 77 - 0.03 - 0.34 to 0.28 77 Positive Attachment Dimensions

2/2 - 0.54 - 1.25 to 0.17 32 0.19 - 0.51 to 0.89 16 0.09 - 0.62 to 0.79 16


3/4 - 0.15 - 0.51 to 0.21 130 - 0.24 - 0.54 to 0.06 84 0.17 - 0.02 to 0.35 261

Note. A negative effect size for males versus females indicates that females scored higher than males. * p < 0.05.


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Table 9.7. Meta-regression of children of survivor versus control results with the female percentage of the child of survivor sample Variable Number of results for

which render breakdown was provided and could be included in the meta-

regression

metar between effect size and

female % of sample

2metar


Depression 20/26 0.26 *** 0.07 950 Anxiety 10/17 0.09 0.01 428 Paranoia 7/12 0.21 ** 0.04 190 Positive Attachment Dimensions 4/8 -0.13 0.02 215 Negative Attachment Dimensions 5/13 0.22 ** 0.05 259 Note. Study results included in meta-regressions are weighted in the analyses by their associated child of survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. ** p < 0.01, *** p < 0.001 Table 9.8. Summary of meta-analyses of incidence/diagnosis studies comparing male and female children of survivors Variable Number of

results with higher incidence among females

than males

Ω 95% confidence

limits for Ω

Average incidence

among females

Average incidence among males


Anxiety 0/1 -1.08 0.42 to 2.82 27% 29% 93

Ω meta-analytic odds ratio Table 9.9. Meta-regression of incidence rates among children of survivors with the female percentage of the child of survivor sample Variable Number of results for

which gender breakdown was provided and could be included in

the meta-regression

metar between incidence and female % of

sample

2metar


Depression 3/5 - 0.88 *** 0.77 233 Anxiety 3/5 - 0.23 *** 0.05 233 Note. Study results included in meta-regressions are weighted in the analyses by their associated child of survivor sample size so that results based on larger samples are weighted more heavily to reflect their increased precision in estimating the true population effect. *** p < 0.001 Overall, the survey studies seem to suggest that sons of survivors have faired better

than daughters of survivors. However, the incidence studies seem to suggest the opposite.

However, the survey study results are based on a larger number of studies and also a larger

sample of children of survivors and so perhaps more credence can be given to those results.

Certainly the meta-regressions with female percentage of sample are a much cruder and

more indirect way of assessing this issue. The incidence study that directly compared a

male and female sample found very similar incidence levels for the genders. On balance

the studies that directly compared male and female children of survivors, be it with a survey

or a diagnostic or incidence study found that female children of survivors are worse off

compared to male children of survivors.


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9.2.10. – Birth Order

Three studies were located that considered children of survivors’ birth order as a

demographic variable that could potentially impact on psychological health (Eskin, 1996;

Lowin, 1983; Schleuderer, 1990). Each used a different mode of operationalisation of birth

order and so meta-analyses could not be conducted.

In Eskin’s (1996) study, participants who were the only child of a survivor or

survivors had the highest depression level on the Centre for Epidemiologic Studies

Depressed Mood Scale (M = 35.30, SD = 11.90, n = 7), followed by middle children (M =

35.00, SD = 11.6, n = 5), first born children (M = 31.30, SD = 9.6, n = 28) and youngest

children (M = 30.10, SD = 4.60, n = 9). No difference reached statistical significance.

Using the SCL-90 depression subscale Lowin’s (1983) second born children had

higher depression levels than their first born counterparts (M = 1.16, SD = 087, n = 23

versus M = 0.81, SD = 0.66, n = 21). A similar pattern was obtained for the anxiety

subscale (M = 0.85, SD = 0.70 versus M = 0.64, SD = 0.57). Neither of these differences

were statistically significant. However, on the paranoia subscale Lowin’s (1983) second

born children had statistically significantly higher paranoia levels than their first born

counterparts (M = 1.19, SD = 0.84, n = 23 versus M = 0.73, SD = 0.58, n = 21; t (42) = -

2.06, p = <0.05).

Schleuderer (1990) looked at the levels of dysthymia, major depression, anxiety and

paranoia among children of survivors in five birth order positions. Again contrary to

theories that first born children are the most affected it was the middle order children that

appeared to be most depressed, anxious and paranoid. Mean dysthymia levels for the

groups were as follows: first born (M = 9.77, SD = 11.83, n = 47), second born (M = 11.26,

SD = 13.01, n = 38), third born (M = 9.33, SD = 7.23, n = 12), fourth born (M = 14.00, SD

= 4.24, n = 2), fifth born (2, n = 1). For major depression the statistics were: first born (M =

6.72, SD = 9.09, n = 47), second born (M = 7.66, SD = 9.81, n = 38), third born (M = 7.17,

SD = 6.55, n = 12), fourth born (M = 6.50, SD = 3.54, n = 2), fifth born (2, n = 1). Mean

anxiety levels for the groups were as follows: first born (M = 5.11, SD = 6.69, n = 47),

second born (M = 6.16, SD = 7.62, n = 38), third born (M = 7.17, SD = 7.09, n = 12), fourth

born (M = 4.00, SD = 1.41, n = 2), fifth born (3, n = 1). None of these differences are

statistically significant. The middle order children had the highest paranoia levels (first M

= 22.36, SD = 11.28, n = 44; second M = 22.50, SD = 12.31, n = 38; third M = 26.83, SD =

9.17, n = 12; fourth M = 20.50, SD = 0.71, n = 2; fifth 65.00, n = 1). The only statistically


168

significant difference found among these groups was for the third born versus the fourth

born with the former group statistically significantly more paranoid than the latter, however

there were only two fourth born children (t (12) = 2.22, p < 0.05).

All three studies suggest that in survivor families with more than one child it is the

middle order children that have higher symptom levels than the first born children which is

contrary to what many would predict (S. Davidson, 1980a; Grubrich-Simitis, 1981;

Newman, 1979; Porter, 1981). Only one study looked at only children compared to

children from multiple children families. There are however, as has been the case

frequently in this body of research, quite small sample sizes involved in most cases. The

issue of birth order has been far from adequately researched to date.

9.2.11. – Membership of Descendants of Survivors Organisations or Support Groups

As was conducted for Holocaust survivors, sub-set meta-analyses are calculated for studies

based on samples derived from descendant organisations and those derived from the

general community. The results of these analyses are presented in Table 9.10 (see

Appendix B for study details). Apart from anxiety, stronger results are obtained for studies

whose samples were obtained from descendant organisations. This suggests that children

of survivors who are members of a descendant organisation are more depressed and

paranoid and experience more negative and less positive attachment attributes, mirroring

the sub-set meta-analysis findings addressing the same issue in the survivor generation. Table 9.10. Summary of sub-set meta-analyses of survey studies by sample source for children of survivors Descendant of Survivor Groups General Community Number of

results based on samples

recruited from descendant of survivor groups

Child of survivor sample

size

g 95% confidence

limits for g

Number of results

based on samples recruited from the general

community

Child of survivor sample

size


Anxiety 10 416 0.12 - 0.02 to 0.27 6 159 0.16 - 0.04 to 0.37 Depression 9 366 0.20 * 0.04 to 0.36 17 721 0.05 - 0.06 to 0.16 Paranoia 4 193 0.40 * 0.16 to 0.64 8 105 0.01 - 0.24 to 0.26 Positive Attachment/Intimacy Variables

4 177 -0.15 - 0.37 to 0.07 3 203 -0.13 - 0.31 to 0.05


7 329 0.11 - 0.05 to 0.26 6 329 -0.05 - 0.19 to 0.10

* p < 0.05


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9.3. – Grandchildren of Holocaust Survivors

Very little research has been conducted with grandchildren of Holocaust survivors to date.

It is granted that it has only been in recent years that grandchildren of survivors have

reached adulthood in large enough numbers to make conducting research with them

feasible. Therefore very little data exists on demographic differences within the

grandchildren of Holocaust survivor population. What little data there is in this regard is

presented in the following subsections.

9.3.1. – Gender

Jurkowitz (1996) compared male and female grandchildren using the Centre for

Epidemiologic Studies Depressed Mood Scale. It was the females (M = 11.37, SD = 10.01,

n = 47) who scored higher on this scale than males (M = 10.14, SD = 7.44, n = 44),

consistent with other findings that females of differing generations are more depressed than

males. This result was not statistically significant.

9.3.2. – Number/Gender of Child of Survivor Parent/s

Gopen’s (2001) study delineated participants based on whether their mother, father or both

were children of survivors. Of the measures used by Gopen (2001), the Perceived

Relationships Quality Components Inventory Intimacy and Trust subscales were considered

relevant to the current review. When the grandchildren of survivor sample was stratified

according to the number and gender of children of survivor parents it was the participants

with only a child of survivor father who scored the lowest on both scales (intimacy M =

5.27, SD = 0.43 and trust M = 5.60, SD = 0.43). Participants with only a child of survivor

mother (intimacy M = 6.05, SD = 0.86 and trust M = 6.44, SD = 1.36) and those whose

parents were both children of survivors (intimacy M = 6.26, SD = 0.58 and trust M = 6.61,

SD = 0.54) scored more similarly. None of these differences reached significance though

the results pertaining to intimacy did come close (p = 0.06).

Rubenstein (1981) searched for differences in anxiety between primary school aged

children with one versus two Holocaust survivor grandparents. While none of his results

reached statistical significance it is interesting to see that the effect noted in children of

survivors based on number of survivor parents seems to also be reflected in the third

generation. Rubenstein’s (1981) group of children with two Holocaust survivor

grandparents (n = 15) recorded higher levels of anxiety, than those with only one (n = 24),

on two measures. The children themselves completed the Fear scale of the Louisville

Behavior Checklist (two survivor grandparents M = 54.20, SD = 13.55; one survivor


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grandparent M = 52.14, SD = 9.91), while their school teachers also rated their anxiety on

the School Behaviour Checklist (two survivor grandparents M = 51.92, SD = 10.64; one

survivor grandparent M = 46.72, SD = 9.03).

Sigal and Weinfeld (1989) presented data relating to parental and teacher ratings of

grandchildren of Holocaust survivors on the level of fear/anxiety they evidenced in

ordinary situations. Specifically they reported the proportion of grandchildren reported to

show this symptom often or very often. They provided data for two groups of

grandchildren of survivors: one group with at least one Holocaust survivor grandparent (n =

58) and one group with at least one survivor parent and one survivor grandparent (n = 11).

Specifically the percentages were: 34% of grandchildren of survivors and 40% of

children/grandchildren of survivors.


This chapter has reviewed and meta-analysed, where possible, the current state of evidence

in relation to the impact of demographic variables on the psychological health of children

and grandchildren of survivors. For the majority of these variables, assessment has been

too sparse or too tainted by methodological problems to make any firm statements about

their impact on descendants of survivors.

While variables such as gender have been studied a number of times, the impact of

variations in the survivor ancestors’ Holocaust experiences have been under-examined to

date. Since we know that such differences led to differing levels of adjustment among

survivors, it follows that the children of the most affected survivors would be the most

affected themselves. However, this is an assumption rather than a statement based on a

large body of hard evidence. The assessment of demographic variables and their impact on

the psychological health of descendants of Holocaust survivors is to date inadequate and is

in need of supplementation.

The assessment of some demographic variables that have been under-examined in

the literature is possible via meta-analytic techniques such as meta-regressions. This

technique has been used here to supplement the current knowledge regarding gender

differences as well as the influence of age, time lapse variables and post-war settlement

location. However, it is necessary to increase the database of raw data assessments of these

variables. Clearly, even though meta-analytic techniques can go some way in addressing

the gaps in knowledge, further data collection is required to clarify the role of a range of

demographic variables on the psychological health of survivors and their descendants.


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Chapter Ten – Refinement of the Model of the Differential Impact of Holocaust Trauma

across Three Generations based on Meta-Analyses

Chapters Eight and Nine collated and synthesised the current state of evidence in relation to

demographic differences among Holocaust survivors and their descendants. The purpose of

this chapter is to revisit the model developed in Chapters Two to Five, in light of the

literature reviewed and meta-analysed in Chapters Eight and Nine. As this chapter

highlights, the literature in relation to the impact of the Holocaust is lacking in a number of

areas. The final sections of this chapter are dedicated to outlining the hypotheses that arise

from the meta-analytic review of the literature and require further empirical study to

answer.

10.1. – Adequacy of the Assessment of Demographic Differences among Holocaust

Survivors and Descendants in the Literature

Chapters Four and Five of the current thesis summarised the theoretical and anecdotal

conjecture on the influence of demographic variables on the psychological well-being of

Holocaust survivors and their descendants. Chapters Eight and Nine went on to conduct a

review of the existing data relating to these demographic variables. Meta-analytic synthesis

was conducted where viable. Cross-referencing the results of the review of the empirical

studies of demographic differences among survivors (presented in Chapters Eight and

Nine) with the literature and conjecture regarding demographic differences (summarised in

Chapters Four and Five) has been conducted to determine whether these demographic

variables have been empirically assessed as adequately as would be warranted by the

strength of the debate in the literature.

10.1.1. – Adequacy of Demographic Analysis for Holocaust Survivors

The variables addressed in this chapter included a survivor’s age during the Holocaust, their

gender, their country of origin, cultural differences, the reason for their persecution, the

nature or type of experiences/traumas they endured during the Holocaust, their loss of

family members and their post-war settlement location. Upon examination of the empirical

literature it was found that only five of these eight variables had been assessed and the

majority of these had not been assessed adequately. Studies were found that had

empirically assessed age, gender, nature/type of experiences, loss of family and post-war

settlement location. The results of these studies were reported and meta-analysed (where

possible) in Chapter Eight. Table 10.1 provides a summary for the current state of the


172

literature for each of the demographic variables theorised to have an impact on survivors’

psychological health.

As can be seen, overall the literature pertaining to demographic differences among

Holocaust survivors is ambiguous at best. The only variable that any statement can be

made about with any real confidence is gender and that is that female survivors are

generally worse off than male survivors. Table 10.1. Summary of the current state of evidence of the impact of survivor demographics on survivor psychological health Variable Number of

direct assessments

of variable

Indirect Assessment

via Meta-Analysis

Clarity of results

Nature of Holocaust Experiences

20 - Overall seems that camp survivors are worse off than non-camp survivors, a number of contradictory results

Loss of family 4 - Ambiguous Gender 1 to 5 Females are worse off than males Age during the Holocaust

13 Overall appears to be a positive relationship between age and symptoms, a number of contradictory results

Time lapse since the Holocaust

- Ambiguous

Post-war settlement location

2 Ambiguous

Reason for persecution

- -

Country of Origin 1 - Eastern European survivors more troubled than Western European survivors but more research needed

Cultural Differences - - 10.1.2. – Adequacy of Demographic Analysis for Children of Holocaust Survivors

Demographic differences among children of survivors can be related to facets of their

survivor parents’ experiences (as in Table 10.2) or demographic variables intrinsic to them

(as in Table 10.3). More data is required in relation to the impact of survivor parent

demographics. In addition, the impact of the delay between the war and the birth of

children of survivors has not been directly assessed by any study at all and was analysed for

the first time by the current author via meta-analysis. Analysis of this variable with raw

study data (as opposed to study effect sizes and average age data) is important to clarify if

this result is a true reflection of the influence of this variable. There are two variables that

statements can be made about with a certain degree of confidence and these are gender (that

daughters of survivors are worse off) and number of survivor parents (that children of two

survivor parents are worse off than those with only one survivor parent).


173

Table 10.2. Summary of the current state of evidence of the impact of survivor parent demographics on child of survivor psychological health Variable Number of direct

assessments of variable

Indirect Assessment via Meta-Analysis

Clarity of results

Type of survivor parents’ Holocaust experiences

5 Ambiguous

Parental loss of family 2 Positive relationship between negative symptoms and survivor parent’s loss of family

Survivor parent’s country of origin

2 Ambiguous

Age of survivor parent during Holocaust

4 Ambiguous

Post-war settlement location

1 Ambiguous

Table 10.3. Summary of the current state of evidence of impact of child of survivor demographics on child of survivor psychological health Variable Number of direct

assessments of variable

Indirect Assessment via Meta-Analysis

Clarity of results

Number of survivor parents 3 to 5 Children of two survivor parents are worse off than those with only one survivor parent

Gender of survivor parent 1 Children of survivor fathers worse off than children of survivor mothers

Delay between end of the war and birth of the children of survivors

0 Negative relationship between delay and negative symptoms

Gender 2 to 17 Females worse off than males Birth order 3 Middle order children worse off 10.1.3. – Adequacy of Demographic Analysis for Grandchildren of Holocaust Survivors

There has been very little research with grandchildren of survivors in any form. Research

considering demographic differences within the grandchild of survivor population has been

even more scant. Four studies were located in total: one that assessed gender differences

and three that considered the number of survivor grandparents or child of survivor parents.

Clearly a larger bank of data is required for gender and number of Holocaust

impacted ancestors. In addition to this are the numerous demographic variables that have

yet to be considered in the grandchildren of survivor literature. These variables include

details of their survivor grandparents’ Holocaust experiences (nature/type of experiences,

loss of family, reason for persecution, country of origin, age during Holocaust, post-war

settlement etc) and demographic factors related to their child of survivor parents (delay

between the end of the war and their birth, birth order). As would be hypothesised for

children of survivors, it would be expected that grandchildren of the most affected

survivors and/or children of the most affected children of survivors will be the most


174

affected themselves. There is much scope for exploration of demographic differences

within the grandchild of survivor population.

10.2. – Intergenerational Differences within the Holocaust Population

The results and meta-analyses presented in Chapter Seven provide support for the argument

that Holocaust survivors, and their children and grandchildren, evidence higher

levels/greater severity of psychological symptoms than the general population (as

represented by control/comparison groups). However, the question of whether survivor

descendants have been affected to the same extent as the survivors themselves needs to be

addressed also. In other words does the difference between survivors and descendants and

the general population decrease with each generational separation from the Holocaust?

10.2.1. – Direct Intergenerational Comparisons in the Literature

There have been very few studies that have directly compared survivor and descendant

samples. Seven studies were located that collected data that allowed the authors to directly

compare at least one generation to another. Puzzlingly, statistical analysis of the

differences between generations of survivors were not always carried out by these

researchers. Fortunately most reported enough data/information that these comparisons

could be conducted by the current author. Of the seven studies that reported multi-

generational data, five reported survivor and children of survivor data, one reported

children and grandchildren of survivor data and the seventh study included all three

generations.

As can be seen by examining Table 10.4, from the small amount of data available it

does appear that survivors overall have scored higher on depression, anxiety and paranoia

and are less likely to view the world as benevolent than children of survivors. The results

for depression, anxiety and world benevolence obtained statistical significance. These

findings tend to support the hypothesised dissipation of the effect of the Holocaust with

each generation.


175

Table 10.4. Summary of meta-analyses of survey studies comparing survivors to children of survivors Variable Number of

results where survivors

scored higher than children of survivors

g 95% confidence

limits for g

Fail Safe N

Highest individual result effect size

(g)

Survivor sample

size

Child of survivor

sample size

Q Homogeneity

test

Depression 2/3 0.55 * 0.33 to 0.78 4 0.93 151 164 13.24 * Anxiety 2/2 0.38 * 0.03 to 0.73 < 1 0.41 60 73 0.04 Paranoia 1/1 0.12 - 0.35 to 0.57 - - 31 44 - Assumption that world is benevolent

0/1 - 0.45 *

0.10 to 0.79 - - 67 67 -

Assumption that world is meaningful

0/1 # - 67 67 -

Note. A positive effect size ( g ) indicates that survivors scored higher on a variable than children of survivors while a negative effect size indicates that survivors scored lower on a variable than children of survivors. It was not possible to calculate an effect size for the world assumption of meaningfulness as there was insufficient data, however it can be stated that the mean score for the children of survivor group was higher than the survivor group, but not statistically significantly higher. * p < 0.05 In addition to the results included in the meta-analyses in Table 10.4, there were two

additional studies that reported data from both survivor and children of survivor groups.

Sagi-Schwartz et al. (2003) quoted data pertaining to the rate of insecure attachment among

survivors and children of survivors while Leon, Butcher, Kleinman, Goldberg and Almagor

(1981) presented data on depression and anxiety.

Sagi-Schwartz et al. (2003) reported the percentage of survivors and children of

survivors in their all female sample that obtained an insecure attachment classification. An

analysis testing the difference in percentage between the female survivors and daughters of

survivors was not conducted by Sagi-Schwartz et al. (2003) and so the current author ran

the test using odds ratio analysis. This odds ratio analysis revealed found that of the 48

female survivors, 77% were classified as insecure compared to 54% of the 48 daughters of

survivors. This difference obtained a statistically significant odds ratio of 2.85, meaning

that the odds of female survivors being classified as insecure were 2.85 higher than the

odds of being classified as insecure among daughters of survivors. Sagi-Schwartz et al.

(2003) also measured anxiety in their study but unfortunately they did not quote the

descriptive data for the female survivors and daughters of survivor groups to allow an

analysis of the difference between them. They only conducted tests comparing each group

to a control group.

Leon et al. (1981) conducted the only other study located to collect data from both

survivors and children of survivors. It was not possible to include their data in the meta-

analysis presented in Table 10.4 because they reported their data in terms of 4 sub-groups,


176

with a total of 8 sub-groups when both generations are included. There was no information

to indicate which groups were related to each other. However, the current author calculated

a mean score for survivors and children of survivors so that at the very least a perusal of the

difference between the means could be made. Leon et al. (1981) used the depression and

paranoia subscales of the MMPI. On the depression subscale the weighted average mean

for the survivors (n=42) was 62.69 compared to 58.00 for the children of survivors (n =

41). For paranoia the pattern was mirrored (survivors M = 57.07; children of survivors M

= 55.24). No significance test is possible here to determine if either of these differences

reached significance but it is notable that in both cases the survivors scored higher (even if

only slightly) than the children of survivors.

Analysis of differences between children and grandchildren of survivors was

afforded by two studies. The results of these studies are presented in Table 10.5. None of

the effect sizes quoted were statistically significant, however the results in relation to

attachment in particular were based on small sample sizes (n = 11 for grandchildren).

Despite the lack of significance, the effect sizes for attachment are in the direction that

would be predicted if further dissipation of the impact of the Holocaust were hypothesised.

In other words, the children of survivors scored higher on negative attachment dimensions

and lower on positive attachment dimensions than grandchildren, suggesting a more

positive attachment picture for the grandchildren than the children of survivors. Table 10.5. Summary of meta-analyses of survey studies comparing children to grandchildren of survivors Variable Number of results where

children scored higher than grandchildren



Grandchild of survivor sample size

Depression 0/1 -0.04 - 0.33 to 0.25 91 91 Positive Attachment Dimensions

0/1 -0.14 - 0.78 to 0.50 70 11


1/1 0.12 - 0.51 to 0.76 70 11

Note. A positive effect size ( g ) indicates that children of survivors scored higher on a variable than grandchildren while a negative effect size indicates that children scored lower on a variable than grandchildren. * p < 0.05

In the only study located that collected data from all three generations, Jurkowitz

(1996) found that her survivor group (n = 91) scored statistically significantly higher than

both her children of survivor group (n = 91, t (180) = 6.25, p < 0.001) and her

grandchildren of survivor group (n = 91, t (180) = 6.20, p < 0.001) on the Center for

Epidemiologic Studies Depressed Mood Scale (survivors M = 21.39, SD = 13.90; children

M = 10.41, SD = 9.20; grandchildren M = 10.78, SD = 8.40). Interestingly here the


177

children of survivors and grandchildren of survivors scored relatively equivalent scores,

rather than evidencing a linear decline in severity of symptoms from survivors down to the

grandchildren.

10.2.2. – Indirect Intergenerational Comparisons via Meta-analysis

Apart from the studies that directly consider the issue of intergenerational differences, an

indirect assessment can also be made by examining the meta-analytic results presented in

Chapter Seven. These meta-analyses combined study results that compared survivors and

descendants to control or comparison groups designed to represent the general population.

The size of the differences between the survivor groups and the control groups can give an

indication of whether the impact of the Holocaust is felt as keenly by survivor descendants

or whether there is evidence of a dissipation of the impact of the Holocaust. If there is a

dissipation of the effect then we would expect to see smaller effect sizes when comparing

descendant groups to control groups than the effect sizes derived when comparing survivor

groups to control groups. In other words, with each generational separation from the

Holocaust, less disparity from the general population is expected. Table 10.6. Survivor, child of survivor and grandchild of survivor groups versus control groups – Intergenerational comparison of meta-analytic effect sizes Survivors versus

control effect sizes

95% confidence limits for g

Children of survivor versus control effect sizes


Grandchildren of survivors versus control effect sizes


Depression 0.32 * 0.26 to 0.39 0.10 * 0.01 to 0.19 0.41 * 0.07 to 0.76 Anxiety 0.57 * 0.47 to 0.67 0.18 * 0.06 to 0.29 0.43 * 0.15 to 0.72 Paranoia 0.45 * 0.34 to 0.56 0.21 * 0.04 to 0.39 - 0.23 - 0.74 to 0.27 Assumption that would is benevolent

- 0.28 * - 0.16 to - 0.40 0.01 - 0.33 to 0.34 -

Assumption that world is meaningful

- 0.11 - 0.23 to 0.00 - -

Positive Attachment Dimensions

- 0.26 * - 0.02 to - 0.51 - 0.09 - 0.22 to 0.04 - 0.43 * - 0.81 to - 0.04


0.28 * 0.03 to 0.52 0.02 - 0.08 to 0.13 0.46 - 0.22 to 1.13

* p < 0.05 Perusal of Table 10.6 provides some evidence for a dissipation of the impact of the

Holocaust when comparing children of survivor results to survivor results. Indeed, the fact

that the confidence intervals associated with depression and anxiety results for survivors

and children of survivors do not overlap suggest that the effect sizes for children of

survivors on these two variables are statistically significantly lower than for the survivor

generation. Curiously the results for the grandchildren of survivors suggest there may be a

reversal of this trend with severity of symptoms for grandchildren more disparate to the

general population/comparison groups than children of survivors. However, the meta-


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analytic results for grandchildren of survivors are based on much smaller sample sizes

(ranging from 11 to 109 compared to a range of 67 to 1,087 for children of survivor results

and 130 to 2,000 for survivor results). Therefore, it is not clear whether these results

represent a genuine finding of heightened symptoms among grandchildren of survivors or

whether it is merely a statistical artefact.

10.3. – The Need for Further Investigation

In Section 10.1 a review of the moderating role of demographic variables as determined by

meta-analyses in the current thesis was conducted. It is clear that for some demographics it

is possible to determine their impact, however it is also clear that for others the available

data provides only ambiguity or may not even exist at all. Section 10.2 outlined the very

limited data available on intergenerational differences with the Holocaust survivor

population.

Some clarity is needed on a whole range of levels as to the demographic sub-groups

of each generation that are more effected by the Holocaust and the degree to which the

impact of the Holocaust has been transmitted across the generations. To this end, it is

necessary to conduct an empirical study to collect the data needed to provide this clarity.

The second stage of research to be conducted for the current thesis is therefore an empirical

study to supplement and clarify the results of the meta-analyses. Section 10.4 outlines the

hypotheses and aims of the empirical study.

10.4. – Hypotheses for Empirical Study

There is a lot of data to make sense of in the current thesis and the process of doing so has

led to the formation of a large number of hypotheses. The specific hypotheses for the

empirical study have been divided into sections. These are:

• hypotheses about the impact of influential psychological processes on the symptom

levels among survivors and descendants;

• hypotheses regarding the modes of intergenerational trauma transmission; and

• hypotheses about demographic differences among survivors and descendants.

10.4.1. – Hypotheses Regarding the Relationships between Model Variables

10.4.1.1. – The impact of influential psychological processes.

Following on from the literature discussed in Chapter Two the following model hypotheses

(MH) are made about the role of psychological processes in determining the severity or

strength of negative and positive psychological symptoms/dimensions:


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MH1: Negative/dysfunctional coping strategies will be positively related to negative

psychological symptoms and negatively related to positive psychological dimensions,

while positive/functional coping strategies will be negatively related to negative

psychological symptoms and positively related to positive psychological dimensions.

MH2: Strength of belief that the world is benevolent and meaningful will be negatively

related to negative psychological symptoms and positively related to positive

psychological dimensions.

Slightly tangential but still somewhat related to this group of hypotheses is a hypothesis

about the relationship between the positive psychological impact of posttraumatic growth

and the negative psychological impacts included in the model. Studies have found a

positive relationship between posttraumatic growth and pathological symptoms (Cadell et

al., 2003; Laufer & Solomon, 2006; McGrath & Linley, 2006; Morris et al., 2005).

However, Green et al’s (1985) trauma model (Processing a Traumatic Event: A Working

Model), which has been used as a partial basis for the model of Holocaust trauma being

developed in the current thesis, implied a mutual incompatibility of negative

symptomatology and posttraumatic growth. The body of evidence on this issue has been

growing and is sufficient enough that for this study it is hypothesised that among survivors:

MH3: Posttraumatic growth aspects will co-exist with negative psychological

symptoms (in other words posttraumatic growth and negative psychological symptoms

will be positively related).

10.4.1.2. –The odes of intergenerational trauma transmission.

The way in which Holocaust trauma is revisited in the descendants of survivors was

discussed in Chapter Three where theorised modes of intergenerational trauma transmission

were discussed. Being guided by the literature review process that went into that chapter,

as well as the overarching theories of attachment and the 3-D Circumplex model of family

systems, it is hypothesised that the following variables will be positively associated with

negative psychological symptoms and negatively associated with positive psychological

symptoms:

MH4: Negative parent-child attachment dimensions such as the degree of coldness and

ambivalence will be positively associated with negative psychological symptoms and

negatively associated with positive psychological symptoms and positive parent-child

attachment dimensions such perceived parental warmth will be negatively associated


180

with negative psychological symptoms and positively associated with positive

psychological dimensions

MH5: A curvilinear/U-shaped relationship will exist between negative psychological

symptoms and family cohesion (with very low and very high cohesion associated with

higher symptom levels than mid-range scores) and an inverted U-shaped relationship

will exist between positive psychological dimensions and family cohesion

MH6: The degree to which parents are encouraging of their children’s attempts to

establish independence will be negatively associated with negative psychological

symptoms and positively associated with positive psychological dimensions

MH7: General communicativeness within the family unit will be negatively associated


psychological dimensions

MH8: Negative modes of communicating about the Holocaust, such as guilt-inducing,

indirect and non-verbal will be positively associated with negative psychological

symptoms and negatively associated with positive psychological symptoms and positive

modes of communicating about the Holocaust, such as frequent, willing and open

discussion will be negatively associated with negative psychological symptoms and

positively associated with positive psychological dimensions

As well as hypothesising links between these family interaction variables and psychological

impact variables it is also hypothesised that these variables mediate the relationship

between ancestor and descendant scores on psychological impact variables.

10.4.2. – Hypotheses Regarding the Influence of Demographic Variables

For the majority of demographic variables it was possible to make at least a tentative

hypothesis as to which sub-group would be most affected or whether a continuous variable

such as age would be positively or negatively associated with symptoms (if not based on

meta-analytic results then at least on theoretical conjecture outlined in Chapters Four and

Five, as well as Green, Wilson and Lindy’s (1985) Working Model for the Processing of a

Traumatic Event and Wilson’s (1989) Person-Environment Interaction Theory of

Traumatic Stress Reactions). However, there are a handful of variables where either

insufficient data or very inconsistent data was found in the literature so that it was not

possible to make even a tentative hypothesis at this stage.


181

The demographic variable hypotheses (DH) are as follows:

DH1: Female survivors, children of survivors and grandchildren of survivors will score

higher on negative variables and lower on positive variables than male survivors,

children of survivors and grandchildren of survivors.

DH2: Scores on negative variables will increase with the age a survivor was during the

Holocaust (as operationalised by their age in 1945) and scores on positive variables will

decrease with age.

DH3: Survivors of camps will score higher on negative variables and lower on positive

variables than survivors with other experiences such as being in hiding or fighting with

partisan groups.

DH4: Scores on negative variables will increase with the amount of a survivors’ family

losses and scores on positive variables will decrease with the amount of family losses

DH5: Survivors who were persecuted for an “understandable reason” such as resistance

to the Nazi regime or committing a “crime” will score lower on negative variables and

higher on positive variables than survivors persecuted for reasons such as race/ethnicity

or religion

DH6: Scores on negative variables will increase with the amount of time Nazi

persecution occurred in country of origin and scores on positive variables will decrease.

Or at least scores will vary depending on a survivors’ country of origin.

DH7: Scores on negative variables will increase and scores on positive variables will

decrease with increases in the number of ancestors affected by the Holocaust (for

example the number of survivor parents a child of survivors has, the number of child of

survivor parents and survivor grandparents a grandchild of survivors has).

DH8: Middle birth order children will score higher on negative variables and lower on

positive variables than first born children.

DH9: Child of survivor scores on negative variables will decrease with the delay

between the end of the war (1945) and their birth and scores on positive variables will

increase with delay

In addition to these generation-specific hypotheses about demographic differences, it is

hypothesised that:

DH10: The descendants of the most affected subgroups of a particular generation will

be the most affected themselves (for example if camp survivors are more affected than


182

hiding survivors than children of camp survivors will have higher symptom levels than

children of hiding survivors)

DH11: There will be evidence of a dissipation of the impact of the Holocaust with each

generational separation from the Holocaust. In other words, children of survivors will

score lower on negative variables and higher on positive variables than survivors, and

grandchildren of survivors will score lower on negative variables and higher on positive

variables than children of survivors.

The following variables are hypothesised to have an effect but a directional

hypothesis cannot be made as yet based on the available empirical literature: post war

settlement location, length of time before resettlement of survivors/time spent in DP camps,

gender of survivor or child of survivor parent if only one, birth of children of survivors

before or after survivor parents’ emigration from Europe, birth order (for grandchildren of

survivors).

The relative importance of the demographic variables in the model is also

something that cannot yet be determined from the current literature. There have been no

studies that have made a concerted effort to prioritise demographic variables as to their

importance in determining the impact of the Holocaust. The majority of studies that have

considered demographic variables have analysed them in isolation, or have only analysed a

very small number of demographic variables at a time. Given that this study will be

collecting data on a whole range of demographic variables, attempts will be made to rank

the demographic variables (and also the influential psychological process and family

interaction/transmission variables) in terms of their importance in predicting scores on

psychological impact variables.

10.4.3. – Hypotheses Relating to Membership of Survivor or Descendant of Survivor

Groups

Quite separate from all of the hypotheses about the relationships discussed in the above

sections is a hypothesis relating to the membership of survivor or descendant of survivor

organisations. There is some conjecture in the literature (see Chapter Two) as to whether

membership of a survivor or descendant organisation is reflective of better or worse

adjustment and whether such groups attract better or worse adjusted people. Following on

from the results of the sub-set meta-analyses presented in Chapters Eight and Nine that

addressed this issue the following sample source hypothesis (SH) can be made:


183

SH1: Survivors or descendants who are members of a survivor or descendant

organisation will display higher levels of negative symptoms and lower levels of

positive dimensions/variables than non-members.


This chapter has attempted to bring together the findings of the meta-analyses in Chapters

Eight and Nine as well as provide meta-analytic investigation of intergenerational

differences within the Holocaust survivor population. It is clear that more investigation is

needed to more accurately determine the relationships between various psychological

processes and psychological health as well as clarifying the impact of numerous

demographic variables. The preliminary Model of the Differential Impact of Holocaust

Trauma across Three Generations that was progressively built in Chapters Two through to

Five has not been refined that much as a result of the many meta-analyses presented in

Chapters Seven, Eight and Nine (see Figure 10.1). The demographic variables for which

hypotheses could be made are indicated in Figure 10.1 via a notation of the subgroups

hypothesised to be most affected or via a note of the direction of a hypothesised

relationship. They have also been bolded for ease of reference. For example females of

each generation are hypothesised to have high symptom levels and a negative relationship

is proposed between symptom levels and the length of time between the end of the war and

a child of survivor’s birth.

The process of reviewing and meta-analysing the available data on Holocaust

survivors and their descendants has highlighted the gaps in our knowledge about the

psychological impact of the Holocaust and the factors that determine its severity. An

empirical study designed to fill in at least some of those gaps is what will be presented in

the remaining chapters of the current thesis which collectively make up Section C of the

thesis. This study aims to assess all the variables in the model, thereby clarifying the role

of some demographic variables and providing the first analysis of the role of others. In

addition, the model will be refined by determining a ranking of the strength of influence of

all variables in the model in predicting the psychological health of survivors and

descendants.


184


Influential Psychological

Processes


of Trauma





1st G

ener

atio

n (S

urviv

ors)

DH11

– Di

ssip

atio

n of

sym

ptom

leve

ls wi

th ea

ch g

ener

atio

nal r

emov

al fro

m H

oloc

aust

expe

rienc

es



MH3 - Post-traumatic Growth

MH2 - World Assumptions MH1 - Coping Strategies

DH2 - Age during the Holocaust (Positive) • Time lapse since the Holocaust

DH1 - Gender (Females) DH3 - Type/nature of Holocaust experiences (Camps) DH5 - Reason for persecution DH4 - Loss of family (Positive) DH6 - Country of origin • Post-war settlement location • Length of time before resettlement/time

spent in displaced persons camps

2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)




DH10 - • Age during the Holocaust • Time lapse since the Holocaust • Gender • Type/nature of Holocaust experiences • Reason for persecution • Loss of family • Country of origin • Post-war settlement location • Length of time before resettlement/time


DH7 - Number of survivor parents (Positive) DH9 - Delay between the end of the war and their birth (Negative) • Birth before or after survivor

parent/s emigration DH8 - Birth order DH1 - Gender (Females)

MH4 - Parent-Child Attachment MH5 - Family Cohesion MH6 - Encouragement of Independence MH7 - General Family Communication MH8 - Communication about Holocaust experiences

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)




DH10 - • Age during the Holocaust • Time lapse since the Holocaust • Gender • Type/nature of Holocaust experiences • Reason for persecution • Loss of family • Country of origin • Post-war settlement location • Length of time before resettlement/time


DH10 - • Number of survivor parents • Delay between the end of

the war and their birth • Birth before or after survivor

parent/s emigration • Birth order • Gender

DH7 - Number of child of survivor parents (Positive) DH8 - Birth order DH1 - Gender (Females)

MH4 - Parent-Child Attachment MH5 - Family Cohesion MH6 - Encouragement of Independence MH7 - General Family Communication

Figure 10.1. Empirical Study Hypotheses Marked on the Test Version Model of the Differential Impact of Holocaust Trauma on Three Generations


185

Section C

Empirical Assessment of the Model of the Differential Impact of Holocaust Trauma across

Three Generations


186

Chapter Eleven – Empirical Study Rationale and Methodology

The body of the thesis to this point has presented the results of meta-analyses of the

research into Holocaust survivors and their descendants and has presented a model of the

intergenerational transmission of the impact of the Holocaust based on these analyses

(Figure 10.1). However findings relating to a large proportion of this model are inadequate

or ambiguous. It has therefore been necessary to conduct an empirical assessment of this

model to try to determine how accurately it reflects the true relationships between variables

and to reduce some of the ambiguities.

It was felt that the meta-analytic review of existing literature provided sufficient

evidence for the higher rates of pathological symptoms among the survivor and descendant

population compared to the general population. What was clear from a review of this body

of research was that there are definitely differences within the survivor and descendant

population. This was further supported by the meta-analytic findings presented in the

current thesis. Further investigation of differences between survivor and descendant groups

and controls will not really provide any further information or insight. Therefore the focus

of the empirical study reported in the current thesis is on within group differences within

the survivor and descendant populations.

This chapter outlines the rationale for the empirical study conducted as well as the

methodology utilised. Issues relating to sample recruitment and derivation are discussed.

Operationalisation of the variables in the model, including details of reliability and validity

of chosen scales are presented next. Finally design issues, such as the ordering of scales

within the questionnaire booklet, and the statistical analysis approach are explained.

11.1. Rationale of the Empirical Study

Having conducted the extensive review and meta-analyses of the literature regarding

Holocaust survivors and their descendants, it was clear that many potential demographic

and situational moderators had been inadequately assessed. The proposed relationships

between some of the variables in the model, while often discussed in theoretical or

anecdotal literature, were also lacking in empirical verification.

An empirical study that aimed to assess all of the variables reviewed in the meta-

analyses would go a long way to clarifying and/or illuminating the influence of some of

these variables.


187

The aims of the empirical study were to:

• Clarify the nature and strength of relationships between the various theorised impacts of

the Holocaust, namely psychopathological and inter-personal processes.

• Clarify the nature and strength of the moderating influence of demographic and

situational variables on the theorised impacts of the Holocaust.

• Attempt to determine which variables are the most predictive or prescriptive of the most

vulnerable sub-groups of survivors, children and grandchildren.

11.2. – Method

The methodological approach of the empirical study conducted for this thesis is outlined in

detail in this section. Specific information about the design, sample, procedures, measures

and statistical approaches are presented in turn.

11.2.1. – Design

The dependent variables (DVs) in this study are labelled as psychological impact variables

in the model of differential impact of Holocaust trauma across three generations.

Specifically the DVs are depression, anxiety, paranoia/vulnerability, adult attachment

dimensions, post-traumatic stress symptoms and post-traumatic growth dimensions. The

independent variables (IVs) in this study are the influential psychological process variables

of coping strategies and world assumptions, the family interaction process/mode of

transmission variables of parent-child attachment, parental fostering of autonomy, family

cohesion, communication about Holocaust experiences and general family communication.

The demographic variables listed on the model also serve as IVs.

11.2.2. – Sample

The total sample derived for the study was 124 participants from the three generations: 27

Holocaust survivors, 69 children of survivors and 28 grandchildren of survivors.

Ultimately, 32% (40) of the sample was obtained via contacts with survivor or descendant

groups, 10% (12) as a result of media coverage, 6% (7) via Jewish groups, supplemented by

family members (34%, 42) and friends (12%, 15) of participants. There were a small

number of returned questionnaires from an unknown source (6%, 8).


188

The same criteria used for the meta-analyses were used to define the three generations in

the empirical study:

• A Holocaust survivor was defined as any person who suffered some form of persecution

by the German Nazi Regime/Third Reich. This was dated from January 1933 (when

Hitler came to power) until the end of World War II.

• A child of a Holocaust survivor had to have at least one parent who met the Holocaust

survivor criteria, and had to be born after the cessation of hostilities. Children born

before the end of the war (1945) were only included if their survivor parent/s had

somehow escaped persecution before the end of the war and the child was born after

their escape.

• A grandchild of a Holocaust survivor had to have at least one grandparent meeting the

criteria to be classified as a Holocaust survivor and a parent meeting the criteria for a

child of a Holocaust survivor (and no parent meeting the survivor criteria).

The sources from which the study participants were derived mean that the current

study sample can be classified as a mixed, non-clinical community sample (in terms of the

sample categories referred to in the meta-analyses conducted for this thesis and reported in

Section B). The sample is a mixed community sample in that it contains participants who

are members of survivor or descendant organisations and also participants who are not

members of such an organisation. Variable scores of members and non-members of

survivor or descendant organisations are compared statistically to determine statistically

significant differences related to group membership. No participants were obtained via

“clinical sources,” such as client/patient lists from in-patient or out-patient

psychiatric/psychological facilities/practices. While the sample is a convenience rather

than a random sample, the difficulty and cost associated in obtaining such a sample are

beyond the scope of a PhD research study.

11.2.3. – Procedure

At the outset ethical clearance for the empirical study was sought and granted from the

Queensland University of Technology Human Research Ethics Committee (reference

3779H). This process ensured the proper conduct of the study including approval of

methods used to maintain participant anonymity and confidentiality as well as ensuring

participants’ well-being during and as a consequence of their participation.


189

A variety of recruitment methods were used to obtain participants including

canvassing various groups and organisations for help, word of mouth, personal contacts and

indirect advertising via media coverage. In addition, many participants informed family

members about the study who then also indicated their willingness to participate.

The internet was searched for organisations and agencies which might be able to

help in contacting potential participants. The search terms “Holocaust” and “Shoah” were

entered into a worldwide Google search. In addition the links pages of organisations

identified via the Google search were also perused. The organisations contacted fell into

the four broad categories of:

• Holocaust survivor and/or descendant organisations (both Jewish and non-Jewish)

• Jewish organisations.

• Cultural groups set up for immigrants from countries from which survivors could have

originated (for example Poland).

• Political groups, including communist parties, that may have members who were

persecuted for political reasons.

These organisations were contacted by an email in which the author introduced

herself and the study and asked if they could help either by allowing her to put a notice on

their website and/or in their newsletter and/or send an email or letter to their membership

list. Appendix H details the organisations that agreed to help and the form of help

provided.

The author received some media attention in January 2005 to coincide with the 60th

anniversary of the liberation of Auschwitz-Birkenau. More coverage was received in May

2005 to coincide with the anniversary of VE Day. Many potential participants contacted the

author as a response to these print and radio interviews. Details of these can be found in

Appendix H.

Potential participants contacted the researcher stating their interest after hearing

about the study. They were then either emailed or posted three questionnaire booklets

(corresponding to the three generations of interest namely survivors, children of survivors

and grandchildren of survivors). In addition, an informed consent information letter was

included (see Appendix I). This included information to help potential participants decide

if they met the criteria for the study and which booklet to complete. By providing a copy of


190

the questionnaire booklet for each generation, participants had the ability to pass on copies

of the appropriate booklets to family members or acquaintances.

After the initial provision of the questionnaire booklet and informed consent letter, a

monthly reminder was sent, with a maximum of four reminders. Participants were quite

hard to obtain and the sample obtained is the end result of over a year of data collection and

canvassing for participants. The response rate (as a proportion of the total number of

people who were made aware of the study) was quite low. The response rate as a

proportion of questionnaires forwarded by the author was 77%.

11.2.4. – Translations

Because an international sample was sought for this study it was recognised that numerous

translations may be needed. The information sent out to participants in the English version

of the questionnaire booklet and study information intimated that translations could be

sought, if they knew of anyone who would be willing to participate if a translation was

available. This was considered particularly relevant in attracting survivors who had

settled/remained in Europe to participate. To this end translations of measures used for the

study that were already in existence were gathered so that a complete translation of the

questionnaire booklet could be obtained at minimal cost (for example the DASS in Dutch,

French and Hungarian, and the IES-R in German). Because of budget restraints,

translations would only be commissioned if sufficient interest was shown to warrant the

expense (approximately $3,000 (AUD) per language). In order to gauge the need for

translations an introductory paragraph about the study was translated into multiple

languages and sent out with all questionnaire packages (see Appendix J). Such interest

never eventuated for any European countries despite numerous contacts to organisations

based in Europe.

Ultimately the only full translation of the questionnaire booklet compiled by the

current author was in Hebrew. It was thought that this would yield the largest number of

additional participants, given that a number of organisations based in Israel had agreed to

help reach potential participants. The FES and the IES – R already existed in Hebrew

translation and copies of these were obtained. For the remaining questionnaires, a Hebrew

translation was commissioned. A back-translation was also obtained in an attempt to

ensure the accuracy of the translation. Back-translation involves employing a translator to

translate the documents back into the original language without sighting the original

versions. The back-translation is then compared to the original to check that each statement


191

or question on each questionnaire asked the same thing or reflected the same thought as the

original. As recommended by Maneesriwongul and Dixon (2004), translations were made

into the native tongue of the translator (i.e., the translation from English to Hebrew was

conducted by a bi-lingual native Hebrew speaker while the translation from Hebrew into

English was conducted by a bi-lingual native English speaker).

Potential participants were told that this Hebrew translation was available in

addition to the English version, and that additional translations may be able to be sourced –

however, all completed questionnaires received used the English version (including three

from Israel and one from Germany). Therefore, while only English language

questionnaires were completed for this study, the reader should note that reasonable

attempts were made to obtain participants who could not speak English and to ensure that

study participation was accessible for all survivors and descendants who wished to

participate and minimise the language barrier to participation.

11.2.5. – Measures

This section will outline the questionnaires used in the study. Each questionnaire is briefly

summarised and information pertaining to its reliability and validity is also presented.

Figure 11.1 provides a graphical representation of the measured variables in the model and

their respective measures.

Variable Types/Classes

Psychological Impacts Influential Psychological Processes

Modes of Intergenerational Transmission of Trauma

Indi

vidua

l Var

iables

• Depression – Depression Anxiety Stress Scales

• Anxiety – Depression Anxiety Stress Scales

• Paranoia – Post Traumatic Vulnerability Scale

• PTSD symptoms – Impact of Events Scale - Revised

• Romantic Attachment Dimensions – Adult Attachment Scale

• Post-traumatic Growth – Posttraumatic Growth Inventory

• World Assumptions – World Assumptions Scale

• Coping Strategies – COPE

• Parent-Child Attachment – Parental Care-giving Style Questionnaire

• Family Cohesion – Family Environment Scale – Cohesion Subscale

• Encouragement of independence – Parental Attachment Questionnaire – Parental Fostering of Autonomy Subscale

• General Family Communication – Family Environment Scale – Expressiveness Subscale

• Communication about Holocaust experiences – Holocaust Communication Questionnaire

Figure 11.1. Identification of Measures of Variables from Model of the Differential Impact of Holocaust Trauma across Three Generations used in the empirical study


192

11.2.5.1. – Depression Anxiety Stress Scales (DASS)

The Depression Anxiety Stress Scales or DASS (S. H. Lovibond & P. F. Lovibond, 1995)

was chosen as the measure for anxiety and depression in this study. A copy of this scale

can be found in Appendix K. The DASS was chosen because it provides scores for both

anxiety and depression, including readily calculable information about severity, while not

burdening the participant with an overly long questionnaire to complete. In addition the

DASS already exists in translation in a number of languages that were potentially useful for

the current study (namely Dutch, French and Hungarian). The DASS is a 42 item, 4-point

likert scale (0-3) measure with the three subscales of anxiety, depression and stress each

containing 14 items. Subscale scores are derived by summing scores for each item that

loads on the subscale, meaning that scores on each subscale can range from a minimum of

0 to a maximum of 42. Severity category scores for the anxiety subscale are normal 0-7,

mild 8-9, moderate 10 -14, severe 15-19 and extremely severe 20 and over. The raw score

cut-offs for the severity categories of depression are as follows: normal range 0-9, mild 10-

13, moderate 14-20, severe 21-27, and extremely severe 28 and over.

The Cronbach’s α for the anxiety subscale was found to be 0.84 (n = 2,914) during

initial assessment of the scales with an undergraduate student sample, while the depression

(0.91) subscale scored even more favourably (S. H. Lovibond & P. F. Lovibond, 1995, p.

27). Brown, Chorpita, Korotitsch and Barlow (1997) cite equally high and higher

reliabilities for the DASS in clinical samples. Reliability co-efficients obtained for the

current sample were 0.84 for the anxiety scale and 0.95 for the depression scale.

Convergent validity is evident via the high correlations between the DASS anxiety subscale

and the Beck Anxiety Inventory (r = 0.81, n = 717) and the DASS depression subscale and

the Beck Depression Inventory (r = 0.74) (P. F. Lovibond & S. H. Lovibond, 1995).

The Depression subscale covers the depressive symptom clusters of dysphoria,

hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia

and inertia. The Anxiety subscale covers autonomic arousal, skeletal muscular effects,

situational anxiety and subjective experience of anxious affect (P. F. Lovibond & S. H.

Lovibond, 1995).

11.2.5.2. – Impact of Events Scale – Revised (IES-R)

The Impact of Events Scale – Revised or IES-R (D. S. Weiss & Marmar, 1997) was used to

assess the three classes of PTSD symptoms (namely, intrusion, avoidance, and hyper-


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arousal), as it is a well-established and recognised measure in the trauma field (see

Appendix L to view this scale). The IES-R scale is scored on a 5-point likert scale (0-4)

and has 22 items in total. The intrusion and avoidance subscales have 7 items and the

hyperarousal subscale has 6 items. Subscale scores are derived by calculating the mean

score for items that load on the subscale. Subscale scores can therefore range from a

minimum score of 0 to a maximum score of 4. A total score is derived by summing the

three subscale scores and can range from 0 to 12.

The 5-point likert scale asks people to consider how distressing a number of

“difficulties” had been for them from 0 “not at all” to 4 “extremely”. Scores on the IES-R

are interpreted in relation to their position on this likert scale. Severity levels or cut-off

scores have not been formulated for the IES-R and in fact the authors of the scale actively

argue against their use (D. S. Weiss, 2005).

The IES-R is always completed with reference to a traumatic event or series of

events. Weiss (1996) obtained reliabilities for the three sub-scales ranging between 0.77

(hyperarousal) and 0.85 (intrusion and avoidance) with a sample of emergency services

workers, whose reference point was a traumatic incident they had attended. Schreiber et al.

(2004) reported alphas ranging between 0.80 and 0.86 for the three subscales, with a

sample of Holocaust survivors measured before and after open-heart surgery with the

surgery being the reference point. Participants of the current study were asked to think

about whether they had experienced any of the symptoms listed on the scale in relation to

their Holocaust experiences in the past week. Reliabilities obtained with the current sample

were 0.88 for intrusion, 0.86 for avoidance, 0.87 for hyperarousal and 0.95 for the total

IES-R score. In support of its validity, Briere (1997, p. 131) reports that the IES-R reliably

differentiates between traumatised and non-traumatised study participants and reflects the

symptoms of PTSD as listed in the DSM-IV-TR.

11.2.5.3. – Post-Traumatic Vulnerability Scale (PTV)

The Post-Traumatic Vulnerability (PTV) Scale (Shillace, 1994) was used to measure

“paranoia” as referred to in the Holocaust survivor literature. The PTV is a 24 item, true-

false measure. Scores on the PTV can range between 0 and 24, with a score of 1 being

given to any item that is scored in the direction that suggests post-traumatic vulnerability.

The descriptions of paranoia suffered by survivors and descendants in the clinical literature

refer to fear and anxiety about safety and vulnerability of self, friends and family. Paranoia

scales tend to address non-relevant tangential issues such as the perception of mind control,


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evil spirits and common phobic reactions. Upon examination, it was felt that the items in

the PTV Scale more accurately reflect the clinical descriptions of paranoia in the survivor

and descendant populations. According to the author, the PTV scale measures: “A

perceived sense of defencelessness; a sense of insecurity and expectation that danger exists

and harm will occur; overvigilance and caution to protect self and loved ones (Shillace,

1996).” This scale has been found to have relatively high reliability (α = 0.79) with a

sample of undergraduate students (Shillace, 1996). The PTV scale was found to have a

reliability of 0.51 with the current study sample. While this reliability is quite low, it

should be noted that the reliability of the scale according to previous research was quite

adequate. Further, according to Streiner (2003), reliabilities between 0.50 and 0.60 are

acceptable for exploratory research. In addition, Shillace (1994) argued for the PTV's

particular usefulness in determining a perceived vulnerability as a result of a traumatic

experience in which defencelessness exists – a characteristic that certainly can be applied to

the experiences of many Holocaust survivors. A copy of this scale can be found in

Appendix M.

11.2.5.4. – Adult Attachment Scale (AAS)

The Adult Attachment Scale developed by Collins and Read (1990), based on Hazan and

Shaver’s (1987) attachment style measure, was used to measure adult/romantic attachment

dimensions (see Appendix N). Hazan and Shaver’s (1987) measure asked participants to

chose between three paragraph descriptions of attachment style corresponding to a secure,

avoidant, or anxious/ambivalent style. The problem with this approach was that

participants could not choose to endorse only part of these descriptions, if they only agreed

with them in part. Collins and Read (1990) divided these three paragraph into individual

statements making it easier for participants to endorse separate aspects of the three

attachment styles in Hazan and Shaver’s (1987) measure. Collins and Read (1990) also

added three new items to the measure. The AAS is an 18 item, 5-point likert scale (1-5)

measure. The three subscales of the AAS are attachment anxiety, comfort with depending

on others and comfort with closeness with others. Each subscale has 6 items that load on it.

Subscale scores are calculated by summing the scores given to items that load on them.

Subscale scores can therefore range between 6 and 30. In the current study, a composite

score for “positive attachment dimensions” was also created by summing the scores derived


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for the comfort with depending on others, and comfort with closeness with others

subscales. Scores for this composite scale can range between 12 and 60.

This scale was chosen because it provides the opportunity to determine a

participant’s attachment style [as a category within the four category (secure, fearful,

dismissing, or pre-occupied) paradigm of Bartholomew and Horowitz (1991)] as well as the

more recently preferred scale scores of attachment anxiety, and comfort with closeness and

dependency (Brennan, Clark, & Shaver, 1998). The scoring method used to derive a

participant’s attachment style in the four category paradigm was obtained from one of the

authors of the scale (Collins, 2004). The four category model of attachment as espoused by

Bartholomew and Horowitz (1991) is considered preferable to Hazan and Shaver’s (1987)

three category model as it delineates two styles of avoidant attachment behaviour (that is

dismissing and fearful – combined in the three category model as avoidant). The four

categories of attachment style, as defined by Bartholomew and Horowitz (1991) are

presented in Table 11.1. Table 11.1 Bartholomew and Horowitz’s (1991) definitions of their four categories of adult attachment Attachment Type Definition Secure A sense of worthiness (lovability) plus an expectation that other people are

generally accepting and responsive. Comfortable with intimacy and autonomy. Insecure Attachment Types Preoccupied A sense of unworthiness (unlovability) combined with a positive evaluation of

others. This combination of characteristics would lead the person to strive for self-acceptance by gaining the acceptance of valued others. Corresponds to Hazan and Shaver’s (1987) ambivalent category

Fearful A sense of unworthiness (unlovability) combined with an expectation that others will be negatively disposed (untrustworthy and rejecting). By avoiding close involvement with others, this style enables people to protect themselves against anticipated rejection by others.

Dismissing A sense of love-worthiness combined with a negative disposition toward other people. Such people protect themselves against disappointment by avoiding close relationships and maintaining a sense of independence and invulnerability.

According to Collins and Read (1990), the three subscales of the AAS have reasonable

reliability levels. Cronbach’s α for attachment anxiety was 0.72, for comfort with

dependence was 0.75 and for comfort with closeness was 0.69, with a sample of 406

undergraduate students. For the current study sample the reliability co-efficients were 0.77

for attachment anxiety and 0.85 for the composite scale combining comfort with closeness

with and dependence on others. The three scales have strong convergent validity,

correlating strongly with corresponding scales of other attachment measures. Sperling,


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Foelsch and Grace (1996) found strong and predictably directed correlations (ranging

between 0.50 and 0.84) between the subscales of the AAS and the subscales of the

Attachment Style Measure, the Attachment Style Inventory and the Anxious Romantic

Attachment Style questionnaire providing evidence of convergent validity for the AAS.

11.2.5.5. – Post-Traumatic Growth Inventory (PTGI)

Post-traumatic growth was measured with Tedeschi and Calhoun’s (1996) Post-traumatic

Growth Inventory (PTGI). A copy of this inventory is reproduced in Appendix O. This

measure was chosen as it was the one used by the only other study to examine post-

traumatic growth among Holocaust survivors (Lev-Wiesel & Amir, 2003). The PTGI is a

21 item, 6-point likert scale (0-5) measure. This questionnaire is made up of five subscales,

all of which have relatively good reliabilities with an undergraduate student sample: new

possibilities (α = 0.84), relating to others (0.85), personal strength (0.72), spiritual change

(0.85), appreciation of life (0.67). The total PTGI score has a reliability of 0.90. For the

current sample, the reliabilities were new possibilities (0.87), relating to others (0.89),

personal strength (0.89), spiritual change (0.84), appreciation of life (0.82), and total PTGI

score (0.94). Subscale scores are derived by summing all items that load on them and the

total PTGI is derived by summing all the items. Not all subscales have the same number of

items that load on them so therefore the ranges of possible scores for each differs. Relating

to others has 7 items and so scores can range between 0 and 35, new possibilities has 5

items and a score range of 0 to 25, personal strength has 4 items and a range of 0 to 20,

appreciation of life has 3 items and a range of 0 to 15 and spiritual change has 2 items and a

range of 0 to 10. The total score has a range from 0 to 105.

In the relating to others subscale, participants are asked to consider whether they

have experienced an increased sense of closeness with others, willingness to express

emotions, compassion for others, effort in relationships, knowledge that others can be

counted on in times of trouble, sense that people can be wonderful and that it is okay to

need others. The new possibilities subscale covers positive impacts of trauma such as the

development of new interests, a new path in life, the recognition that better things can be

done with life, the recognition of new opportunities as a result of trauma survival and a

readiness to try to change things that need changing. The posttraumatic growth aspect of

personal strength encompasses an increased sense of self-reliance, acceptance of events,

knowledge that difficulties can be handled and the discovery of strong inner-strength.


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Spiritual change aspects include a strengthening of religious faith as well as enhanced

focus on life’s’ priorities. Finally, the appreciation of life subscale addresses issues such as

an appreciation of the value of life and of every day or, in other words, a desire to live life

to its fullest.

The scoring of these subscales requires a summation of scores given to all items.

However, because the number of items that load on each scale differs, a comparison of

subscale scores is not possible in this format. In light of this, average scores for each

subscale were also calculated so that the relative rating given to each subscale could also be

deduced.

11.2.5.6. – COPE – Long Version

Coping strategies were assessed with the aid of the COPE – Long Version (Carver et al.,

1989). The COPE is a 60 item 4-point likert scale (1-4) questionnaire comprising 15

subscales. Subscale scores are derived by summing the 4 items that load on it creating a

score range between 4 and 16. The questions were framed so as to determine dispositional

coping strategies as opposed to being situation-specific. Table 11.2 provides definitions of

the 15 coping strategies as well as an indication of whether they are generally considered to

be a positive or negative influence on mental health by the scale authors (Carver et al.,

1989).

Correlation matrices between the 14 subscales of the COPE and the psychological

impact variables were examined. The coping strategies of behavioural disengagement,

mental disengagement, denial, substance use, focus on and venting of emotions and

religious coping were consistently positively related to negative impact variables and

negatively related to positive impact variables. This grouping is largely consistent with that

made by the authors of the COPE scale (Carver et al., 1989). The nine remaining

subscales/coping strategies assessed by the COPE are considered positive or functional by

the scales’ authors (Carver et al., 1989) and are consistently negatively related to negative

impact variables and consistently positively related to positive impact variables. These

coping strategies are acceptance, active coping, humour, planning, positive reinterpretation

and growth, restraint, suppression of competing activities and the use of emotional and

instrumental social support. The only departures from Carver et al’s (1989) categorisations

are the classification of religious coping as a negative influence (it was not described as

either negative or positive by Carver et al (1989)) and also focus on and venting of

emotions as a negative influence which was considered positive by the COPE authors


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(however they only considered it a positive influence if moderate and acknowledged it

could be a negative influence if extreme). In order to simplify the analyses and aid

understanding it was decided that all analyses considering coping strategies would use a

composite score for “maladaptive coping strategies” and a composite score for “adaptive

coping strategies” based on the groupings derived from the examination of correlation

matrices of data from this study. Scores for the “maladaptive coping strategies”

composite, with 24 items, can range between 24 and 80 while scores for the “adaptive

coping strategies” composite, with 36 items can range between 36 and 144. The two

composite scales were found to have relatively high reliability with a Cronbach’s α for the

maladaptive composite scale of 0.76 and 0.91 for the adaptive composite scale. No specific

information pertaining to the validity of the COPE could be located. A copy of the COPE

can be found in Appendix P while correlation matrices of the individual coping strategy

subscales with the psychological impact variables can be found in Appendix Q. Table 11.2. Definitions and categorisations of COPE subscales Subscale/ Coping Strategy

Carver, Scheier and Weintraub (1989) Current Study

Description of subscales Categorisation Categorisation Behavioural disengagement

reducing effort to deal with the stressor, even giving up the attempt to attain goals with which the stressor is interfering.

Negative Maladaptive

Denial refusal to believe that the stressor exists or of trying to act as though the stressor is not real


Mental disengagement use of mental strategies to avoid dealing with stressor such as day-dreaming


Substance Use turning to substances as a way of avoiding stressor Negative Maladaptive Acceptance accepting reality of situation Positive Adaptive Active coping taking active steps to try to remove or circumvent

the stressor or to ameliorate its effects. Positive Adaptive

Focus on and venting of emotions

focus on distress experiencing and ventilating those feelings.

Positive Maladaptive

Humour making light of the stressor by joking about it Positive Adaptive Planning coming up with action strategies, thinking about

what steps to take and how best to handle the problem.

Positive Adaptive

Positive reinterpretation and growth

construing a stressful transaction in positive terms Positive Adaptive

Restraint waiting until an appropriate opportunity to act presents itself, holding oneself back and not acting prematurely.

Positive Adaptive

Suppression of competing activities

putting other projects aside and trying to avoid becoming distracted by other events

Positive Adaptive

Use of emotional social support

seeking moral support, sympathy or understanding Positive Adaptive

Use of instrumental social support

seeking advice, assistance or information Positive Adaptive

Religious coping tendency to turn to religion in times of stress Not classified Maladaptive


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11.2.5.7. – Benevolence and Meaningfulness of the World sub-scales of the World

Assumptions Scale (WAS)

The benevolence and meaningfulness of the world subscales of the World

Assumptions Scale (Janoff-Bulman, 1996) were utilised in this study (see Appendix R). A

belief in the benevolence of the world is the belief that the world (in both its people and its

events) is a kind and caring place (Janoff-Bulman, 1992 p. 6). A person believes the world

is meaningful if they believe there is a predictable and understandable relationship between

a person’s actions and what events befall them. In other words, good things happen to

good people and bad things only happen to bad people or people who have behaved in such

a way as to deserve a negative consequence (Janoff-Bulman, 1992 p. 8). Both subscales

have been quoted as having quite reasonable reliabilities (Janoff-Bulman, 1996

benevolence = 0.87, meaningfulness = 0.76) with an undergraduate student sample. In the

current study the reliability co-efficients derived were 0.83 for benevolence and 0.75 for

meaningfulness. No validity information could be located for this scale. Participants are

invited to indicate their agreement or disagreement with 20 statements on a 6-point likert

scale (1-6). The benevolence subscale has 8 items while the meaningfulness subscale has

12 items. Subscale scores are derived by summing item scores (with a total of 6 items that

need reverse scoring overall). Benevolence scores range between 8 and 48 while

meaningfulness scores range between 12 and 72.

11.2.5.8. – Parental Care-giving Style Questionnaire (PCS)

The Parental Care-giving Style Questionnaire (PCS) asks participants to consider

their parent’s attachment behaviour towards them as they were growing up and so were

completed from the “child’s” perspective of the parent-child dyad (see Appendix S). The

PCS is a 12 item, 5-point likert scale (0-4) measure. The PCS is based on Hazan and

Shaver’s (1986, unpublished, cited in Collins & Read, 1990) paragraph descriptions of the

three parental care-giving styles of warm/responsive, cold/rejecting and

ambivalent/inconsistent. The three subscales, based on these paragraphs, each have 4 items

that load on them and since subscale scores are derived by summing, subscale scores range

between 0 and 16. A warm or responsive care-giving style as rated by the PCS is described

as warm, responsive, supportive and comfortable. A cold/rejecting style is characterised as

cold, distant, rejecting, non-responsive and a seeming lack of concern. An ambivalent or

inconsistent care-giving style is characterised by noticeably inconsistent reactions and

warmth, inability to show love, and seeming pre-occupation with own agendas.


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The paragraph descriptions of parental care-giving style were separated into single

statements and rated on a 5-point likert scale, akin to the method used by Collins and Read

(1990) in adapting Hazan and Shaver’s (1987) adult attachment descriptions. This likert

scale version of the questionnaire was first used by Walisever (1995). Walisever (1995)

did not cite any reliability data for the PCS she constructed and so the data from the current

sample was analysed to provide information about the measure’s reliability. As can be seen

in Table 11.3 all three subscales (both mother and father version) obtained quite high

reliability co-efficients. No validity information for this scale was reported by Walisever

(1995). Table 11.3. Reliability analysis results for the Parental Care-giving Style questionnaire Subscale Cronbach’s α Mother Warm/Responsive 0.92 (n =95) Mother Cold/Rejecting 0.82 (n = 95) Mother Ambivalent/Inconsistent 0.87 (n = 94) Father Warm/Responsive 0.90 (n = 91) Father Cold/Rejecting 0.80 (n = 91) Father Ambivalent/Inconsistent 0.82 (n = 91)

11.2.5.9. – Parental Fostering of Autonomy Subscale of the Parental Attachment

Questionnaire (PAQ-PFA)

The degree to which parents encourage their children’s independence/autonomy is often

used as an indicator of the success of the children’s separation-individuation in the

adolescent and young adult years. The measure chosen to address this issue in the current

study was the Parental Fostering of Autonomy Subscale of Kenny’s (1987) Parental

Attachment Questionnaire (PAQ-PFA). The PAQ-PFA was chosen because after perusing

the individual items/statements on numerous scales purporting to assess this issue, the

PAQ-PFA’s items most closely corresponded to descriptions of survivor and descendant

relations in the literature. The PAQ-PFA is a 14 item, 5-point likert scale (1-5). Scores for

the PAQ-PFA are derived by summing the scores given to each of the 14 items (after 7 of

the negatively worded statements have been reverse scored). Scores can range between 14

and 70. Participants were asked to reflect the degree to which their parents encouraged

their independence during adolescence and early adulthood. Kenny (1987) obtained a

Cronbach’s α of 0.88 for this subscale. However, this figure is based on the version of the

scale that considers both parents together. In this study, it was of interest to consider each

parent, mother and father separately. Therefore reliability analysis was conducted with the


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current study sample to provide reliability indicators for the scale when parents are

considered separately. The Cronbach’sα ’s obtained from the current study data were 0.93

when referring to a participant’s mother and 0.91 when based on a participant’s father (n =

95). Heiss, Berman and Sperling (1996) found this scale to be strongly negatively related

to scores on the parental over-protectiveness scale of the Parental Bonding Inventory,

attesting to its divergent validity. The Parental Attachment Questionnaire was viewed

positively in a review of measures designed to assess separation-individuation (Lopez &

Gover, 1993). A copy of this measure can be found in Appendix T.

11.2.5.10. – Lichtman Holocaust Communication Questionnaire (HCQ)

Researchers have measured communication about Holocaust experiences in a myriad of

ways. Therefore, the majority of research to date has measured this variable with adhoc,

constructed questionnaires rather than established questionnaires. Rather than construct a

new measure/questions as many have done, the current author chose to use the

questionnaire developed by Lichtman (1983), as it has been subsequently utilised in a

number of studies and appeared to have good construct/face validity in terms of the issues it

addresses. No reliability or validity statistics have ever been quoted for this scale. The

subscales and the reliabilities obtained with the sample of children of Holocaust survivors

in this study are presented in Table 11.4. Table 11.4. Reliability co-efficients for the Holocaust Communication Questionnaire and subscales

Subscale Number of items

Cronbach’s α

Total scale 19 0.80 (n = 44) Father’s affective communication about the Holocaust, as conveyed by father 1 Not computable Father’s frequent and willing discussion of his wartime experiences and the transmission of factual information.

3 0.80 (n = 62)

Father’s guilt-inducing communication 2 0.36 (n = 61) Father’s indirect communication about the Holocaust, as conveyed by father 1 Not computable Mother’s affective communication about the Holocaust, as conveyed by mother 1 Not computable Mother’s frequent and willing discussion of her wartime experiences and the transmission of factual information.

3 0.77 (n = 55)

Mother’s guilt-inducing communication 2 0.61 (n = 57) Mother’s indirect communication about the Holocaust, as conveyed by mother 1 Not computable Awareness of the Holocaust at a young age and its nonverbal presence in the home, as conveyed by either parent

3 0.47 (n = 68)

As can be seen, the reliability of the scales is quite variable with a number obtaining

quite reasonable reliability levels, while two scales have quite low reliabilities. In defence

of its continued use in the study, it should be noted that these reliability issues could not

have been determined prior to data collection. It should also be noted that the scales are


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mostly made up of a very small number of items which has been shown to have a negative

influence on Cronbach’s alpha calculations (Hair, Anderson, Tatham, & Black, 1998, p.

118). Certainly any future research study using this scale should consider attempting to

revise this measure to increase its reliability. However, given the hypothesised central role

played by communication about the Holocaust it was not possible to exclude the measure

from analyses in this study. A copy of this questionnaire can be found in Appendix U.

11.2.5.11. – Cohesion and Expressiveness Subscales of the Family Environment

Scale (FES)

The Cohesion subscale of the Family Environment Scale (Moos, 1974) was used to

measure family cohesion. The questions were phrased retrospectively, and participants

were asked to consider their family of origin. This subscale comprised 9 statements to

which a true or false answer was required. A raw score is derived by giving any positive

item as true and any negative item as false. This raw score is then converted to a

standardised score with the help of tables provided by Moos (1974). Standard scores for

the cohesion subscale range between 1 and 68. Tutty (1995) cites reliability co-efficients

ranging between 0.77 and 0.86 for this subscale. Moos (1990) cites reliability co-efficients

for this subscale ranging from 0.76 to 0.79 among a variety of samples (including

distressed families). With the current sample a reliability co-efficient of 0.40 was obtained.

While it is granted that this reliability is far from ideal, again this could not have been

predicted apriori. Given the key role family cohesion is hypothesised to play within the

family dynamics and their role in trauma transmission its omission from the analysis

would have had strong repercussions. As cited earlier, Streiner (2003) was of the view that

lower reliabilities are acceptable when the research is exploratory in nature. In further

support of this scales use, strong positive correlations between scores on the FES cohesion

scale and the affective involvement scale of the Family Assessment Device (r = 0.68, p <

0.001) , the enmeshment/disengagement scale of the Structural Family Interaction Scale –

Revised (r = 0.89, p < 0.001 ) the cohesion scale of the Family Adaptability and Cohesion

Evaluation Scale III (r = 0.86, p < 0.001) as found by Perosa and Perosa (1990) more than

attest to this scale’s convergent validity.

Another subscale of the Family Environment Scale (Moos, 1974), Expressiveness,

was used to measure general communication within the family unit. As with the Cohesion

subscale, the Expressiveness subscale comprised 9 true/false statements. The

expressiveness subscale is scored in the same way as the cohesion subscale with the


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exception that standard scores range between 15 and 73. Again, participants completed this

scale in relation to their family of origin. Tutty (1995) suggests the reliability of this scale

ranges between 0.46 and 0.63. Moos (1990) quotes co-efficients between 0.58 and 0.69

from various samples (including various types of distressed families) for this subscale.

With the current sample, the reliability co-efficient was 0.84. No information regarding

validity of this measure was located.

The FES was chosen as a measure for family communicativeness and cohesion

because it has been used in a number of studies with the Holocaust survivor population. By

using only the two subscales of interest, there was the added benefit of minimising the

number of items that participants had to complete within the questionnaire booklet. A copy

of the two FES subscales used could not be appended due to copyright restraints.

11.2.5.12. – Control questionnaire for historical influences.

The data collection stage for this study began shortly before the Indian Ocean Tsunami

which occurred on 26 December 2004. Given that such a large scale event had the

potential to alter many people’s mood when completing the questionnaires, a control

questionnaire was devised. This questionnaire asked participants to list any historical

events that they felt had a negative impact on them at the time they were completing the

questionnaires. They were also asked to give a rating between 1 and 10 of the strength of

that impact. On the same questionnaire, participants were asked to nominate any

significant personal events in a similar manner. A copy of this questionnaire can be found

in Appendix V. No participant indicated undue negative affects by contemporary historical

events that would preclude their inclusion in the study sample.

11.2.5.13. – Omission of unresolved mourning measure.

There are very few measures of unresolved mourning in existence. The one study

located that used such a measure (specifically the Grief Measurement Scale) with a

survivor sample concluded that there were problems with its construct validity, particularly

as it applied to the specific Holocaust survivor population (Chayes, 1987). In addition, it

was also thought that survivor respondents may have a response bias when completing such

a measure to reflect perhaps a high degree of unresolved mourning so as to not dishonour

the memory of their family members who died during the Holocaust. Such measures ask

the respondent to contemplate issues such as how often they think about the lost loved one

which are questions which would obviously elicit a biased response, if honouring the


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memory of loved ones was of concern. Therefore the issue of unresolved mourning was

not directly measured in the study but, the variables theorised to be affected by it, are.

11.2.5.14. – Ordering of questionnaires in questionnaire booklets.

Table 11.5 outlines which questionnaires were completed by each generation and the

ordering of those questionnaires within the questionnaire booklets. Each participant

completed a demographic questionnaire about themselves, and children and grandchildren

were asked to fill out demographic questionnaires for any ancestors applicable to the study

who were not participating themselves. In this way the influence of ancestral demographic

variables could be examined for all participants even if their parents or grandparents did not

participate in the study. Copies of the demographic questionnaires appear in Appendix W.

Within the three generation questionnaire booklets, questionnaires were ordered so that the

more potentially distressing scales such as the DASS and the IES-R were separated. While

the ordering of questionnaires was largely the same for the children and grandchildren of

survivors, the ordering was different for survivors. This was because there were more

questionnaires about symptoms which needed to be spread out amongst fewer more

positive questionnaires. Table 11.5. Order and content of questionnaire booklets

Holocaust Survivors Children of Holocaust Survivors Grandchildren of Holocaust Survivors

Parental Care-giving Style Questionnaire


Parental Attachment Questionnaire – Parental Fostering of Autonomy Subscale

Parental Attachment Questionnaire – Parental Fostering of Autonomy Subscale

Adult Attachment Scale Family Environment Scale – Cohesion and Expressiveness Subscales

Family Environment Scale – Cohesion and Expressiveness Subscales

COPE Lichtman’s Holocaust Communication Questionnaire

Depression Anxiety Stress Scales Depression Anxiety Stress Scales Depression Anxiety Stress Scales World Assumptions Scale – Meaningfulness and Benevolence of the World Subscales

COPE COPE

Shillace PTV Scale Adult Attachment Scale Adult Attachment Scale Impact of Events Scale - Revised Shillace PTV Scale Shillace PTV Scale Post-traumatic Growth Inventory World Assumptions Scale –

Meaningfulness and Benevolence of the World Subscales

World Assumptions Scale – Meaningfulness and Benevolence of the World Subscales

Participant Demographics Participant Demographics Participant Demographics Open Ended Page Open Ended Page Open Ended Page Child of Survivor Parent

Demographics Survivor Parent Demographics Survivor Grandparent Demographics


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11.3. – Description of Sample Obtained

11.3.1. – Description of Holocaust Survivor Sample

A total of 27 Holocaust survivors participated in the study of whom 14 (52%) are male and

13 (48%) are female. Their average current age is 76.93 years with a range of 62 to 100

years. Their average age during the Holocaust (as operationalised by their age in 1945) was

17.33 years with a range of 2 to 41 years.

Education levels of the participants are as follows: 4% (1) have attained

primary/elementary school level, 52% (14) have attained high school level and 44% (12)

have some form of tertiary qualifications. Close to nine out of ten participants (24, 89%)

identify themselves as Jewish, with 7% (2) reporting they are atheist and 4% (1) Christian.

In terms of marital status, 52% (14) are married, 37% (10) are widowed and 11% (3) are

divorced or separated.

In terms of country of residence, 56% (15) currently live in Australia, 30% (8) in

America, 7% (2) in England, 4% (1) in Germany and 4% (1) in Israel. The average amount

of time that survivors spent in Europe after the war before emigrating was 5.17 years.

There is a relatively good range when perusing the country of birth data with 26%

(7) having been born in Austria, 19% (5) in Hungary, 15% (4) in Poland, 11% (3) in the

Netherlands, 11% (3) in Germany, 7% (2) in Belgium, 7% (2) in Lithuania, and 4% (1) in

Latvia.

With regard to their experiences during the Holocaust, 44% (12) spent time in either

a concentration or labour camp. A number indicate that they had been in hiding either as a

child (22%, 6) or as an adult (7%, 2) with the help of false papers or under an assumed

identity. One survivor participant indicated they had been part of the resistance or a

partisan group. No participant indicated that they had endured any medical

experimentation during the Holocaust. In the immediate aftermath of the war, 37% (10)

spent some time in a displaced persons camp.

It should be noted that 22% (6) of the survivor sample managed to escape Nazi

persecution before 1945 and so did not endure the full extent of traumas suffered by others

from their country of origin. Three of these participants are from Germany with one

escaping in 1937 and two in 1939. The other three participants who escaped are from

Austria with two escaping in 1939 and one in 1941. Given that Nazi persecution of Jews in

Germany started in 1933 when Hitler came to power and in 1938 after the Anschluss in

Austria, it is valid to state that all of these six participants endured some persecution.


206

Therefore, while they did escape some of the more severe forms of traumatisation, they did

endure the beginning stages of what has become known as the Holocaust and so can still be

categorised as Holocaust survivors. Differences between this group of 6 survivors (who

escaped prior to 1945) and other survivors in this sample are assessed as part of the

analyses presented in this chapter.

While 19% (5) survivor participants believe they are the sole survivor of their

family, 44% (12) indicate that they were alone (without family members) during at least

part of the Holocaust. In terms of specific losses of family members, 44% (11) say their

mother was killed, 39% (10) say their father was killed, with 27% indicating both parents

had been killed. Almost six in ten of those who had siblings (12, 44%) indicated that at

least one of their siblings had been killed (7, 58%). Of the six participants who had a

spouse, two (33%) had been killed. Of the participants who still had living grandparents at

the outset of the war (14, 52%), 79% (11) indicate that at least one of their grandparents

had been killed during the war.

The reason for persecution was included as potentially influential variable in the

Model of the Differential Impact of the Holocaust; however the sample of survivors

obtained are all Jewish (although the reader should note the current author’s attempts to

obtain non-Jewish survivors in Appendix H). Therefore analysis of Jewish versus non-

Jewish survivors is not possible. Almost eight in ten (21, 78%) indicate that they still

actively participate and practise their Jewish faith.

Just over four in ten (11, 42%) of the survivor sample are members of some kind of

survivor organisation. Just over a quarter (7, 27%) report they have been in individual

therapy at some stage in their life compared to 73% (19) who did not report any therapy

participation. No survivor participants indicate participation in any form of group therapy.

11.3.2. – Description of Children of Holocaust Survivor Sample

There are 69 children of survivors in the sample obtained for this study, with 24 males

(35%) and 45 females (65%). Their average age is 51.22 years and ranges between 29 and

61. The vast majority have a tertiary education (94%, 65), with 4% (3) attaining a high

school certificate and one person not responding to the question. The most frequently cited

religion is Judaism (87%, 60), followed by none/atheism (9%, 6), Christianity (1%, 1) and

other/not specified (1%, 1). Finally, with regard to marital status, 61% (42) reported that

they are currently married, 17% (12) divorced/separated, 10% (7) single/never married, 7%

(5) defacto, and 3% (2) widowed.


207

The vast majority of participants in this sample have two survivor parents (51,

74%). Twelve (17%) of the 69 children of survivors have a survivor father only and six

(9%) have a survivor mother only. The average time lapse/delay between the end of the

war (1945) and the birth of children of survivor participants was 8.26 years, with a range of

0 to 31 years. One participant was born while their survivor parent/s were in a displaced

persons camp, however 27 (39%) were born in Europe before their parents immigrated to

other continents.

Almost a third (20, 29%) of the child of survivor sample were born in Australia,

with 21% (14) in America, 12% (8) in Poland, 9% (6) in Hungary, 9% (6) in Israel, 4% (3)

in Czechoslovakia, 4% (3) England, 3% (2) in Austria, 3% (2) in the Netherlands, 2% (1)

in Canada, 2% (1) in Denmark, 2% (1) in France, and 2% (1) in Germany. One participant

did not indicate their country of birth. Over half (42, 61%) of the children of survivor

sample currently live in Australia, followed by 28% (19) in America, 6% (4) in New

Zealand, 3% (2) in Canada, and 1% (1) in Israel.

Among the child of survivor sample, 32% have never been in any form of

therapy/counselling, 65% had been in individual therapy, 26% have been in group or

relationship therapy with 24% indicating they have been in both individual and group

therapy. Almost half (45%) report being a member of some form of survivor descendants’

organisation.

The average age of survivor mothers in 1945 of the child of survivor sample was

24.18 and ranged between 5 and 41 years. The average age of survivor fathers in 1945 of

the child of survivor sample was 27.84 and ranged between 2 and 49 years. There was a

reasonable spread of survivor parent Holocaust experiences: 69% of mothers and 70% of

fathers were camp survivors, 22% of mothers and 23% of father were in hiding or had some

other non-camp Holocaust experiences and 10% of mothers and 7% of fathers endured part

of the Holocaust but had escaped before 1945 to another country.

11.3.3. – Description of Grandchildren of Holocaust Survivor Sample

Among the 28 grandchildren of survivors who participated in the study, 8 (29%) are male

while 20 (71%) are female. The average age of grandchildren participants is 25.36 years,

with a range of 20 to 34 years. For 36% (10), both parents are children of survivors, 46%

(13) have a child of survivor mother only and 18% (5) have a child of survivor father only.

In terms of number survivor grandparents, 18% (5) have one, 46% (13) have two, 4% (1)

has three and 32% (9) have all four grandparents as survivors.


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Two thirds (18, 64%) of the grandchildren sample were born in Australia, followed

by 14% (4) in America, 11% (3) in Israel, 4% (1) in the Netherlands, 4% (1) in New

Zealand and 4% (1) in South Africa. Almost three quarters (20, 71%) of the grandchildren

in the study currently live in Australia, with a further 21% (6) in America, 4% (1) in Israel

and 4% (1) in New Zealand.

Less than six out of ten grandchildren of survivors in the sample have been in any

form of therapy: 42% (11) have been in individual therapy and 15% (4) have been in both

group and individual therapy, leaving 42% (11) with no therapy experience. Just over one

in ten (12%, 3) indicate they are a member of some form of descendant of survivors

organisation.

As far as education level goes, 4% (1) say they have no formal education, 11% (3)

have a high school education while the vast majority have obtained some form of tertiary

education (86%, 24). Not surprisingly, given the age profile of this group, 89% (25) report

their marital status as single/never married with the remainder living in some form of

relationship (defacto 7% (2) and married 4% (1)). One quarter (75%, 21) identify as Jewish

with 14% (4) reporting their religion as none or atheist and 11% (3) citing some other non-

specified religion.

11.4. – Statistical Analysis Approach

Because a large focus of the thesis and the study is to look at demographic subgroups

within the survivor and descendant population, it is necessary to stratify the sample in many

ways. In so doing, the sample sizes in these sub-samples are often very small (n < 10).

Having to work with small sub-samples has several repercussions for the statistical analyses

that can be validly conducted.

Firstly, it should be noted that while it would be desirable to test the multiple

relationships presented in the model via multivariate analyses this was not at all possible.

The sample size requirements for such tests were prohibitive. Therefore, a largely

univariate or bivariate approach has been used out of necessity. The statistical tests that are

used include t tests, ANOVAs, 2χ tests and zero-order bivariate correlations. Statistical

tests designed to measure the relationship between two variables with a third potentially

influential or confounding variable controlled for (namely ANCOVA, mixed design

ANOVA and partial correlations) were also used so that inter-relating IVs were taken into


209

account as much as the sample sizes and available statistical tools (that could be used

validly with the small samples) would allow.

The determination of the relative importance of model variables in predicting

survivor and descendant scores on psychological impact variables was one of the key aims

of the empirical study. Ideally a multivariate approach would be used to ascertain the

relative importance/rank-ordering of variables. However, because it was not possible to do

this validly (because of the small sample sizes derived) another method of ranking was

used. The proportion of variation in psychological impact variables accounted for by all

remaining model variables (namely influential psychological processes, family interaction

variables and demographic variables) was calculated in the form of 2η or 2r . These 2η and 2r were then ranked in order to determine a rank ordering of each class of

variables. Ranking variables by effect sizes in this way as opposed to using significance

level as a ranking tool means that the ranking is not unduly influenced by varying sample

sizes.

Small sample sizes often lead to a decreased ability to obtain statistically significant

results because of a lack of power. When sample sizes are small, much larger differences

between groups, or much larger correlations are required before the significance threshold

is reached. The traditional significance level of 0.05 is set to keep the incidence of Type I

errors (incorrectly rejecting the null hypothesis) to a minimum. When power is low the

incidence of Type II errors (incorrectly retaining the null hypothesis) is increased. While

Type I errors are certainly undesirable, Type II errors are by no means a more palatable

alternative.

There are three main ways to increase power and decrease the likelihood Type II

errors: increase the sample size, increase the size of the effect or increase the significance

level (Keppel & Wickens, 2004; Tilley, 1999). The difficulties in obtaining the sample

derived for the study are evidence that it would be too time-consuming and costly to

increase the sample size. Increasing the effect size is something that largely relates to

experimental manipulations where it is relatively easy to increase the differentiation

between experimental groups by manipulating levels of stimuli, but is not something that is

applicable in this case. This leaves the third option of increasing the significance level as

the only real option left in this case.


210

To decrease the incidence of Type II errors a more liberal significance level can be

used so that the threshold for a statistically significant result is easier to reach. It was

decided that the threat of Type II errors was quite high for this study, given the large

number of analyses based on small samples, and that the significance level of 0.10 be used

to counter this. Results that have a probability of less than 0.10, but more than 0.05, are

clearly delineated in the text. Results based on samples of 30 or more (or where all groups

in the analysis are more than 10) use only the 0.05 significance level.

The use of the more liberal significance level of 0.10 is also more palatable because

this study is largely exploratory in nature. In many cases, it assesses variables that have not

been assessed before. It is within such a spirit of exploration that a more liberal approach

to statistical significance is perhaps more permissible. The writer is, however, aware of the

limitations of such an approach and recognises and points out to the reader, that larger

samples and further testing are required to validate any findings reported herein.

A small note is also required in relation to the assumptions of the parametric

statistical tests used. The homogeneity of variance assumption, applicable to the t-tests and

ANOVAs reported in the current thesis, was breached numerous times. In the case of t-

tests, SPSS reports test results that are based on the assumption of equal variances as well

as the assumption of unequal variances. When the homogeneity of variance assumption has

been breached for a t-test result, the results of the t-test which control for the breach (the

version that does not assume equal variances) are reported where the test remains

significant. This will be obvious to the reader via the reporting of adjusted degrees of

freedom. In the case of ANOVAs, the non-parametric equivalent of an ANOVA, namely

the Kruskal-Wallis test, is used.

For the sake of brevity, statistics assessing the already well-established relationships

between the negative psychological symptoms in the psychological impacts column of the

model (i.e., depression, anxiety, paranoia, PTSD symptoms, and insecure attachment) are

presented in Appendix X. Correlation matrices for the influential psychological process

variables as well as the family interaction variables have also been appended (Appendices

Y and Z respectively). These statistics are not required to answer any hypotheses. The

reader should note that these correlations are all in the direction they would be expected to

be.


211

Chapter Twelve – Empirical Assessment of Influential Psychological Processes and Modes

of Intergenerational Transmission Modes among Survivors and Descendants

In this chapter, the version of the model of the differential impact of Holocaust trauma

across three generations put forward at the end of Chapter Three (before the demographic

variables were added) is assessed empirically. This section of the model is focussed on

establishing the relationships between symptoms among survivors and descendants and the

proposed modes of trauma transmission that attempt to explain why descendants suffer

similarly to the survivors themselves.

Figure 12.1 reproduces the section of the model which will be assessed in this

chapter. The variables of world assumptions and coping strategies which have been

labelled the influential psychological processes in the model are proposed as factors that

will be correlated with the severity of symptoms/psychological impacts experienced by the

survivors and descendants. The family interaction variables of parent-child attachment,

family cohesion, encouragement of independence, general family communication and

communication about Holocaust experiences are the proposed modes by which Holocaust

trauma is transmitted intergenerationally. In a statistical sense, they are argued to mediate

the relationship between ancestor (for example Holocaust survivor) and descendant (for

example child of survivors) scores on psychological impact variables.


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Psychological Impacts

of the Holocaust Influential

Psychological Processes


of Trauma

1st G

ener

atio

n (S

urviv

ors)


Dimensions • Post-traumatic

Growth


2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)


Dimensions


• Parent-Child Attachment • Family Cohesion • Encouragement of Independence • General Family Communication • Communication about Holocaust

experiences

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Su

rvivo

rs)


Dimensions


• Parent-Child Attachment • Family Cohesion • Encouragement of Independence • General Family Communication

Figure 12.1. Section of the Test Model of the Differential Impact of Holocaust Trauma on Three Generations to be tested

in this chapter

In order to test the veracity of the full mechanisms of this model, it will be

necessary to establish statistically the following five relationships:

1. that the influential psychological processes are correlated with the severity or level of

psychological impact variables among survivors and their descendants (and identify the

strongest predictors) – MH1 and MH2 (see Chapter Ten, Section 10.4.1.1);

2. that the proposed modes of trauma transmission/family interaction variables are

correlated with the severity or level of psychological impact variables and influential


213

psychological process variables among descendants of survivors (and identify the strongest

predictors) – MH4 to MH8 (see Chapter Ten, Section 10.4.1.2);

3. that ancestor scores on psychological impact variables are correlated with descendant

scores on psychological impact variables;

4. that the relationship between ancestor and descendant scores on psychological impact

variables is mediated by the proposed modes of trauma transmission/family interaction

variables; and

5. that there is a dissipation/lessening of the effects of Holocaust trauma as evidenced by

improvement in scores on psychological impact variables with each generational removal

from the Holocaust – DH11 (see Chapter Ten, Section 10.4.2).

There are insufficient family dyads/pairs within the sample derived for this study to

enable correlation analyses between ancestor and descendant scores on psychological

impact variables (point three) and thus it is also not possible to test for the mediation of this

relationship by the proposed modes of trauma transmission/family interaction variables

(point four). Specifically, only six survivor-child of survivor pairs/dyads and nine child of

survivor-grandchild of survivor pairs/dyads remain, after screening for missing data and

potential confounding demographic variables (such as the number of ancestors directly or

indirectly affected by the Holocaust) is conducted. However, it is possible to test points

one, two and five and the results of these tests are reported in this chapter.

12.1. – The Role of Influential Psychological Processes in Predicting Severity of


In this section, the ability of the influential psychological processes of coping strategies and

world assumptions to predict survivor and descendant scores on the psychological impact

variables outlined in the model is examined.

12.1.1. – Influence of Coping Strategies

Correlations between the composite scores for maladaptive and adaptive coping strategies

and the psychological impact variables of depression, anxiety, post-traumatic vulnerability,

post-traumatic stress disorder (PTSD) symptoms, positive and negative romantic

attachment dimensions and post-traumatic growth (PTG) are reported in this section. These

correlations serve to address the hypothesis that maladaptive coping strategies will be

positively related to negative psychological symptoms and negatively related to positive

psychological dimensions while adaptive coping strategies will be negatively related to


214

negative psychological symptoms and positively related to positive psychological

dimensions (MH1).

Table 12.1 presents the correlations between maladaptive and adaptive coping

scores and the psychological impact variables for each of the three generations.

Maladaptive coping is statistically significantly correlated with more variables than

adaptive coping, suggesting it is perhaps more influential in determining the severity of

symptoms experienced than adaptive coping. The four statistically significant correlations

with adaptive coping are all in the anticipated direction (with a negative relationship with

negative variables and a positive relationship with positive variables). While the

statistically significant correlations with maladaptive coping outnumber the statistically

significant correlations with adaptive coping it is interesting to note that all of the

statistically significant maladaptive coping correlations are with negative impact variables

(with correlations with positive variables not reaching significance). Correlations between

maladaptive coping and depression, anxiety and posttraumatic vulnerability/paranoia are all

of a similar magnitude across the generations. It is interesting to note that there is a much

stronger correlation between maladaptive coping and PTSD symptoms (as measured by the

IES-R) among Holocaust survivors compared to the other negative impact variables

measured. Table 12.1. Correlations between coping strategies and psychological impact variables among Holocaust survivors and their descendants Survivors

(n = 23) Children of Survivors

(n = 68) Grandchildren of Survivors

(n = 28) COPE

Maladaptive COPE

Adaptive COPE

Maladaptive COPE

Adaptive COPE

Maladaptive COPE

Adaptive DASS Depression 0.39 # 0.11 0.30 * - 0.39 ** 0.51 ** - 0.16 DASS Anxiety 0.37 # 0.15 0.33 ** - 0.11 0.40 * - 0.02 PTV 0.40 # - 0.24 0.38 ** 0.00 0.21 - 0.48 ** IES-R Total 0.63 ** - 0.03 Not applicable Not applicable AAS Positive Dimensions

- 0.19 0.44 * - 0.04 0.42 *** 0.13 - 0.05

AAS Negative Dimensions

0.05 - 0.26 0.35 ** - 0.07 - 0.12 0.06

PTGI Total - 0.02 0.23 Not applicable Not applicable Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory * p < 0.05, ** p < 0.01, # p < 0.10 (denoted only when n < 30). 12.1.2. – Influence of World Assumptions of Benevolence and Meaningfulness

The relationship between world assumptions and psychological impact variables are

considered in this section. Again, correlation analyses are used. The hypothesis, in relation

to world assumptions, is that the strength of belief that the world is benevolent and


215

meaningful will be negatively related to negative psychological symptoms and positively

related to positive psychological dimensions (MH2).

Correlations for each generation are presented in Table 12.2. All statistically

significant correlations are in directions consistent with the hypothesis with stronger beliefs

in world benevolence and meaningfulness having a positive influence on scores on

psychological impact variables, with the one exception of the positive correlation between

meaningfulness and anxiety for Holocaust survivors. Overall, it seems that the belief in

world benevolence is more influential than the belief in world meaningfulness. While there

are three statistically significant correlations between impact variables and meaningfulness

for the Holocaust survivor sample, the two statistically significant correlations with

benevolence are of a larger magnitude. Table 12.2. Correlations between the assumptions of world benevolence and world meaningfulness and psychological impact variables among Holocaust survivors and their descendants Survivors


(n = 68) Grandchildren of Survivors

(n = 28) WAS – Benevolence WAS – Meaningfulness WAS – Ben. WAS – Mean. WAS – Ben. WAS – Mean. DASS Depression - 0.07 0.30 - 0.31 * - 0.22 - 0.50 ** - 0.27 DASS Anxiety 0.14 0.50 * 0.07 0.10 - 0.56 ** - 0.30 PTV - 0.61 ** - 0.36 - 0.44 *** 0.08 - 0.56 ** - 0.41 * IES-R Total - 0.03 - 0.06 Not applicable Not applicable AAS Positive Dimensions 0.67 ** 0.51 * 0.19 0.05 0.37 # 0.24 AAS Negative Dimensions - 0.02 0.14 - 0.25 * - 0.03 - 0.12 0.06 PTGI Total 0.22 0.17 Not applicable Not applicable Notes. WAS = World Assumptions Scale, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30).

12.1.3. – Summary of the Role of Influential Psychological Processes

A summary of the statistically significant relationships between the influential

psychological processes of coping and world assumptions and the psychological impact

variables is presented in Table 12.3. Looking at these relationships graphically it is clear

that the use of maladaptive coping strategies has a key role in determining the severity of

symptoms experienced across the three generations, and that maladaptive coping strategies

are much more influential or predictive than the use of adaptive coping strategies. The

assumption of world benevolence (that the world is a kind and caring place) is clearly also

more determinant than the assumption of world meaningfulness (that the world is a

predictable and understandable place).

The hypotheses about the roles played by world assumptions and coping strategies

are supported with the further clarification of the type of world assumption (benevolence)


216

and the type of coping strategies (maladaptive) that are the most strongly predictive. These

results support the presence of world assumptions and coping strategies in the model of the

differential impact of Holocaust trauma as influential psychological processes in predicting

the severity of psychological impact among survivors and descendants. Table 12.3. Relationships between influential psychological processes and psychological impact variables WAS –

Benevolence WAS – Meaningfulness

COPE Maladaptive

COPE Adaptive

Survivors DASS Depression Positive relationship

DASS Anxiety Positive relationship

Positive relationship

PTV Negative relationship

Negative relationship


IES-R Total Positive relationship


AAS Positive Dimensions




PTGI Total Children of Survivors

DASS Depression Negative relationship


DASS Anxiety Positive relationship








Grandchildren of Survivors

DASS Depression Negative relationship


DASS Anxiety Negative relationship








Notes. WAS = World Assumptions Scale, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory. Blank cells indicate the absence of a statistically significant relationship.

12.2. – The Relationship between Posttraumatic Growth and Psychological Impact

Variables

A test of the hypothesis that posttraumatic growth will be positively associated or

correlated with negative symptom levels (MH3) is presented in this section. Table 12.4


217

reports the correlations between the psychological impact variables and the total score and

subscale scores of the Posttraumatic Growth Inventory. There are very few correlations

that reach even the p < 0.10 level. The correlations with the IES-R which measures PTSD

symptoms and the anxiety subscale of the DASS are consistent with previous research that

found a positive relationship between symptoms and growth. However, the negative

correlation with the depression subscale of the DASS and the positive correlation with

positive attachment dimensions, as measured by the AAS, suggest the opposite – that

growth and negative symptoms are polar opposites. Also, interestingly, there is no notable

correlation in either direction between growth and vulnerability. Looking at the particular

subscales that are correlated the most with depression and positive attachment dimensions,

the pattern of results obtained is not that surprising. The negative correlation with a

recognition of personal strength and depression scores is certainly predictable. Likewise,

the finding that an increased ability to relate to others would be positively associated with

attachment dimensions, such as comfort with closeness and dependence on others is also

intuitively understandable. Table 12.4. Relationships between posttraumatic growth and psychological impact variables among survivors (n = 23) PTGI Total Score PTGI Subscales

Relating to others New Possibilities Personal Strength Spiritual Change Appreciation of life

DASS Depression - 0.30 - 0.33 - 0.07 - 0.38 # 0.13 - 0.36 DASS Anxiety 0.11 0.01 0.26 - 0.03 0.37 # - 0.01 PTV - 0.06 - 0.19 - 0.10 0.02 0.15 0.20 IES-R Total 0.29 0.31 0.04 0.19 0.55 ** 0.37 # AAS Positive Dimensions

0.35 0.49 * 0.35 0.16 0.15 0.09


- 0.13 - 0.20 - 0.13 - 0.05 - 0.19 - 0.11

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory * p < 0.05, ** p < 0.01, # p < 0.10 (denoted only when n < 30).

12.3. –The Role of the Proposed Modes of Trauma Transmission/Family Interaction

Variables

In this section, the degree to which the family interaction variables (which are the proposed

modes of trauma transmission) are related to/can predict scores on psychological impact

variables and influential psychological processes is considered.

12.3.1. – Influence of Parent-child Attachment Dimensions

It is hypothesised that negative parent-child attachment dimensions, such as the degree of

coldness and ambivalence, will be positively associated with negative psychological

symptoms and negatively associated with positive psychological symptoms, while positive


218

parent-child attachment dimensions, such as perceived parental warmth, will be negatively

associated with negative psychological symptoms and positively associated with positive

psychological dimensions (MH4). Both children of survivor/s and grandchildren of

survivor/s perceptions of their parents on parent-child attachment dimensions of warmth,

coldness and ambivalence and how they relate to their scores on psychological impact

variables and influential psychological variables are considered in this section.

Correlations between children of survivor/s perceptions of their survivor parents’

warmth, coldness and ambivalence and children of survivor/s scores on psychological

impact and influential psychological process variables, as displayed in Table 12.5, are all

largely in the expected direction (positive dimensions correlating negatively with negative

variables and positively with positive variables and the opposite for negative dimensions).

Because each parent was considered separately it is possible to compare the strength of

relationships with parent-child attachment between mother and father ratings. To eliminate

confounds with survivor status of parents, these correlations were conducted within the

children of survivor sample subset for whom both parents are survivors. Overall, there are

stronger and more statistically significant relationships with maternal than paternal

dimensions, suggesting Holocaust survivor parent gender (as does parent gender in the

normal population) plays a moderating role. Table 12.5. Correlations between children of survivor’s scores on psychological impact and influential psychological process variables and their perceptions of their survivor parents (among children with two survivor parents only [n = 51])

PCS – Warmth PCS – Coldness PCS – Ambivalence Survivor

Mother Survivor Father

Survivor Mother

Survivor Father

Survivor Mother

Survivor Father

Impact Variables DASS Anxiety - 0.31 * - 0.28 * 0.29 * 0.32 * 0.35 * 0.10 DASS Depression - 0.37 ** - 0.48 *** 0.48 *** 0.48 *** 0.30 * 0.29 * PTV - 0.21 - 0.17 0.22 0.05 0.06 0.10 AAS Positive Dimensions 0.52 *** 0.40 ** - 0.32 * -0.18 - 0.37 ** - 0.36 * AAS Negative Dimensions - 0.33 * - 0.29 * 0.48 *** 0.25 0.24 0.25 Influential Psychological Processes COPE Maladaptive - 0.10 - 0.17 0.12 0.17 0.18 0.30 * COPE Adaptive 0.30 * 0.17 - 0.15 - 0.02 - 0.26 - 0.12 WAS – Benevolence 0.33 * 0.21 - 0.32 * - 0.15 - 0.21 - 0.13 WAS – Meaningfulness 0.12 0.15 - 0.27 - 0.10 - 0.05 - 0.11 Notes. PCS = Parental Care-giving Style Questionnaire, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale. * p < 0.05, ** p < 0.01, *** p < 0.001. There are far fewer correlations that reach significance for the grandchildren of

survivor/s sample than there are for the children of survivor/s sample, when considering

relationships between perceptions of parent-child attachment and psychological impact

variables (see Table 12.6). However, part of the reason for this is the much smaller sample


219

size involved (n = 10) meaning much larger correlation co-efficients are required to reach

even the more liberal probability level of 0.10 or less. The correlations that are statistically

significant are for the most part in the area of adult attachment dimensions. Again, it is the

maternal parent-child attachment dimensions that are more strongly related than paternal

dimensions however the size of the correlations are quite large for both parents. All

correlations are in the direction consistent with MH4. Table 12.6. Correlations between grandchildren of survivors’ scores on psychological impact and influential psychological process variables and their perceptions of their child of survivor parents (among those with two child of survivor parents only [n = 10])

PCS – Warmth PCS – Coldness PCS – Ambivalence Child of

Survivor Mother

Child of Survivor Father

Child of Survivor Mother


Child of Survivor Mother


Impact Variables DASS Anxiety - 0.30 - 0.05 0.39 - 0.01 0.47 0.16 DASS Depression - 0.11 - 0.15 0.04 - 0.07 0.47 0.37 PTV 0.15 0.10 - 0.09 - 0.31 0.17 0.02 AAS Positive Dimensions 0.88 ** 0.60 # - 0.89 *** -0.74 * - 0.78 ** - 0.70 * AAS Negative Dimensions - 0.92 *** - 0.35 0.98 *** 0.62 * 0.73 * 0.51 Influential Psychological Processes COPE Maladaptive - 0.30 - 0.05 - 0.08 - 0.28 0.24 0.01 COPE Adaptive - 0.42 - 0.17 0.57 # 0.26 0.15 0.10 WAS – Benevolence 0.04 - 0.19 - 0.18 0.08 - 0.02 0.28 WAS – Meaningfulness - 0.30 - 0.31 0.08 0.45 0.15 0.43 Notes. PCS = Parental Care-giving Style Questionnaire, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale. * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30). 12.3.2. – Influence of Family Cohesion

It is hypothesised that a curvilinear/U-shaped relationship will exist between negative

psychological symptoms and family cohesion (with very low and very high cohesion

associated with higher symptom levels than mid-range scores) and an that an inverted U-

shaped relationship will exist between positive psychological dimensions and family

cohesion (MH5). In this section, the relationships between family cohesion in survivor and

child of survivor families and children’s scores on psychological impact variables and

influential psychological process variables are assessed via correlation analyses to test this

hypothesis. Table 12.7 presents the results of these correlation analyses. As can been seen,

there are numerous statistically significant linear correlations between children of

survivor/s perceptions of cohesion in their family of origin and their scores on both

psychological impact and influential psychological process variables. While two of these

statistically significant correlations are quadratic/curvilinear in nature as predicted by MH5,

it is notable that the remaining four statistically significant correlations are linear and not

curvilinear in nature. The four linear correlations agree with the two curvilinear


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correlations that low cohesion has a negative influence, but disagree that high cohesion also

has a negative influence. It is interesting, however, that it is the two psychopathological

measures of anxiety and depression that appear to be negatively influenced by either very

high or very low cohesion.

Within the grandchildren of survivor/s sample, only two correlations reached

significance with a linear relationship between positive attachment dimensions and

perceptions of family cohesion and a quadratic/curvilinear relationship between the

negative attachment dimension of attachment anxiety and cohesion. Table 12.7. Correlations between children and grandchildren of survivor/s scores on impact and influential process variables and their perceptions of their family of origin cohesion

Children of Survivors (n = 66) Grandchildren of Survivors (n = 28) Linear Quadratic Linear Quadratic Impact Variables DASS Anxiety - 0.40 ** 0.47 * 0.03 0.23 DASS Depression - 0.61 *** 0.68 *** 0.01 0.20 PTV - 0.16 0.22 - 0.07 0.24 AAS Positive Dimensions 0.50 *** 0.50 0.49 ** 0.49 AAS Negative Dimensions - 0.35 ** 0.35 - 0.26 0.55 ** Influential Psychological Processes COPE Maladaptive - 0.10 0.10 0.01 0.02 COPE Adaptive - 0.41 ** 0.42 0.03 0.16 WAS – Benevolence 0.28 * 0.28 0.04 0.07 WAS – Meaningfulness 0.15 0.26 0.05 0.12 Notes. FES = Family Environment Scale, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale * p < 0.05, ** p < 0.01, *** p < 0.001.

Figures 12.2 and 12.3 present graphical representations of the three statistically

significant curvilinear relationships with perceptions of family cohesion reported in Table

12.7. It is particularly noteworthy that all of the children of survivor/s who score above

normal on anxiety (as marked on the graph by the horizontal line) perceive their family

cohesion level to be at one of the extremes (either enmeshed or disengaged). The pattern of

extreme cohesion scores accompanying above normal depression scores is not as clearly

curvilinear as is the case for anxiety. It is noteworthy that the very high depression scores

are mostly associated with very low cohesion (or disengagement). Among grandchildren of

survivor/s, the influence of perceptions of family cohesion on attachment anxiety are also

U-shaped and again it is notable that the scores that fall above the normative mean score for

this scale correspond to extreme cohesion scores representing enmeshment or

disengagement.


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0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00

FES Cohesion Score

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Figure 12.2. Scatterplots of children of survivor anxiety and depression with child of survivor perceptions of family cohesion Note. The horizontal lines represent the upper most limits of scores within the normal range on the DASS subscales as provided by the scale authors (S. H. Lovibond & P. F. Lovibond, 1995).

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00

FES Cohesion Scale Score

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Figure 12.3. Scatterplot of grandchildren of survivor/s Negative Attachment Dimension/Attachment Anxiety with grandchildren of survivor/s Perceptions of Family Cohesion Note. The horizontal line represents the normative score for the attachment anxiety subscale of the AAS as reported by Collins and Read (1990).

12.3.3. – Influence of Parental Encouragement of Independence

It is hypothesised that the degree to which parents are encouraging of their children’s

attempts to establish independence, when children are attempting to establish and assert

their autonomy in their late teen and early adult years (MH6), will be negatively associated


psychological dimensions. This section reports correlation analyses between perceptions of

parental encouragement of independence on children of survivors’ and grandchildren of

survivors’ scores and their scores on psychological impact and influential psychological

process variables. Perceptions of maternal and paternal encouragement of independence


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were measured separately. In order to examine the relative importance of maternal versus

paternal influence without clouding the issue with survivor status of the parent, these

analyses were conducted with children whose parents are both survivors.

The correlations for children of survivor/s and grandchildren of survivor/s with their

perceptions of parental facilitation of autonomy/encouragement of independence are

presented in Table 12.8. As with parent-child attachment dimensions, all correlations with

parental facilitation of independence are in the anticipated direction with negative

symptoms decreasing, and scores on positive dimensions of attachment increasing with

increasing encouragement of independence on the part of parents. This is certainly true

when maternal encouragement is considered; however none of the correlations with

paternal encouragement reached the necessary probability level. Additionally, none of the

influential psychological process variables correlate statistically significantly with either

maternal or paternal encouragement/facilitation of independence. Table 12.8. Correlations between child and grandchild of survivor scores on impact and influential process variables and their perceptions of their survivor and child of survivor parent’s facilitation of independence/fostering of autonomy

Children of Survivor perceptions of Survivor Parents (among children with two survivor parents

[n = 50]) PAQ – Fostering of Autonomy

Grandchildren of Survivor Perceptions of Child of Survivor Parents (among those with two child of survivor parents only

[n = 10]) PAQ – Fostering of Autonomy

Mother Father Mother Father Impact Variables DASS Anxiety - 0.24 - 0.07 - 0.34 - 0.15 DASS Depression - 0.33 * - 0.23 - 0.15 - 0.44 PTV - 0.13 - 0.12 0.16 - 0.24 AAS Positive Dimensions 0.47 ** 0.18 0.79 ** 0.28 AAS Negative Dimensions

- 0.25 - 0.16 - 0.85 ** - 0.12


COPE Maladaptive - 0.14 - 0.19 0.02 0.15 COPE Adaptive 0.23 - 0.01 - 0.48 - 0.03 WAS – Benevolence 0.26 0.13 - 0.10 - 0.40 WAS – Meaningfulness 0.04 0.20 - 0.30 - 0.18 Notes. PAQ – Parental Attachment Questionnaire, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale * p < 0.05, ** p < 0.01.

12.3.4. – Influence of Level of Family Communication

It is hypothesised that general communicativeness within the family unit (MH7) will be

negatively associated with negative psychological symptoms and positively associated with

positive psychological dimensions. The general level of communicativeness or

expressiveness in children of survivor/s and grandchildren of survivor/s nuclear families is


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considered, in this section, in terms of how it relates to their scores on psychological impact

variables.

Table 12.9 reports the results of correlation analyses between the expressiveness

subscale of the Family Environment Scale (FES) and the psychological impact variable

scores of children of survivor/s and grandchildren of survivor/s. There are only three

statistically significant correlations among either children of survivor/s or grandchildren of

survivor/s between family expressiveness and psychological impact variables; however all

three are in the direction hypothesised. It is interesting that the positive romantic

attachment dimensions, of comfort with closeness and dependence on others, are the

strongest correlations for both generations. Table 12.9. Correlations between children and grandchildren of survivors’ scores on impact and influential psychological process variables and their perceptions of their family of origin expressiveness

FES – Expressiveness Children of survivors

(n = 67) Grandchildren of survivors

(n = 28) Impact Variables DASS Anxiety - 0.18 - 0.01 DASS Depression - 0.27 * 0.03 PTV - 0.13 - 0.08 AAS Positive Dimensions 0.39 ** 0.44 * AAS Negative Dimensions - 0.22 - 0.27 Influential Psychological Processes COPE Maladaptive 0.04 - 0.11 COPE Adaptive 0.24 * 0.23 WAS – Benevolence 0.23 0.02 WAS – Meaningfulness 0.15 - 0.03 Notes. FES = Family Environment Scale, DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale * p < 0.05, ** p < 0.01.

12.3.5. – Influence of Communication about the Holocaust

It is hypothesised that negative modes of communicating about the Holocaust, such as

guilt-inducing, indirect and non-verbal communication, will be positively associated with

negative psychological symptoms and negatively associated with positive psychological

symptoms, while positive modes of communicating about the Holocaust, such as frequent,

willing and open discussion will be negatively associated with negative psychological

symptoms and positively associated with positive psychological dimensions (MH8). As

was the case with parent-child attachment dimensions and parental facilitation of

independence, only data for children with both survivor parents are presented here (see

Table 12.10), so that the issue of number of survivor parents does not confound the

analysis, as parental gender is also considered.


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Table 12.10. Correlations between modes of communication about Holocaust experiences and children with two survivor parents’ (n = 51) scores on psychological impact variables. Guilt Inducing

communication about the Holocaust

Indirect communication about the Holocaust

Affective communication about the Holocaust

Non Verbal Presence of

the Holocaust

Frequent and Willing communication about

the Holocaust

Survivor Mother

Survivor Father

Survivor Mother

Survivor Father

Survivor Mother

Survivor Father

Survivor Mother

Survivor Father

Impact Variables DASS Anxiety 0.19 0.16 0.03 - 0.00 0.10 - 0.05 0.38 ** 0.08 - 0.01 DASS Depression 0.04 0.28 - 0.03 - 0.15 0.13 0.23 0.40 ** - 0.10 - 0.24 PTV 0.01 0.15 - 0.18 - 0.00 0.17 0.19 0.39 ** - 0.19 0.21 AAS Positive Dimensions

- 0.15 - 0.21 0.03 0.24 - 0.28 - 0.35 * - 0.19 0.15 0.23


0.16 0.14 - 0.01 - 0.13 0.29 * 0.28 0.32 * 0.02 - 0.04


WAS – Benevolence

- 0.16 0.05 0.01 0.08 - 0.39 ** - 0.07 - 0.17 0.04 0.04

WAS – Meaningfulness

- 0.12 0.00 - 0.02 0.16 - 0.36 * - 0.12 - 0.05 - 0.00 0.02

COPE Maladaptive 0.14 0.11 0.02 - 0.02 0.31 * - 0.04 0.12 - 0.20 0.12 COPE Adaptive - 0.17 - 0.22 - 0.03 0.19 - 0.16 0.03 - 0.10 - 0.08 0.10 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale * p < 0.05, ** p < 0.01. Given the possible number of results, there are relatively few statistically significant

correlations between modes of communication about the Holocaust and children of

survivor/s scores on psychological impact variables. However, the correlations that do

reach significance are all in the direction predicted. The two communication methods that

statistically significantly relate to psychological impact variables are two negative modes;

namely affect-laden communication and non-verbal presence and they do so in the

anticipated direction (that is they are associated with higher scores on negative variables).

Again, it is the maternal line that is more predictive than the paternal line. The positive

mode of communication (frequent and willing communication) is not statistically

significantly correlated with any of the psychological impact variables which adds further

support to the notion that it is not so much the content of the communication that is

potentially damaging but the way in which it is conveyed.

12.3.6. – Summary of the Influence of Family Interaction Variables

Tables 12.11 and 12.12 provide a visual summary of the relationships between the family

interaction variables/proposed modes of trauma transmission and children of survivor/s and

grandchildren of survivor/s scores on psychological impact and influential psychological

process variables. All of the relationships between family interaction/intergenerational

transmission variables and children of survivor/s and grandchildren of survivor/s scores on


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psychological impact variables are in the hypothesised directions. Generally there are more

statistically significant correlations for maternal interaction variables when parental gender

is considered separately.

Among the children of survivor/s it is the parent-child attachment, family cohesion

and communication about the Holocaust variables that are related to the largest number of

psychological impact variables from the model. Parental warmth is associated with

positive outcomes, while parental coldness and ambivalence are associated with negative

outcomes. The more cohesive a family is perceived to be, the more positive the effects are

for the children; however, for both depression and anxiety the u-shaped relationships

suggest that too much cohesion (enmeshment) is as detrimental as not enough

(disengagement). The styles of communication most predictive are the negative modes of

affective communication and the silence of a non-verbal unspoken presence of the

Holocaust which both have negative influences on psychological functioning.

Among the grandchildren of survivor/s, parent-child attachment is again the factor

that is linked to the most number of variables; however family cohesion and parental

fostering of autonomy are also implicated more than once. The influence of maternal

attachment behaviour is again much stronger than paternal attachment behaviour. Notably

all the statistically significant correlations for this generation are with the romantic

attachment dimensions and not with any of the psychopathology measures.


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Table 12.11. Statistically significant relationships between proposed modes of trauma transmission/family interaction variables and psychological impact variables and influential psychological processes among children of survivors Parental Care-giving Style

Questionnaire Parental Attachment

Questionnaire – Fostering of Autonomy

Family Environment

Scale – Cohesion

Family Environment

Scale – Expressiveness

Holocaust Communication Questionnaire

Maternal Paternal Maternal Paternal Maternal Paternal Non-Verbal Presence


DASS Depression

Negative relationship with warmth Positive relationship with coldness and ambivalence



U-shaped relationship



DASS Anxiety Negative relationship with warmth Positive relationship with coldness and ambivalence

Negative relationship with warmth Positive relationship with coldness



PTV Positive relationship





Positive relationship with affective communication about the Holocaust



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Parental Attachment Questionnaire –

Fostering of Autonomy

Family Environment

Scale – Cohesion

Family Environment


Holocaust Communication Questionnaire

Maternal Paternal Maternal Paternal Maternal Paternal Non-Verbal Presence


Positive relationship with warmth Negative relationship with coldness and ambivalence

Positive relationship with warmth Negative relationship with ambivalence




Negative relationship with affective communication about the Holocaust


COPE Maladaptive

Positive relationship with ambivalence

Positive relationship with affective


COPE Adaptive Positive relationship with warmth


WAS – Benevolence

Positive relationship with warmth Negative relationship with coldness



Negative relationship with affective



Negative relationship with affective


Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale Blank cells denote an absence of statistically significant relationships.


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Table 12.12. Statistically significant relationships between proposed modes of trauma transmission/family interaction variables and psychological impact variables and influential psychological processes among grandchildren of survivors Parental Care-giving Style

Questionnaire Parental Attachment

Questionnaire – Fostering of Autonomy

Family Environment

Scale – Cohesion

Family Environment


Maternal Paternal Maternal Paternal Psychological Impacts

DASS Depression

DASS Anxiety PTV AAS Negative Dimensions






Positive relationship with warmth





COPE Maladaptive

COPE Adaptive Negative relationship with warmth Positive relationship with coldness

WAS – Benevolence



Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale Blank cells indicate the absence of a statistically significant relationship.

12.4. – Intergenerational Differences

In this section, the hypothesis that there will be a dissipation of the impact of the Holocaust

with each generational separation from the Holocaust (DH11) will be examined.

12.4.1. – Intergenerational Differences on Psychological Impact Variables

Tables 12.13 and 12.14 present comparisons between the three generations of survivors and

normative data on the psychological impact variables from the model being tested in the


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current thesis. Table 12.13 reports mean scores on these scales while Table 12.14 reports

the percentages of each generation that fall within the normal range as defined by measure

authors. Table 12.13. Intergenerational differences in scores on psychological impact variables (including statistically significant differences)

Survivors (n = 23)

Children of survivors (n = 69)

Grandchildren of survivors (n = 27)

Top Score in Normal Range

Normative Data

Impact Variables DASS Depression 6.13 (6.32) 7.50 (9.10) 6.22 (7.84) 9.00 5.55 DASS Anxiety 4.87 (6.04) 3.43 (3.96) 5.19 (5.99) 7.00 3.56 PTV Scale 10.83 (4.28) 10.66 (4.73) 10.48 (4.37) - 8.69 AAS Positive Dimensions

38.29 (8.20) 40.32 (9.66) 40.11 (10.36) - 39.5

AAS Negative Dimensions *

12.00 (3.79) 14.71 (6.26) 16.52 (5.44) - 16.2

Notes. AAS Negative Dimensions = Kruskal-Wallis 2χ (2) = 7.38, p < 0.05 Normative data for DASS based on a sample of 1,771 members of the general adult population (Crawford & Henry, 2003). Normative data for the PTV scale based on a convenience sample of 686 undergraduate students and adults from the general population (Shillace, 1994). Normative data (provided to only one decimal point) for the AAS based on a sample of 406 undergraduate students (Collins & Read, 1990). * p < 0.05

Firstly, in relation to the psychopathology measures of depression, anxiety, and

posttraumatic vulnerability/paranoia there are some counter-intuitive findings, but some

that, despite this, are consistent with meta-analytic findings. Scores on depression and

anxiety certainly do not follow the predicted decrease with each generational separation

from the Holocaust. In fact, it is the grandchildren that score the highest on anxiety. While

none of these differences are significant, it is interesting to note that the result of

grandchildren scoring higher than children of survivors is consistent with the seemingly

incongruous findings of the meta-analysis conducted for the current thesis which are of a

similar pattern. The only variable to follow the predicted pattern is posttraumatic

vulnerability/paranoia which clearly decreases through the generations. However, all three

generations almost uniformly score above the normative mean scores for depression,

anxiety and posttraumatic vulnerability shown in Table 12.13. Attempts were made to find

more recent normative data for the PTV scale (or at least data collected after the September

11 terrorist attacks in 2001) but were unsuccessful. However, the normative data obtained

for the DASS is relatively recent and it is interesting to note that the survivor and

descendant groups score higher than the norms even within the current world political

climate. Turning to the romantic attachment dimensions tabulated in Table 12.13, children

of survivor/s and grandchildren of survivor/s score higher on positive dimensions than the

survivors but not statistically significantly so. The statistically significant difference


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between the generations for the negative attachment dimension of attachment anxiety is

curiously in the exact opposite direction to what is predicted in the hypothesis, with

attachment anxiety increasing rather than decreasing through the generations. However,

levels seen for the grandchildren of survivor/s, which is the highest of the three generations,

is at a similar level to the normative score (which is based on a similarly aged group).

Another way of considering the psychological impact variables across the

generations is to look at the percentage of each generation group that score within the

normal range (or are classified with a secure attachment for the attachment variable). To be

consistent with the hypothesis, it would be expected that with each generational removal

from the Holocaust, the percentage classified within normal range or securely attached will

increase. An examination of Table 12.14 demonstrates that this is the case for depression

but not for anxiety (which is consistent with the mean score results presented in Table

12.13). The percentages of each generation that fall within the normal range for the DASS

are still lower than those found for the general population. Also there is a decrease in the

proportion of each generation that can be classified as secure. Table 12.14. Intergenerational differences in the percentage of samples scoring within normal range of tests Survivors

(n = 23) Children of survivors

(n = 69) Grandchildren of survivors

(n = 27) General

Population DASS Depression 70% 75% 78% 82% DASS Anxiety 78% 86% 78% 94% Attachment 61% 50% 48% 56% Note. DASS = Depression Anxiety Stress Scales For attachment the percentage represents the percentage classified with a secure attachment style. Percentage of normal population classified as within normal range for the DASS derived from normative data published in Crawford and Henry (2003) based on a sample of 1,771 members of the general adult population. Percentage of normal population generally classified with a secure attachment style based on Hazan and Shaver (1987).

12.4.2. – Intergenerational Differences on Influential Psychological Processes

In this section, intergenerational differences on the two influential psychological process

variables of coping and world assumptions are assessed. This involves comparisons

between the generations on scores on the COPE and the benevolence and meaningfulness

scales of the WAS (see Table 12.15).


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Table 12.15. Intergenerational differences in scores on influential psychological process variables (including statistically significant differences) Survivors

(n = 23) a Children of survivors

(n = 69) b Grandchildren of survivors

(n = 27) c COPE Scales • Maladaptive 42.22 (8.65) 40.52 (7.52) 40.66 (8.34) • Adaptive 101.61 (15.88) 95.12 (16.90) 90.96 (17.52)

WAS Scales • Assumption of world benevolence 30.04 (6.92) b 34.38 (7.00) a 34.55 (7.67) • Assumption of world meaningfulness 32.08 (9.15)c 33.08 (7.41) c 37.46 (10.77) a b

Note. WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.

There are no statistically significant differences between the generations in the level

of usage of maladaptive or adaptive coping strategies. However, it is interesting to note

that the use of adaptive coping strategies decreases with each generational removal from

the Holocaust. Usage levels of maladaptive coping strategies are also slightly higher

among survivors, but their usage levels are much more uniform across the three

generations.

In relation to world assumptions, the results are mostly consistent with the

dissipation hypothesis, with improvements being noted with generational separation from

the Holocaust. Certainly, survivor beliefs in world benevolence and meaningfulness are

statistically significantly lower than at least one of the descendant groups. It is interesting

to note that a noticeable jump in the belief of world benevolence occurs for the children of

survivors, whereas the increase in the belief in world meaningfulness occurs only at the

grandchildren of survivor stage. Could it be that it takes further separation from the events

of the Holocaust for beliefs that the world is fair and just to return to more normal levels?

Unfortunately, no normative data with a non-traumatised sample could be located for the

World Assumptions Scale. It would be of interest to note how survivor and descendant

scores on this measure compare to a general population sample.

12.3.3. – Intergenerational Differences on Perceptions of Family Interaction

In this section, differences between how children of survivors view their parents and how

grandchildren of survivors view their parents are examined. To be consistent with the

hypothesis that there will be a gradual improvement with each generational separation from

the Holocaust (DH11), it is hypothesised that child of survivor parents will be viewed more

positively than survivor parents. The results reported in this section are supportive of this

hypothesis.


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Table 12.16 presents perceptions of survivors and children of survivors as parents in

terms of parent-child attachment dimensions of warmth, coldness and ambivalence as well

as the degree to which they encouraged/facilitated their children’s independence. Overall,

children of survivors are perceived more positively by their children than survivors in terms

of these parenting dimensions. Three of these differences reached statistical significance.

Survivor mothers are rated as having been less warm (t (75) = 2.74, p < 0.01) than child of

survivor mothers, while survivor fathers are rated as having been less warm (t (71) = 2.51,

p < 0.05) and less facilitating of their children’s independence (t (28.98) = 3.89, p < 0.01)

than child of survivor fathers. Table 12.16. Mean differences in ratings of survivor parents versus child of survivor parents on parent-child attachment dimensions and parental facilitation of independence

Perception of Survivor Parents Perception of Child of Survivor Parents Mother n = 55 n = 22 • PCS – Warm ** 8.38 (5.28) 11.89 (4.51) • PCS – Cold 2.95 (4.03) 1.41 (3.00) • PCS – Ambivalent 5.15 (4.89) 3.86 (5.15) • PAQ – Fostering of autonomy 43.47 (14.96) 48.86 (14.49)

Father n = 61 n = 12 • PCS – Warm * 8.52 (5.05) 12.42 (4.10) • PCS – Cold 3.70 (4.07) 1.67 (3.63) • PCS – Ambivalent 5.38 (4.38) 4.33 (4.72) • PAQ – Fostering of autonomy ** 45.30 (14.07) 54.21 (7.84)

Notes. PCS = Parental Care-giving Style questionnaire, PAQ = Parental Attachment Questionnaire * p < 0.05, ** p < 0.01.

On the family cohesion and expressiveness scales of the Family Environment Scale (FES),

the families of origin of the children of survivor/s (where the parents are the survivors) are

rated more negatively than the grandchildren of survivor/s families of origin. Specifically,

children of survivor/s rate their families as less cohesive and statistically significantly less

expressive or communicative then grandchildren of survivor/s rate their families (see Table

12.17). Table 12.17. Mean differences in ratings of survivor versus child of survivor families on family cohesion and expressiveness

Survivor Parent families (n = 67)

Child of Survivor Parent Families (n = 28)

Normative Score for General Population

Normative Score for Distressed Families

Cohesion 42.04 (22.57) 48.18 (21.82) 49.88 38.24 Expressiveness ** 36.23 (18.15) 50.07 (15.65) 49.70 44.60

Notes. FES = Family Environment Scale. Normative data sourced from Moos (1974). “Distressed families” include families with issues surrounding psychiatric diagnosis, children in crisis, alcohol abuse, and criminal records. ** p < 0.01.

In relation to normative scores for the FES, cohesion within survivor parent families

is rated notably lower than for the general population, but higher than normative data


233

collected from distressed families. Cohesion within families with at least one parent who is

a child of survivors is very close to the normative score for the general population. Among

survivor families expressiveness is rated very much lower than both the normative score for

the general population and for distressed families. In stark contrast to this is the level of

expressiveness in the families of the next generation, which is very close but higher than

the normative score for the general population (and significantly higher than that noted in

the survivor parent families).


The model of the differential impact of Holocaust trauma across three generations has been

tested segmentally in this chapter. To test the model fully it would be necessary to:

1. Establish that the influential psychological processes could predict the severity or level

of psychological impact variables among survivors and their descendants.

2. Establish that the proposed modes of trauma transmission/family interaction variables

could predict the severity or level of psychological impact variables and influential

psychological process variables among descendants of survivors.

3. Establish that ancestor scores on psychological impact variables could predict

descendant scores on psychological impact variables.

4. Establish that the relationship between ancestor and descendant scores on psychological

impact variables is mediated by the proposed modes of trauma transmission/family

interaction variables.

5. Establish the dissipation/lessening of the effects of Holocaust trauma by improvement in

scores on psychological impact variables with each generational removal from the

Holocaust.

In relation to point one, it was established that the influential psychological process

variables in the proposed model, coping strategies and world assumptions, could both be

used to predict survivor and descendant scores on psychological impact variables. It was

further established that maladaptive coping strategies are more strongly related to

psychological variables than adaptive coping strategies and that the belief in world

benevolence is more strongly related to them than the belief in world meaningfulness.

Point two seeks to quantify the strength of the relationship between the family

interaction variables (which are the proposed modes of trauma transmission) and the

psychological impact and influential psychological process variables. To this end, it was

determined that all five of the family interaction variables, namely parent-child attachment,


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parental fostering of autonomy, family cohesion, family expressiveness and communication

about the Holocaust, are related to the varying numbers of the psychological impact and

influential psychological process variables. All statistically significant relationships are in

the directions hypothesised.

Based on the current sample, it appears that the parent-child attachment dimensions

of parental warmth, coldness and ambivalence are certainly among the most predictive of

the family interaction variables. Maternal attachment behaviour is much more strongly

related to descendant outcomes than paternal attachment behaviour. Family cohesion was

the next most strongly predictive variable for children of survivor/s and grandchildren of

survivor/s outcomes.

In terms of communication about the Holocaust on the part of survivors parents to

their children, a very strong pattern emerged with the negative communication modes of

affective communication (where Holocaust experiences are communicated in a heavily

negative-affect laden way) and non-verbal communication (which implies a non-verbal

ambiguous presence of the Holocaust in the home) being clearly the most related to

children of survivor/s scores on psychological impact variables. It is interesting to note the

lack of statistically significant relationships with the positive frequent and willing

communication about the Holocaust (given the extensive anecdotal literature attesting to its

positive influence). In addition, the fact that there are no statistically significant

relationships with guilt-inducing communication about the Holocaust (which is also affect-

laden) is puzzling given the strong relationships with affective communication. Affective

communication refers to the affective state of the survivor when relaying their Holocaust

experiences to their children. Perhaps when a survivor had strong affective reactions when

talking about their experiences (either anger or noticeable grief and sadness), their children

were deeply affected by the sight of their visibly affected survivor parent. On the other

hand guilt-inducing communication refers to situations where for example a child may have

been disobedient and the parent referred to their Holocaust experiences while disciplining

the child (for example “How can you do this to me after all I went through”). While both

styles of communication are laden with affect, perhaps it is the kind of communication

tapped by the affective communication subscale that reflects parental vulnerability which in

turn could be argued to be the most detrimental to impressionable children.

Communication about the Holocaust is a more powerful predictor than general


235

communication among family members: this hints at the important role that the knowledge

of parental Holocaust survivorship has for the children of survivor/s generation.

The disparate magnitudes and numbers of correlations with parental fostering of

autonomy and family cohesion are also interesting to note. Given the large amount of

discourse in the literature about the difficulties children of survivor/s face/faced during the

separation/individuation phase, it was expected that parental fostering of autonomy would

be a strong predictor of children of survivor/s scores on psychological impact variables.

Problems with separation/individuation are seen to be symptomatic of problematic family

cohesion and the two are certainly related (both theoretically and statistically in the current

study data set). However, family cohesion is more strongly and more frequently related to

psychological impact scores than parental fostering of autonomy. Partial correlation

analyses with both family cohesion and parental fostering of autonomy, alternately

controlling for the influence of the other, led to the same results: family cohesion remained

statistically significantly related to all of the variables it did before partialling out parental

fostering of autonomy and parental fostering of autonomy was no longer statistically

significantly correlated to anything once family cohesion was partialled out. This suggests

that while separation-individuation problems (as measured in this study by parental

fostering of autonomy) are symptomatic of family cohesion problems, it is the family

cohesion problems overall and not those specifically related to the separation-individuation

phase that are the more determinant of psychological symptom and dimension scores.

Figure 12.4 provides a visual summary of the relative importance of the predictive

variables from the model of the differential impact of Holocaust trauma across three

generations. As can be seen, the ordering of the importance of influential psychological

process variables and intergenerational transmission/family interaction variables is exactly

mirrored across the three generations. The ordering is determined based on the number of

statistically significant correlations as well as the magnitude of correlations reported

throughout this chapter.

Among the influential psychological process variables, it is the use of maladaptive

coping strategies that is the most strongly predictive of scores on psychological impact

variables. The two world assumptions dimensions of world benevolence (that the world is

a kind and caring place) and meaningfulness (that the world is a predictable and fair place)

are more strongly related to psychological impact scores than the use of adaptive coping

strategies.


236

Among the transmission variables, parent-child attachment clearly is a very

powerful force in determining the psychological health of children, followed by family

cohesion. It is interesting to note that for the children of survivors, parental communication

about the Holocaust is ranked third, above parental encouragement of independence and

more tellingly above general family communication. So within a survivor family, the

extent to which a survivor communicated with their children about their Holocaust

experiences and the way in which they did this is more important than how communicative

they were on any other aspect of life.

It should be noted by the reader that the current author acknowledges that the rank

ordering of the transmission modes/family interaction variables via correlations is not as

ideal as it would be via multiple regressions. However, the sample sizes involved

precluded the valid conduct of such analyses (as evidenced by uninterpretable and

nonsensical output derived when these analyses were attempted).

Psychological Impact

Variables Ranking of Influential

Psychological Processes Ranking of Modes of

Intergenerational Transmission of Trauma

1st G

ener

atio

n

(Sur

vivor

s)

Depression Anxiety Paranoia PTSD Symptoms Romantic Attachment Dimensions Post-traumatic growth

1. Maladaptive coping strategies

2. Assumption of World Benevolence

3. Assumption of World Meaningfulness

4. Adaptive coping Strategies

2nd G

ener

atio

n

(Chi

ldre

n of

Sur

vivor

s)

Depression Anxiety Paranoia Romantic Attachment Dimensions





1. Parent-Child Attachment (especially maternal)

2. Family Cohesion 3. Communication about

Holocaust experiences (specifically via affective or non-verbal modes)

4. Encouragement of Independence (maternal)

5. General Family Communication

3rd G

ener

atio

n

(Gra

ndch

ildre

n of

Su

rvivo

rs)





4. Adaptive coping strategies


2. Family Cohesion 3. Encouragement of

Independence (maternal) 4. General Family Communication

Figure 12.4. Ranking (from most important to least important) of Influential Psychological Processes and Family Interaction Variables/Proposed Modes of Trauma Transmission in terms of their relative importance in predicting scores on Psychological Impact Variables


237

As was mentioned at the outset of this chapter, data restrictions precluded the

assessment of points three and four (the relationship between ancestor and descendant

scores on psychological impact variables and the mediation of this relationship by family

interaction variables). However, there is substantial evidence from the literature with other

populations to support these relationships. As was discussed in Chapter Three, higher rates

of psychopathology among the children of people with psychopathological symptoms or

disorders has been established in the general population. The mediation of parent and child

symptom levels by parent-child attachment has been established in at least two studies (see

Section 3.1.2 of Chapter Three). The potential mediatory role of the remaining family

interaction processes of family cohesion, parental fostering of autonomy, general

communication and also communication about Holocaust experiences (specifically for the

Holocaust population) have yet to be sufficiently tested.

The hypothesised dissipation of the impact of the Holocaust with generational

separation from the Holocaust, as stated in point five, has been tested with the current study

data. There is support for the dissipation hypothesis in relation to post-traumatic

vulnerability/paranoia and the world assumptions of benevolence and meaningfulness.

However, the findings in relation to depression and anxiety certainly do not fit into the neat

linearly decreasing pattern that was hypothesised. The fact that the upturn in anxiety levels

among grandchildren of survivor/s found with the current study data replicates the pattern

found in the meta-analyses, also reported in the current thesis, “begs the question” of

whether this upturn is a statistical anomaly or reflective of a real pattern. If it is, then the

question of why grandchildren of survivor/s are more anxious than their parents needs to be

asked. It is acknowledged that there are many factors, both personal to the grandchildren of

survivor/s as well as at a community, national and global level that could lead to the

younger generation feeling more anxious. Clearly, the reason for the disparity in anxiety

levels between the generations is an area that requires further investigation. However,

despite the differences between generations on psychological impact variables, survivors

and their descendants still score less favourably than the general population (as represented

by normative data for the measures used in the current thesis).

An improvement in family interaction patterns was clearly noted to correspond with

successive generational removal from direct Holocaust trauma. Perceptions of child of

survivor parents were certainly improved in comparison to perceptions of survivor parents

in relation to attachment patterns and the degree to which they were perceived to encourage


238

their children’s independence. Marked improvements were also seen in the general family

atmosphere variables of cohesion and expressiveness.

Overall, no contradictory results were obtained in relation to the model of the

differential impact of Holocaust trauma that has been tested in this chapter. The model has

been further refined by prioritising/establishing the relative importance of the proposed

influential psychological processes and proposed modes of trauma transmission. Chapter

Thirteen goes on to test the expanded version of this model which incorporates the

demographic and situational variables which are hypothesised to moderate scores on

psychological impact variables and the flow of the relationships in the model.


239

Chapter Thirteen – Empirical Assessment of the Moderating Role of Holocaust Survivor

Demographic Variables

Chapter Twelve reported on analyses designed to test the model of the differential impact

of Holocaust trauma across three generations in terms of the three classes of psychological

variables, namely psychological impact, influential psychological process and family

interaction/trauma transmission mode variables. In this chapter, the numerous demographic

variables that have been discussed in the literature (see Chapter Three) and hypothesised to

play a moderating role on model variables, as well as relationships between model variables

(see Chapter Ten), are analysed in terms of their function in the model.

The specific demographic variables to be tested are presented in the representation

of the model in Figure 13.1. They have been bolded. A number of demographic variables

cannot be tested by the current study/sample. These variables are the survivor

demographics of reason for persecution (as no non-Jewish survivors were obtained), as well

as time lapse since the Holocaust (as this is a longitudinal variable which therefore requires

a repeated measures/longitudinal research design).

The descendants of survivor samples (both children and grandchildren) are analysed

both in terms of demographic variables relevant to their generation, as well as demographic

variables related to their ancestors. Specifically, children of survivors are analysed in terms

of both their survivor parent demographic variables as well as the demographics intrinsic to

their own generation, and the grandchildren of survivors are analysed in terms of both their

grandparents and parents demographics as well as those relating to their own generation.

The influence of a number of ancestral demographic variables cannot be tested for all three

generations because of lack of data or prohibitive sample sizes. Such variables are noted at

the relevant juncture in the chapter.

At the end of this chapter, a rank ordering of survivor demographics in terms of the

strength of their relationship to survivor and descendant scores on psychological impact

variables is produced. Thus, as well as assessing each demographic variable in turn, this

chapter provides an idea of the relative importance of each demographic variable in order to

further refine the model of the differential impact of Holocaust trauma.


240


Ranking of Influential Psychological Processes

Ranking of Modes of Intergenerational Transmission of Trauma



1st G

ener

atio

n (S

urviv

ors)



1. Maladaptive coping strategies 2. Assumption of World Benevolence 3. Assumption of World Meaningfulness 4. Adaptive coping Strategies

• Age during the Holocaust • Time lapse since the Holocaust – Unable to test • Gender • Type/nature of Holocaust experiences • Reason for persecution – Unable to test • Loss of family • Country of origin • Post-war settlement location • Length of time before resettlement/time spent in


2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)


Dimensions





2. Family Cohesion 3. Communication about Holocaust

experiences (specifically via affective or non-verbal modes)



3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)


Dimensions





2. Family Cohesion 3. Encouragement of Independence

(maternal) 4. General Family Communication

Figure 13.1. Addition of Holocaust Survivor Descendant Demographic Moderators to Testing Model of the differential impact of Holocaust Trauma across Three Generations


241

13.1. – Demographic Variable Inter-relationships

Where statistically significant relationships between demographic variables exist, it is

possible that they may confound the analysis of relationships between demographic

variables and variables in the model. Therefore, the inter-relationships among survivor

demographic variables are examined first and the results of this process are reported in this

section. Where statistically significant relationships exist, they serve to inform the use of

controlled statistical analysis, such as ANCOVA or partial correlations, when considering

relationships between demographic variables and model variables.

There are a number of notable relationships between the survivor demographic

variables that may lead to misleading results when looking at their impact univariately. A

survivor’s age during the Holocaust (as operationalised by their age in 1945) differs

statistically significantly on a number of variables. Specifically, these are the nature of

their Holocaust experiences, the region they currently reside in and whether they are a sole

survivor of their family.

Within the nature of Holocaust experience categories, those who escaped prior to

1945 and did not experience the full gamut of possible traumas were aged on average 15.67

years in 1945 (SD = 4.37, n = 6), those who spent time in a camp were aged 23.08 years

(SD = 7.29, n = 12) and those who had other Holocaust experiences such as living in

hiding were aged only 10.78 years (SD = 8.57, n = 9) on average. Specifically, it is the

camp survivors who were statistically significantly older in 1945 than the survivors with

other experiences (F (2, 24) = 7.57, p < 0.01). This result is not surprising given the low

likelihood of survival of children in camps and much higher likelihood of children

surviving in hiding. Survivors who are the sole survivor of their family (M = 23.40, SD =

6.58, n = 5) were much older in 1945 than those who had surviving family members (M =

15.95, SD = 8.91, n = 22; (t (25) = 1.75, p = 0.092).

The final notable difference relating to age is that of the survivor’s current region of

residence. Specifically the three participants who remained in Europe (M = 7.33, SD =

4.04) were much younger than those who immigrated to other regions of the world

(America M = 14.63, SD = 4.50, n = 8; Australia/New Zealand M = 20.33, SD = 9.84, n =

15; Israel 24, n = 1; F (3, 23) = 2.70, p = 0.070). This result is also reflected in the

correlation between age and the number of years spent in Europe after the war (r = - 0.35, p

= 0.083).


242

The Holocaust experience categories of escapees, camp survivors and non-

camp/hiding survivors differ in terms of the proportion who spent at least part of the war

separated from family members and whether they are the sole survivor of their family. This

is not surprising, as separation from family was an intrinsic part of the process of ending up

in a camp, and those in hiding were more likely to have been with other family members.

Specifically, the result for experience type by sole survivor status is 2χ (2) = 7.67, p <

0.05. All sole survivors in the survivor sample are camp survivors and all survivors in the

non-camp/hiding and escapee groups had at least one surviving family member. The 2χ for

experience type by whether the survivor ever spent time alone without a family member

also reaches the less than 0.10 threshold ( 2χ (2) = 4.81, p = 0.090).

The final category of relationships between demographic variables that is worthy of

mention is associations with the time a survivor spent in Europe after the war and before

they were able to immigrate to their chosen country away from Europe. Camp survivors

(M = 6.17, SD = 3.97, n = 12) and non-camp/hiding survivors (M = 8.20, SD = 9.58, n =

5) stayed in Europe for a much larger number of years than those who managed to escape

persecution prior to 1945 (M = 0.67, SD = 1.63, n = 6). This group not only made an early

escape from persecution but a rapid escape from the entire continent. Survivors who

remained in Europe until the end of the war were then faced with huge competition among

millions of refugees for the limited immigration places available (F (2, 20) = 3.24, p =

0.060). Somewhat consistent with the finding that camp survivors were more often alone

than non-camp survivors, the number of years spent in Europe after the war by survivors

who spent some time alone during the war is higher than those who always had a family

member with them (M = 8.00, SD = 7.45, n = 9 versus M = 2.89, SD = 3.92, n = 9 t (16) =

1.82, p = 0.087).

The relationship between survivor parent variables was also assessed to check for

the continuation of possible confounds noted for the survivor sample within the child of

survivor sample. None of the statistically significant inter-relationships between

demographic variables noted for the survivor sample are repeated for the survivor parents

of the children of survivor sample.

13.2. – Moderating Influence of Holocaust Survivor Demographics

In this section, the possible moderating influence of Holocaust survivor demographic and

situational variables on the variables and relationships in the model of the differential


243

impact of Holocaust trauma is addressed. Each potential moderator is discussed with

respect to its effect on survivor, child and grandchild scores on psychological impact and

influential psychological process variables as well as on the family interaction/proposed

modes of trauma transmission variables. Co-efficients of determination (r2) and eta-

squareds ( 2η ) are cited to provide a quantitative method of determining a rank ordering of

the demographic variables in terms of their influence on variables in the model. Both of

these statistics represent the proportion of variance in the dependent variables (model

variables) accounted for by the independent variables (demographic variables): r2 for

correlation analyses and 2η for ANOVAs and t-tests.

13.2.1. – Holocaust Survivor Gender

13.2.1.1 – Influence on survivor and descendant psychological health.

It was hypothesised that female survivors would score lower on positive variables and

higher on negative variables (DH1). A glance at Table 13.1 shows there is only one

statistically significant difference between the male and female survivors in the current

study sample with male survivors having a statistically significantly stronger belief in

world meaningfulness than female survivors.

The flow-on hypothesis argues that the descendants of the most affected ancestors

will be the most affected themselves (DH10). Given that it is hypothesised that female

survivors will be worse off than male survivors, it follows that it is also hypothesised that

children with only one survivor parent will fare less well if their survivor parent is their

mother as opposed to their father. However, it should also be noted that the one study that

directly examined this issue (Schleuderer, 1990) found that children of survivor fathers

scored less favourably than children of survivor mothers (as discussed in Chapters Nine and

Ten).

As can be seen in Table 13.1, once analyses controlling for confounds between

survivor parent gender and delay between 1945 and birth of children of survivors have been

conducted, there are no statistically significant differences between children of survivor

mothers and children of survivor fathers on psychological impact variables. However, it is

interesting to note that the pattern of results is consistent with having a survivor father

being more of a negative influence than having a survivor mother. This is consistent with

the findings of Schleuderer (1990), but inconsistent with the hypothesis that the children of


244

the most affected survivors should be the most affected themselves, which would suggest

children of survivor mothers should evidence higher symptom levels. Table 13.1. Influence of survivor gender on survivor and children of survivor scores on impact and influential process variables Female

Survivors (n = 11)

Male Survivors (n = 13)

Significance Test Results

2η Children

of Survivor Mother

only (n = 5)

Children of

Survivor Father only

(n = 12)

Significance Test Results 2η

Impact Variables DASS Anxiety 4.00

(6.24) 5.54

(6.05) t (21) = 0.60,

p = 0.56 0.017 1.20

(0.84) 5.83

(5.20) t (12.28) = 2.99, p < 0.05, ANCOVA with delay as

covariate (F (1,14) = 2.43, p = 0.141

0.201 ANCOVA = 0.148

DASS Depression 5.80 (5.69)

6.38 (6.98)

t (21) = 0.22, p = 0.83

0.002 4.70 (6.02)

7.67 (9.13)

t (15) = 0.66, p = 0.52 0.028

IES-R Total Score 3.77 (2.64)

2.76 (2.92)

t (22) = 0.88, p = 0.39

0.034 Not applicable

PTV 10.91 (4.65)

10.77 (4.13)

t (22) = 0.08, p = 0.94

0.000 11.00 (5.29)

13.67 (3.94)

t (15) = 1.15, p = 0.27 0.082


37.50 (9.86)

38.77 (7.41)

t (19) = 0.34, p = 0.74

0.006 42.90 (11.76)

38.17 (10.30)

t (15) = 0.83, p = 0.42 0.044


11.13 (4.12)

12.54 (3.64)

t (19) = 0.82, p = 0.42

0.034 12.00 (5.66)

18.75 (7.88)

t (15) = 1.73, p = 0.11 0.166

PTGI Total Score 56.10 (26.30)

56.08 (30.40)

t (20) = 0.00, p = 0.99

0.000 Not applicable


COPE Maladaptive 43.20 (7.60)

41.46 (9.62)

t (21) = 0.47, p = 0.64

0.010 38.20 (9.88)

45.50 (10.67)

t (15) = 1.31, p = 0.21 0.103

COPE Adaptive 101.70 (15.36)

101.54 (16.88)

t (21) = 0.02, p = 0.98

0.000 87.80 (21.29)

97.92 (16.63)

t (15) = 1.06, p = 0.31 0.069

WAS - Benevolence 31.00 (7.28)

29.23 (6.80)

t (21) = 0.62, p = 0.55

0.017 32.60 (5.94)

36.08 (4.10)

t (15) = 1.40, p = 0.18 0.116

WAS - Meaningfulness 28.27 (7.55)

35.31 (9.40)

t (22) = 1.99, p = 0.059

0.153 32.60 (4.62)

36.42 (6.64)

t (15) = 1.16, p = 0.26 0.083

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale

13.2.1.2. – Influence on children of survivors’ perception of their parents/family

environment.

Further to the hypothesis about survivor gender is its hypothesised relationship with the

perceptions that the children have of their survivor parents. To be consistent with the flow

on hypothesis, it would be predicted that survivor mothers would be rated less favourably

than survivor fathers. Table 13.2 presents the ratings given by children whose parents are

both survivors of their survivor mother and their survivor father. As can be seen, there are

no statistically significant differences in ratings of survivor mothers and survivor fathers on

any of the dimensions measured. However it is interesting to note that survivor fathers are

rated less favourably on all three parent-child attachment dimensions, but more favourably

on their perceived level of support for their childrens’ independence.


245

Table 13.2. Mean differences in ratings of survivor mothers versus survivor fathers among children with two survivor parents (n = 51) on parent-child attachment dimensions and parental facilitation of independence

Perception of Survivor Mother

Perception of Survivor Father


2η PCS - Warm 8.22 (5.10) 8.20 (5.13) t (48) = 0.03, p = 0.98 0.000 PCS - Cold 3.12 (4.06) 4.06 (4.31) t (48) = 1.71, p = 0.10 0.057 PCS - Ambivalent 5.37 (4.79) 5.63 (4.48) t (48) = 0.35, p = 0.73 0.002 PAQ – Fostering of Autonomy 43.52 (14.18) 44.13 (14.92) t (47) = 0.34, p = 0.74 0.002 HCQ - Frequent and Willing communication about the Holocaust

9.23 (2.93) 8.44 (3.29) t (47) = 1.36, p = 0.18 0.038

HCQ - Guilt Inducing Communication 3.35 (1.76) 3.42 (1.74) t (47) = 0.25, p = 0.81 0.001 HCQ - Indirect Communication 1.79 (1.04) 1.57 (0.88) t (46) = 1.30, p = 0.20 0.035 HCQ - Affective Communication 2.65 (1.02) 2.41 (0.98) t (43) = 1.13, p = 0.26 0.029

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire

Table 13.3 presents children of survivors’ ratings on family environment variables that are

not parent specific. In this case, it was necessary to compare the perceptions of children

who have a survivor mother only to those held by children who have a survivor father only.

There are no statistically significant differences. Table 13.3. Children with a survivor mother versus a survivor father only perceptions of family environment variables Children of Survivor Mother only

(n = 6) Children of Survivor Father only

(n = 12) Significance Test

Results 2η

FES – Cohesion 49.17 (19.13) 41.92 (21.70) t (16) = 0.69, p = 0.50 0.029 FES – Expressiveness 38.33 (20.70) 42.17 (19.27) t (16) = 0.39, p = 0.70 0.009 HCQ – Non-Verbal Presence of the Holocaust

8.50 (2.95) 9.08 (2.57) t (15) = 0.43, p = 0.67 0.012

Notes. HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale

13.2.2. – Holocaust Survivor Age during the Holocaust

13.2.2.1. – Influence on survivor and descendant psychological health.

Survivor age during the Holocaust was operationalised by calculating the age of each

Holocaust survivor participant in 1945. It was hypothesised that negative effects would

increase with age (DH2). Correlations were conducted to assess the impact of age on

survivor scores on psychological impact and influential psychological process variables and

these are displayed in Table 13.4.


246

Table 13.4. Correlations between survivor age in 1945 and impact and influential process variables among survivors and children of survivors Holocaust Survivors


Age in 1945 Survivor Father’s age in 1945 (n = 62) Survivor Mother’s age in 1945 (n = 55) r r2 r r2 r r2 Impact Variables DASS Anxiety -0.05 0.003 -0.004 0.000 0.031 0.001 DASS Depression -0.19 0.037 0.265 * 0.070 0.075 0.006 IES-R Total Score 0.45 * 0.205 Not applicable PTV -0.05 0.003 -0.199 0.040 -0.069 0.005 AAS Positive Dimensions -0.06 0.003 -0.024 0.001 -0.033 0.001 AAS Negative Dimensions -0.23 0.054 -0.078 0.006 0.058 0.003 PTGI Total Score 0.31 0.093 Not applicable Influential Psychological Processes COPE Maladaptive 0.15 0.023 -0.037 0.001 -0.141 0.020 COPE Adaptive 0.08 0.006 -0.062 0.004 -0.220 0.048 WAS – Benevolence -0.21 0.042 -0.157 0.025 -0.019 0.000 WAS – Meaningfulness -0.30 0.091 -0.162 0.026 0.143 0.020 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. * p < 0.05. There is a statistically significant positive relationship between PTSD symptoms

and survivor age during the Holocaust; however none of the other psychological impact or

influential psychological process variables correlate statistically significantly with survivor

age. The direction of this correlation is consistent with three of the four studies included in

the meta-analytic review of the literature to calculate correlations between survivor age and

PTSD symptoms (see Chapter Eight, Section 8.6).

Among the children of survivors, there is one statistically significant correlation

with survivor fathers’ age during the Holocaust with a positive relationship being found

between children of survivors’ depression scores and their survivor fathers’ age. As to

whether this result is in keeping with the meta-analytic review, it is consistent with the

results of Budick (1985) who found that depression scores among children increased with

the age of survivor parents, but is inconsistent with the findings of Eskin (1996) who found

a relationship in the opposing direction (see Chapter Nine, Section 9.2.6 for more

discussion of these studies). Overall, the correlations between survivor father age and

children of survivors’ scores are stronger than those with survivor mother age for the

current study sample.

13.2.2.2. – Influence on children of survivors’ perceptions of their parents/family

environment.

Table 13.5 presents a comparison of the strength of the relationships between survivor

fathers’ and survivor mothers’ age during the Holocaust and the perceptions held by their


247

children of each parent individually and the family environment. While there are no

statistically significant correlations, it is noteworthy that again it is the correlations with

paternal age that are stronger than for maternal age. Table 13.5. Correlations between Holocaust survivor parent age and children of survivors’ ratings of survivor parents on family interaction variables Survivor father’s age in 1945

(n = 62)

Survivor mother’s age in 1945 (n = 55)

r r2 r r2 Parent specific family interaction variables PCS – Warmth -0.118 0.014 -0.095 0.009 PCS – Coldness 0.178 0.032 0.012 0.000 PCS – Ambivalence 0.013 0.000 0.057 0.003 PAQ – Fostering of Autonomy -0.042 0.002 -0.053 0.003 HCQ – Frequent and willing communication about the Holocaust -0.201 0.040 0.041 0.002 HCQ – Affective communication about the Holocaust 0.066 0.004 0.040 0.002 HCQ – Guilt-inducing communication about the Holocaust -0.095 0.009 -0.016 0.000 HCQ – Indirect communication about the Holocaust 0.068 0.005 0.146 0.021 Non-Parent specific family interaction variables HCQ – Non-verbal presence of the Holocaust 0.251 0.063 0.098 0.010 FES – Cohesion -0.017 0.000 -0.020 0.000 FES – Expressiveness -0.043 0.002 -0.130 0.017 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale

13.2.3. – Nature of Holocaust Experiences


The nature of Holocaust experiences is operationalised by camp internment, non-camp

experiences (mostly in hiding) and escape prior to 1945. It was hypothesised that camp

internment would lead to higher symptom levels than non-camp experiences such as hiding

or escaping (DH3). Due to the statistically significant relationship between the nature of

Holocaust experience and age during the Holocaust, ANCOVAs with age as a covariate

were conducted with the variables that were also statistically significantly correlated with

age. These ANCOVAs allow the reader to determine whether the statistically significant

differences between Holocaust experience groups in these cases are merely reflecting the

impact of age rather than a true difference between experience groups. This is the case

only for the IES-R total score.

As can be seen in Table 13.6, the statistically significant ANOVA result for

experience type is no longer statistically significant when conducted as an ANCOVA with

age in 1945 as a covariate. However, differences between survivor experience groups on

the Adult Attachment Scale do reach significance at the 0.10 level. Specifically, camp

survivors score statistically significantly lower on positive attachment dimensions than


248

survivors who escaped prior to 1945 and survivors who were in hiding or had other non-

camp experiences score statistically significantly higher on negative attachment

dimensions/attachment anxiety than survivors who escaped prior to 1945. Within the

influential psychological process variables, three of the four variables differ statistically

significantly by survivor experience group. Specifically, camp survivors report statistically

significantly higher usage of maladaptive coping strategies than those who escaped prior to

1945 and cite statistically significantly weaker belief in world benevolence and

meaningfulness than survivors who escaped in hiding or in some other non-camp way. The

sizes of the 2η cited in Table 13.6 are notable with many suggesting that a quarter or more

of the variation in scores can be explained by the type of experiences survivors had during

the Holocaust. While a small number of studies, cited in the meta-analytic review of the

literature, found that survivors who were hiding had/have higher levels of symptoms, the

findings of the current study are consistent with the majority of studies that have examined

the influence of the nature of Holocaust experiences on survivors’ mental health and

functioning (refer back to Chapter Eight, Section 8.2 for further details of the studies

reviewed). Table 13.6. Holocaust survivor experience group scores on impact and influential process variables Escape prior to 1945 a

(n = 6) Camp b (n = 10)

Hiding/ Other c (n = 8)

Significance Test Results 2η Impact Variables DASS Anxiety 3.50 (5.50) 5.22 (7.93) 5.50 (4.34) F (2,20) = 0.20, p = 0.82 0.019 DASS Depression 6.50 (8.17) 5.78 (6.24) 6.25 (5.75) F (2,20) = 0.02, p = 0.98 0.002 IES-R Total Score 2.08 (2.10) 5.05 (2.90) 1.79 (1.81) F (2,21) = 5.03, p < 0.05 ANOVA,

F (2,20) = 1.89, p = 0.177 ANCOVA with age in 1945 as

covariate,

0.324 0.159

PTV 10.17 (4.17) 12.60 (4.35) 9.13 (3.90) F (2,21) = 1.65, p = 0.22 0.136 AAS Positive Dimensions 44.33 (8.73) b 33.57 (4.65) a 37.88 (8.10) F (2,18) = 3.49, p = 0.052 0.280 AAS Negative Dimensions 9.00 (2.83) c 11.57 (1.90) 14.63 (4.07) a F (2,18) = 5.60, p < 0.05 0.383 PTGI Total Score 46.33 (27.38) 68.11 (15.52) 49.00 (37.62) 2χ Kruskal Wallis (2) = 1.91, p =

0.39

0.136


COPE Maladaptive 36.17 (6.43) b 46.78 (9.98) a 41.63 (5.78) F (2,20) = 3.31, p = 0.057 0.249 COPE Adaptive 107.50 (11.07) 96.89 (18.52) 102.50 (15.92) F (2,20) = 0.81, p = 0.46 0.075 WAS – Benevolence 31.17 (7.57) 26.40 (7.29) c 33.75 (3.54) b F (2,21) = 3.08, p = 0.067 0.227 WAS – Meaningfulness 31.83 (4.40) 27.30 (10.64) c 38.25 (6.30) b 2χ Kruskal Wallis (2) = 7.15, p <

0.05

0.277

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


249

The flow on effects of the nature of survivors’ experience during the Holocaust on

their offspring have also been assessed. To be consistent with DH10 that the children of

the most affected survivors would be the most affected themselves, it is hypothesised that

children of camp survivors will fare less well than children of non-camp survivors.

Children of survivors are stratified by the nature of their survivor mother and survivor

fathers’ Holocaust experiences.

As can be seen in Table 13.7, children of survivor fathers who were in camps have

statistically significantly weaker belief in world benevolence than children of survivor

fathers who were in hiding or had some other non-camp experiences. In addition, children

of survivor fathers who were in hiding report the highest usage of adaptive coping

strategies, followed by children of camp survivor fathers and children of fathers who

escaped prior to 1945. The result pertaining to the world benevolence assumption is

consistent with the flow-on hypothesis. The findings of the meta-analytic review on this

issue were somewhat ambiguous, but did suggest a trend towards the children of non-camp

survivors evidencing higher symptomatology. Certainly a perusal of the mean scores in

Table 13.7 do not suggest a blanket trend towards the children of camp survivors

evidencing higher symptom levels. However, the pattern of results do suggest that the

nature of survivor parents’ experiences during the Holocaust have some role to play.


250

Table 13.7. Children of survivor scores on impact and influential process variables by survivor parent experience groups

Survivor Father’s Holocaust Experience Survivor Mother’s Holocaust Experience

Escape prior to 1945 (n = 4) a

Camp (n = 40) b

Hiding/Other (n = 13) c


2η Escape prior to 1945

(n = 5) a Camp

(n = 35) b Hiding/ Other

(n = 11) c Significance Test

Results 2η

Impact Variables

DASS Anxiety 6.50 (6.45) 3.14 (3.41) 4.15 (4.39) F (2,53) = 1.47, p = 0.24

0.054 3.80 (4.97) 3.10 (3.57) 2.27 (2.15) F (2,48) = 0.39, p = 0.68

0.016

DASS Depression 14.75 (12.07) 7.33 (9.07) 6.62 (9.07) F (2,53) = 1.25, p = 0.30

0.045 6.80 (5.81) 8.00 (10.39) 5.91 (6.43) F (2,48) = 0.22, p = 0.80

0.009

PTV 12.00 (5.77) 11.28 (4.52) 9.04 (5.08) F (2,53) = 1.43, p = 0.25

0.044 12.00 (4.85) 10.09 (4.51) 9.09 (5.55) F (2,48) = 0.64, p = 0.53

0.026

AAS Positive Dimensions 34.25 (5.68) 40.18 (9.72) 40.85 (10.64) F (2,53) = 0.72, p = 0.49

0.027 38.60 (8.56) 40.31 (9.65) 40.82 (10.61) F (2,48) = 0.09, p = 0.91

0.004

AAS Negative Dimensions 21.00 (8.25) 14.63 (6.24) 15.31 (6.24) F (2,53) = 1.83, p = 0.17

0.063 14.60 (4.93) 14.17 (6.11) 12.55 (4.25) F (2,48) = 0.39, p = 0.68

0.016


COPE Maladaptive 44.25 (8.96) 41.38 (7.71) 39.10 (6.99) F (2,53) = 0.78, p = 0.47

0.029 40.60 (3.91) 39.89 (6.32) 38.30 (7.70) F (2,48) = 0.31, p = 0.73

0.013

COPE Adaptive 80.25 (11.70) c 95.98 (17.06) 101.54 (11.91) a F (2,54) = 2.79, p = 0.070

0.094 90.00 (21.71) 93.35 (17.86) 99.36 (12.18) F (2,48) = 0.69, p = 0.51

0.028

WAS – Benevolence 36.50 (3.11) 32.77 (7.45) c 38.62 (5.92) b F (2,53) = 3.65, p < 0.05

0.121 35.00 (2.83) 33.15 (8.79) 35.55 (5.26) 2χ Kruskal Wallis (2) = 0.26, p = 0.88

0.019

WAS – Meaningfulness 31.75 (1.26) 33.44 (8.03) 32.23 (7.52) 2χ Kruskal

Wallis (2) = 1.38, p = 0.50

0.007 32.20 (8.98) 31.18 (8.13) 33.82 (5.33) F (2,46) = 0.49, p = 0.62

0.021

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


251

Among children whose parents are both survivors there is the question of how the

experiences of both parents interplay. To address this issue, a comparison was made

between children of survivors who have two parents who survived in hiding, two parents

who survived the camps and children of parents with differing experiences (see Table

13.8). The one statistically significant difference resulting from this analysis group is that

children whose parents have differing Holocaust experiences score the lowest on positive

attachment dimensions (comfort with being close to and depending on others), followed by

children of two camp survivors and children of two hiding survivors. Table 13.8. Children of survivors’ scores on impact and influential process variables by survivor parent experience mixture groups

Both hiding/other (n = 5) a

Both camps (n = 26) b

Mixture (n = 12) c

Significance testing 2η Impact Variables DASS Anxiety 2.00 (2.56) 3.13 (3.78) 3.08 (2.84) F (2,40) = 0.24, p = 0.79 0.012 DASS Depression 3.40 (3.85) 8.46 (10.32) 7.92 (9.98) F (2,40) = 0.57, p = 0.57 0.028 PTV 6.50 (6.56) 10.52 (4.73) 10.96 (3.29) F (2,40) = 1.83, p = 0.17 0.084 AAS Positive Dimensions 48.60 (6.43) c 40.35 (10.32) 36.92 (7.90) a F (2,40) = 2.74, p = 0.077 0.121 AAS Negative Dimensions 12.20 (1.79) 13.96 (6.08) 15.00 (6.25) F (2,40) = 0.41, p = 0.67 0.020 Influential Psychological Processes

COPE Maladaptive 35.87 (6.27) 39.77 (5.98) 41.00 (6.65) F (2,40) = 1.22, p = 0.31 0.058 COPE Adaptive 105.40 (3.96) 92.54 (17.45) 98.42 (16.83) 2χ Kruskal Wallis (2) = 2.85, p =

0.24

0.071

WAS – Benevolence 38.20 (4.09) 32.04 (8.93) 35.75 (6.54) F (2,39) = 1.75, p = 0.19 0.082 WAS – Meaningfulness 34.80 (4.32) 31.56 (8.18) 32.17 (8.36) F (2,39) = 0.35, p = 0.71 0.018 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


environment.

To be consistent with the flow-on hypothesis (DH10), it is hypothesised that survivors who

were in camps would be rated less favourably by their children than survivors with non-

camp experiences in terms of parent specific variables and general family

interaction/environment variables. As can be seen in Table 13.9, none of the parent specific

family interaction variables differ statistically significantly by survivor parent experience

category; however, the experiences of both survivor mother and father are statistically

significantly related to their children’s perceptions of a non-verbal presence of the

Holocaust when they were growing up. Specifically, mother and father camp experience is

related to elevated scores on this variable, as opposed to mother and father non-camp

experiences.


252

Table 13.9. Children of survivors’ scores on family interaction variables by Holocaust experience of survivor parents

Survivor Father’s Holocaust Experience Survivor Mother’s Holocaust Experience

Escape prior to 1945

(n = 4) a

Camp (n = 40) b

Hiding/Other (n = 13) c

Significance Test Results 2η Escape prior

to 1945 (n = 5) a

Camp (n = 35) b

Hiding/ Other (n = 11) c

Significance Test Result 2η

Parent Specific Family Interaction Variables

PCS – Warmth 8.75 (5.19) 9.10 (4.93) 7.58 (5.73) F (2,51) = 0.32, p = 0.73 0.015 8.20 (3.27) 8.03 (5.52) 9.91 (5.87) F (2,47) = 0.50, p = 0.61 0.021 PCS – Coldness 2.75 (2.99) 3.33 (4.12) 4.75 (4.45) F (2,51) = 0.71, p = 0.50 0.024 2.40 (3.05) 3.32 (4.38) 1.82 (3.25) F (2,47) = 0.61, p = 0.55 0.025 PCS – Ambivalence 6.50 (5.20) 4.54 (3.77) 6.58 (5.81) 2χ Kruskal Wallis (2) =

1.02, p = 0.60 0.045 5.40 (3.44) 5.65 (5.13) 3.91 (5.24) F (2,47) = 0.50, p = 0.61 0.021

PAQ – Fostering of Autonomy 45.00 (22.41) 46.21 (14.98) 44.50 (14.43) F (2,50) = 0.03, p = 0.97 0.002 47.40 (9.91) 41.76 (14.18) 46.00 (18.26) F (2,47) = 0.55, p = 0.58 0.023 HCQ – Frequent and willing communication about the Holocaust

9.25 (1.71) 8.95 (3.45) 7.42 (2.81) F (2,51) = 1.23, p = 0.30 0.041 8.20 (3.56) 9.18 (2.70) 9.55 (3.62) F (2,42) = 1.68, p = 0.20 0.015

HCQ – Guilt-inducing communication about the Holocaust

3.00 (1.41) 3.13 (1.65) 2.83 (1.27) F (2,50) = 0.21, p = 0.82 0.007 3.40 (1.95) 3.59 (2.06) 3.00 (1.41) F (2,47) = 0.39, p = 0.68 0.016

HCQ – Indirect communication about the Holocaust

1.50 (1.00) 1.63 (0.85) 1.09 (0.30) 2χ Kruskal Wallis (2) = 4.08, p = 0.13

0.075 1.20 (0.45) 1.82 (0.97) 1.55 (1.29) F (2,47) = 0.99, p = 0.38 0.040

HCQ – Affective communication about the Holocaust

2.00 (0.82) 2.38 (0.93) 3.00 (0.87) F (2,46) = 2.13, p = 0.13 0.087 2.20 (1.10) 2.82 (1.00) 2.11 (0.78) F (2,41) = 2.30, p = 0.11 0.101

Non Parent Specific Family Interaction Variables

FES – Cohesion 25.25 (19.36) 43.33 (22.33) 43.83 (22.56) F (2,52) = 1.20, p = 0.31 0.045 47.20 (27.54) 39.94 (22.02) 45.55 (23.26) F (2,46) = 0.40, p = 0.68 0.017 FES – Expressiveness 34.25 (19.14) 37.10 (19.04) 35.86 (17.20) F (2,52) = 0.03, p = 0.98 0.002 38.20 (18.61) 34.00 (18.57) 32.57 (17.14) F (2,47) = 0.17, p = 0.85 0.007 HCQ – Non-verbal presence of the Holocaust

8.25 (0.96)

10.76 (2.88) 9.00 (3.05) F (2,52) = 2.76, p = 0.073 0.096

10.00 (1.00) 11.01 (2.81) c 8.20 (3.39) b F (2,46) = 3.86, p < 0.05 0.144

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses


253

Again, a comparison is made between the perceptions of children with two survivor

parents who had similar Holocaust experiences and children of two survivor parents with

differing Holocaust experiences. There are numerous statistically significant differences.

Maternal warmth is rated higher among children with two parents who survived in hiding.

Maternal indirect and frequent and willing communication about the Holocaust is also rated

higher among children with two parents who were in hiding. By contrast, paternal affective

communication is perceived to be higher among children whose survivor parents’

Holocaust experiences differed, while frequent and willing communication about the

Holocaust is rated higher among children of two camp survivors. Finally, non-verbal

presence of the Holocaust is also perceived to be higher in two camp survivor families. Table 13.10. Children of survivors’ scores on family interaction variables by survivor parent experience mixture groups

Both hiding/other

(n = 5) a

Both camps (n = 26) b

Mixture (n = 12) c

Significance testing 2η

Maternal Variables PCS – Warmth 13.80 (1.92) 7.46 (5.69) 8.18 (4.83)

Kruskal Wallis 2χ (2) = 5.93, p = 0.052 0.138

PCS – Coldness 0.80 (1.30) 3.88 (4.76) 1.82 (3.46) F (2,39) = 1.69, p = 0.20 0.080 PCS – Ambivalence 0.40 (0.55) 5.69 (4.91) 5.18 (4.60) F (2,39) = 1.75, p = 0.19 0.127 PAQ – Fostering of Autonomy 56.40 (8.65) 41.62 (15.35) 41.18 (14.08) F (2,39) = 2.34, p = 0.11 0.107 HCQ – Affective communication about the Holocaust

1.75 (0.50) 2.78 (0.98) 2.60 (1.17) F (2,36) = 1.83, p = 0.18 0.092


2.20 (1.79) 1.92 (0.98) 1.18 (0.60) Kruskal Wallis 2χ (2) = 5.85, p = 0.054

0.117



0.061

HCQ – Frequent and willing communication about the Holocaust

12.00 (2.83) 9.52 (2.31) 7.64 (3.50) F (2,38) = 4.58, p < 0.05 0.194

Paternal Variables PCS – Warmth 8.80 (5.76) 8.12 (5.10) 8.09 (5.52) F (2,38) = 0.04, p = 0.96 0.002 PCS – Coldness 6.20 (5.22) 3.88 (4.54) 3.18 (3.82) F (2,38) = 0.81, p = 0.45 0.041 PCS – Ambivalence 6.60 (5.37) 4.92 (4.35) 6.00 (5.12) F (2,38) = 0.39, p = 0.68 0.020 PAQ – Fostering of Autonomy 47.40 (18.47) 42.88 (16.64) 43.90 (11.08) F (2,37) = 0.17, p = 0.84 0.009 HCQ – Affective communication about the Holocaust

2.33 (0.58) 2.22 (0.86) 3.20 (1.03) F (2,33) = 4.22, p < 0.05 0.204



0.094



0.057


7.00 (2.45) 9.16 (3.44) 6.64 (2.94) F (2,38) = 2.76, p = 0.076 0.127

Non parent specific family interaction variables

HCQ – Non-verbal presence of the Holocaust

7.80 (3.63) 11.48 (2.66) 9.70 (2.71) F (2,38) = 4.33, p < 0.05 0.186

FES – Cohesion 47.20 (21.94) 38.69 (22.32) 44.91 (25.55) F (2,39) = 0.46, p = 0.63 0.023 FES – Expressiveness 34.46 (19.35) 33.50 (18.53) 34.73 (15.86) F (2,39) = 0.02, p = 0.98 0.001 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


254

13.2.4. – Loss of Family

The assessment of the impact of loss of family was possible from two angles. Firstly, it

was determined whether each survivor participant believed themselves to be the sole

survivor of their family. However, it is also true for many that although other family

members survived, the survivors found themselves separated from other family members

for at least part of their Holocaust experiences. So the two issues here are whether the

survivor was alone after the war and whether the survivor was ever alone during their

Holocaust traumas. It was hypothesised that greater negative effects would be associated

with greater losses of family (DH4).


Two sets of t-tests have been conducted to assess these two issues within the survivor

sample (see Table 13.11). The first set of t-tests compares survivors who are/were the sole

surviving member of their family at the end of the war and survivors for whom at least

some family members survived. There is one statistically significant difference between

sole-survivors and non-sole-survivors with non-sole survivors scoring statistically

significantly higher on depression than sole-survivors. This is the direct opposite of what

was predicted. However, it is interesting to note that in all other variables (apart from

anxiety which has a similar result to depression), it is the sole-survivors who score less

favourably than the non-sole-survivors albeit not statistically significantly. Indeed the

pattern here for the psychopathological variables suggests the presence of PTSD symptoms

among sole survivors, but PTSD symptoms with signs of co-morbid depression and anxiety

among the survivors with surviving family members. While it is intuitive to predict that

sole survivors would score higher on measures of psychopathology, this result is in keeping

with the results of Hafner (1968, discussed in Chapter Eight section 8.4) who found higher

incidence rates of psychopathological symptoms among survivors with surviving family

members. He hypothesised that interacting with surviving family members exacerbated

their symptoms. Unfortunately, a second study to consider sole-survivor status failed to

report descriptive statistics when a non-statistically significant result was obtained, so no

trends can be noted (Silow, 1993). The reader is invited to refer back to Chapter Eight,

Section 8.4 for further information on these studies.

The second set of t-tests which compare survivors who were always with at least

one family member during the war to survivors who for at least part of the war were

separated from their family yields one statistically significant difference. Survivors who


255

were alone at some stage during the war report much higher post-traumatic growth than

survivors who were always accompanied by family members. Again the one study located

for the review of the literature in Chapter Eight, Section 8.4, which considered time spent

alone by survivors (Cordell, 1980), obtained no statistically significant result but reported

no descriptive statistics.

The finding of the current study of higher post-traumatic growth among survivors

who had spent some time alone during the Holocaust is intuitively understandable. Being

forced to face their situation on their own, these survivors may have initially doubted their

ability to cope and survive but in hindsight would have no choice but to acknowledge that

they had been able to. Such an acknowledgement would have included a recognition of

personal strength, the realisation of which would no doubt have remained with them after

the Holocaust. Table 13.11. Holocaust Survivor scores on impact and influential process variables by loss of family variables

Sole surviving member of family after the Holocaust Spent time without any family members during the Holocaust

Yes (n = 3)

No (n = 20)


2η Yes

(n = 10) No

(n = 9) Significance Test Results

2η Impact Variables DASS Anxiety 0.33 (0.58) 5.55 (6.20) t (21) = 1.43,

p = 0.17 0.088 5.10 (5.74) 6.22 (7.29) t (17) = 0.38,

p = 0.71 0.008

DASS Depression 0.67 (0.58) 6.95 (6.39) t (20.55) = 4.29, p < 0.001

0.117 5.70 (6.06) 8.67 (7.02) t (17) = 0.99, p = 0.34

0.054

IES-R Total Score 3.60 (2.70) 3.17 (2.86) t (22) = 0.24, p = 0.81

0.003 2.75 (2.68) 3.69 (3.30) t (18) = 70, p = 0.49

0.027

PTV 10.50 (0.71)

10.86 (4.47)

t (22) = 0.11, p = 0.91

0.001 9.46 (3.82) 12.50 (5.09)

t (19) = 1.57, p = 0.13

0.115

AAS Positive Dimensions 30.00 (4.24)

39.16 (8.08)

t (19) = 1.55, p = 0.14

0.113 39.67 (5.87) 38.56 (10.57)

t (16) = 0.28, p = 0.79

0.005

AAS Negative Dimensions 12.50 (3.54)

11.95 (3.91)

t (19) = 0.19, p = 0.85

0.002 13.11 (3.95) 10.67 (3.91)

t (16) = 1.32, p = 0.21

0.098

PTGI Total Score 56.00 (8.49)

56.10 (29.31)

t (20) = 0.01, p = 0.99

0.000 71.20 (21.46) 38.11 (29.29)

t (17) = 2.83, p < 0.05

0.320


COPE Maladaptive 40.33 (4.62)

42.50 (9.16)

t (21) = 0.40, p = 0.70

0.007 41.60 (6.90) 43.78 (11.91)

t (17) = 0.49, p = 0.63

0.014

COPE Adaptive 96.67 (14.19)

102.35 (16.32)

t (21) = 0.57, p = 0.58

0.015 103.50 (12.27) 104.44 (18.47)

t (17) = 0.13, p = 0.90

0.001

WAS – Benevolence 29.33 (6.43)

30.14 (7.14)

t (22) = 0.19, p = 0.86

0.002 31.82 (5.78) 29.00 (8.49)

t (18) = 0.88, p = 0.39

0.041

WAS – Meaningfulness 25.00 (5.00)

33.10 (9.23)

t (22) = 1.47, p = 0.16

0.089 33.36 (10.49) 32.33 (8.53)

t (18) = 0.24, p = 0.82

0.003


The reverberation of survivors’ loss of family during the Holocaust can also be

examined. Children of survivors have been sub-divided based on whether their survivor

parent was the sole survivor of their family. This issue was addressed separately for


256

survivor fathers and survivor mothers. As can be seen in Table 13.12, there are two

statistically significant results for this issue and both are in the direction that would be

predicted. Specifically children of sole-survivor mothers report higher depression scores

and lower positive attachment dimensions scores than children whose mothers were not

sole survivors. These results are intuitively predictable and consistent with the two studies

reported in the review of the literature in Chapter Nine, Section 9.2.4 (Gertler, 1986;

Schwarz, 1986). The reader should note that there is no potential for confound with the

sole-survivorship status of the other parent, as there is only one child of two sole survivors

in the sample and this participant was removed from the analyses. Therefore all analyses

presented in Table 13.12 assume the other parent is a not a sole survivor. Table 13.12. Children of survivor’ scores on impact and influential process variables by survivor parents’ loss of family during the Holocaust

Survivor Father Survivor Mother Sole Survivor

(n = 12) Not Sole Survivor (n = 38)


2η Sole Survivor

(n = 3) Not Sole Survivor (n = 46)


2η

Impact Variables DASS Anxiety 4.67 (3.65) 3.57 (4.17) t (48) = 0.82,

p = 0.42 0.014 4.00 (4.58) 2.79 (3.40) t (47) = 0.59,

p = 0.56 0.007

DASS Depression

11.08 (13.06) 7.79 (8.27) t (13.89) = 0.82, p = 0.42

0.022 23.00 (14.18) 6.55 (8.22) t (47) = 3.23, p < 0.01

0.181

PTV 13.08 (3.78) 11.07 (4.54) t (48) = 1.39, p = 0.17

0.039 6.33 (2.08) 10.17 (4.81) t (47) = 1.37, p = 0.18

0.038


36.83 (12.52) 39.53 (8.87) t (48) = 0.83, p = 0.41

0.014 30.33 (4.73) 40.86 (9.64) t (47) = 1.86, p = 0.069

0.069


18.25 (8.14) 14.97 (5.98) t (48) = 1.51, p = 0.14

0.046 16.33 (10.50) 13.83 (5.36) t (47) = 0.74, p = 0.46

0.012


COPE Maladaptive

42.00 (9.18) 41.34 (7.30) t (48) = 0.26, p = 0.80

0.001 42.67 (6.81) 39.31 (6.52) t (47) = 0.86, p = 0.39

0.016

COPE Adaptive 97.25 (15.94) 95.09 (17.70) t (48) = 0.38, p = 0.71

0.003 80.33 (16.50) 94.22 (16.69) t (47) = 1.40, p = 0.17

0.040

WAS – Benevolence

31.83 (6.28) 34.03 (7.49) t (47) = 0.91, p = 0.37

0.017 36.00 (2.65) 33.25 (7.79) t (45) = 0.60, p = 0.55

0.008


33.33 (8.76) 32.78 (7.81) t (47) = 0.21, p = 0.84

0.001 29.33 (11.72) 31.84 (7.55) t (45) = 0.54, p = 0.59

0.006

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale


environment.

Whether the fact that a survivor was the sole survivor of his or her family after the

Holocaust has an impact on the perceptions their children have of their survivor parents is

examined in this sub-section. Given that it is hypothesised that sole survivors have been

more negatively affected by the Holocaust than non-sole survivors, one would expect


257

children of survivors to rate sole survivor parents less favourably than non-sole survivor

parents. While overall sole survivor status does seem to be related to less favourable

ratings (see Table 13.13), there are a few perplexing findings as well. In particular, it

seems that while sole survivor mothers are rated as more ambivalent than non-sole survivor

mothers, sole survivor fathers are rated as less ambivalent than non-sole survivor fathers.

There are no other studies, that were located, that considered the role of this variable among

children of survivors’ perceptions of family environment. Table 13.13 Children of survivors’ scores on family interaction variables by sole-survivor status of survivor parents

Survivor Father Survivor Mother Yes

(n = 12) No

(n = 38)


2η Yes

(n = 3) No

(n = 46) Significance Test Results

2η

Parent specific family interaction Variables

PCS – Warmth 8.09 (5.26) 8.42 (4.76) t (47) = 0.20, p = 0.84

0.001 6.33 (1.53) 8.61 (5.59) t (6.78) = 1.89, p = 0.10

0.010

PCS – Coldness 3.27 (4.00) 3.42 (3.74) t (47) = 0.11, p = 0.91

0.000 3.67 (2.08) 2.83 (4.18) t (47) = 0.34, p = 0.73

0.003

PCS – Ambivalence

3.36 (2.62) 5.84 (4.65) t (29.89) = 2.27, p < 0.05

0.057 10.00 (3.00) 4.83 (5.01) t (47) = 1.76, p = 0.086

0.062

PAQ – Fostering of Autonomy

45.80 (10.38) 45.24 (14.56) t (46) = 0.11, p = 0.91

0.000 29.67 (6.43) 44.17 (14.91) t (47) = 1.66, p = 0.10

0.055


9.55 (4.08) 8.89 (2.89) t (47) = 0.60, p = 0.55

0.008 11.00 (4.00) 9.16 (2.87) t (46) = 1.06, p = 0.30

0.024


4.00 (1.95) 2.87 (1.38) t (47) = 2.18, p < 0.05

0.092 3.67 (2.08) 3.48 (1.92) t (47) = 0.16, p = 0.87

0.001


2.00 (1.00) 1.37 (0.67) t (12.75) = 1.97, p = 0.071

0.113 2.00 (1.00) 1.72 (1.03) t (47) = 0.46, p = 0.65

0.005


2.50 (0.85) 2.50 (0.92) t (44) = 0.00, p = 1.00

0.000 3.00 (1.41) 2.56 (0.99) t (40) = 0.60, p = 0.55

0.009


FES – Cohesion 44.33 (26.54) 39.74 (21.24) t (48) = 0.62, p = 0.54

0.008 18.67 (24.01) 43.07 (21.88) t (46) = 1.86, p = 0.069

0.070

FES – Expressiveness

40.58 (16.98) 33.75 (16.95) t (48) = 1.22, p = 0.23

0.030 36.33 (9.71) 33.12 (17.98) t (47) = 0.31, p = 0.76

0.002

HCQ – Non-verbal presence of the Holocaust

11.91 (3.36) 9.99 (2.62) t (47) = 2.01, p = 0.050

ANCOVA with number of

parents F (1,46) = 5.89,

p < 0.05

0.079 0.114

11.33 (1.15) 10.34 (3.10) t (46) = 0.55, p = 0.59

0.006

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale


258

13.2.5. – Holocaust Survivors’ Country of Origin


A survivor’s country of origin may have been indirectly influential in the nature of the post-

war adjustment. This is because the period of persecution differed depending on the

country a survivor was from. Because experiences during the Holocaust depended on the

survivor’s country of origin, it was hypothesised that statistically significant differences in

psychological health would be noted when survivors are stratified by country of origin

(DH6). The planned method of analysis was to conduct ANOVAs with a survivor’s

country of origin as the independent variable. This was not possible due to very small

sample sizes for some countries. Therefore, survivors are grouped according to regions

created by the researcher to reflect similar wartime experiences. These groupings are:

Germany and Austria; Poland, Latvia and Lithuania; Belgium and the Netherlands; and

Hungary.

Table 13.14 reports the group means and results of significance testing examining

the role of survivors’ country of origin. As was the case for the nature of Holocaust

experiences, the effect sizes for a number of variables suggest that quite a sizeable

proportion of variance in scores are associated with country of origin (five of the 2η reveal

at least a quarter of the variance is explainable), suggesting it is a variable of a fair degree

of import. With regard to the statistically significant differences, it appears that survivors

from Hungary have a heightened sense of vulnerability and a much weaker faith in world

meaningfulness than survivors from other countries. However in the area of attachment

anxiety, it is eastern European survivors who fare the worst. There were no studies located

for the meta-analysis that considered survivor country of origin so no comparison can be

made to the current study data.


259

Table 13.14. Holocaust survivor scores on impact and influential process variables by country of origin

Germany, Austria

(n = 10) a

Poland, Lithuania, Ukraine (n = 5) b

Netherlands, Belgium (n = 4) c

Hungary (n = 4) d


Impact Variables DASS Anxiety 5.80 (7.07) 7.00 (7.75) 3.75 (2.06) 1.00 (1.15)

Kruskal Wallis 2χ (3) = 2.67, p = 0.45

0.120

DASS Depression 7.30 (7.42) 5.60 (6.66) 6.00 (6.38) 4.00 (4.08) F (3,19) = 0.25, p = 0.86 0.038 IES-R Total Score 3.59 (3.00) 2.67 (3.75) 1.28 (1.20) 4.60 (1.54) F (3,20) = 1.21, p = 0.33 0.154 PTV 11.56 (4.07) 9.75 (2.40) 6.63 (1.80) d 14.20 (5.26) c F (3,20) = 3.30, p < 0.05 0.331 AAS Positive Dimensions

40.40 (8.91) 32.75 (6.95) 43.00 (5.89) 32.33 (3.21) F (3,17) = 2.09, p = 0.14 0.269


10.10 (2.81) b 16.50 (1.29) a 13.00 (5.35) 11.00 (1.00) F (3,17) = 4.29, p < 0.05 0.431

PTGI Total Score 47.56 (30.93) 63.60 (30.62) 60.33 (39.27) 61.40 (13.89) F (3,18) = 0.45, p = 0.72 0.069 Influential Psychological Processes

COPE Maladaptive 40.90 (10.44) 40.80 (5.67) 42.25 (7.80) 47.25 (8.69) F (3,19) = 0.54, p = 0.66 0.078 COPE Adaptive 103.40 (19.44) 102.00 (12.35) 104.25 (14.73) 94.00 (14.05) F (3,19) = 0.35, p = 0.79 0.053 WAS – Benevolence 30.20 (6.36) 30.40 (5.03) 35.50 (4.04) 25.00 (9.25) F (3,20) = 1.93, p = 0.16 0.224 WAS – Meaningfulness

34.20 (6.03) d 32.40 (6.47) d 41.75 (4.99) d 19.80 (6.76) a b c F (3,20) = 10.40, p < 0.001 0.609


The focus now turns to whether a survivor’s country of origin can explain

differences within the children of survivor population. Certainly this appears to be the case

when it comes to strength of belief in world benevolence with children of Hungarian

survivor mothers and fathers reporting statistically significantly weaker beliefs than

children of survivors from other countries (see Tables 13.15 and 13.16). Children of

Hungarian survivor fathers also record the highest vulnerability levels. These findings for

the child of survivor generation mirror those for the survivor generation, with Hungarian

ancestry related to the most negative outcomes. Why survivors (and their descendants)

from Hungary would be particularly susceptible to higher levels of pathological symptoms

can perhaps be explained by the speed with which survivors (particularly Jews) were

moved into concentration camps. In most other countries, the process was more gradual

with a period of ghettoisation preceding camp internment. The transportation of Jews to

camps in Hungary was quite late in the war and was more hurried. The gradual

acclimatisation to regimented living provided by a period of ghetto living has been

suggested as enabling the survivor to develop resilience which would be somewhat

protective in the camp environment (see Chapter Four, Section 4.7). If a more gradual

increase in persecution allowed survivors to get used to their living conditions and

treatment then the lack of this experienced by survivors in Hungary can certainly explain


260

the results found here. This is not to say that other factors may not play a role such as

cultural, ethnic differences in pre-existing resilience. Table 13.15. Children of survivors’ scores on impact and influential process variables by survivor mother country of origin

Germany, Austria (n = 6) a

Poland, Lithuania, Ukraine, Latvia

(n = 29) b

Netherlands (n = 4 ) c

Hungary (n = 9) d


Impact Variables DASS Anxiety 3.17 (4.71) 3.16 (3.67) 1.75 (2.22) 1.89 (1.83) F (3,44) = 0.45, p = 0.72 0.030 DASS Depression 5.50 (6.02) 8.02 (10.75) 5.75 (9.60) 7.22 (7.80) F (3,44) = 0.16, p = 0.93 0.010 PTV 9.00 (4.98) 9.50 (4.83) 6.88 (5.27) 12.67 (3.32) F (3,44) = 1.77, p = 0.17 0.108 AAS Positive Dimensions 38.33 (6.68) 41.16 (10.42) 45.75 (10.50) 38.56 (8.88) F (3,44) = 0.64, p = 0.60 0.042 AAS Negative Dimensions 14.33 (4.46) 14.21 (6.01) 13.25 (7.27) 13.22 (5.87) F (3,44) = 0.09, p = 0.97 0.006 Influential Psychological Processes

COPE Maladaptive 39.83 (5.95) 39.55 (6.29) 34.83 (6.26) 39.89 (6.94) F (3,44) = 0.71, p = 0.55 0.046 COPE Adaptive 79.83 (16.09) b 98.20 (17.04) a 101.92 (11.59) 85.89 (14.30) F (3,44) = 3.27, p < 0.05 0.182 WAS – Benevolence 36.83 (3.82) d 34.64 (6.90) d 39.50 (2.38) d 27.11 (8.72) a b c F (3,43) = 4.39, p < 0.01 0.234 WAS – Meaningfulness 33.33 (8.50) 31.39 (8.12) 34.75 (6.90) 32.00 (6.98) F (3,43) = 0.27, p = 0.84 0.019 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses. Table 13.16. Children of survivors’ scores on impact and influential process variables by survivor father country of origin

Germany, Austria

(n = 11) a

Poland, Lithuania (n = 30) b

Netherlands (n = 3) c

Hungary, Yugoslavia (n = 10) d


Impact Variables DASS Anxiety 4.55 (4.63) 4.02 (4.12) 2.00 (2.65) 2.20 (2.49) F (3,50) = 0.90, p = 0.45 0.051 DASS Depression 7.91 (8.78) 7.67 (10.64) 6.67 (11.55) 8.40 (7.38) F (3,50) = 0.03, p = 0.99 0.002 PTV 12.91 (3.78) 9.80 (4.97) 6.50 (6.38) 13.30 (3.40) F (3,50) = 3.13, p < 0.05 0.158 AAS Positive Dimensions 39.82 (7.21) 39.47 (10.98) 44.00 (12.12) 40.00 (9.42) F (3,50) = 0.18, p = 0.91 0.011 AAS Negative Dimensions

19.27 (7.35) 14.10 (6.30) 15.67 (6.66) 14.50 (5.80) F (3,50) = 1.79, p = 0.16 0.097


COPE Maladaptive 41.91 (7.09) 41.00 (7.37) 35.78 (7.32) 42.30 (10.04) F (3,50) = 0.58, p = 0.63 0.033 COPE Adaptive 94.18 (19.30) 99.41 (16.36) 98.89 (12.10) 86.60 (13.68) F (3,50) = 1.60, p = 0.20 0.088 WAS – Benevolence 35.36 (3.80) d 35.55 (6.29) d 40.00 (2.65) d 27.20 (8.95) a b c

Kruskal Wallis 2χ (3) = 10.26,

p < 0.05

0.249

WAS – Meaningfulness 34.27 (5.35) 32.52 (7.76) 37.67 (4.51) 32.00 (10.19) F (3,49) = 0.55, p = 0.65 0.033 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


environment.

The question of whether a survivor’s country of origin is related to their children’s

perception of them as parents is addressed in this section. Children of Dutch survivors are

statistically significantly less likely to note a non-verbal presence of the Holocaust in their

home. However the third statistically significant result has Dutch fathers rated as


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statistically significantly colder than survivor fathers from other regions. Whether this is a

result of Holocaust experiences or pre-existing cultural differences cannot be determined. Table 13.17. Children of survivors’ scores on family interaction variables by survivor mother country of origin

Germany, Austria (n = 6) a

Poland, Lithuania, Ukraine, Latvia

(n = 29) b

Netherlands (n = 4 ) c

Hungary (n = 9) d


Parent specific family interaction variables

PCS – Warmth 9.00 (3.52) 8.17 (5.04) 11.75 (6.65) 11.00 (5.50) F (3,44) = 1.09, p = 0.36 0.069 PCS – Coldness 2.00 (2.90) 2.86 (3.95) 3.25 (5.19) 1.89 (3.14) F (3,44) = 0.24, p = 0.87 0.016 PCS – Ambivalence 4.33 (3.93) 5.24 (5.10) 2.75 (4.86) 4.00 (4.47) F (3,44) = 0.41, p = 0.75 0.027 PAQ – Fostering of Autonomy 49.00 (10.26) 41.93 (14.74) 51.25 (18.46) 48.11 (12.58) F (3,44) = 1.00, p = 0.40 0.064 HCQ – Affective communication about the Holocaust

2.00 (1.22) 2.69 (0.93) 2.00 (0.00) 3.14 (1.21) F (3,38) = 1.73, p = 0.18 0.120


3.17 (1.83) 3.62 (2.04) 3.25 (1.89) 2.89 (1.36) F (3,44) = 0.39, p = 0.76 0.026


1.50 (0.84) 1.86 (1.09) 1.50 (1.00) 1.78 (1.09) F (3,44) = 0.29, p = 0.83 0.019


8.83 (3.76) 8.72 (2.95) 9.75 (4.11) 9.63 (3.02) F (3,43) = 0.26, p = 0.86 0.018


FES – Cohesion 45.67 (24.92) 42.89 (23.28) 36.25 (25.20) 41.56 (25.07) F (3,43) = 0.13, p = 0.94 0.009 FES – Expressiveness 37.50 (21.97) 34.08 (17.43) 37.25 (16.36) 37.78 (23.02) F (3,44) = 0.13, p = 0.94 0.009 HCQ – Non-verbal presence of the Holocaust

9.50 (2.35) 11.22 (2.63) c 5.67 (3.06) b 8.89 (3.02) F (3,43) = 5.06, p < 0.01 0.261

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses. Table 13.18. Children of survivors’ scores on impact and influential process variables by survivor father country of origin

Germany, Austria

(n = 11) a

Poland, Lithuania (n = 30) b

Netherlands (n = 3) c

Hungary, Yugoslavia (n = 10) d


Parent specific family interaction variables

PCS – Warmth 10.09 (3.67) 8.50 (5.62) 5.00 (5.00) 9.89 (4.70) F (3,49) = 0.96, p = 0.42 0.055 PCS – Coldness 1.55 (2.21) c 3.87 (4.46) 8.67 (1.15) a 3.11 (4.28) F (3,49) = 2.68, p = 0.057 0.141 PCS – Ambivalence 4.36 (3.78) 4.67 (4.10) 10.00 (2.65) 5.11 (5.88) F (3,49) = 1.47, p = 0.24 0.082 PAQ – Fostering of Autonomy 49.82 (14.88) 44.43 (15.50) 41.50 (23.33) 49.00 (13.51) F (3,48) = 0.50, p = 0.68 0.031 HCQ – Affective communication about the Holocaust

2.45 (0.93) 2.50 (0.99) 2.00 (0.00) 2.56 (1.05) F (3,44) = 0.19, p = 0.91 0.013


2.82 (1.17) 3.07 (1.56) 3.67 (2.08) 2.89 (1.69) F (3,48) = 0.27, p = 0.85 0.017


1.27 (0.65) 1.72 (0.88) 1.00 (0.00) 1.11 (0.33) Kruskal Wallis 2χ (3) =

6.28, p = 0.099

0.126


9.09 (2.47) 8.27 (3.51) 7.00 (3.46) 8.89 (3.02) F (3,49) = 0.43, p = 0.73 0.026


FES – Cohesion 46.27 (22.28) 43.57 (23.26) 28.33 (24.01) 37.50 (22.43) F (3,50) = 0.66, p = 0.58 0.038 FES – Expressiveness 39.45 (18.05) 36.38 (18.94) 29.67 (7.51) 34.90 (22.04) F (3,50) = 0.24, p = 0.87 0.014 HCQ – Non-verbal presence of the Holocaust

9.00 (1.67) c 11.05 (2.85) c 4.00 (1.41) a b d 10.20 (3.05) c F (3,49) = 5.34, p < 0.01 0.246

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.


262

The overall trend appears to be that both survivors and children of survivors from

the Netherlands score themselves more positively than those from other countries,

especially Hungary. However, it is difficult to disentangle the specifics of which survivor

countries of origin are the most predictive of negative outcomes for survivors and children

of survivors solely on this data. Larger sample sizes and more countries are required for a

more definitive assessment of this issue. What is clear, however, is that there is certainly an

argument for survivor country of origin being influential not only on the survivors

themselves but also their offspring. This does not necessarily relate to a linear relationship

with the number of years of persecution experienced in each country (which is open to

debate), but perhaps more to the cultural, economic, social, religious and political climates

of these countries before, during and after the war.

13.2.6. – Length of Time after 1945 Before Survivor Resettlement

What is of interest in this subsection is the potential negative influence of a drawn-out

emigration process for the survivors who wanted to emigrate from Europe after the war.


The amount of time that survivors spent “in limbo” in Europe immediately after the war

and before they arrived in their final resettlement location has been mentioned by numerous

authors as being an important factor in the post-Holocaust recovery of survivors. Much of

this time would have been spent in displaced persons camps or DP camps, which, as has

been discussed in numerous chapters already, was a potentially compounding traumatic

event (given the similarities in conditions between many DP camps and the concentration

camps the survivors had just been liberated from). It is thought that a longer delay in

resettlement, (which in many cases involves a longer duration of time spent in DP camps)

would have a more detrimental influence on survivors. The flow on effect of this waiting

time in Europe on the children of survivors is also examined in this section.

To investigate the influence of the amount of time survivors waited in Europe

before resettlement, correlations between the number of years spent in Europe between

1945 and the year survivors settled in their new home and the psychological impact and

influential psychological process variables have been calculated. However, as can be seen

in Table 13.19 there are no statistically significant relationships.


263

Table 13.19. Correlations between survivor time in Europe before emigration and impact and influential process variables (n = 23) r r2 Impact Variables DASS Anxiety -0.038 0.001 DASS Depression -0.015 0.000 IES-R Total Score -0.019 0.000 PTV -0.014 0.000 AAS Positive Dimensions -0.075 0.006 AAS Negative Dimensions 0.248 0.062 PTGI Total Score 0.346 0.120 Influential Psychological Processes COPE Maladaptive 0.332 0.110 COPE Adaptive 0.102 0.010 WAS – Benevolence -0.012 0.000 WAS – Meaningfulness 0.053 0.003 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale.

The reverberation of this issue with children of survivors can be assessed by a

comparison of children of survivors who were born in Europe before their survivor parent/s

resettled and children of survivors who were born after their survivor parent/s emigration.

As Table 13.20 shows, there are no statistically significant differences between children of

survivors born in Europe before their survivor parents’ emigration and children of survivors

born in their parents’ post-war settlement location. Table 13.20. Children of survivors born before their survivor parents’ emigration from Europe versus those born after on impact and influential process variables Born before emigration – in

Europe (n = 27)

Born after emigration – not in Europe (n = 41)

Significance test results 2η

Impacts DASS Depression 6.30 (6.60) 8.48 (10.44) t (65.93) = 1.06, p = 0.30 0.014 DASS Anxiety 2.48 (3.10) 4.13 (4.38) t (65.73) = 1.83, p = 0.07 0.042 PTV 9.69 (4.82) 11.39 (4.63) t (66) = 1.46, p = 0.15 0.031 AAS Positive Dimensions 41.74 (8.80) 39.38 (10.19) t (66) = 0.99, p = 0.33 0.015 AAS Negative Dimensions 13.15 (4.24) 15.73 (7.15) t (65.42) = 1.87, p = 0.07 0.041 Influential Psychological Processes

COPE Maladaptive 39.35 (5.70) 41.29 (8.48) t (66) = 1.05, p = 0.30 0.016 COPE Adaptive 97.89 (15.78) 93.30 (17.55) t (66) = 1.10, p = 0.28 0.018 WAS – Benevolence 33.81 (8.08) 34.75 (6.27) t (64) = 0.53, p = 0.60 0.004 WAS – Meaningfulness 33.65 (6.47) 32.49 (7.96) t (64) = 0.62, p = 0.54 0.006 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale.

13.2.6.2. – Influence on children of survivor’s perception of their parents/family

environment.

In this section, differences in the perceptions held by children of survivors born before and

after their parents’ emigration from Europe of family interaction patterns are considered.

As is the case for the impact and influential process variables, there are no statistically


264

significant differences in perceptions of family interaction that relate to whether a child of

survivors was born before, or after, parental emigration (refer to Table 13.21). Table 13.21. Perceptions of children of survivors born before and after their survivor parents’ emigration from Europe on family interaction variables Born before emigration – in

Europe (n = 27)

Born after emigration – not in Europe (n = 41)

Significance Testing 2η

Survivor Mother PCS – Warmth 9.38 (5.71) 8.00 (4.74) t (64) = 0.49, p = 0.63 0.018 PCS – Coldness 2.73 (3.67) 2.97 (4.20) t (64) = 0.36, p = 0.72 0.001 PCS – Ambivalence 4.42 (4.60) 5.72 (5.12) t (64) = 0.53, p = 0.60 0.018 PAQ – Fostering of Autonomy 46.50 (15.36) 41.31 (14.07) t (64) = 0.55, p = 0.58 0.031 HCQ – Affective communication about the Holocaust

2.48 (0.99) 2.71 (1.00) t (46) = 0.80, p = 0.43 0.014


1.88 (1.18) 1.62 (0.82) t (53) = 0.97, p = 0.34 0.018


3.12 (1.77) 3.52 (1.94) t (53) = 0.80, p = 0.43 0.012


9.88 (2.73) 8.52 (2.98) t (52) = 1.74, p = 0.09 0.055

Survivor Father PCS – Warmth 8.29 (5.35) 8.68 (4.90) t (63) = 0.17, p = 0.87 0.001 PCS – Coldness 4.46 (4.36) 3.22 (3.85) t (63) = 1.05, p = 0.30 0.023 PCS – Ambivalence 6.17 (4.77) 4.86 (4.09) t (63) = 0.96, p = 0.34 0.021 PAQ – Fostering of Autonomy 45.50 (15.50) 45.17 (14.46) t (62) = 0.11, p = 0.91 0.000 HCQ – Affective communication about the Holocaust

2.43 (0.99) 2.46 (0.89) t (54) = 0.11, p = 0.91 0.000


1.35 (0.71) 1.69 (0.92) t (54.73) = 1.62, p = 0.11 0.040


2.88 (1.23) 3.44 (1.83) t (57.99) = 1.44, p = 0.15 0.030


7.92 (3.05) 9.43 (3.19) t (59) = 1.84, p = 0.07 0.054


HCQ – Non-verbal presence of the Holocaust 9.87 (2.80) 10.38 (2.99) t (64) = 0.69, p = 0.49 0.007 FES – Cohesion 43.88 (19.99) 41.50 (24.20) t (64) = 0.42, p = 0.68 0.003 FES – Expressiveness 37.44 (18.10) 35.84 (18.44) t (65) = 0.35, p = 0.73 0.002 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale 13.2.7. – Post-war Settlement Location of Survivors

The final survivor demographic variable assessed is their post-war settlement location.

Specifically, the issue of interest here is whether a survivor remained in Europe (and the

site of their traumatisation) or immigrated to a distant continent such as Australia or

America or moved to Israel (a country specifically associated with the reason for the

persecution – i.e., Judaism).


The ANOVA analyses assessing post-war settlement location among survivors considered

three settlement regions. These regions are Europe, Australia/New Zealand and America.

Only one survivor in the sample currently lives in Israel and so it was not valid to include

Israel in the analysis. Because age is statistically significantly related to current region of


265

settlement (see Section 13.1) ANCOVAs were also conducted with age as a covariate

where age correlates statistically significantly with a variable that differs statistically

significantly by settlement location.

As can be seen in Table 13.22, survivors who settled in Australia or New Zealand

suffer more from PTSD symptoms (as measured by the IES-R) than those who went to

America or stayed in Europe. The Australian/New Zealand group also report significantly

more usage of maladaptive coping strategies than those who settled in America. Table 13.22. Holocaust Survivor post-war settlement group scores on impact and influential process variables Europe a

(n = 3) Australia/New

Zealand b (n = 12)

America c (n = 8)


Impact Variables DASS Anxiety 3.33 (2.31) 5.55 (7.51) 4.63 (5.53) F (2,19) = 0.15, p = 0.86 0.016 DASS Depression 6.00 (7.81) 6.36 (6.04) 6.13 (7.43) F (2,19) = 0.01, p = 0.99 0.001 IES-R Total Score 1.28 (1.47) b 4.81 (2.76) a c 1.58 (1.96) b F (2,20) = 5.49, p < 0.05.

F (2,19) = 3.64, p < 0.05 ANCOVA with age in 1945 as covariate

0.354 0.277

PTV 6.50 (2.18) 11.71 (4.92) 10.88 (3.27) F (2,20) = 1.86, p = 0.18 0.157 AAS Positive Dimensions 41.00 (5.29) 34.78 (7.31) 41.00 (9.77) F (2,17) = 1.42, p = 0.27 0.143 AAS Negative Dimensions 13.00 (6.56) 12.00 (2.69) 11.50 (4.44)


PTGI Total Score 48.50 (47.38) 59.73 (30.18) 51.63 (25.36) F (2,18) = 0.24, p = 0.79 0.025 Influential Psychological Processes

COPE Maladaptive 40.67 (8.74) 46.55 (9.11) c 37.13 (5.84) b F (2,19) = 3.27, p = 0.060 0.256 COPE Adaptive 100.00 (14.73) 99.00 (17.45) 109.50 (9.32) F (2,19) = 1.26, p = 0.31 0.117 WAS – Benevolence 34.67 (4.51) 29.08 (6.97) 30.75 (7.40) F (2,20) = 0.80, p = 0.47 0.074 WAS – Meaningfulness 39.33 (1.53) 29.17 (11.46) 33.13 (5.14)



Two post-war settlement location groups could be compared within the child of

survivor sample derived for this study: Australia/New Zealand and America. Only one

child of survivor participant had grown up in Israel and so an Israeli group could not be

included. The current country of residence of the grandchildren of survivors is a relatively

accurate indication of their survivor grandparent’s chosen post-war settlement location. It

was possible to compare grandchildren whose survivor grandparents had settled in

Australia or New Zealand to those who settled in America. There were no grandchildren of

survivors in the sample currently residing in Europe and only one residing in Israel and so

these regions/countries could not be included in the analyses.

The pattern of statistically significant results for descendants of survivors is

somewhat contradictory. Among the children of survivors, those who live in America

score statistically significantly lower on positive attachment dimensions than those in


266

Australia or New Zealand, but among grandchildren the pattern is reversed with

grandchildren in Australia or New Zealand scoring statistically significantly lower than

their American counterparts. The other statistically significant finding is that grandchildren

in Australia and New Zealand have a statistically significantly weaker belief in world

benevolence than American grandchildren. There have been no other studies to compare

survivors or descendants from these countries/regions to compare these results to. Table 13.23. Children and grandchildren of survivors’ post-war settlement group scores on impact and influential process variables Children of survivors Grandchildren of survivors

Australia/New Zealand (n = 46)

America (n = 21)


2η Australia/New

Zealand (n = 21)

America (n = 6)


2η

Impact Variables DASS Anxiety 3.32 (4.01) 3.76 (4.02) t (65) = 0.42,

p = 0.67 0.003 5.10 (5.18) 1.67 (2.58) t (25) = 1.55,

p = 0.13 0.088

DASS Depression 7.05 (8.05) 8.86 (11.41) t (65) = 0.74, p = 0.46

0.008 5.43 (5.42) 3.00 (4.15) t (25) = 1.01, p = 0.32

0.039

PTV 10.05 (4.90) 11.95 (4.22) t (65) = 1.53, p = 0.13

0.035 10.45 (3.96) 8.42 (3.98) t (25) = 1.11, p = 0.28

0.047


42.01 (8.51) 36.19 (11.03) t (65) = 2.36, p < 0.05

0.079 38.43 (10.65) 47.50 (5.68) t (25) = 1.99, p = 0.058

0.137


14.43 (5.82) 15.00 (7.25) t (65) = 0.34, p = 0.73

0.002 15.50 (5.16) 19.50 (5.96) t (25) = 1.62, p = 0.12

0.095


COPE Maladaptive 40.07 (6.68) 41.71 (9.26) t (65) = 0.82, p = 0.41

0.010 39.12 (6.34) 44.17 (12.83) t (5.72) = 0.93, p = 0.39

0.068

COPE Adaptive 96.09 (16.66) 93.83 (17.71) t (65) = 0.51, p = 0.62

0.004 88.71 (17.34) 97.00 (19.15) t (25) = 1.01, p = 0.32

0.039

WAS – Benevolence

34.73 (6.36) 33.86 (8.40) t (63) = 0.46, p = 0.64

0.003 34.12 (6.45) 39.67 (5.16) t (25) = 1.93, p = 0.065

0.130


32.94 (8.03) 33.14 (6.13) t (65) = 0.10, p = 0.92

0.000 36.83 (11.79) 41.33 (5.01) t (20.52) = 1.37, p = 0.19

0.031


13.2.7.2. – Influence on survivor descendants’ perception of their parents/family

environment.

Table 13.24 presents descriptive and inferential statistics assessing differences in

perceptions of family environment held by children and grandchildren of survivors relating

to their survivor parent or grandparents’ post-war settlement location. There are no

statistically significant differences relating to perceptions of survivor or child of survivor

mothers in relation to post-war settlement. However, children of survivor fathers who

settled in Australia or New Zealand rate their survivor father as statistically significantly

colder and also statistically significantly more likely to use guilt-inducing communication

about their Holocaust experiences than those in America. There are no previous studies

that have assessed this issue to make a comparison of this finding to.


267

Table 13.24 Children and grandchildren of survivors’ perceptions of family interaction stratified by survivor post-war settlement location Children of Survivor Perceptions Grandchildren of Survivor Perceptions

Australia/ New Zealand (n = 46)

America (n = 21)

Significance Test Results 2η Australia/New Zealand

(n = 21) America (n = 6)


Survivor/Child of Survivor Mother

PCS – Warmth 8.66 (5.36) 8.31 (5.01) t (52) = 0.21, p = 0.84 0.001 11.55 (4.70) 14.00 (2.65) t (20) = 0.87, p = 0.40 0.036 PCS – Coldness 3.10 (3.78) 2.31 (4.52) t (52) = 0.63, p = 0.53 0.007 1.53 (3.20) 0.67 (1.15) t (20) = 0.45, p = 0.66 0.010 PCS – Ambivalence 5.24 (4.74) 5.08 (5.47) t (52) = 0.11, p = 0.92 0.000 4.00 (5.27) 3.00 (5.20) t (20) = 0.31, p = 0.76 0.005 PAQ – Fostering of Autonomy 44.56 (14.76) 40.46 (15.32) t (52) = 0.87, p = 0.39 0.014 49.52 (14.80) 44.67 (14.22) t (20) = 0.53, p = 0.60 0.014 HCQ – Affective communication about the Holocaust 2.46 (0.79) 2.91 (1.45) t (11.87) = 0.99, p = 0.34 0.039 Not applicable HCQ – Indirect communication about the Holocaust 1.78 (1.01) 1.69 (1.03) t (52) = 0.27, p = 0.79 0.001 Not applicable HCQ – Guilt-inducing communication about the Holocaust 3.44 (1.95) 3.00 (1.63) t (52) = 0.73, p = 0.47 0.010 Not applicable HCQ – Frequent and willing communication about the Holocaust

8.83 (3.01) 10.08 (2.57) t (51) = 1.31, p = 0.20 0.032 Not applicable

Survivor/Child of Survivor Father

PCS – Warmth 7.93 (5.15) 9.68 (4.83) t (58) = 1.25, p = 0.22 0.026 11.50 (5.23) 8.75 (5.06) t (12) = 0.90, p = 0.39 0.063 PCS – Coldness 4.41 (4.38) 2.37 (2.97) t (49.86) = 2.12, p < 0.05 0.055 3.10 (3.57) 3.00 (6.00) t (12) = 0.04, p = 0.97 0.000 PCS – Ambivalence 5.98 (4.16) 4.37 (4.69) t (58) = 1.34, p = 0.19 0.030 5.00 (4.62) 6.75 (5.85) t (12) = 0.60, p = 0.56 0.029 PAQ – Fostering of Autonomy 45.24 (14.99) 44.83 (12.33) t (57) = 0.94, p = 0.35 0.015 51.05 (12.29) 50.25 (8.06) t (12) = 0.12, p = 0.91 0.001 HCQ – Affective communication about the Holocaust 2.42 (0.97) 2.47 (0.85) t (53) = 0.20, p = 0.84 0.001 Not applicable HCQ – Indirect communication about the Holocaust 1.59 (0.88) 1.53 (0.84) t (56) = 0.26, p = 0.80 0.001 Not applicable HCQ – Guilt-inducing communication about the Holocaust 3.50 (1.68) 2.63 (1.42) t (41.36) = 2.06, p < 0.05 0.062 Not applicable HCQ – Frequent and willing communication about the Holocaust

8.54 (3.26) 9.37 (3.11) t (58) = 0.93, p = 0.36 0.015 Not applicable


HCQ – Non-verbal presence of the Holocaust 10.06 (3.18) 10.35 (2.30) t (63) = 0.37, p = 0.71 0.002 Not applicable

FES – Cohesion 42.76 (22.08) 40.85 (24.18) t (63) = 0.31, p = 0.76 0.002 46.90 (21.50) 51.83 (26.34) t (25) = 0.47, p = 0.64 0.009 FES – Expressiveness 36.88 (18.54) 36.27 (17.94) t (64) = 0.13, p = 0.90 0.000 49.75 (17.68) 50.50 (9.07) t (17.06) = 0.14, p = 0.89 0.000

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale


268


This chapter has examined the interplay between measured variables in the model of the

differential impact of Holocaust trauma across three generations (the three categories of

psychological impact variables, influential psychological process variables and family

interaction/mode of trauma transmission variables) and survivor demographic and

situational variables. Consistent with one of the main arguments of the current thesis, it

was found that numerous demographic variables statistically significantly related to

survivor and descendant scores on psychological impact variables. This suggests that

survivors and descendants are not a homogenous group but are made up of many

distinguishable sub-groups with varying levels of psychological impairments.

It is of interest not only to consider each demographic variable separately, but also

to determine some kind of rank ordering of importance for the demographic variables. To

this end, Tables 13.25 and 13.26 summarise the strength of effects found for each of the

survivor demographic variables by providing the average as well as highest eta-squareds

( 2η ) and co-efficients of determination (r 2 ) which both provide a measure of the

proportion of variation in a dependent variable accounted for. As was mentioned in

Chapter Eleven, Section 11.4, ranking by effect sizes rather than statistical significance

levels provides a ranking unfettered by power problems inherent with small sample sizes.

Figure 13.2 adds to the ranking of the influential psychological processes and

family interaction variables considered in Chapter Twelve by adding a ranking of the

survivor demographics considered in this chapter. As can be seen from the average and

highest proportion of variance accounted for, as well as the number of statistically

significant results associated with each demographic variable, the three most influential

demographics for both survivors and their children are the nature of the survivors’

experiences, the survivors’ country of origin and the loss of family experienced by the

survivor during the Holocaust. In other words, three aspects of the narrative of a survivor’s

Holocaust experience are the most important in determining survivor and descendant scores

on psychological impact variables.

These variables relate directly to specific details of their traumatic experience. The

nature of their experiences refers to whether they went through the camp system or endured

time in hiding. A survivor’s country of origin (as previously discussed in Chapter Four,

Section 4.4) relates closely to the duration of their persecution and the speed with which


269

they progressed through the persecution “system”. Finally, the third ranked variable of loss

of family obviously relates to their experiences of separation from loved ones such as

parents, spouses, extended family members, and the bereavement over their loss. It is

interesting, given the importance placed on post-trauma milieu in the trauma literature, that

details of survivors’ post-war resettlement, such as the speed of their resettlement, and the

country or region they chose to settle in, are ranked lower than the three key elements of the

traumatic experience itself. It is also interesting to note, given the theoretical conjecture as

to the importance of a survivors’ age or developmental stage during the Holocaust, that

survivor age during the Holocaust (or in 1945) is only ranked at number five. The pattern

of post-trauma environment factors being less important than elements of the Holocaust

experience itself is exactly mirrored for the children of survivors.

Chapter Fourteen continues the examination of the role of demographic variables by

considering descendant demographics. The ranking of the importance of demographic

variables is then revised to include both survivor and descendant demographic variables.


270

Table 13.25 Average and highest proportions of variance accounted for by survivor demographic variables among survivor and descendant scores on psychological impact and influential psychological process variables. Survivors Children of Survivors Grandchildren of Survivors Average

2η or 2r Highest

2η or2r

Number of Statistically significant results

Average 2η or 2r

Highest 2η or

2r


Average 2η or 2r

Highest 2η or

2r


Age during the Holocaust 0.05 0.205 1 0.019 father 0.012 mother

0.070 1 for father 0 for mother

Unable to test due to insufficient data

Gender 0.025 0.153 1 0.09 0.166 1 Unable to test due to insufficient data Nature of Holocaust experiences 0.189 0.383 6 0.054 for father

0.017 for mother 0.121 2 for father

0 for mother Unable to test due to insufficient data

Loss of family during the Holocaust Sole survivor 0.04 Ever alone 0.06

0.117 0.320

0 1

0.017 for father 0.042 for mother



Country of origin 0.216 0.609 3 0.075 for mother 0.080 for father



Post-war settlement location 0.111 0.277 2 0.016 0.079 1 0.075 0.137 2 Length of time before resettlement 0.028 0.120 0 0.020 0.042 0 Unable to test due to insufficient data Table 13.26 Average and highest proportions of variance accounted for by survivor demographic variables among descendant of survivors’ perceptions on family interaction variables Children of Survivors Perceptions of Family Environment Grandchildren of Survivors Perceptions of Family Environment Holocaust Survivor Parent or Grandparent Variables

Average 2η or 2r

Highest 2η or 2r


Average 2η or 2r

Highest 2η or 2r


Age during the Holocaust 0.002 for father 0.006 for mother


0 for father 0 for mother


Gender 0.021 0.057 0 Unable to test due to insufficient data Type/nature of H experiences 0.040 for father

0.039 for mother 0.096 for father 0.144 for mother



Loss of family 0.038 for father 0.030 for mother




Country of origin 0.072 for father 0.058 for mother




Post-war settlement location 0.016 0.062 2 for father 0.017 0.063 0 Length of time before resettlement

0.018 0.055 0 Unable to test due to insufficient data


271

Psychological Impact Variables


Ranking of Modes of Intergenerational Transmission of Trauma

Ranking of Holocaust Survivor Demographic Moderators

1st G

ener

atio

n

(Sur

vivor

s)

Depression Anxiety Paranoia PTSD Symptoms Romantic Attachment Dimensions Post-traumatic growth





1. Nature of experiences 2. Country of origin 3. Loss of family 4. Post-war settlement location 5. Age during the Holocaust (in 1945) 6. Gender 7. Length of time before resettlement

2nd G

ener

atio

n

(Chi

ldre

n of

Sur

vivor

s) Depression

Anxiety Paranoia Romantic Attachment Dimensions





1. Parent-Child Attachment (especially maternal) 2. Family Cohesion 3. Communication about Holocaust experiences (specifically via affective or non-verbal modes) 4. Encouragement of Independence (maternal) 5. General Family Communication

1. Survivor parent country of origin 2. Survivor parent experiences during the Holocaust 3. Survivor parent loss of family 4. Survivor parent gender 5. Survivor parent post-war settlement location 6. Survivor Parent age during the Holocaust (in 1945) 7. Length of time before survivor parents’ resettlement after the war

3rd G

ener

atio

n

(Gra

ndch

ildre

n of

Su

rvivo

rs)





4. Adaptive coping strategies

1. Parent-Child Attachment (especially maternal) 2. Family Cohesion 3. Encouragement of Independence (maternal) 4. General Family Communication

Figure 13.2. Ranking (from most important to least important) of Influential Psychological Processes, Family Interaction Variables/Proposed Modes of Trauma Transmission and Survivor Demographic Moderators in terms of their relative importance in predicting scores on Psychological Impact Variables


272

Chapter Fourteen – Empirical Assessment of the Moderating Role of Descendant

Demographic Variables

This chapter continues the process begun in Chapter Thirteen: the testing of the role

demographic variables play in the model of the differential impact of Holocaust trauma

across three generations in terms of the three classes of psychological variables; namely

psychological impact, influential psychological process and family interaction/trauma

transmission mode variables. While Chapter Thirteen considered demographic variables

intrinsic to the survivor generation, the current chapter examines demographic variables

that are intrinsic to the descendant generations. The background literature to these

demographics was outlined in Chapter Five.

The specific demographic variables to be tested have been added to the

representation of the model overleaf and have been bolded for ease of reference.

Grandchildren of survivors are analysed both in terms of the demographics relevant to their

own generation and those relevant to their parents’ generation. As was the case for the

survivor demographics discussed in the previous chapter, the influence of a number of

ancestral demographic variables cannot be tested for all generations because of a lack of

data or prohibitive sample sizes. Such variables are noted at the relevant juncture in the

chapter.


273

Psychological Impacts of the

Holocaust


Ranking of Modes of Intergenerational Transmission

of Trauma


Ranking of Holocaust Survivor Generation Demographics


Grandchildren of Survivor

Generation

Sur

vivor

s




1. Maladaptive coping strategies 2. Assumption of World

Benevolence 3. Assumption of World

Meaningfulness 4. Adaptive coping Strategies

1. Nature of experiences 2. Country of origin 3. Loss of family 4. Post-war settlement location 5. Age during the Holocaust (in 1945) 6. Gender 7. Length of time before resettlement

Chi

ldre

n of

Sur

vivor

s






1. Survivor parent country of origin 2. Survivor parent experiences during

the Holocaust 3. Survivor parent loss of family 4. Survivor parent gender 5. Survivor parent post-war settlement

location 6. Survivor Parent age during the

Holocaust (in 1945) 7. Length of time before survivor

parents’ resettlement after the war






2. Family Cohesion 3. Communication about Holocaust

experiences (specifically via affective or non-verbal modes)



Gra

nd-c

hild

ren

of S

urviv

ors










• Number of child of survivor parents



2. Family Cohesion 3. Encouragement of Independence

(maternal) 4. General Family Communication

Figure 14.1. Addition of Holocaust Survivor Descendant Demographic Moderators to the Test Model of the Differential Impact of Holocaust Trauma across Three Generations


274

14.1. – Demographic Variable Inter-relationships

As was undertaken for the survivor demographics, inter-relationships between descendant

demographic variables have been examined so that potential confounds could be identified.

Where statistically significant relationships between demographic variables exist, they

serve to inform the use of controlled statistical analysis such as ANCOVA or partial

correlations when considering relationships between demographic variables and model

variables.

14.1.1. – Child of Survivor Demographic Variable Inter-relationships

Time lapse between the end of the war and the birth of children of survivors is statistically

significantly related, and therefore confounded, with a number of variables. These

statistically significant relationships are outlined in this section. All analyses with variables

statistically significantly related to time lapse are conducted as partial correlation analyses

(with time lapse partialled out) or ANCOVAs, with time lapse entered as a covariate to

control for this confound.

There is a statistically significant difference in time lapse in birth (F (2, 65) = 21.19,

p < 0.001) between children of survivors with one versus two survivor parents and also

within the children of one survivor group, depending on whether the survivor parent is their

mother or father. Specifically, the average time lapse for children with two survivor

parents is 5.67 years (SD = 4.57, n = 51), followed by children with a survivor mother with

10.40 years (SD = 9.34, n = 5), with children with a survivor father born after the longest

delay of 18.42 years (SD = 9.85, n = 12). The average age of survivor parents in 1945 is

also correlated statistically significantly to the time lapse in birth of children of survivors.

Specifically, age of survivor mother in 1945 is correlated with time lapse at r = - 0.65 (p <

0.001, n = 55) and age of survivor father in 1945 is correlated to time lapse at r = - 0.60 (p

< 0.001, n = 62).

The size of the time lapse or delay between the end of the war and birth of children

of survivors also differs statistically significantly, depending on whether the child was born

before or after their survivor parents emigrated from Europe (t (66) = 2.78, p < 0.01).

Children of survivors born before emigration were born an average of 5.19 years after 1945

(SD = 6.64, n = 27), while children born after emigration were born an average of 10.29

years after 1945 (SD = 7.89, n = 41). The birth order position of children of survivors is


275

also unsurprisingly statistically significantly correlated to time lapse between the war and

their birth (r = 0.43, p < 0.001).

14.1.2. – Grandchild of Survivor Demographic Variable Inter-relationships

The problems of confounding demographic variables are less of an issue for the analyses of

the grandchildren of survivor sample. This is mainly because many of the demographic

variables, that are related strongly within the survivor and children of survivor samples,

cannot be assessed in relation to the grandchildren sample due to lack of data or small sub-

group sample sizes.

The one obvious relationship between two demographic variables assessed in this

section that presents a potential confound is the relationship between the number of child of

survivor parents and the number of survivor grandparents. A participant with only one

child of survivor parent can have either one or two survivor grandparents, while a

participant whose parents are both children of survivors can have between two and four

survivor grandparents. This relationship is taken into account and noted in the assessment

of both these variables in relation to grandchildren’s scores.

14.2. – Moderating Influence of Child of Survivor Demographics

In this section, the demographic variables that relate to the children of survivor generation

are examined in terms of their influence on the measured variables in the model.

14.2.1. – Number of Holocaust Survivor Parents

14.2.1.1. – Influence on descendant psychological health.

Differences between children of survivors, related to the number of survivor parents they

have, were analysed and the results are presented in this section. There is a strong

relationship between the number of survivor parents a child has and the time lapse between

the end of the war and their birth. All statistically significant t-test results were re-run as

ANCOVAs (with time lapse as a covariate) where time lapse between the end of the war

and children of survivor’s birth was also statistically significantly related to the variable in

question. The results of this set of analyses are presented in Table 14.1. As can be seen,

there is only one statistically significant difference related to number of survivor parents.

The children with one survivor parent report statistically significantly higher vulnerability

than children with two survivor parents. While this is incongruous with the hypothesis that

children with two survivors will not fare as well as children with one survivor parent

(DH7), it is consistent with the meta-analytic finding that children with one survivor parent


276

scored higher on paranoia measures than children with two survivor parents (see Chapter

Nine, Section 9.2.1). Table 14.1. Children of one versus two Holocaust survivor parents’ scores on impact and influential process variables One survivor parent

(n =17) Two survivor parents

(n =51) Significance Test Results 2η

Impact Variables DASS Anxiety 4.47 (4.85) 3.15 (3.62) t (66) = 1.20, p = 0.24 0.021 DASS Depression 6.79 (8.26) 7.88 (9.45) t (66) = 0.42, p = 0.67 0.003 PTV 12.88 (4.39) 9.99 (4.68) t (66) = 2.24, p < 0.05,

ANCOVA with time lapse in birth since 1945 as covariate F (1, 65) = 1.53, p = 0.221

0.071 0.023

AAS Positive Dimensions 39.56 (10.61) 40.57 (9.43) t (66) = 0.37, p = 0.71 0.002 AAS Negative Dimensions 16.76 (7.79) 14.02 (5.58) t (21.73) = 1.34, p = 0.19 0.037 Influential Psychological Processes COPE Maladaptive 43.35 (10.70) 39.58 (5.95) t (19.40) = 1.39, p = 0.18 0.048 COPE Adaptive 94.94 (18.05) 95.18 (16.69) t (66) = 0.05, p = 0.96 0.000 WAS - Benevolence 35.06 (4.80) 34.14 (7.64) t (64) = 0.46, p = 0.65 0.003 WAS - Meaningfulness 35.29 (6.23) 32.13 (7.63) t (64) = 1.54, p = 0.13 0.036 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale

14.2.1.2. – Influence on survivor descendants’ perception of their parents/family

environment.

The results in Table 14.2 suggest that negative perceptions of survivor parents are

heightened when both parents are survivors, as opposed to when just one parent, is a

survivor. Specifically, if we turn to the statistically significant results in Table 14.2, it

seems that survivor mothers and fathers in a two survivor parent families are perceived to

make more frequent use of guilt-inducing communication about their Holocaust

experiences than when the other parent is not a survivor. In addition, children in two

survivor parent families report a statistically significantly higher non-verbal presence of the

Holocaust than one-survivor parent families. These results also somewhat mirror the

thoughts of Hafner (1968) who suggested the presence of other survivors within a

household may serve to compound the effects of the Holocaust on an individual (with each

survivor parent further reinforcing the symptoms and affected parenting approaches of the

other).


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Table 14.2. Children of one versus two Holocaust survivor parents’ perceptions of family interactions One survivor

parent

Two survivor parents (n =51)


Survivor Mother Specific Variables (n = 6) HCQ – Guilt-inducing communication about the Holocaust

2.17 (0.41) 3.44 (1.91) t (38.53) = 4.02, p < 0.001 0.046


1.33 (0.52) 1.80 (1.03) t (54) = 1.09, p = 0.28 0.021


2.00 (0.00) 2.61 (1.00) t (46) = 0.60, p = 0.55 0.008


7.50 (2.59) 9.29 (2.93) t (53) = 1.42, p = 0.16 0.037

Survivor Father Specific Variables (n =12) HCQ – Guilt-inducing communication about the Holocaust

2.42 (0.67) 3.42 (1.74) t (47.65) = 3.16, p < 0.01 0.061


1.50 (0.80) 1.57 (0.88) t (57) = 0.27, p = 0.79 0.001


2.58 (0.67) 2.41 (0.98) t (54) = 0.58, p = 0.57 0.006


10.17 (2.44) 8.51 (3.30) t (59) = 1.63, p = 0.11 0.043

Non parent specific family interaction variables (n =17) FES Cohesion 44.33 (20.61) 41.20 (23.39) t (65) = 0.50, p = 0.62 0.004 FES Expressiveness 40.89 (19.23) 34.56 (17.64) t (66) = 1.28, p = 0.21 0.024 HCQ – Non-verbal presence of the Holocaust 8.89 (2.63) 10.62 (2.86) t (65) = 2.24, p < 0.05,

ANCOVA with time lapse in birth since 1945 as covariate F (1,65) = 4.08, p < 0.05

0.072 0.061

Notes. HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. Differences in perceptions of survivor parents in one and two survivor parent dyads on parent specific variables not related to Holocaust communication are presented in Section 14.2.1.3 within the context of comparing perceptions of survivor to non-survivor parents.

14.2.1.3. – Perceptions of survivor versus non-survivor parents.

Previous research has not looked at the perceptions of non-survivor spouses of survivor

parents, or the non-survivor parent in a one survivor parent family. Analyses reported in

this section represent the first assessment of this issue. Research that has compared

perceptions of survivor and non-survivor parents have taken the perceptions of parents from

control or comparison groups where neither parent was a survivor and has left views of the

non-survivor parent in one survivor parent families unaddressed. The same lack of

assessment also applies for the next generation, with no data existing on views of non-

descendant of survivor parents in single child of survivor parent families.


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Table 14.3. Mean differences in ratings of survivor versus non-survivor parents on parent-child attachment dimensions and parental facilitation of independence

Perception of Survivor Parent (total COHS

sample) a

Perception of Survivor Parent (among children with one survivor

parent) b

Perception of Survivor Parent (among children with two survivor

parents) c

Perception of Non-Survivor Parent d

Mother n = 56 n = 6 n = 51 n = 12 PCS – Warmth 8.58 (5.17) 11.25 (6.40) 8.35 (5.07) 10.73 (4.29) PCS – Coldness 2.81 (3.83) d 1.00 (1.41) 2.96 (3.94) 0.91 (1.04) a PCS – Ambivalence

5.19 (4.89) 4.25 (6.65) 5.27 (4.80) 3.27 (3.44)


43.73 (14.63) d 46.25 (21.96)

43.52 (14.18) 52.91 (8.68) a

Father n = 61 n = 12 n = 51 n = 6 PCS – Warmth 8.63 (5.00) 9.73 (4.86) 8.38 (5.04) 11.25 (2.99) PCS – Coldness 3.66 (4.02) 2.45 (2.54) 3.94 (4.27) 3.00 (3.56) PCS – Ambivalence

5.37 (4.44) 4.36 (4.11) 5.60 (4.53) 4.25 (4.35)


45.19 (14.85) 49.82 (14.27)

44.13 (14.92) 53.00 (5.89)

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.

An interesting pattern in relation to perceptions of survivor and non-survivor

parents emerges when perusing Table 14.3. In column A, the perceptions held by children

of survivors of their survivor parent (irrespective of whether that parent is their only

survivor parent or if they have two survivor parents) are definitely universally more

negative than the views held by children with one survivor parent of their non-survivor

parent (column D). Indeed, survivor mothers in this categorisation are seen as statistically

significantly colder (t (60.05) = 3.34, p < 0.01) and less encouraging of their children’s

independence (t (23.35) = 2.88, p < 0.01). However, when this issue was examined a little

more deeply, a pattern emerges that suggests that when there are two survivor parents, both

parents are viewed more negatively than the survivor parent in single survivor parent

families. Could it be the case that survivor parents are generally less facilitating of

independence and less warm, more cold and more ambivalent, but the presence of a non-

survivor parent lessens the effect or the presence of another survivor parent enhances the

effect? This pattern mirrors that found for the Holocaust communication variables assessed

in the previous section.

14.2.2. – Time Lapse between the Holocaust and the Birth of Children of Survivors


Based on the results of meta-regressions (presented in Chapter Nine, Section 9.2.7) it has

been hypothesised that the shorter the timeframe between the end of the war and the birth

of a child of survivors, the worse they will fare (DH9). In order to analyse this issue with a

raw data sample (which was not possible within the meta-analyses), correlations were


279

calculated between child of survivors’ scores and the delay between the end of the war and

their birth and are presented in Table 14.4. Surprisingly, the correlations that are

statistically significant are in the opposite direction to that hypothesised (and found with the

meta-regression). Specifically both anxiety and vulnerability scores for children of

survivors correlate positively with delay in birth rather than negatively as hypothesised. Table 14.4. Correlations between children and grandchildren of survivors’ scores on impact and influential process variables with the time lapse between the Holocaust and the birth of children of survivors Children of Survivors Grandchildren of Survivors

Time lapse in birth (n = 68)

Time lapse in Father’s birth (n =14)

Time lapse in Mother’s birth (n =19)

r r2 r r2 r r2 Impact Variables DASS Anxiety 0.27 * 0.073 -0.243 0.059 0.007 0.000 DASS Depression -0.02 0.000 -0.207 0.043 -0.007 0.000 PTV 0.25 * 0.063 -0.421 0.177 0.090 0.008 AAS Positive Dimensions - 0.08 0.007 0.395 0.156 -0.274 0.075 AAS Negative Dimensions 0.09 0.009 0.134 0.018 0.084 0.007 Influential Psychological Processes COPE Maladaptive 0.21 0.043 0.076 0.006 -0.055 0.003 COPE Adaptive 0.10 0.010 0.265 0.070 -0.223 0.050 WAS - Benevolence 0.13 0.017 0.141 0.020 -0.450 # 0.203 WAS - Meaningfulness 0.17 0.029 0.324 0.105 -0.179 0.032 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale, * p < 0.05, # p < 0.10 (denoted only with n < 30) However, it is interesting to note that a number of correlations among the

grandchildren’s generation are in the hypothesised direction (albeit not statistically

significantly). Specifically of note is the negative correlation between delay in child of

survivor fathers’ birth and grandchildren’s vulnerability scores and the positive correlation

with positive attachment dimensions. However, the negative correlation between delay in

mother’s birth and world benevolence again suggest the counter-intuitive increase in

negative effects with increasing delays. Clearly the influence of the delay in birth of

children of survivors on their own and their children’s psychological well-being is still an

area that needs further clarification.

14.2.2.2. – Influence on descendants’ perceptions of their parents/family

environment.

Given that it is hypothesised that more positive outcomes are associated with a longer post-

war delay in the birth of children of survivors, it follows that children of survivors’

perceptions of their family environment will be more positive with a longer delay. In

addition, the flow on hypothesis would hold that children of survivors born after a longer

delay would be viewed more positively by their own children (the grandchildren of


280

survivors) than children of survivors born after a shorter delay. Table 14.5 presents the

correlation analyses designed to test this issue. There are no statistically significant

correlations with children of survivors’ perceptions of their family environment, but there

are a number of sizeable correlations for the next generation which are in the hypothesised

direction. Interestingly, the correlations are much stronger when paternal delay in birth is

considered, rather than maternal delay in birth. Analyses suggest that up to a third of the

variation in perceptions of child of survivor fathers are related to the post-war delay in the

child of survivor fathers’ birth. Longer delays are associated with perceptions of increased

warmth and fostering of autonomy/independence and decreased coldness and ambivalence,

as well as increased family cohesion. A decrease in family communication/expressiveness

with shorter delays in child of survivor mothers is also somewhat apparent. A number of

these moderately sized correlations are not statistically significant because of the small

sample sizes involved, but their magnitude means they are worthy of mention. Table 14.5. Correlations between children and grandchildren of survivors’ scores on family interaction variables with the time lapse between the Holocaust and the birth of children of survivors Children of Survivors Grandchildren of Survivors

Time lapse in birth Time lapse in Father’s birth (n = 13)

Time lapse in Mother’s birth (n =19)

r r2 r r2 r r2 Gender specific family interaction PCS – Warmth

Not applicable 0.477 0.228 -0.129 0.017

PCS – Coldness -0.571 * 0.326 0.021 0.000 PCS – Ambivalence -0.518 # 0.268 0.006 0.000 PAQ – Fostering of Autonomy 0.582 * 0.339 0.009 0.000 Survivor Mother (n =55) PCS – Warmth 0.122 0.015

Not applicable

PCS – Coldness 0.018 0.000 PCS – Ambivalence 0.031 0.001 PAQ – Fostering of Autonomy -0.069 0.005 HCQ – Affective communication about the Holocaust 0.093 0.009 HCQ – Indirect communication about the Holocaust -0.207 0.043 HCQ – Guilt-inducing communication about the Holocaust 0.076 0.006 HCQ – Frequent and willing communication about the Holocaust -0.066

0.004 Survivor Father (n =61) PCS – Warmth 0.055 0.003

Not applicable

PCS – Coldness -0.078 0.006 PCS – Ambivalence -0.041 0.002 PAQ – Fostering of Autonomy 0.083 0.007 HCQ – Affective communication about the Holocaust 0.212 0.045 HCQ – Indirect communication about the Holocaust -0.048 0.002 HCQ – Guilt-inducing communication about the Holocaust -0.070 0.005 HCQ – Frequent and willing communication about the Holocaust 0.183 0.033 Family Interaction Variables (non-parent specific) (n =66) HCQ Non-verbal presence of the Holocaust -0.12 0.013 Not applicable FES Cohesion -0.01 0.000 0.599 * 0.359 0.046 0.002 FES Expressiveness 0.23 0.052 - 0.046 0.002 - 0.415 # 0.172 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. * p < 0.05, # p < 0.10 (denoted only when n < 30)


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14.2.3. – Child of Survivor Gender


The hypothesised moderating role of child of survivor gender on child of survivors’ scores,

as well as relationships between variables in the model of the differential impact of

Holocaust trauma, are examined in this section. If the hypotheses about gender are to be

supported a more negative picture for females and children through the female line would

be expected.

Table 14.6 presents the mean scores and significance testing of daughters versus

sons of survivors on psychological impact variables. While none of the differences are

significant, it is notable that, overall, it is the daughters of survivors who score less

favourably than the sons of survivors. Turning to the grandchildren of survivor generation,

Table 14.6 also presents data for members of this generation with a child of survivor

mother only versus those with a child of survivor father only. Following on with the flow

on hypothesis, it is predicted that children of child of survivor mothers would fare less well

than children of child of survivor fathers. A cursory look at the psychopathological

measures shows that the children of child of survivor fathers have mostly scored worse than

the children of child of survivor mothers. While this is contradictory to the hypotheses

about gender, it is somewhat consistent with the findings within the current study relating

to the influence of survivor parent gender among children of survivors. However the one

mean difference that reached statistical significance among the grandchildren generation

has those with a child of survivor father reporting more frequent usage of adaptive coping

strategies than those with a child of survivor mother.


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Table 14.6. Female versus male children of survivors’ scores on impact and influential process variables

Children of Survivors Grandchildren of Survivors Females

(n = 44) Males (n =24)


2η Child of survivor

mother only (n =12)

Child of survivor father

only (n = 6)


2η

Impact Variables

DASS Anxiety 4.03 (4.46) 2.46 (2.62) t (65.57) = 1.83, p = 0.07

0.037 5.50 (5.95) 7.50 (8.78) t (16) = 0.58, p = 0.57

0.020

DASS Depression

8.86 (9.62) 5.31 (7.78) t (66) = 0.61, p = 0.13

0.035 6.58 (5.02) 9.33 (14.61) t (5.60) = 0.45, p = 0.67

0.022

PTV 11.49 (4.69) 9.29 (4.60) t (66) = 1.09, p = 0.28

0.050 11.29 (4.21) 10.33 (6.38) t (16) = 0.38, p = 0.71

0.009


40.02 (10.18) 40.85 (8.83) t (66) = 0.34, p = 0.74

0.002 40.08 (9.71) 47.33 (8.73) t (16) = 1.54, p = 0.14

0.129


15.34 (6.42) 13.54 (5.89) t (66) = 1.14, p = 0.26

0.019 16.25 (5.38) 19.33 (3.67) t (16) = 1.26, p = 0.23

0.090


COPE Maladaptive

40.93 (6.81) 39.76 (8.77) t (66) = 0.61, p = 0.54

0.006 42.25 (8.36) 43.50 (9.09) t (16) = 0.29, p = 0.78

0.005

COPE Adaptive 96.77 (16.03) 92.11 (18.36) t (66) = 1.09, p = 0.28

0.018 81.00 (16.93) 99.33 (8.96) t (15.84) = 3.00, p < 0.01

0.274

WAS - Benevolence

33.90 (7.55) 35.21 (5.96) t (64) = 0.73, p = 0.47

0.008 35.33 (4.12) 32.50 (11.06) t (16) = 0.80, p = 0.43

0.039

WAS - Meaningfulness

31.87 (7.15) 34.83 (7.56) t (64) = 1.59, p = 0.12

0.038 37.50 (12.30) 39.67 (4.59) t (16) = 0.41, p = 0.69

0.011



environment.

Table 14.7 presents the data as to how male and female children of survivors’ perceptions

differ regarding their survivor parents and their family environment. As can be seen, none

of the differences reach statistical significance; however there is an overall pattern of

daughters of survivors having more negative perceptions than sons of survivors.


283

Table 14.7. Female versus male child of survivor perceptions of their survivor parent/s on family interaction variables Females

Males


Survivor Mother Specific Variables (n =37) (n =19) PCS – Warmth 7.95 (5.38) 9.58 (5.10) t (54) = 1.09, p = 0.28 0.022 PCS – Coldness 3.43 (3.97) 2.11 (4.03) t (54) = 1.18, p = 0.24 0.025 PCS – Ambivalence 5.54 (5.06) 4.37 (4.41) t (54) = 0.86, p = 0.40 0.013 PAQ – Fostering of Autonomy 43.24 (14.50) 43.89 (15.83) t (54) = 0.15, p = 0.88 0.000 HCQ – Affective communication about the Holocaust 2.47 (0.98) 2.87 (0.99) t (46) = 1.29, p = 0.20 0.035 HCQ – Indirect communication about the Holocaust 1.68 (0.97) 1.89 (1.05) t (54) = 0.78, p = 0.44 0.011 HCQ – Guilt-inducing communication about the Holocaust 3.24 (1.67) 3.42 (2.19) t (54) = 0.34, p = 0.74 0.002 HCQ – Frequent and willing communication about the Holocaust 8.68 (2.94) 9.94 (2.78) t (53) = 1.53, p = 0.13 0.042 Survivor Father Specific Variables (n =40) (n =21) PCS – Warmth 8.30 (5.38) 8.95 (4.42) t (59) = 0.48, p = 0.64 0.004 PCS – Coldness 4.05 (3.93) 3.05 (4.35) t (59) = 0.91, p = 0.37 0.014 PCS – Ambivalence 5.40 (4.53) 5.33 (4.18) t (59) = 0.06, p = 0.96 0.000 PAQ – Fostering of Autonomy 45.72 (13.60) 44.52 (17.02) t (58) = 0.30, p = 0.77 0.002 HCQ – Affective communication about the Holocaust 2.46 (0.88) 2.42 (1.02) t (54) = 0.15, p = 0.88 0.000 HCQ – Indirect communication about the Holocaust 1.48 (0.82) 1.74 (0.93) t (57) = 1.10, p = 0.28 0.021 HCQ – Guilt-inducing communication about the Holocaust 3.25 (1.74) 3.15 (1.42) t (58) = 0.22, p = 0.83 0.001 HCQ – Frequent and willing communication about the Holocaust 8.58 (3.32) 9.33 (2.97) t (59) = 0.88, p = 0.38 0.013 Non Parent Specific Family Interaction Variables (n =43) (n =24) FES Cohesion 40.98 (24.55) 43.96 (18.82) t (58.53) = 0.56, p = 0.58 0.004 FES Expressiveness 34.68 (18.17) 39.08 (18.14) t (66) = 0.96, p = 0.34 0.014 HCQ Non-verbal presence of the Holocaust 10.55 (2.76) 9.46 (3.04) t (65) = 1.49, p = 0.14 0.033 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale

Table 14.8 compares the perceptions held by the grandchildren of survivor

generation of their child of survivor parents of their mother versus their father. This has

been done within the grandchildren subgroup for whom both parents are the child of

survivors. There are no statistically significant differences. Table 14.8. Mean differences in ratings of child-of-survivor mothers versus child-of-survivor fathers among grandchildren with two child-of-survivor parents on parent-child attachment dimensions and parental facilitation of autonomy

Perception of Mother (n =10) Perception of Father (n =10) Significance Test Results 2η PCS – Warmth 10.55 (5.95) 10.00 (5.21) t (9) = 0.33, p = 0.75 0.012 PCS – Coldness 2.70 (4.14) 3.40 (3.41) t (9) = 0.69, p = 0.51 0.051 PCS – Ambivalence 6.00 (6.11) 6.10 (4.61) t (9) = 0.11, p = 0.92 0.001 PAQ – Fostering of Autonomy 46.00 (15.09) 48.15 (12.19) t (9) = 0.49, p = 0.64 0.026 Notes. PCS = Parental Care-giving Style Questionnaire

14.2.3.3. – Interaction between parent gender and descendant gender.

Mixed design ANOVAS were conducted to test for interactions between child of survivor

and survivor gender on child of survivor perceptions of survivor parents (with child of

survivor gender as a between subjects IV and survivor gender as a within subjects IV).

None of these analyses reach statistical significance. It is likely that low power (resulting

from small sample sizes, in particular n =17 for male children of survivors and the analysis

of two rather than one independent variable) plays a large role in this, as the results of


284

numerous other analyses (where only one independent variable was assessed) suggest a

differential parental gender influence. Issues relating to power in the analyses of data from

the study were mooted in Chapter Eleven, but are particularly relevant here where a more

complicated analysis (requiring a larger sample for adequate power) has been used.

To further test the possible moderating role of child of survivor gender, separate

correlation matrices were calculated for male and female children of survivors for scores on

psychological impact variables and influential psychological process variables with their

scores on the family interaction/modes of transmission variables. The hypothesis being

tested by these gender stratified correlation matrices is that the relationships with family

interaction variables will be stronger for female than male children of survivors. The

method for calculating whether the difference between two correlation co-efficients (in this

case between correlation co-efficients for males and correlation co-efficients for females)

was obtained from Howell (1992, p. 251). In the majority of cases, there are stronger

relationships between family interaction variables and impact and process variables for

daughters of survivors than sons of survivors, with 49% of the 171 correlations being in the

same direction and stronger for daughters than sons, 33% of the correlations in the same

direction and stronger for sons than daughters and 18% of the correlations in opposing

directions for sons and daughters. Ten of the son and daughter correlations are statistically

significantly different from each other and nine of these come from the 18% of correlations

with different signs. These are presented in Table 14.9. The results of these analyses show

that there are certainly grounds to contend that there is an interaction between parent and

child gender on family environment and transmission of Holocaust trauma. Table 14.9. Statistically significantly different correlations between impact and influential process variables and family interaction variables when stratified by child of survivor gender Family Interaction Variables Impact and Influential Process Variables Female

(n =32) Male

(n =17) Survivor Father PCS – Father Cold PTV 0.30 -0.41 HCQ – Guilt-inducing communication about the Holocaust by Father WAS - Meaningfulness 0.18 -0.62 HCQ – Frequent and willing communication about the Holocaust by Father AAS Negative Dimensions -0.21 0.42 HCQ – Frequent and willing communication about the Holocaust by Father AAS Positive Dimensions 0.44 -0.29 HCQ – Frequent and willing communication about the Holocaust by Father WAS - Benevolence 0.25 -0.57 HCQ – Indirect communication about the Holocaust by Father AAS Positive Dimensions 0.47 -0.28 Mother HCQ – Affective communication about the Holocaust by Mother DASS - Anxiety 0.05 0.64 HCQ – Affective communication about the Holocaust by Mother AAS Positive Dimensions -0.07 -0.80 HCQ – Frequent and willing communication about the Holocaust by Mother DASS - Anxiety 0.27 -0.49 HCQ – Indirect communication about the Holocaust by Mother AAS Positive Dimensions 0.25 -0.46 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale


285

14.2.4. – Child of Survivor Birth Order

14.2.4.1. – Influence on children of survivor psychological health.

The effect of child of survivor birth order on their psychological health is assessed in two

ways: correlations with birth order position and comparisons between only children and

those with siblings. It should be noted that while there is a statistically significant

relationship between birth order and time lapse in birth of children of survivors, it was not

necessary to conduct any controlled analyses (either partial correlations or ANCOVAs), as

none of the variables that correlate with time lapse in birth are statistically significantly

related to birth order as well. Based on the review of the literature on this issue (see

Chapter Nine, Section 9.2.10), it was hypothesised that middle order children would have

the highest scores on negative variables (DH8).

Table 14.10 presents the results of correlation and t-test analyses designed to test the

influence of birth order on children of survivors’ scores on impact and influential process

variables from the model. There are no statistically significant correlations with birth

order; however analyses comparing only children to those with siblings did yield one

statistically significant difference. Contrary to what has been hypothesised in the literature

(see Chapter Five, Section 5.2.3), but consistent with the results of studies that have

directly assessed birth order (see Chapter Nine, Section 9.2.10), it is the children of

survivors with siblings who rate themselves statistically significantly higher on depression

than only children. Table 14.10. Correlations with child of survivor birth order and differences between children of survivors who are only children and children of survivors with siblings on impact and influential process variables Correlations with birth

order (n =66) Comparisons between only children and children with siblings

r r2 Only child (n =14)

With siblings (n =52)

Significance Test Results 2η Impact Variables DASS Anxiety 0.028 0.001 2.36 (2.56) 3.68 (4.28) t (34.88) = 1.46, p = 0.15 0.019 DASS Depression 0.161 0.026 3.93 (3.41) 8.82 (9.99) t (60.37) = 2.95, p < 0.01 0.048 PTV -0.022 0.000 9.50 (4.70) 10.97 (4.83) t (64) = 1.02, p = 0.31 0.016 AAS Positive Dimensions 0.005

0.000 39.57 (5.43) 40.64 (10.43) t (41.28) = 0.52, p = 0.60 0.002

AAS Negative Dimensions -0.093 0.009 15.79 (6.66) 14.65 (6.18) t (64) = 0.60, p = 0.55 0.006 Influential Psychological Processes

COPE Maladaptive 0.184 0.034 40.07 (6.98) 40.72 (7.83) t (64) = 0.28, p = 0.78 0.001 COPE Adaptive -0.084 0.007 92.79 (17.45) 95.41 (17.11) t (64) = 0.51, p = 0.61 0.004 WAS - Benevolence -0.028 0.001 34.50 (4.97) 34.00 (7.36) t (62) = 0.24, p = 0.81 0.001 WAS - Meaningfulness -0.192 0.037 34.43 (7.28) 32.29 (7.42) t (62) = 0.96, p = 0.34 0.015 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale


286


environment.

Table 14.11 reports the descriptive and inferential statistics examining the influence of

child of survivor birth order on their perceptions of their survivor parents and their family

of origin. There are only two statistically significant results, but both are consistent with

the findings of the previous section. Specifically, the statistically significant correlation

between birth order and perceptions of survivor fathers’ use of affective communication

about the Holocaust suggests that children of survivors, who are later in the birth order,

notice this type of paternal communication more frequently than those in higher birth order

positions. The other statistically significant result is also suggestive of more negative

perceptions among later born children, with family cohesion being rated statistically

significantly lower by children with siblings than only children. Table 14.11. Correlations with child of survivor birth order and differences between child of survivor only children and children of survivors with siblings on family interaction variables Correlations with Birth

Order Comparisons between only children and children with siblings

r r2 Only child With siblings Significance Test Results 2η Survivor Mother Specific Variables (n =55) (n =12) (n =43) PCS – Warmth -0.054 0.003 9.50 (4.93) 8.42 (5.33) t (53) = 0.63, p = 0.53 0.007 PCS – Coldness 0.018 0.000 2.42 (4.52) 2.98 (3.79) t (53) = 0.43, p = 0.67 0.004 PCS – Ambivalence 0.130 0.017 4.58 (3.70) 5.26 (5.19) t (24.42) = 0.51, p = 0.62 0.003 PAQ – Fostering of Autonomy -0.120 0.014 47.00 (15.60) 42.86 (14.61) t (53) = 0.86, p = 0.40 0.014 HCQ – Affective communication about the Holocaust

0.137 0.019

2.89 (1.05) 2.53 (0.98) t (46) = 0.99, p = 0.33 0.021


-0.251 0.063

2.17 (1.34) 1.63 (0.87) t (53) = 1.67, p = 0.10 0.050


0.158 0.025

3.08 (2.11) 3.40 (1.80) t (53) = 0.51, p = 0.61 0.005


-0.176 0.031

9.50 (3.85) 9.05 (2.65) t (52) = 0.47, p = 0.64 0.004

Survivor Father Specific Variables (n =61) (n =11) (n =48) PCS – Warmth -0.113 0.013 10.09 (4.46) 8.12 (5.18) t (58) = 1.17, p = 0.25 0.023 PCS – Coldness 0.111 0.012 1.73 (2.76) 4.22 (4.20) t (58) = 1.88, p = 0.07 0.057 PCS – Ambivalence 0.114 0.013 5.09 (2.59) 5.47 (4.74) t (57) = 1.48, p = 0.15 0.001 PAQ – Fostering of Autonomy -0.141 0.020 51.09 (13.66) 43.83 (14.92) t (27.53) = 0.37, p = 0.72 0.037 HCQ – Affective communication about the Holocaust

0.368 ** 0.135

2.10 (0.99) 2.53 (0.90) t (53) = 1.35, p = 0.18 0.033


-0.092 0.009

1.64 (0.92) 1.51 (0.83) t (56) = 0.44, p = 0.66 0.003


-0.003 0.000

3.09 (1.45) 3.27 (1.69) t (57) = 0.33, p = 0.75 0.002


0.076 0.006

8.55 (3.45) 8.86 (3.20) t (58) = 0.29, p = 0.77 0.001

Family Interaction Variables (non-parent specific)

(n =66) (n =14) (n =52)

HCQ Non-verbal presence of the Holocaust

0.115 0.013 9.07 (3.05) 10.42 (2.83) t (63) = 1.56, p = 0.13 0.037

FES Cohesion -0.117 0.014 51.43 (15.97) 39.63 (23.56) t (30.36) = 2.19, p < 0.05 0.047 FES Expressiveness -0.083 0.007 44.21 (19.31) 34.42 (17.67) t (64) = 1.81, p = 0.08 0.048 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire, FES = Family Environment Scale. ** p < 0.01.


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It was not possible to assess the impact of child of survivor birth order on grandchildren of

survivors due to lack of data.

14.3. – Moderating Influence of Grandchild of Survivor Demographics

In this section, the demographic variables from the model that directly pertain to the

grandchild of survivor generation are analysed in terms of their role in influencing scores

on impact, psychological process and family interaction variables.

14.3.1. – Number of Child of Survivor Parents/Survivor Grandparents

It was hypothesised that grandchildren of survivors’ scores on negative psychological

variables will increase with the number of ancestors affected by the Holocaust (DH7).

Grandchildren of Holocaust survivors have the possibility of having up to four ancestors

traumatised by the Holocaust. It was necessary to not only consider whether a grandchild

had one or two children of survivor parents but also the number of survivor grandparents

they had. It is possible that a grandchild of survivors with one child of survivor parent

could have one or two survivor grandparents, while grandchildren with two child of

survivor parents could have between two and four survivor grandparents. Given how

strongly related these two variables (number of survivor grandparents and number of child

of survivor parents) are, they are considered together in this section. In both cases,

controlled analyses are conducted with ANCOVAs comparing grandchildren with one

versus two child of survivor parents (with number of survivor grandparents as a covariate)

and partial correlations with number of survivor grandparents (with number of child of

survivor parents partialled out).


Table 14.12 presents the results of ANCOVAs and partial correlations designed to partition

the unique contribution of number of child of survivor parents and number of survivor

grandparents on grandchildren of survivors. As can be seen, there are numerous

statistically significant relationships with both variables. With respect to number of child of

survivor parents first, this variable statistically significantly relates to anxiety, depression,

vulnerability and belief in world benevolence, even when number of survivor grandparents

is partialled out. Counter-intuitively, it is the grandchildren with only one child of survivor

parent who are scoring statistically significantly less favourably here, than those whose

parents are both children of survivors. It is interesting to note, however, that statistically


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significant relationships between number of child of survivor parents and coping styles are

not statistically significant when the number of survivor grandparents is partialled out.

Conversely, when attention is turned to the partial correlations examining the

unique relationships between number of survivor grandparents and grandchildren’s scores

(partialling out the number of child of survivor parents), there are a number of quite

sizeable relationships which are all in the hypothesised direction: namely that anxiety,

depression and vulnerability increase with increases in the number of survivor

grandparents, while belief in world benevolence weakens with an increase in the number of

survivor grandparents.

Table 14.12. Children of one versus two child of Holocaust survivor parents’ scores on impact and influential process variables Comparisons between children with one and two child of survivor parents Correlations with number

of survivor grandparents One child of

survivor parent (n =18)

Two child of survivor parents (n =10)


2η sr sr2

Impact Variables DASS Anxiety 6.17 (6.82) 2.90 (3.35) t (26) = 1.42, p = 0.17

F (1, 25) = 9.28, p < 0.01 0.071 0.271

0.463 * 0.214

DASS Depression 7.50 (9.00) 3.30 (4.03) t (26) = 1.39, p = 0.18 F (1, 25) = 11.64, p < 0.01

0.069 0.318

0.517 ** 0.267

PTV 10.97 (4.86) 9.25 (3.12) t (26) = 1.01, p = 0.32 F (1, 25) = 6.79, p < 0.05

0.037 0.214

0.430 * 0.185

AAS Positive Dimensions 42.50 (9.79) 35.80 (10.44) t (26) = 1.70, p = 0.10 F (1, 25) = 0.00, p = 1.00

0.100 0.000

- 0.196 0.038

AAS Negative Dimensions 17.28 (4.99) 15.15 (6.19) t (26) = 0.99, p = 0.33 F (1, 25) = 2.97, p = 0.10

0.036 0.106

0.270 0.073


COPE Maladaptive 42.67 (8.36) 37.05 (7.37) t (26) = 1.77, p = 0.09 F (1, 25) = 1.11, p = 0.30

0.108 0.042

0.040 0.002

COPE Adaptive 87.11 (16.98) 97.90 (17.14) t (26) = 1.61, p = 0.12 F (1, 25) = 0.01, p = 0.94

0.090 0.000

0.166 0.028

WAS - Benevolence 34.39 (6.99) 34.85 (9.18) t (26) = 0.15, p = 0.88 F (1, 25) = 5.81, p < 0.05

0.001 0.189

- 0.475 * 0.226

WAS - Meaningfulness 38.22 (10.25) 36.55 (11.69) t (26) = 0.39, p = 0.70 F (1, 25) = 0.11, p = 0.75

0.006 0.004

0.031 0.001

Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale * p < 0.05, ** p < 0.01.

14.3.1.2. – Influence on descendants’ perceptions of their family environment.t

Table 14.13 reports on how the number of child of survivor parents and survivor

grandparents impacts on grandchildren of survivors’ perception of their family

environment. There are no statistically significant results relating to family expressiveness,

but the results relating to family cohesion are somewhat confusing. They suggest that the

overlapping variance between number of child of survivor parents and number of survivor


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grandparents is so large that it cannot be disentangled. What is clear, though, is that the

degree of survivor ancestry has a definite negative effect on the perception of family

cohesion among the grandchildren’s generation. Table 14.13. Children of one versus two Child of Holocaust survivor parents scores on impact and influential process variables Comparisons between children with one and two child of survivor parents Correlations with number of

survivor grandparents One child of

survivor parent (n =18)

Two child of survivor parents

(n =10)


2η sr sr2

FES Cohesion 55.44 (17.85) 35.10 (23.04) t (26) = 2.61, p < 0.05 F (1,25) = 1.07, p = 0.31

0.207 0.041

-0.051 0.003

FES Expressiveness

49.00 (16.25) 52.22 (15.08) t (25) = 0.50, p = 0.62 F (1,24) = 0.00, p = 0.97

0.010 0.000

0.071 0.005

Notes. FES = Family Environment Scale Differences in perceptions of child-of-survivor parents in one and two child-of-survivor parent dyads on parent specific variables are presented in Section 14.3.1.3 within the context of comparing perceptions of child-of-survivor to non-child-of-survivor parents.

14.3.1.3. – Perceptions of child of survivor versus non-child of survivor parents.

Table 14.14 presents the mean rating of child of survivor and non-child of survivor parents

on parent-child attachment dimension as well as their perceived level of facilitation of

independence. Table 14.14 Ratings of child of survivor versus non-child of survivor parents on parent-child attachment dimensions and parental facilitation of independence

Perception of Child Survivor Parent (total grandchild sample) a

Perception of Child Survivor Parent (among those with one child of

survivor parent) b

Perception of Child of Survivor Parent (among those with two child of

survivor parents) c

Perception of Non-Child of Survivor Parent d

Mother n = 22 n = 12 n = 11 n = 6 PCS – Warmth 11.89 (4.51) 13.00 (2.63) 10.86 (5.74) 13.00 (2.97) PCS – Coldness 1.41 (3.00) 0.33 (0.65) 2.45 (4.01) 0.83 (1.60) PCS – Ambivalence 3.86 (5.15) d 2.08 (3.53) 5.45 (6.07) 1.33 (2.07) a PAQ – Fostering of Autonomy

48.86 (14.89) d 51.25 (14.16) 47.36 (15.01) 58.33 (4.37) a

Father n = 16 n = 6 n = 10 n = 10 PCS – Warmth 10.44 (5.02) 11.17 (5.08) 10.00 (5.21) 11.90 (4.25) PCS – Coldness 2.88 (3.93) 2.00 (4.90) 3.40 (3.41) 1.10 (2.51) PCS – Ambivalence 5.63 (4.80) d 4.83 (5.46) 6.10 (4.61) 2.20 (2.94) a


50.41 (11.08) 54.17 (8.57) 48.15 (12.19) 53.00 (11.84)

Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire. Lettered superscripts indicate which groups differ statistically significantly according to Tukey post-hoc analyses.

Almost the identical pattern to that seen when comparing perceptions of survivor

parents to non-survivor parents emerges when comparing perceptions of child of survivor

parents to non-child of survivor parents. Certainly the perceptions of child of survivor

parents of both genders (irrespective of whether the other parent is also a child of survivors


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– reported in the second column/column “a”) are all more negative than the perceptions of

non-child of survivor parents. There are two statistically significant differences here on the

maternal side with child of survivor mothers seen as more ambivalent (t (21.56) = 1.83, p =

0.081) and less facilitating of independence (t (25.46) = 2.66, p < 0.05) than mothers who

are descended from survivors. In addition, child of survivor fathers (t (24.00) = 2.26, p <

0.05) are seen as more ambivalent than fathers with non-Holocaust traumatised parents.

The pattern of child of survivor parents being viewed more negatively when they

are a part of a child of survivor parent dyad, as opposed to part of a child of survivor and

non-child of survivor parent dyad, is practically identical to that seen for the preceding

generation. The question of whether the effects of having both parents with survivor

experience or ancestry appears to have more support for the affirmative.

14.3.2. – Grandchild of Survivor Gender


The hypothesis relating to gender is that female grandchildren of survivors will score

higher on negative variables and lower on positive variables than male grandchildren of

survivors. Table 14.15 displays the mean scores and significance tests examining gender

differences on impact and influential process variables among grandchildren of survivors.

As can be seen, females report statistically significantly higher depression, higher

attachment anxiety, higher usage of maladaptive coping strategies and a weaker belief in

world meaningfulness than male grandchildren. These results support the hypothesis and

are mostly consistent with meta-analytic results (see Chapter Nine, Section 9.2.9) as well as

gender differences in the general population (for example Oltmanns & Emery, 1995).

Table 14.15. Female versus male grandchildren of survivors’ scores on impact and influential process variables Females

(n =20) Males (n =8)

Significance Test Results 2η Impact Variables DASS Anxiety 5.85 (6.03) 2.88 (5.59) t (26) = 1.20, p = 0.24 0.053 DASS Depression 7.65 (8.60) 1.88 (2.36) t (26) = 1.85, p = 0.075 0.117 PTV 11.15 (4.54) 8.38 (3.20) t (26) = 1.57, p = 0.13 0.086 AAS Positive Dimensions 40.30 (10.23) 39.63 (11.39) t (26) = 1.85, p = 0.075 0.001 AAS Negative Dimensions 17.78 (5.44) 13.38 (4.21) t (26) = 0.15, p = 0.88 0.139 Influential Psychological Processes COPE Maladaptive 43.93 (6.81) 32.50 (6.00) t (26) = 4.14, p < 0.001 0.397 COPE Adaptive 89.60 (16.37) 94.38 (20.94) t (26) = 0.64, p = 0.53 0.016 WAS - Benevolence 34.48 (7.45) 34.75 (8.75) t (26) = 0.08, p = 0.93 0.000 WAS - Meaningfulness 35.23 (9.64) 43.63 (11.12) t (26) = 2.00, p = 0.056 0.133 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale


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environment.

There are no statistically significant differences relating to grandchild of survivor gender in

terms of their perceptions of their child of survivor parents or family environment. Table

14.16 reports the descriptive statistics and the results of significance testing on this issue.

Table 14.16 Female versus male grandchildren of survivors’ perceptions of their child of survivor parents on family interaction variables Females

Males


Child of Survivor Mother Specific Variables (n =15) (n =7) PCS – Warmth 11.90 (4.47) 11.86 (4.95) t (20) = 0.02, p = 0.98 0.000 PCS – Coldness 1.53 (3.09) 1.14 (3.02) t (20) = 0.28, p = 0.78 0.004 PCS – Ambivalence 4.13 (5.36) 3.29 (5.02) t (20) = 0.35, p = 0.73 0.006 PAQ – Fostering of Autonomy 48.80 (13.11) 49.00 (18.26) t (20) = 0.03, p = 0.98 0.000 Child of Survivor Father Specific Variables (n =11) (n =5) PCS – Warmth 10.82 (4.77) 9.60 (6.02) t (14) = 0.44, p = 0.67 0.013 PCS – Coldness 2.73 (3.93) 3.20 (4.38) t (14) = 0.22, p = 0.83 0.003 PCS – Ambivalence 5.82 (5.17) 5.20 (4.38) t (14) = 0.23, p = 0.82 0.004 PAQ – Fostering of Autonomy 50.68 (8.60) 49.80 (16.57) t (14) = 0.14, p = 0.89 0.001 Non parent specific family interaction variables (n =20) (n =8) FES Cohesion 45.90 (23.33) 53.88 (17.53) t (26) = 0.87, p = 0.39 0.028 FES Expressiveness 51.58 (14.60) 46.50 (18.47) t (26) = 0.76, p = 0.45 0.023 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, FES = Family Environment Scale

14.3.2.3. – Interaction between parent gender and descendant gender.

As was conducted for the children of survivors, separate correlation matrices were

calculated for male and female grandchildren of survivors for scores on psychological

impact variables and influential psychological process variables with their scores on the

family interaction/modes of transmission variables. The hypothesis being tested by these

gender-stratified correlation matrices is that the relationships with family interaction

variables will be stronger for female grandchildren than male grandchildren. The method

for calculating whether the difference between two correlation co-efficients (in this case

between correlation co-efficients for male grandchildren and correlation co-efficients for

female grandchildren) was obtained from Howell (1992, p. 251). In the majority of cases,

there are stronger relationships between family interaction variables and impact and process

variables for grandsons of survivors than granddaughters of survivors, with 52% of the 90

correlations being in the same direction and stronger for sons than daughters, 11% of the

correlations in the same direction and stronger for daughters than sons and 37% of the

correlations in opposing directions for sons and daughters. Three of the son and daughter

correlations are statistically significantly different from each other and two of these three


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came from the 37% of correlations with different signs. These correlations are presented in

Table 14.17. Table 14.17. Statistically significantly different correlations between impact and influential process variables and family interaction variables when stratified by grandchild of survivor gender Family Interaction Variables Impact and Influential Process Variables Females

(n =20) Males (n =8)

PCS – Ambivalence – Paternal AAS Negative Dimensions 0.08 0.8 PAQ – Fostering of Autonomy – Paternal AAS Negative Dimensions 0.17 -0.69 PAQ – Fostering of Autonomy – Paternal AAS Positive Dimensions -0.16 0.83 Notes. AAS = Adult Attachment Scale, PCS = Parental Care-giving Style Questionnaire, PAQ = Parent Attachment Questionnaire

14.3.3. – Grandchild of Survivor Birth Order


It was not possible to validly compare only child to non-only child grandchildren of

survivors because of insufficient samples (there is only one or two grandchildren who are

only children in each analysis); therefore only correlations with birth order are presented

here.

As can be seen the one statistically significant correlation with birth order among

grandchildren of survivors is the positive correlation with a belief in world meaningfulness.

This result suggests a strengthening of belief in world meaningfulness the younger or the

lower down the birth order the grandchild of survivors is. This result is consistent with the

hypothesis that higher birth order will be associated with more negative effects. Table 14.18 Correlations with grandchild of survivor birth order and impact and influential process variables (n = 27) r r2 Impact Variables DASS Anxiety -0.087 0.008 DASS Depression -0.232 0.054 PTV -0.203 0.041 AAS Positive Dimensions -0.027 0.001 AAS Negative Dimensions 0.135 0.018 Influential Psychological Processes COPE Maladaptive -0.046 0.002 COPE Adaptive -0.101 0.010 WAS - Benevolence 0.176 0.031 WAS - Meaningfulness 0.399 * 0.159 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale * p < 0.05.


293


environment.

The way in which the birth order of grandchildren of survivors relates to their perceptions

of their parents (who are children of survivors) and family environment is considered in

Table 14.19. The statistically significant correlations all relate to perceptions of child of

survivor fathers. Specifically, later born grandchildren perceive their child of survivor

father as less warm, more ambivalent and less fostering of their autonomy/encouraging of

their independence than grandchildren born earlier in the birth order. Again, this result

points to more negative effects and perceptions being related to later, rather than earlier,

birth order positions and is consistent with the meta-analytic findings (Chapter Nine,

Section 9.2.10 in relation to children of survivors), but inconsistent with the anecdotal

literature (Chapter Five). Table 14.19 Correlations with grandchild of survivor birth order and their perceptions of their child of survivor parents as rated on family interaction variables r r2 Child of Survivor Mother Specific Variables (n =22) PCS – Warmth -0.159 0.026 PCS – Coldness -0.054 0.003 PCS – Ambivalence 0.094 0.009 PAQ – Fostering of Autonomy 0.018 0.000 Child of Survivor Father Specific Variables (n =15) PCS – Warmth -0.496 # 0.246 PCS – Coldness 0.334 0.112 PCS – Ambivalence 0.623 * 0.388 PAQ – Fostering of Autonomy -0.422 0.178 Non parent specific family interaction variables (n =27) FES Cohesion 0.051 0.003 FES Expressiveness -0.053 0.003 Notes. PCS = Parental Care-giving Style Questionnaire, PAQ = Parental Attachment Questionnaire, FES = Family Environment Scale * p < 0.05, # p < 0.10 (denoted only when n < 30)

14.4. - Differences Related to Sample Characteristics

Differences among survivors and children and grandchildren of survivors related to their

membership of survivor or descendant organisations and their therapy history are assessed

in this subsection.

14.4.1. – Membership of Survivors Organisations/Support Groups

Following on from the results of the sub-set meta-analyses presented in Chapters Eight and

Nine that addressed this issue, it was hypothesised in Chapter Ten that survivors or

descendants who are members of a survivor or descendant organisation will display higher


294

levels of negative symptoms and lower levels of positive dimensions/variables than non-

members (SH1). The results of analyses comparing members and non-members of survivor

organisations among the three generations in the study sample are presented in Table 14.20.

Among survivors, the one statistically significant difference finds a much higher

level of posttraumatic growth among members of survivor organisations than non-members

and also a lower usage of maladaptive coping strategies. Apart from anxiety, overall the

survivor organisation members score more positively than the non-members. This is

inconsistent with both the hypothesis and the results of the meta-analyses on this issue (see

Chapter Eight, Section 8.9).

With respect to the children of survivors, those who are not members of a

descendant of survivor organisation report statistically significantly less usage of adaptive

coping strategies than children of survivors who have joined such organisations. There is

less of a discernible pattern overall for group membership among children of survivors.

For the grandchildren’s generation, the non-members score less favourably on a whole

range of variables from depression, anxiety and vulnerability to world assumption

variables, but the one statistically significant difference has non-members reporting

statistically significantly lower usage of maladaptive coping strategies than members. No

data exists prior to this study comparing grandchildren of survivors based on descendant

organisation membership status.


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Table 14.20. Comparison of survivor/descendant group member and non-members among survivors and descendants on impact and influential process variables Survivors Children of Survivors Grandchildren of Survivors

Members (n =9)

Non-Members (n =13)

Significance Test Results Members (n =37)

Non-Members (n =30)


Members (n =3)

Non-Members (n =23)


Impact Variables

DASS Anxiety 6.22 (6.67) 4.15 (5.89) t (20) = 0.77, p = 0.45 3.47 (3.54) 3.28 (4.19) t (65) = 0.19, p = 0.85 3.33 (2.89) 5.30 (6.44) t (24) = 0.52, p = 0.61 DASS Depression 5.33 (5.79) 6.54 (7.07) t (20) = 0.42, p = 0.68 6.92 (7.29) 7.70 (10.15) t (65) = 0.36, p = 0.72 4.00 (5.29) 6.17 (8.23) t (24) = 0.44, p = 0.66 IES-R Total Score 2.64 (2.91) 3.64 (2.83) t (21) = 0.84, p = 0.41 Not applicable Not applicable PTV 9.36 (3.11) 11.83 (4.97) t (18.66) = 1.44, p = 0.17 11.10 (4.88) 10.26 (4.65) t (65) = 0.72, p = 0.47 6.67 (4.73) 10.87 (4.08) t (24) = 1.65, p = 0.11 AAS Positive Dimensions 41.38 (9.30) 36.42 (7.49) t (18) = 1.32, p = 0.20 40.78 (9.58) 39.81 (9.94) t (65) = 0.41, p = 0.69 49.00 (6.08) 39.17 (10.77) t (24) = 1.53, p = 0.14 AAS Negative Dimensions 12.88 (5.06) 11.42 (3.00) t (18) = 0.81, p = 0.43 15.50 (5.27) 14.14 (7.03) t (65) = 0.88, p = 0.38 21.33 (4.51) 16.11 (5.39) t (24) = 1.60, p = 0.12 PTGI Total Score 71.33 (12.41) 43.00 (30.76) t (19) = 2.57, p < 0.05 Not applicable Not applicable


COPE Maladaptive 38.33 (6.48) 45.23 (9.31) t (20) = 1.92, p = 0.070 42.37 (6.90) 39.09 (7.85) t (65) = 1.79, p = 0.08 52.67 (9.45) 38.80 (7.26) t (24) = 3.02, p < 0.01 COPE Adaptive 99.94 (16.93) 102.27 (16.28) t (20) = 1.92, p = 0.07 102.22 (16.36) 89.94 (15.30) t (65) = 3.17, p < 0.01 104.67 (5.86) 89.57 (17.96) t (24) = 1.42, p = 0.17 WAS - Benevolence 32.10 (6.54) 28.69 (7.32) t (21) = 1.16, p = 0.26 33.93 (6.00) 34.84 (7.78) t (63) = 0.51, p = 0.61 41.00 (5.57) 33.50 (7.86) t (24) = 1.59, p = 0.13 WAS - Meaningfulness 33.70 (7.04) 30.92 (10.94) t (21) = 0.70, p = 0.49 32.36 (7.03) 33.32 (7.79) t (63) = 0.52, p = 0.61 44.67 (4.04) 36.41 (10.45) t (24) = 1.33, p = 0.20 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale


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14.4.2. – Participation in Counselling/Therapy

A comparison is made in this section of study participants with, and without, a history of

some form or counselling or therapy. Among the Holocaust survivors, it seems that the

group of survivors who have never been in therapy score higher on all measures of negative

impacts (except for vulnerability and attachment anxiety). Survivors with no therapy

history report statistically significantly more PTSD symptoms (as measured by the IES-R).

but also report statistically significantly higher levels of posttraumatic growth and score

more favourably on both negative and positive attachment dimensions. Lower scores of

survivors who have been in therapy on negative impact variables may reflect improvements

in these symptoms post-therapy rather than lower levels existing prior to therapy.

Turning to the child of survivor generation, the opposite pattern to that noted for

survivors is apparent. Children of survivors who have been in some form of therapy score

statistically significantly higher on anxiety, depression and attachment anxiety and

statistically significantly lower on positive attachment dimensions. In addition, more

frequent usage of maladaptive coping strategies is noted by those with therapy experience.

The pattern that emerges among the grandchildren of survivors is similar to that for

the survivors and opposite to that found for the children of survivors. Grandchildren who

have had some therapy score lower on negative symptom measures. In fact, they also have

much stronger beliefs in world meaningfulness and benevolence (statistically significantly

so for the latter). However, the grandchildren with therapy history do score statistically

significantly higher on attachment anxiety than grandchildren with no therapy history.

The findings among survivors and grandchildren of survivors that those with

therapy experience score better than those with no therapy experience could be explained

by the benefits of the therapy itself. Since no pre-therapy baseline measurement is

available, it is not possible to know whether these groups scored higher than the no-therapy

groups on negative symptom measures. The opposing results for the child of survivor

generation is more in keeping with what might be expected in a comparison of a clinical

and non-clinical sample. However, it also points to the potentially discomforting idea that

therapy has not been successful with this generation overall. Of course, it would be unwise

to make wide generalisations based on one study sample but these analyses do raise

important questions regarding gauging the effectiveness (via the collection of baseline data)

of therapy modes for survivors and descendants.


297

Table 14.21. Comparison of survivor/descendant therapy history or no therapy history among Holocaust survivors and descendants on impact and influential process variables Holocaust Survivors Children of Survivors Grandchildren of Survivors

Therapy (n =7)

No Therapy (n =16)

Significance Test Results Therapy (n =46)

No Therapy (n =22) Significance Test Results Therapy (n =15)

No Therapy (n =11)


Impact Variables

DASS Anxiety 3.57 (4.31) 5.67 (6.87) t (20) = 0.74, p = 0.47 4.42 (4.32) 1.50 (2.04) t (66.00) = 3.79, p < 0.001 3.53 (3.80) 7.00 (8.06) t (13.27) = 1.32, p = 0.21 DASS Depression 5.00 (6.30) 7.07 (6.44) t (20) = 0.71, p = 0.49 9.86 (9.95) 2.91 (4.35) t (65.68) = 4.00, p < 0.001 4.80 (5.52) 8.27 (10.49) t (24) = 1.10, p = 0.28 IES-R Total Score 1.42 (1.93) 4.04 (2.86) t (21) = 2.20, p < 0.05 Not applicable Not applicable PTV 11.29 (4.18) 10.81 (4.52) t (21) = 0.24, p = 0.82 11.48 (4.75) 9.11 (4.41) t (66) = 1.96, p = 0.05 10.13 (4.18) 11.18 (4.77) t (24) = 0.60, p = 0.56 AAS Positive Dimensions 33.00 (6.11) 40.38 (8.04) t (18) = 2.11, p < 0.05 38.64 (10.03) 43.82 (7.96) t (66) = 2.12, p < 0.05 40.67 (9.70) 41.64 (10.06) t (24) = 0.25, p = 0.81 AAS Negative Dimensions 14.71 (4.31) 10.38 (2.69) t (18) = 2.78, p < 0.05 16.35 (6.51) 11.27 (3.97) t (61.98) = 3.97, p < 0.001 18.43 (4.72) 12.64 (3.26) t (24) = 3.50, p < 0.01 PTGI Total Score 37.17 (31.81) 65.20 (23.00) t (19) = 2.27, p < 0.05 Not applicable Not applicable


COPE Maladaptive 39.71 (6.07) 43.60 (9.80) t (20) = 0.96, p = 0.35 42.72 (7.74) 35.92 (4.39) t (63.93) = 4.61,p < 0.001 41.50 (8.95) 39.45 (8.26) t (24) = 0.59, p = 0.56 COPE Adaptive 97.64 (14.46) 102.63 (16.92) t (20) = 0.67, p = 0.51 96.01 (15.75) 93.26 (19.35) t (66) = 0.63, p = 0.53 90.93 (16.81) 87.45 (18.14) t (24) = 0.50, p = 0.62 WAS - Benevolence 29.86 (4.67) 29.81 (7.94) t (21) = 0.01, p = 0.99 34.33 (6.55) 34.48 (8.05) t (64) = 0.08, p = 0.94 37.83 (4.60) 30.82 (8.95) t (24) = 2.61, p < 0.05 WAS - Meaningfulness 33.29 (6.34) 31.13 (10.37) t (21) = 0.51, p = 0.62 33.08 (7.89) 32.67 (6.33) t (64) = 0.21, p = 0.84 39.43 (7.71) 34.82 (12.57) t (15.44) = 1.08, p = 0.30



298


This chapter, in conjunction with Chapter Thirteen, has examined the interplay between

measured variables in the model of the differential impact of Holocaust trauma across three

generations (the three categories of psychological impact variables, influential

psychological process variables and family interaction/mode of trauma transmission

variables) and demographic and situational variables. The demographic variables

considered were tracked not only for the generation to which they directly relate, but also

through the descendant subgroups they created. Consistent with one of the main arguments

of the current thesis, it was found that numerous demographic variables statistically

significantly related to survivor and descendant scores suggesting that survivors and

descendants are not a homogenous group, but are made up of many distinguishable sub-

groups with varying levels of psychological impairments and functioning.

Tables 14.22 and 14.23 act as a summary of the statistically significant effects of

descendant demographic variables on descendant scores on the model variables. As was

undertaken at the end of Chapter Thirteen, these tables report average, as well as highest

eta-squareds ( 2η ) and co-efficients of determination (r2 ), which both provide a measure of

the proportion of variation in a dependent variable accounted for by demographic variables.

This process allows a rank ordering of the demographic variables in terms of their import to

the model.

In Figure 14.2, the ranking of both survivor demographics (considered in Chapter

Thirteen) and descendant demographics (discussed in this chapter) has been brought

together in order to provide overall rankings. What is startling to note is the continuing

importance of survivor parent demographic variables in determining the psychological

well-being of the children of survivor generation despite the addition of child of survivor

demographics. The three key Holocaust trauma elements of survivors’ country of origin,

the nature of their Holocaust experiences and the extent of familial losses which were the

most important predictors of survivor mental health, are reverberating through the

generations, and remain the top three demographic predictors among the children of

survivor generation, even with the addition of descendant demographics. In fact,

demographics intrinsic to the child of survivor generation itself (such as gender, birth order

and post-war delay in birth) do not appear in the rankings until the very end of the ranked

list of demographic variables.


299

Indeed, ancestral demographic variables are also dominant for the grandchildren of

survivors with the number of child of survivor parents topping the ranking, and number of

survivor grandparents coming in in third position. Insufficient data was available to assess

the impact of many of the survivor generation demographics on the grandchild of survivor

generation. It would be interesting to see whether the three Holocaust trauma elements of

nature of experience, family loss and country of origin would continue to be as salient for

the grandchild of survivor generation as they are for both the survivor and child of survivor

generations. Despite this shortcoming, the fact that the extent of survivor ancestry a

grandchild of survivor has is the top ranking demographic variable in differentiating their

scores on psychological impact variables is suggestive of the continuing influence of the

Holocaust even two generations removed from direct suffering of the trauma itself.

It should be noted here that an attempt was made to conduct multiple regressions

with the demographic variables as predictors and psychological impact variables as

criterion/dependent variables in order to examine the unique and overlapping effects of the

demographic variables in a multivariate way with the children of survivors (for whom a

total sample size of 70 was deemed adequate for such an approach). The approach

attempted was to dummy code each level of each categorical demographic variable (such as

nature of Holocaust experience). These analyses could not proceed due to a number of

reasons. The sample size was reduced substantially when ineligible cases/participants were

excluded (a reduction from the original 70 children of survivors to 32 children of survivors

when reduced to cases with no missing data for all the relevant demographic variables). A

number of the demographic variables could not be included because once the sample was

reduced to 32, there were insufficient or no participants in some levels/categories of the

dependent variable, rendering it meaningless to include in the analysis. This process

involved eliminating a number of demographic variables considered the most important in

the univariate approach (such as the nature of the survivor parents’ Holocaust experiences

and their country of origin). The small sample size also led to incredibly low power for the

analyses. In addition, further variables were eliminated because of collinearity problems.

These include predictably strong relationships between such as things as the birth country

of survivor mothers and survivor fathers. Because of these issues, a multivariate multiple

regression approach, while desirable and preferable to a univariate approach, was rendered

invalid. However, the reader should bear in mind that this approach was attempted.


300

Chapter Fifteen goes on to present a number of case studies from the survivor, child

of survivor and grandchild of survivor generations. The key elements of Holocaust trauma

(nature of experiences, family loss and country of origin) that have proved to be so pivotal

for the psychological health of survivors and their descendants are highlighted in the choice

of case studies. The case studies demonstrate how varied the experiences of Holocaust

survivors were during the war with a richness of detail that only case studies can provide.


301

Table 14.22 Average and highest proportions of variance accounted for by descendant demographic variables among descendant scores on psychological impact and influential psychological process

variables.

Children of survivors Grandchildren of survivors

Average 2η or 2r

Highest 2η or 2r


Average 2η or 2r

Highest 2η or 2r


Child of survivor demographics

Number of survivor parents 0.019 0.048 1 0.115 0.267 4

Delay between the end of the war and birth

0.028 0.073 2 0.073 for father 0.042 for mother


Birth order 0.013 birth order 0.012 only child versus with siblings

0.037 birth order 0.048 only child versus with siblings

0 0

Unable to test

Gender 0.024 0.038 0 0.067 0.274 1

Grandchild of survivor demographics

Not applicable

Number of child of survivor parents

Not applicable 0.127 0.318 4

Birth order Not applicable 0.036 0.159 1

Gender Not applicable 0.104 0.397 4


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Table 14.23 Average and highest proportions of variance accounted for by descendant demographic variables among descendant of survivors’ perceptions on family interaction variables

Children of survivors Grandchildren of survivors

Average 2η or 2r

Highest 2η or 2r


Average 2η or 2r

Highest 2η or 2r


Child of survivor demographics

Number of survivor parents 0.028 0.061 3 0.004 0.005 0

Delay between the end of the war and birth

0.013 0.052 0 0.254 for father 0.032 for mother



Birth order 0.022 for birth order 0.021 for only child versus with siblings

0.063 for birth order 0.057 for only child versus with siblings

0 for birth order 1 for only child versus with siblings

Unable to test

Gender 0.013 0.042 0 0.023 0.051 1

Grandchild of survivor demographics

Number of child of survivor parents

Not applicable 0.021 0.041 0

Birth order Not applicable 0.097 0.388 2

Gender Not applicable 0.011 0.031 0


303

Psychological

Impacts of the Holocaust


Ranking of Modes of Intergenerational Transmission of

Trauma

Ranking of Demographic Moderators




1st G

ener

atio

n (S

urviv

ors)




(1) Maladaptive coping strategies (2) Assumption of World Benevolence (3) Assumption of World Meaningfulness (4) Adaptive coping Strategies

(1) Nature of experiences (2) Country of origin (3) Loss of family during the Holocaust (4) Post-war settlement location (5) Age during the Holocaust (in 1945) (6) Gender (7) Length of time before resettlement

2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)




(1) Parent country of origin (2) Parent nature of Holocaust experiences (3) Parent loss of family during the Holocaust (4) Survivor Parent gender (5) Parent post-war settlement location (7) Parent age during the Holocaust (in 1945) (8) Number of survivor parents

(6) Post-war delay in birth (9) Birth order (10) Birth before or after parent settlement outside of Europe (11) Gender

•

(1) Parent-Child Attachment (especially maternal) (2) Family Cohesion (3) Communication about Holocaust experiences (specifically via affective or non-verbal modes) (4) Encouragement of Independence (maternal) (5) General Family Communication

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)




(3) Number of survivor grandparents (4) Grandparent post-war settlement location

(1) Number of child of survivor parents (6) Delay between the end of the war and the birth of parents (5) Parent gender

(7) Birth order (2) Gender

(1) Parent-Child Attachment (especially maternal) (2) Family Cohesion (3) Encouragement of Independence (maternal) (4) General Family Communication

Figure 14.2. Ranking (from most important to least important) of Influential Psychological Processes, Family Interaction Variables/Proposed Modes of Trauma Transmission and

Demographic Moderators (both survivor and descendant) in terms of their relative importance in predicting scores on Psychological Impact Variables


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Chapter Fifteen – Holocaust Survivor and Descendant Case Studies

Chapters Thirteen and Fourteen (from empirical study data) as well as Chapters Seven,

Eight and Nine (based on meta-analyses) have demonstrated that to attempt to represent the

Holocaust survivor and descendant populations as homogeneous groups seriously

misrepresents the effects of the Holocaust. Not only are the range of Holocaust experiences

heterogeneous but so too are the post-Holocaust adjustment levels and trauma transmission

to subsequent generations.

The results of the empirical study have served to highlight a number of

demographic variables which appear to be of import in determining post-Holocaust mental

health outcomes. In this chapter, a number of case studies representing subgroups of these

key demographics will be described and discussed. They will highlight the wide range in

experience and psychological reactions to direct survival of the Holocaust or being

descended from a survivor. All participants’ names have been changed to protect their

identity.

A number of study participants have been selected from the sample to be

highlighted as case study examples. They were chosen to reflect a diverse range of

Holocaust experiences and ancestral backgrounds and serve to emphasise the heterogeneity

of the influence of the Holocaust that has been argued throughout the current thesis. In

particular, demographic variables that are the most discriminatory in relation to

psychological impact variables are highlighted further by these case studies. Case studies

from each of the three generations are presented in turn, with comparisons made to relevant

sub-groups of the empirical study sample.

15.1. – Survivor Case Studies

Five Holocaust survivor case studies are presented in this section. The five cases were

chosen to highlight the heterogeneity of experiences a Holocaust survivor may have

endured during the Holocaust. They serve to further illuminate the influence of the key

demographic variables identified in Chapter Thirteen, namely nature of experiences, loss of

family and country of origin.

15.1.1. – “Zosia”- Polish Child Survivor who was in Hiding

Zosia is of Polish/Lithuanian descent. She was a young child during the Holocaust, turning

10 years old in 1945 at the end of the war. During the initial years of the war she remained


305

with her parents, as well as during their transfer to a Lithuanian ghetto. In 1941, Zosia was

smuggled out of the ghetto to live with another family under an assumed identity. She was

not reunited with her parents until after the war. Zosia immigrated to America in 1951 at

age 16, after spending time in both Austria and Italy in DP camps. In her current life, Zosia

is heavily involved in survivor and child survivor organisations, but reported she has never

attended any therapy. She married and had two sons and is now divorced. Zosia has

obtained tertiary qualifications.

Table 15.1 outlines Zosia’s scores on the psychological impact and influential

psychological process variables from the model of Holocaust trauma developed over the

course of the current thesis. As can be seen, Zosia’s scores indicate that she suffers from a

moderate level of anxiety and a mild level of depression. Her scores on these two measures

are much higher than the grand mean for the survivor sample, as well as sub-group means

for other survivors in hiding and other child survivors. Her scores for PTSD symptoms, as

measured by the Impact of Events Scale – Revised (IES-R) indicate that while her overall

score and scores on the intrusion and avoidance subscales are lower than the grand survivor

means and equivalent or lower than the relevant sub-group means, she has a higher score on

hyperarousal than both the grand and subgroup means. While a score of 1 for hyperarousal

on a scale from 0-4 hardly indicates severe pathology, it is noteworthy that she contrasts to

the rest of her cohort on this scale.

Zosia scores very high on post-traumatic growth, much higher than the grand mean

and both of the relevant sub-groups used for comparison. When her scores on the sub-

scales of this measure are consulted it seems that she rates the identification of new

possibilities, personal strength and relating to others as being the most resultant of her

Holocaust experiences.

In terms of attachment, Zosia’s classification is on the cusp of the secure and

dismissing attachment types. This is because her rating of her comfort with being to close

to others is relatively high, but her rating of her comfort with depending on others is lower

than most others classified as secure.


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Table 15.1. Zosia’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables Zosia All

Survivors Survivors in

Hiding Children < 13 years in 1945

Minimum Score

Maximum Score

Highest Score in Normal Range

Impact Variables DASS Anxiety 12.00 (Moderate) 4.87 5.50 5.38 0.00 42.00 7.00 DASS Depression 10.00 (Mild) 6.13 6.25 6.25 0.00 42.00 9.00 IES-R – Intrusion 0.75 1.26 0.70 0.72 0.00 4.00 See note under

table. IES-R – Avoidance 0.25 1.11 0.47 0.45 0.00 4.00 IES-R – Hyperarousal 1.00 0.85 0.54 0.58 0.00 4.00 IES-R – Total Score 2.00 3.22 1.79 1.76 0.00 12.00 PTV 11.00 10.83 9.13 10.31 0.00 24.00 AAS Positive Dimensions

36.00 38.29 37.88 38.63 12.00 60.00


16.00 12.00 14.63 13.25 6.00 30.00

AAS Type Dismissing/Secure PTGI Total Score 71.00 56.09 49.00 55.00 0.00 105.00 Influential Psychological Processes

COPE Maladaptive 43.00 42.22 41.63 40.13 24.00 80.00 COPE Adaptive 118.00 101.61 102.50 103.31 36.00 144.00 WAS - Benevolence 32.00 30.04 33.75 33.25 8.00 48.00 WAS - Meaningfulness 37.00 32.08 38.25 38.63 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. The scale authors suggest that scores on the IES-R be interpreted in terms of their position on the likert scale used by participants. The scale points are denoted as follows in terms of the amount of distress caused in the past week in relation to Holocaust experiences: 0 = not at all, 1 = a little bit, 2 = moderately, 3 = quite a bit, 4 = extremely.

15.1 2. – “Siegfried”- German Child Survivor who was in Hiding

Siegfried was also a child during the war turning 12 in 1945. Siegfried was born in the

Netherlands after his German parents fled Germany when Hitler came to power. He

remained with his parents, brother and some extended family until quite late in the war. In

1943, the family had a lucky escape when they were all arrested for deportation to

Auschwitz but were released after four or five days. However, in 1944 while most of his

family members were taken to concentration camps, Siegfried survived the remainder of

the war in hiding in the northern area of the Netherlands. While his parents, brother, an

uncle and his grandmother survived the war, an aunt and uncle and many family friends did

not survive the camps. Siegfried has remained in Europe since the end of the war,

remaining in the Netherlands until 1974 when he moved to Switzerland. In 2004, he

decided to move to Germany and while he lives very close to the Swiss border, he says that

his decision to move to Germany was a very hard and emotional one. Siegfried attained a

high school education. He married and had a son and a daughter but is now divorced. He

is not a member of a survivor organisation and has never been in any form of therapy.

Siegfried has written/published a book based on his Holocaust experiences.


307

While Siegfried’s scores for anxiety and depression are within the normal range and

his vulnerability score is also very low, his score for the PTSD symptom of intrusion is

quite high relative to the whole survivor sample and certainly to his relevant sample sub-

groups. His rating for intrusion suggests he suffers from this PTSD symptom to a moderate

extent. This finding suggests that Siegfried finds himself remembering or reliving his

Holocaust experiences a fair bit but his low scores on other pathology measures suggest

that he is not overly troubled by this.

Indeed, apart from the intrusion score, Siegfried scores remarkably well on all other

measures, certainly much better than the sample means would predict. For example, his

score for positive attachment dimensions is very high and for negative attachment

dimensions is very low. Siegfried’s coping strategies also appear to be predominantly

adaptive and healthy (low maladaptive coping score and high use of adaptive coping). His

scores for the two world assumptions variables are also suggestive of his robustness, with

his beliefs in world benevolence and meaningfulness quite strong in comparison to his

fellow survivors. In addition, Siegfried reports a very high post-traumatic growth score –

markedly higher than the grand and sub-group means quoted for comparison. The growth

factors he most attributes to his Holocaust experiences, in descending order, are personal

strength, relating to others and an appreciation of life.

Siegfried’s case study serves to highlight the fact that there are survivors who suffer

very few if any negative symptoms and have actually come out of their Holocaust

experiences perhaps psychologically stronger (refer to his scores in Table 15.2). It is

noteworthy that Siegfried rated the identification of his own personal strength as a result of

the Holocaust as the highest possible rating. It is quite possible that it was the fact that he

recognised in himself the strength to overcome and survive Nazi persecution that

emboldened him in his post-Holocaust years.


308

Table 15.2. Siegfried’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables Siegfried All

Survivors Survivors in

Hiding Children < 13 years

in 1945 Minimum

Score Maximum

Score Highest Score in Normal Range


(normal) 4.87 5.50 5.38 0.00 42.00 7.00

DASS Depression 2.00 (normal)

6.13 6.25 6.25 0.00 42.00 9.00

IES-R – Intrusion 1.88 1.26 0.70 0.72 0.00 4.00 See note under table. IES-R – Avoidance 0.25 1.11 0.47 0.45 0.00 4.00 IES-R – Hyperarousal 0.83 0.85 0.54 0.58 0.00 4.00 IES-R – Total Score 2.96 3.22 1.79 1.76 0.00 12.00 PTV 4.00 10.83 9.13 10.31 0.00 24.00 AAS Positive Dimensions 47.00 38.29 37.88 38.63 12.00 60.00 AAS Negative Dimensions

7.00 12.00 14.63 13.25 6.00 30.00

AAS Type Secure PTGI Total Score 82.00 56.09 49.00 55.00 0.00 105.00 Influential Psychological Processes


15.1.3. – “Greta”- Austrian Camp Survivor

According to the results of the empirical study conducted for the current thesis, Greta

suffered from the worst combination of experiences during the Holocaust. Born in Austria,

Greta was an adult during the Holocaust, turning 34 in 1945. In fact, she had married in

1936. Along with her husband and parents, Greta was forced to move into a ghetto in 1942

and was there for two years. In 1944, they were all sent to Auschwitz where her parents

and husband were killed in the gas chambers, making her the sole survivor of her family.

On her own from that point on, Greta moved through a number of labour and concentration

camps including Bergen-Belsen and Theriesenstadt. When liberated by the Russians in

1945 Greta was near death as a result of typhus. After recuperating in Austria, she

immigrated to Australia in 1948. She remarried in 1950 and had a son before divorcing in

1973. In 1973, she married for a third time and was widowed in 2000. ‘Greta” is not a

member of a survivor organisation and has never had any form of therapy. She attained a

high school level education.

Not surprisingly, given her incredibly traumatic experiences during the Holocaust

(and also divorce and bereavement after the war), Greta suffers a fair amount from the

PTSD symptoms of intrusion and avoidance, and her scores are higher than the grand and


309

sub-group means quoted in Table 15.3. However, her hyperarousal score is very low,

especially in comparison to the camp survivor sub-group. Interestingly the mean for the

sole survivor group for hyperarousal is also quite low. Unfortunately there is some missing

data from Greta’s questionnaire booklet and so scores for vulnerability and posttraumatic

growth could not be obtained for her. On the page of the questionnaire booklet which

contained the PTGI, Greta noted that “it is very hard to imagine how I would have dealt

with life if I would not have been caught up in the Holocaust”.

However, ‘Greta” scores equivalently to her camp survivor peers on attachment

dimensions. She is classified as having a dismissing attachment type. Given the discourse

on this issue (see Chapter Two, Section 2.1 and Chapter Three, Section 3.1.1), it may be

ventured that a dismissing attachment type may have developed as a defence mechanism

following the overwhelming loss of family during the Holocaust.

Despite her elevated intrusion and avoidance scores, Greta also evidences some

resilience. Her scores on the world assumptions scales, while roughly equivalent to the

grand survivor mean, are much higher than her fellow camp survivors, suggesting that

despite her horrific experiences, her beliefs in world benevolence and meaningfulness were

not as shaken as they were for other survivors. She also scores quite highly on her use of

adaptive coping strategies. Table 15.3. Greta’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables Greta All Survivors Camp

Survivors Sole

Survivors Minimum

Score Maximum


Impact Variables DASS Anxiety 1 (normal) 4.87 5.22 0.33 0.00 42.00 7.00 DASS Depression 1 (normal) 6.13 5.78 0.67 0.00 42.00 9.00 IES-R – Intrusion 2.00 1.26 1.85 1.58 0.00 4.00 See note

under table. IES-R – Avoidance 2.50 1.11 1.84 1.63 0.00 4.00 IES-R – Hyperarousal 0.33 0.85 1.37 0.39 0.00 4.00 IES-R Total Score 4.83 3.22 5.05 3.60 0.00 12.00 PTV - 10.83 12.60 10.50 0.00 24.00 AAS Positive Dimensions 33.00 38.29 33.57 30.00 12.00 60.00 AAS Negative Dimensions 10.00 12.00 11.57 12.50 6.00 30.00 AAS Type Dismissing PTGI Total Score - 56.09 68.11 56.00 0.00 105.00 Influential Psychological Processes



310

15.1.4. – “Laszlo”- Hungarian Camp Survivor

Laszlo is a Hungarian born survivor. He was born in 1925, making him 20 years old at the

end of the war. While he notes that he endured numerous years of restrictions based on his

Judaism (and having to wear a yellow armband from 1940), he was not transferred to a

ghetto and it was not until 1944 that he was transported to a labour camp in Serbia. This

late transference to camps of Hungarian Jews corresponded with Hitler’s move to

exterminate Hungary’s Jews once the Hungarian government (once complicit) moved to

withdraw from its alliance with the Nazis. Before this time, while the Hungarian

government had certainly enacted numerous laws which institutionalised anti-semitism, the

plan for mass extermination of Jews was not in force in Hungary. Indeed up until 1944,

Hungary was considered relatively safe for Jews and became a country to which to escape

(Edelheit & Edelheit, 1994).

Laszlo indicates that no family members died during the Holocaust, with both of his

parents and even his paternal grandmother managing to survive. After the war, Laszlo

spent a number of years in Belgium before immigrating to Australia in 1952 with his

parents. It is interesting to note that while he does not indicate whether his first wife was a

survivor or not, his second marriage in 1982 (after the death of his first wife in 1976 whom

he married in 1952) was to a fellow survivor from Hungary. Laszlo reports no membership

of any survivor organisation and also indicates no history of therapy.

Laszlo’s scores on impact and influential process variables in relation to the total

survivor sample and the camp survivor sub-sample are presented in Table 15.4. Laszlo

scores within the normal range for both anxiety and depression; in fact he indicates not

even the slightest experience of any symptoms associated with these two disorders. While

his cohort groups also score within the normal range, they do report much higher levels of

anxiety and depression symptoms. However, Laszlo reports quite frequent intrusion and

avoidance symptoms, certainly much higher than both the grand means for survivors and

the means for camp survivors. Interestingly, his hyperarousal score is relatively low being

equivalent to the survivor grand mean but notably less than the camp survivor mean.

Laszlo also scores relatively highly for posttraumatic vulnerability, indicating a notable

degree of fear about the safety of his loved ones and himself.


311

Table 15.4. Laszlo’s scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables Laszlo All Survivors Camp

Survivors Minimum

Score Maximum


Impact Variables DASS Anxiety 0.00 (normal) 4.87 5.22 0.00 42.00 7.00 DASS Depression 0.00 (normal) 6.13 5.78 0.00 42.00 9.00 IES-R – Intrusion 2.50 1.26 1.85 0.00 4.00 See note

under table.

IES-R – Avoidance 2.25 1.11 1.84 0.00 4.00 IES-R – Hyperarousal 0.83 0.85 1.37 0.00 4.00 IES-R Total Score 5.58 3.22 5.05 0.00 12.00 PTV 17.00 10.83 12.60 0.00 24.00 AAS Positive Dimensions 30.00 38.29 33.57 12.00 60.00 AAS Negative Dimensions 11.00 12.00 11.57 6.00 30.00 AAS Type Dismissing PTGI Total Score 62.00 56.09 68.11 0.00 105.00 Influential Psychological Processes COPE Maladaptive 50.00 42.22 46.78 24.00 80.00 COPE Adaptive 104.00 101.61 96.89 36.00 144.00 WAS - Benevolence 18.00 30.04 26.40 8.00 48.00 WAS - Meaningfulness 13.00 32.08 27.30 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. The scale authors suggest that scores on the IES-R be interpreted in terms of their position on the likert scale used by participants. The scale points are denoted as follows in terms of the amount of distress caused in the past week in relation to Holocaust experiences: 0 = not at all, 1 = a little bit, 2 = moderately, 3 = quite a bit, 4 = extremely.

His scores are very low on the world assumptions scales, in particular world

meaningfulness. The lowness of these scores suggests he has little faith at all in the world

as a kind, caring place in which events are predictable and understandable. Perhaps given

these scores, it is not surprising that Laszlo is classified with a dismissing attachment style

– an understandable defence mechanism or survival adaptation.

Laszlo’s level of posttraumatic growth falls in the middle of the grand mean for

survivors and the mean for camp survivors. He indicates the growth factors most related to

his Holocaust experiences are an appreciation of life, personal strength and spiritual

change.

15.1.5. – “Hans”- German Survivor who Escaped in 1939

Hans was born in Germany in 1930 but was saved from the Holocaust via a kindertransport

to England in 1939. He indicates that that the only forms of persecution he directly

experienced prior to escaping from Germany was anti-semitism during a summer camp at

the age of six and being forced out of his school to go to a Jewish only school at age seven.

However, Hans’s father was taken to one of the first concentration camps in 1938 a year

before he escaped to England. During the war he stayed with an English family whom he

describes as “wonderful”. He was reunited with his parents in England in 1940 at which

point the family managed to immigrate to America. A brother also survived. While all


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members of his family of origin not only survived the Holocaust but escaped from it, his

maternal grandparents were both killed during the war.

Hans describes his life as being “a succession of strokes of good luck”: getting a

spot on the kindertransport; escaping submarines on the trip across the Atlantic; and having

his parents also survive. Because of this, Hans says he feels a special obligation to

tell/educate people about the Holocaust. To this end, Hans now gives talks to students from

primary school age to university. He is also currently a member of two survivor

organisations, with one membership having lasted for the past 14 years. Hans did not

indicate any therapy history in his questionnaire.

Interestingly, while Hans obtains very low scores on the pathology measures for

PTSD symptoms and posttraumatic vulnerability compared to his cohorts, he scores much

higher on depression and anxiety (see Table 15.5). In fact, according to Lovibond and

Lovibond (1995), Hans can be described as suffering from mild levels of depressive

symptoms and moderate levels of anxiety symptoms.

Hans scores very favourably on the remainder of the impact and influential process

variables in the model of differential impact of Holocaust trauma. Hans’s usage of

maladaptive coping strategies is much lower than the survivor mean and the escaped

survivor mean. His scores on the AAS attachment measure are almost identical to his

fellow escaped survivors’ means and he is classified with a secure attachment style. He

scores higher than both the grand mean for survivors and his fellow escaped survivors on

both of the world assumptions. While his post-traumatic growth score is lower than the

grand mean for survivors, it is equivalent to that scored by other escaped survivors. He

rates his appreciation of life and his recognition of new possibilities as a result of the

Holocaust as being the most relevant growth factors for him.


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Table 15.5. “Hans’s” scores compared to whole survivor sample and relevant survivor subgroups means on psychological impact and influential psychological process variables Hans All Survivors Escaped Minimum

Score Maximum


Impact Variables DASS Anxiety 14.00 (moderate) 4.87 3.50 0.00 42.00 7.00 DASS Depression 13.00 (mild) 6.13 6.50 0.00 42.00 9.00 IES-R – Intrusion 0.13 1.26 0.84 0.00 4.00 See note

under table.

IES-R – Avoidance 0.13 1.11 0.96 0.00 4.00 IES-R – Hyperarousal 0.00 0.85 0.56 0.00 4.00 IES-R Total Score 0.25 3.22 2.08 0.00 12.00 PTV 6.00 10.83 10.17 0.00 24.00 AAS Positive Dimensions 44.00 38.29 44.33 12.00 60.00 AAS Negative Dimensions 9.00 12.00 9.00 6.00 30.00 AAS Type Secure PTGI Total Score 46.00 56.09 46.33 0.00 105.00 Influential Psychological Processes COPE Maladaptive 28.00 42.22 36.17 24.00 80.00 COPE Adaptive 108.00 101.61 107.50 36.00 144.00 WAS - Benevolence 32.00 30.04 31.17 8.00 48.00 WAS - Meaningfulness 34.00 32.08 31.83 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale. The scale authors suggest that scores on the IES-R be interpreted in terms of their position on the likert scale used by participants. The scale points are denoted as follows in terms of the amount of distress caused in the past week in relation to Holocaust experiences: 0 = not at all, 1 = a little bit, 2 = moderately, 3 = quite a bit, 4 = extremely.

15.1.6. – Conclusions from Survivor Case Studies

While it cannot be denied that all five survivors, described in the case studies in the

previous sub-sections, suffered as a result of the Third Reich’s policy to persecute and

exterminate the Jewish population of Europe, it is clear that how an individual survivor

suffered as a result of this policy can differ widely. Table 15.6 provides a tabulated

comparison of the five case studies’ scores on the impact and influential process variables.

They are certainly heterogeneous. After reading the diverse narratives of the five survivors

and examining their scores, it is difficult to conceive why the dominant modus operandi of

survivor research has been to treat this population as if it was homogenous in its post-

traumatic responses (see Chapter Two, Section 2.5.)

From a clinical perspective, it is interesting that the survivors who score the highest

on PTSD symptoms are the ones who have the lowest scores for anxiety and depression and

the survivors with the highest anxiety and depression scores evidence minimal PTSD

symptoms. Of course, this is just a sample of five survivors, but it is interesting to note the

apparent lack of co-morbidity of symptomatology.


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In terms of country of origin, the fact that Hungarian survivors rated themselves the

least favourably in the empirical study conducted for the current thesis (see Chapter

Thirteen, Section 13.2.5.1) is reflected in the case of the Hungarian survivor Laszlo who

scores by far the lowest on the world assumptions scales and also the highest on the use of

maladaptive coping strategies. It is interesting that the survivor who may be labelled by

some as having suffered the most during the war, being a camp survivor and the sole

survivor of her family, Greta still has much stronger beliefs in world meaningfulness and

benevolence than Laszlo. Chapter Four, Section 4.4 explained the argument that survivors

who endured longer periods of persecution were potentially less affected than those with a

shorter period of persecution because of an acclimatisation process. Essentially, it was

argued that when survivors endured a number of years of restriction of liberties and then

ghettoisation before being transferred to camps, their experiences before they entered the

camps at least partially prepared them mentally for life in the camps. On the other hand,

survivors who were abruptly transported to camps with little if any acclimatisation stages,

were potentially more traumatised because the process for them was less gradual. This

argument is certainly supported when comparing Laszlo’s and Greta’s scores on the world

assumptions. Being Hungarian, Laszlo would have had a much more abrupt move towards

the camps than Greta who spent time in ghetto before her time in the camps. Table 15.6. Comparison of survivor case study scores on psychological impact and influential psychological process variables Zosia Siegfried Greta Laszlo Hans Impact Variables DASS Anxiety 12.00

(moderate) 2.00 (normal) 1.00

(normal) 0.00 (normal) 14.00 (moderate)

DASS Depression 10.00 (mild)

2.00 (normal) 1.00 (normal)

0.00 (normal) 13.00 (mild)

IES-R – Intrusion 0.75 1.88 2.00 2.50 0.13 IES-R – Avoidance 0.25 0.25 2.50 2.25 0.13 IES-R – Hyperarousal 1.00 0.83 0.33 0.83 0.00 IES-R – Total Score 2.00 2.96 4.83 5.58 0.25 PTV 11.00 4.00 - 17.00 6.00 AAS Positive Dimensions 36.00 47.00 33.00 30.00 44.00 AAS Negative Dimensions 16.00 7.00 10.00 11.00 9.00 AAS Type Dismissing/

Secure Secure Dismissing Dismissing Secure

PTGI Total Score 71.00 82.00 - 62.00 46.00 Influential Psychological Processes COPE Maladaptive 43.00 31.00 43.00 50.00 28.00 COPE Adaptive 118.00 103.00 112.00 104.00 108.00 WAS - Benevolence 32.00 39.00 32.00 18.00 32.00 WAS - Meaningfulness 37.00 41.00 30.00 13.00 34.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, IES-R = Impact of Events Scale – Revised, AAS = Adult Attachment Scale, PTGI = Posttraumatic Growth Inventory, WAS = World Assumptions Scale


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15.2. – Child of Survivor Case Studies

In this section, three child of survivor case studies are described. Each has a very different

Holocaust ancestry and the differences in impacts/transmission of Holocaust trauma can

clearly be seen. As was the case for the six survivor case studies presented, the child of

survivor cases chosen reflect the three most important demographic variables of survivor

parent’s type of Holocaust experiences, loss of family and country of origin. In addition,

differences related to perceived parental communication about the Holocaust, number of

survivor parents and post-war delay in birth or indirectly also highlighted.

15.2.1. – “Lena” – Daughter of two Polish Sole Survivors of the Camps

Both of Lena’s survivor parents were the sole surviving members of their families after the

Holocaust. Lena was born in 1956 in America, 11 years after the end of the war. Her

parents were both Polish Jews. Lena knows very few details of her father’s wartime

experiences, however she notes on her questionnaire that her mother was in hiding for over

a year before being caught trying to cross the Russian border. She then spent time in a

number of labour camps. She was transported (prior to Russia becoming one of the Allied

countries) deeper into Russia where she spent the rest of the war.

Lena has obtained tertiary qualifications. She has never married and has no

children. Lena has participated in both individual and group therapy. She is a member of

several descendant organisations. On the page where participants were invited to write

down any thoughts, Lena provided a detailed outline of the efforts she has gone to to

document her parents’ Holocaust experiences, including piecing together some idea of her

father’s experiences which are largely unknown to her.

Table 15.7 reports Lena’s scores on the psychological impact and influential

psychological process variables from the model that are applicable to the child of survivor

generation. Lena’s scores are quite negative for the pathology measures. In fact, according

to the DASS cut-offs, Lena is classified as suffering from mild anxiety and extremely

severe depression. Interestingly though, other children of sole survivor mothers (whose

survivor fathers are not sole survivors) also score very highly on depression, although not

as highly as Lena has). However, given this, her vulnerability score is not as low as it

could be. Lena’s attachment scores are also far from positive and she is classified with a

fearful attachment style. With respect to coping strategies it appears that her usage of

adaptive coping strategies is lower than most of her cohort groups (except again for the


316

children with sole survivor mothers), and her usage of maladaptive coping strategies is

higher than the same comparison groups. Given this largely negative picture it is

interesting to note that Lena’s scores for the world assumptions are comparatively high or

at least certainly not lower than the majority of the child of survivor means and sub-group

means presented in Table 15.7. Table 15.7. Lena’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables Lena All children

of survivors All children of two survivors

All children of sole

survivor father

All children of

sole survivor mother

Minimum Score

Maximum Score


Impact Variables DASS Anxiety 9.00 (mild) 7.50 3.15 4.67 4.00 0.00 42.00 7.00 DASS Depression 28.00

(extremely severe)

3.43 7.88 11.08 23.00 0.00 42.00 9.00

PTV 8.00 10.66 9.99 13.08 6.33 0.00 24.00 AAS Positive Dimensions

25.00 40.32 40.57 36.83 30.33 12.00 60.00


27.00 14.71 14.02 18.25 16.33 6.00 30.00

AAS Type Fearful Influential Psychological Processes

COPE Maladaptive 45.00 40.52 39.58 42.00 42.67 24.00 80.00 COPE Adaptive 85.00 95.12 95.18 97.25 80.33 36.00 144.00 WAS - Benevolence 35.00 34.38 34.14 31.83 36.00 8.00 48.00 WAS - Meaningfulness

34.00 33.08 32.13 33.33 29.33 12.00 72.00


How Lena’s perceptions of her survivor mother and survivor father compare both to

each other and the total child of survivor sample is outlined in Table 15.8. Lena rates her

father as quite cold and her mother as very ambivalent in terms of their attachment

behaviour towards her. While she rates her father similar to the rest of the child of survivor

cohort in terms the degree to which he encouraged her autonomy, she rates her mother very

poorly in this regard.

With regard to her survivor parents’ communication about their Holocaust

experiences there is quite a stark difference. While she rates them similarly (and higher

than her cohort) on the level of guilt-inducing communication they used, she rates them as

polar opposites in terms of the frequency and willingness of their communication about

their experiences during the war. Lena notes that her mother spoke incessantly about her

experiences and was incredibly and perhaps over eager to do so. Her father, it seems, was


317

very reluctant to talk and she obtained very few details of his experiences. That a parent’s

silence with regard to their Holocaust experiences may lead to their children attempting to

imagine what happened (often worse than the reality) was alluded to in Chapter Three,

Section 3.4. Indeed, in the comments Lena made in her questionnaire booklet she hints that

this occurred for her. She imagined that his silence hinted that he had “experienced

something so mind blowing that it is literally unspeakable”. Lena theorises on the basis of

her research, with a few sparse details as her staring point, that he had a wife and family

and that he had quite possibly passed through a ghetto and then the Dachau concentration

camp where his family may have been killed. She believes that witnessing the death of

one’s wife and children would explain his strong reluctance to talk about his experiences.

Lena further commented on her attempts to get information out of her father: “Once I

pressured my mother to ask him about his past and he exploded in a rage. We got the

message and backed off.” These comments suggest that her father had not even shared

with her mother, his wife, what he had been through during the war. Table 15.8. Lena’s perceptions of her survivor father versus her perceptions of her survivor mother on gender specific family interaction variables Lena’s

perception of her survivor

father

All children of survivors’

perceptions of survivor fathers

Lena’s perception of her survivor

mother


perceptions of survivor mothers

Minimum Score

Maximum Score

PCS – Warmth 2.00 8.52 6.00 8.50 0.00 16.00 PCS – Coldness 7.00 3.70 3.00 2.98 0.00 16.00 PCS – Ambivalence 4.00 5.38 13.00 5.14 0.00 16.00 PAQ – Fostering of Autonomy 47.00 45.30 25.00 43.46 14.00 70.00 HCQ – Affective communication about the Holocaust

- 2.45 - 2.59 1.00 5.00


1.00 1.56 3.00 1.75 1.00 5.00


6.00 3.22 6.00 3.30 2.00 10.00


3.00 8.84 15.00 9.09 3.00 15.00

Notes. PCS = Parental Caregiving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire Given Lena’s rating of her parents on attachment and encouraging of autonomy

measures, it is perhaps unsurprising that she rates the level of cohesion in her family as

very low, much lower even than the children with a sole survivor mother which scores

much lower than the other cohort groups. The extent to which Lena felt a non-verbal

presence of the Holocaust when she was growing up is relatively comparable to other

children of survivors, particularly as it is elevated slightly among others who have at least

one sole survivor parent.


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Table 15.9. Lena’s perceptions of family interaction patterns compared to whole survivor sample and relevant survivor subgroups means Lena All children of

survivors All children of two

survivors All children of sole survivor

father

All children of sole survivor

mother

Minimum Score

Maximum Score

FES – Cohesion 9.00 42.04 41.20 44.33 18.67 1.00 68.00 FES – Expressiveness 34.00 36.23 34.56 40.58 36.33 15.00 73.00 HCQ – Non-verbal presence of the Holocaust

12.00 10.16 10.62 11.91 11.33 3.00 16.00

Notes. FES = Family Environment Scale, HCQ = Holocaust Communication Questionnaire

15.2.2. – “Otto” - Son of two Dutch Survivors who were in Hiding

Otto is the child of two Dutch survivors who as a married couple survived the war in

Holland under assumed non-Jewish identities. Otto was born at the very end of the war, a

matter of a few months before his parents were able to come out of hiding. He has a sister

who was born a number of years later in 1947. The family immigrated to New Zealand in

1950 before further immigrating to Australia in 1952.

Otto is divorced, but has a daughter and two sons. He has attained a tertiary

education. He also indicated that he had spent a year in Israel in 1971-1972. Otto has been

a member of a descendant organisation for over ten years and has had some individual

counselling. While he indicates that he has not had any group therapy, it is worthy of note

that the descendant organisation he is a member of meets regularly.

Otto has taken a strong interest in the Holocaust and in specifically recording his

family’s story. The family that helped his parents maintain their assumed identity during

the war also migrated to Australia and Otto has kept in touch with them and says he still

makes an annual visit to the surviving member of this couple. Perhaps because of the fact

that he was born while his parents were still in hiding, and his sister was born a number of

years later, Otto notes that his strong interest in the Holocaust, and the role it plays in

shaping his identity, is not shared by his sister at all. This point highlights the fact that

there can be differences even within survivor families, as to how the Holocaust experiences

of the parents can impact and influence their children.

In relation to his peers, and in general, Otto’s profile of scores is very positive (refer

to Table 15.10). He scores very low on anxiety and depression and vulnerability. His

attachment scores are suggestive of a very strongly secure attachment type. His usage of

adaptive coping strategies is much higher than all of the comparison data, although his

usage of maladaptive coping strategies (while equivalent to the whole generation sample) is


319

higher than children of survivor parents with like experiences. Otto’s belief in world

assumptions is also quite strong. Table 15.10. Otto’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables Otto All children of


survivors All children of

two hiding parents

Minimum Score

Maximum Score



(normal) 7.50 3.15 2.00 0.00 42.00 7.00


3.43 7.88 3.40 0.00 42.00 9.00

PTV 5.00 10.66 9.99 6.50 0.00 24.00 AAS Positive Dimensions

57.00 40.32 40.57 48.60 12.00 60.00


14.00 14.71 14.02 12.20 6.00 30.00

AAS Type Secure Influential Psychological Processes

COPE Maladaptive 40.00 40.52 39.58 35.87 24.00 80.00 COPE Adaptive 110.00 95.12 95.18 105.40 36.00 144.00 WAS - Benevolence 39.00 34.38 34.14 38.20 8.00 48.00 WAS - Meaningfulness 38.00 33.08 32.13 34.80 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale

Otto rates his mother very favourably (very warm and encouraging of his

developing autonomy) but his father not so (colder and ambivalent and discouraging of his

autonomy). In relation to their communication about the Holocaust with him, ‘Otto” rates

both his parents equivalently as relatively lower than his cohort on the negative modes of

communication and quite high on their willingness and frequency of discussions on the

subject (refer to Table 15.11). Table 15.11. Otto’s perceptions of his survivor father versus his perceptions of his survivor mother on gender specific family interaction variables Otto’s

perception of his survivor

father


perceptions of survivor fathers

Otto’s perception of his survivor

mother



Minimum Score

Maximum Score


2.00 2.45 2.00 2.59 1.00 5.00


1.00 1.56 1.00 1.75 1.00 5.00


3.00 3.22 3.00 3.30 2.00 10.00


11.00 8.84 10.00 9.09 3.00 15.00

Notes. PCS = Parental Caregiving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire


320

Otto rates the level of cohesion within his family as lower than other children of

survivors and much lower than other children of survivors with similar hiding experiences.

However, he does rate the level of expressiveness/general communicativeness within the

family as equivalent to the other cohorts and more positively rates the degree of non-verbal

presence of the Holocaust very low. Table 15.12. Otto’s perceptions of family interaction patterns compared to whole child of survivor sample and relevant child of survivor subgroups means Otto All children of



hiding parents Minimum

Score Maximum

Score FES – Cohesion 38.00 42.04 41.20 47.20 1.00 68.00 FES – Expressiveness 34.00 36.23 34.56 34.46 15.00 73.00 HCQ – Non-verbal presence of the Holocaust

5.00 10.16 10.62 7.80 3.00 16.00

Notes. FES = Family Environment Scale, HCQ = Holocaust Communication Questionnaire 15.2.3. – “Mimi” - Daughter of a Female Belgian Child Survivor who was in Hiding

Mimi is a relatively young member of the child of survivor generation having been born in

1972 in England, (a post-war delay in birth of 27 years). However, this is understandable

when one discovers that her survivor mother was only five years old when the war ended in

1945. Mimi’s mother spent three years in hiding with an assumed identity in Belgium. Her

maternal grandparents were also in hiding close by and her mother was occasionally visited

by her own mother, in “health emergencies”. However, although she and her parents

survived, Mimi’s mother’s grandparents all died during the war. Her mother recalls that

she was very well treated by the family who looked after her during the war. After the war,

having been reunited with her parents, Mimi’s mother immigrated to Israel in 1950, but she

and her family returned to Belgium in 1952 due to financial difficulties. They attempted

emigration again in 1961 to England. This is where Mimi was born and where her mother

met her South African born father. Mimi’s family remained in England until 1994 when

they moved to Canada. In 2000, Mimi moved to New Zealand on her own. Mimi is the

last born child of three children. She has a tertiary education. She has never married.

Mimi indicates that she is not a member of a descendants’ organisation and she has never

had any therapy of any kind.

Table 15.13 compares Mimi’s scores on impact and influential process variables to

the whole children of survivor sample, as well as children of survivor mothers only. As can

be seen, Mimi scores very well overall, with normal and/or lower than her cohort’s scores

on depression, anxiety and vulnerability. She scores very favourably on the attachment


321

measure comfortably being assigned a secure attachment type. Her scores on coping

strategies are also comparatively favourable, with a very low maladaptive coping score and

very high adaptive coping score. Mimi’s belief in world benevolence is also quite strong

and much higher than the other relevant child of survivor groups; however her belief in

world meaningfulness is not as strong as her cohorts. Table 15.13. Mimi’s scores compared to whole child of survivor sample and relevant child of survivor subgroups means on psychological impact and influential psychological process variables Mimi All children of

survivors All children with a

survivor mother only Minimum

Score Maximum



(normal) 7.50 1.20 0.00 42.00 7.00


3.43 4.70 0.00 42.00 9.00

PTV 8.00 10.66 11.00 0.00 24.00 AAS Positive Dimensions 51.00 40.32 42.90 12.00 60.00 AAS Negative Dimensions 6.00 14.71 12.00 6.00 30.00 AAS Type Secure Influential Psychological Processes

COPE Maladaptive 32.00 40.52 38.20 24.00 80.00 COPE Adaptive 111.00 95.12 87.80 36.00 144.00 WAS - Benevolence 38.00 34.38 32.60 8.00 48.00 WAS - Meaningfulness 26.00 33.08 32.60 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale Table 15.14 presents the comparison of Mimi’s perceptions of her parents to the

relevant whole sample perceptions. Mimi rates her survivor mother comparatively very

favourably: notably warmer and more encouraging of her autonomy. In terms of her

communication about her Holocaust experiences, Mimi’s perceptions match those of other

children of survivors. Table 15.14. Mimi’s perceptions of her survivor mother versus her non-survivor father r on gender specific family interaction variables Mimi’s

perception of her survivor

mother



Mimi’s perception of

her non-survivor father


perceptions of non-survivor

fathers

Minimum Score

Maximum Score


2.00 2.59

Not applicable

1.00 5.00


1.00 1.75 1.00 5.00


2.00 3.30 2.00 10.00


9.00 9.09 3.00 15.00

Notes. PCS = Parental Caregiving Style Questionnaire, PAQ = Parental Attachment Questionnaire, HCQ = Holocaust Communication Questionnaire


322

Mimi’s overall perceptions of her family environment are considered in Table

15.15. While she notes a similar level of non-verbal presence of the Holocaust, Mimi rates

her family as notably more cohesive and expressive than other children of survivors do,

both overall and among children with a survivor mother only. Table 15.15. Mimi’s perceptions of family interaction patterns compared to whole child of survivor sample and relevant child of survivor subgroups means Mimi All children of

survivors All children with a survivor

mother only Minimum

Score Maximum

Score FES – Cohesion 60.00 42.04 49.17 1.00 68.00 FES – Expressiveness 60.00 36.23 38.33 15.00 73.00 HCQ – Non-verbal presence of the Holocaust 9.00 10.16 8.50 3.00 16.00 Notes. FES = Family Environment Scale, HCQ = Holocaust Communication Questionnaire

15.2.4. – Summary and Conclusions from Child of Survivor Case Studies

The three child of survivor case studies have served to highlight a number of issues relevant

to the differential transmission of Holocaust trauma. Lena’s case emphasises the impact of

differing communication styles about Holocaust experiences. Her frustration with the lack

of information she obtained from her father led her to frequently try to imagine what he

went through and spend countless hours trying to establish the details of his experiences

through historical research.

In addition, further pointing to the heterogeneity of the survivor group, survivors

within a two survivor couple who experienced very similar/identical experiences during the

war can be perceived very differently by their children. Otto’s parents were in hiding

together during the war and yet Otto rates his father as cold and ambivalent and his mother

as warm. Of course, it cannot be determined if these differences would have been apparent

before the war/if the war had not occurred, but it is an interesting point to note.

Certainly there are differences between the three cases in terms of the level of

symptomatology they experience and the differences do reflect the results of the empirical

study. It is Lena, the child of two sole survivors of the Holocaust, who would be expected

to, and does, score the least favourably on the study measures.

15.3. – Grandchild of survivor case studies

Two grandchildren of survivor case studies are presented in this section. They were chosen

to represent the two extremes of degree of survivor ancestry with one having one survivor

grandparent and one having four survivor grandparents. The number of survivor

grandparents and child of survivor parents were in the top ranked demographic variables in


323

influencing psychological impact variable scores among the grandchildren generation in the

empirical study. The overall theme that emerges from these two case studies is that no

matter what the extent of familial connection with the Holocaust is, it still leaves its mark in

some way.

15.3.1. – “Geena” - Grandchild with One Survivor Grandparent

Geena was born in 1984 and was aged 21 at the time of her participation in the current

study. She lives in America. Geena’s paternal grandmother is a Polish Holocaust survivor

who was aged 13 years at the end of the war. Her grandmother spent time in a ghetto but

escaped camp internment by living in hiding, initially with a false identity with another

family and then unaided. Geena’s father was born in the US in 1956 (a post-war delay in

birth of 11 years). Her mother is also US born, but not descended from Holocaust

survivors. Geena reports that she first learned of her grandmother’s Holocaust experiences

at the age of five.

Geena has been a member of a descendant of survivor’s organisation for a number

of years. She also indicates that she has in the past had some individual counselling. Geena

has a tertiary qualification. She is single, but moved out of her family home at age 17.

Table 15.16 presents Geena’s scores on the impact and influential process variables

in relation to the whole grandchild of survivor sample and other grandchildren with one

survivor grandparent. Geena’s scores are very positive overall. Her scores on all the

pathology measures are very low and indeed much lower than others in her cohort. She has

quite strongly held beliefs in world benevolence and world meaningfulness with respect to

her cohort as well. The only negative things that can be gleaned from the comparison of

Geena’s scores to those of the other grandchildren in the study sample is that she scores

higher on the usage of maladaptive coping strategies and also higher on the negative

attachment dimension of attachment anxiety. However, despite her higher score on the

negative attachment dimension she can still be classified with a secure attachment style, as

her scores for the positive attachment dimensions are also quite high.


324

Table 15.16. Geena’s scores compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means on psychological impact and influential psychological process variables Geena All grandchildren All with one

survivor grandparent

Minimum Score

Maximum Score


Impact Variables DASS Anxiety 0.00 (normal) 6.22 4.80 0.00 42.00 7.00 DASS Depression 2.00 (normal) 5.19 7.00 0.00 42.00 9.00 PTV 3.00 10.48 9.60 0.00 24.00 AAS Positive Dimensions 56.00 40.11 43.60 12.00 60.00 AAS Negative Dimensions 17.00 16.52 13.20 6.00 30.00 AAS Type Secure Influential Psychological Processes COPE Maladaptive 56.00 40.66 43.60 24.00 80.00 COPE Adaptive 109.00 90.96 83.40 36.00 144.00 WAS - Benevolence 47.00 34.55 36.60 8.00 48.00 WAS - Meaningfulness 44.00 37.46 31.00 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale Table 15.17 below presents Geena’s perceptions of her child of survivor father compared to

her perceptions of her mother who is not descended from Holocaust survivors. As can been

seen, Geena rates both of her parents very favourably and there is little difference in the

ratings she gives for her father and mother. The ratings Geena gave her parents are also

more favourable than comparable sections of the grandchild of survivor sample. Table

15.18 presents Geena’s perception of cohesion and expressiveness/level of communication

within her family. She perceives a very high level of cohesion within her family; in fact

she obtains the highest possible score on this scale. Her rating of family expressiveness is

similar to ratings given by her contemporaries. Table 15.17. Geena’s perceptions of her child of survivor father versus her perceptions of her non-child of survivor mother Geena’s

perception of her child of

survivor father

Grandchildren’s perceptions of

child of survivor fathers

Geena’s perception of

her non-child of survivor mother


non-child of survivor mothers

Minimum Score

Maximum Score

PCS – Warmth 15.00 10.44 14.00 13.00 0.00 16.00 PCS – Coldness 0.00 2.88 0.00 0.83 0.00 16.00 PCS – Ambivalence 0.00 5.63 0.00 1.33 0.00 16.00 PAQ – Fostering of Autonomy 57.00 50.41 57.00 58.33 14.00 70.00 Notes. PCS = Parental Caregiving Style Questionnaire, PAQ = Parental Attachment Questionnaire Table 15.18. Geena’s perceptions of family interaction patterns compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means Geena All grandchildren of

survivors All grandchildren with a child of

survivor father only Minimum

Score Maximum

Score FES – Cohesion 68.00 48.18 62.00 1.00 68.00 FES – Expressiveness 54.00 50.07 52.40 15.00 73.00 Note. FES = Family Environment Scale


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15.3.2. – “Solange” - Grandchild with Four Survivor Grandparents

Solange was born in Australia in 1979 and was 26 years old when she completed the

questionnaires for this study. All four of her grandparents survived the Holocaust in some

way. They originated from Poland, Hungary, Romania and Lithuania. Her mother was

born seven years after the end of the war and her father was born four years after the war.

In her current life, Solange is single and has a tertiary education. She is not a member of

any descendant organisation. She reports that she has attended therapy in the past.

Solange’s scores on the psychological impact variables and influential

psychological processes are presented in Table 15.19. She scores within the normal range

for anxiety and depression, however in comparison to Geena (who has only one survivor

grandparent) she experiences more anxiety and depressive symptoms. Her score on

vulnerability (which relates to her fear for the safety of herself and others from harm) is

relatively high and is slightly higher than her contemporaries and certainly also much

higher than Geena’s score of 3.00. Solange’s use of maladaptive coping strategies is higher

than the comparison grandchild of survivor groups, while her usage of adaptive coping

strategies is markedly lower. Solange is classified with a dismissing attachment style.

While it is of course possible that the differences between Solange and Geena are due to

factors other than the number of survivor grandparents they have it is hard to ignore the

confirmatory pattern of results. Table 15.19. Solange’s scores compared to whole grandchild of survivor sample and relevant grandchild of survivor subgroups means on psychological impact and influential psychological process variables Solange All Grandchildren All with four

survivor grandparents

Minimum Score

Maximum Score


Impact Variables DASS Anxiety 3.00 (normal) 6.22 5.10 0.00 42.00 7.00 DASS Depression 5.00 (normal) 5.19 6.80 0.00 42.00 9.00 PTV 11.00 10.48 10.75 0.00 24.00 AAS Positive Dimensions 32.00 40.11 35.10 12.00 60.00 AAS Negative Dimensions 15.50 16.52 15.35 6.00 30.00 AAS Type Dismissing Influential Psychological Processes COPE Maladaptive 44.50 40.66 37.65 24.00 80.00 COPE Adaptive 85.00 90.96 97.90 36.00 144.00 WAS - Benevolence 37.50 34.55 32.25 8.00 48.00 WAS - Meaningfulness 39.50 37.46 34.25 12.00 72.00 Notes. DASS = Depression Anxiety Stress Scales, PTV = Posttraumatic Vulnerability Scale, AAS = Adult Attachment Scale, WAS = World Assumptions Scale

Table 15.20 provides a comparison of Solange’s perceptions of her child of survivor

parents both to each other and the perceptions of other grandchildren in the sample. While


326

she credits both her parents with a certain degree of warmth, she rates both of them quite

highly on ambivalence (which no doubt plays at least a partial role in her classification with

a dismissing attachment style). She rates her mother as notably less warm than her father.

Her father is rated warmer than other child of survivor fathers rated by the study sample,

but her mother is rated less warm than other child of survivor mothers. However, both

parents are rated relatively favourably (and equivalently to perceptions of her cohort) in

terms of their perceived encouragement of her autonomy and independence. Table 15.21

compares Solange’s perceptions of family cohesion and expressiveness to relevant

grandchild of survivor subgroups. Solange perceives a very low level of cohesion within

her family and she also rates family expressiveness lower than grandchild of survivor

subgroups. The overall portrait of her family life painted by Solange’s scores on the family

interaction variables is one of disengagement. Table 15.20. Solange’s perceptions of her child of survivor father versus her perceptions of her child of survivor mother Solange’s

perception of her child of

survivor father


child of survivor fathers

Solange’s perception of her child of

survivor mother


child of survivor mothers

Minimum Score

Maximum Score

PCS – Warmth 13.00 10.44 8.50 11.89 0.00 16.00 PCS – Coldness 3.00 2.88 3.00 1.41 0.00 16.00 PCS – Ambivalence 10.00 5.63 10.00 3.86 0.00 16.00 PAQ – Fostering of Autonomy 51.50 50.41 48.50 48.86 14.00 70.00 Notes. PCS = Parental Caregiving Style Questionnaire, PAQ = Parental Attachment Questionnaire Table 15.21. Solange’s perceptions of family interaction patterns compared to the whole grandchild of survivor sample and relevant grandchild of survivor subgroups means Solange All grandchildren of

survivors All grandchildren with two child of

survivor parents only Minimum

Score Maximum

Score FES – Cohesion 16.00 48.18 36.73 1.00 68.00 FES – Expressiveness 41.00 50.07 52.40 15.00 73.00 Notes. FES = Family Environment Scale

15.3.3. – Summary and Conclusions from Grandchild of Survivor Case Studies

The cases of Geena and Solange serve to emphasise how the influence of the Holocaust has

far from dissipated two generations on. While Geena scores very well on psychological

measures and also rates her parents favourably in terms of parent-child attachment

dimensions and their encouragement of her independence, she is still sufficiently influenced

by her family history to have joined a descendant organisation. The influence of that one

survivor grandparent and the knowledge of her experiences has certainly shaped her

identity to some degree.


327

The case of Solange highlights the probable effects of the Holocaust on family

dynamics and how that influences the children within these contexts. Solange certainly

rates her family environment quite negatively and her classification as having a dismissing

attachment style is certainly predictable from the environment she intimates through her

ratings. It is also interesting to note her relatively high score on vulnerability as well. She

notes that she often thinks about the war and perhaps this focus has contributed to her

heightened sense of self and family vulnerability.


The case studies presented in this chapter underscore the wide range in the degree of post-

war adaptation among survivors as well as the flow on effects to future generations. The

demographic variables of nature of Holocaust experiences, loss of family and country of

origin of the survivors themselves which were the highest ranking demographic variables in

terms of influence on psychological health (as identified in Chapters Thirteen and Fourteen

in the empirical study) were chosen as guidelines for the selection of case studies. Of

course, it is also acknowledged that the scores of the case study participants cannot be

solely due to Holocaust experience or ancestry but overall they (along with the quantitative

analysis of the study data) do relate to Holocaust-related variables in a predictable way and

so its potentially strong influence cannot be ignored.

In reading the details of the survivor and survivor ancestor’s Holocaust experiences,

it can be more fully understood how individual survivors may have endured quite different

events and traumas. However, what unites them all is that their experiences during the war

were as a result of their being targeted by the Third Reich, whether they succumbed to the

fate planned for them (camp incarceration) or escaped it (by living in hiding or escaping

Europe). With a diverse range of experiences, it is not unpredictable that there should be a

diverse range and severity of responses. What the research in the current thesis has

demonstrated is the heterogeneity of the impact of the Holocaust, not only on survivors but

on their descendants as well. It is the reasons behind this heterogeneity that should have

been the focus of research from the outset, not determined attempts to collectively “pigeon

hole” the entire population of survivors and descendants as if they would display exactly

the same level of symptomatology and interpersonal difficulties.


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Chapter Sixteen – Discussion and Conclusions

Over the course of the current thesis, the reader has been presented with large amounts of

data and analysis relating to a plethora of variables and how they relate (or not) to the

psychological health of Holocaust survivors and their descendants. What has been revealed

is a complex web of inter-related variables which perhaps may seem to uncover more

questions than answers. Clearly the impact of the Holocaust on survivors and their

descendants is not readily defined by black and white boundaries; it is indeed tempered by

innumerate shades of grey. The Holocaust survivor population (and that of its descendants)

is definitely far from a uniform, homogenous group in terms of its post-war psychological

health and functioning. What is also clear is that the Holocaust had a profound influence

on the way survivors interacted with their children and that it continues to reverberate

through the generations. The extent to which this has occurred also differs widely within

the survivor descendant population. The research presented in the current thesis has

attempted to delineate the variables that may help to explain this differential level of post-

traumatic symptomatology and transmission of traumatic impact within the Holocaust

survivor and descendant population.

16.1. – Unique Contribution to the Holocaust Trauma Literature by the Current

Thesis

The body of research presented in the current thesis represents numerous unique

contributions to the literature with regard to the lasting effects of the Holocaust on

survivors and their descendants. These contributions include:

• the first meta-analysis of research comparing Holocaust survivors to the general

population (as represented by control groups);

• the first meta-analysis of research comparing grandchildren of survivors to the general

population;

• the first meta-analysis of research comparing children of survivors to the general

population to include both published and unpublished data.

• the first international study to attempt to follow the psychological impacts and potential

modes of trauma transmission across three generations

What is apparent is that overall survivors and their descendants do differ statistically

significantly from the general population, in terms of having a higher baseline level of


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psychopathological symptoms. The higher baseline may well be still within the normal

range of symptom experience but it is measurable and discernible. However, what is also

apparent is that it is essentially meaningless to attempt to aggregate all survivors or all

descendents as if they are part of a homogeneous group – they clearly are not.

To this end, the current thesis has made numerous contributions in the assessment

of demographic differences within the survivor and descendant populations. These

contributions include:

• the first meta-analytic synthesis of studies considering demographic differences within

the survivor and descendant populations;

• meta-regressions of existing data with respect to the influence of gender, age and time

lapse since the war among survivors which have provided new clarifications as to the

role of these variables;

• the first empirical examination of a number of demographic variables within the

survivor population such as country of origin;

• the first examination of the possible influence of post-war delay in the birth of children

of survivors and those children’s psychological health – examined both indirectly via

meta-regressions and directly with raw data in the empirical study.

• the first comparison of perceptions of survivor and non-survivor parents within one

survivor parent families and the first comparison of perceptions of child-of-survivor

parents and non-child-of-survivor parents within one child-of-survivor parent families.

The aggregation of data relating to numerous demographic factors has served to

both clarify the role of some, while highlighting the lack of knowledge that exists in

relation to many others because of widely differing operationalisation, methodological

flaws or lack of assessment.

16.2. – Thought-provoking Findings Emerging from the Current Thesis

A large number of analyses were presented in this thesis and to attempt to address each and

every one here would make this chapter as long as the rest of the thesis. In this section, a

number of interesting themes that have emerged throughout the course of the meta-analyses

and empirical study are articulated.

16.2.1. – The Role of Gender

The influence of gender (both individual and parental) on survivor and descendant

psychological functioning is a complex one. While gender differences among survivors


330

and descendants are relatively uniform in suggesting greater female vulnerability in terms

of their own psychological health, the role of gender within the parent-child relationship is

much more complicated.

According to the results of the empirical study reported in this thesis, the nature of

the mother-child relationship (in terms of warmth, coldness or ambivalence and

encouragement of the child’s independence) generally have a stronger influence on the

child’s psychological health than the father-child relationship. However, greater

differentiation in child of survivors’ scores on psychological impact variables and

perceptions of survivor parents was based on the nature of survivor father’s Holocaust

experiences, rather than survivor’s mother’s experiences. In other words, while maternal

dimensions are more strongly related to childrens’ adult psychological profile and maternal

Holocaust experiences do create some differences in their care-giving behaviours, within

the lower baseline of paternal influence there is greater variation based on paternal

Holocaust experiences. This suggests that Holocaust experiences may well have a stronger

effect on female survivors in terms of mental health symptoms, but may have a stronger

effect on the male survivors’ parenting abilities and approaches which in turn translates to

greater variability in the transmission of traumatic impact to the children.

In addition, results of the empirical study suggest an interaction between survivor

parent and child of survivor gender in relation to the transmission of Holocaust trauma

cross-generationally. In other words, the degree to which negative effects of the Holocaust

infuse the parent-child relationship and the degree to which trauma transmission occurs

depends on the parent-child gender combination. To reiterate, the strength of these

processes differ between mothers and daughters, mothers and sons, fathers and daughters

and fathers and sons. Specific details of which pairing is the most detrimental could not be

derived based on the relatively small empirical study data set, however this is certainly an

area worth exploring in more detail in further research.

16.2.2. – Country of Origin

Survivors’ country of origin was found to be the second most influential demographic

among the survivor generation and the most influential demographic among the children of

survivor generation. This variable has been relatively understudied within the Holocaust

literature, with only one study being found to consider its influence among survivors (using


331

only a Western versus Eastern Europe dichotomy) and only two studies located to consider

its potential influence on children of survivors.

The reasons why survivor country of origin was found to be so influential within the

empirical study conducted for this thesis are numerous. A survivor’s country of origin

determined the course of the events during the Holocaust as well as the duration of

persecution they experienced. Survivors from Poland had quite different experiences to

those from Hungary, who in turn had different experiences to those from the Netherlands.

It can be argued that the duration of persecution can be positively or inversely related to

post-Holocaust symptom levels, depending on whether longer more gradual periods of

persecution are seen as more traumatising, or provide a process of acclimatisation not

afforded to those who experienced a shorter and more rapid persecution timeline.

Quite apart from the differing Holocaust experiences, are the cultural differences

that exist (and existed prior to the Holocaust) between people from different countries, of

different nationalities, racial and cultural groups. What proportion of the variation found

that is based on country of origin is really attributable to cultural differences as opposed to

experiences during the Holocaust? Are there differences in resiliency between people from

different cultures, perhaps attributable to some form of national character? Are differences

in attachment dimensions reflective of existing cultural differences with the comfort with

closeness and dependence on others, the need for companionship, the desire for

independence, the nature of parent-child relationships?

The extent to which a survivor felt able to return to their home country after the war

also differed by country. For example, Jewish survivors wanting to return home were

greeted with far from welcoming arms in some Eastern European countries such as Poland,

while those from countries such as the Netherlands or France may have felt more

comfortable and less vulnerable. Therefore, could it be that the reception they received

upon their attempted home-coming that further compounded their symptomatology as

opposed to the Holocaust traumas themselves? Certainly this was found to be the case for

returning Vietnam Veterans (de Silva, 1999; Lomranz, 1995; McCann & Pearlman, 1990;

Z. Solomon, 1995).

It was not possible to delineate the proportion of influence attributable to culture,

differential Holocaust timelines or post-Holocaust reception within the empirical study in

the current thesis. What is clear though, is that discernible differences in post-Holocaust


332

symptom levels can be ascribed to a survivor’s country of origin, whatever the specific

source. It would be desirable, but not possible, to compare means obtained in the

empirical study to normative data for each European country relevant. Unfortunately,

separate normative data for different European countries does not exist for the measures

used in the current thesis. It is certainly acknowledged, however, that the relative

importance of cultural differences and the role of the Holocaust on symptom measures and

family interaction variables is something worthy of investigation.

16.2.3. – The Impact of Post-war Delay in Child-rearing

The use of meta-regression techniques allowed the assessment of demographic variables

that to date had not been tested including the post-war delay in birth of children of

survivors. Time lapse between the end of the war and the birth of the second generation

has been an issue often mentioned within theoretical conjecture and anecdotal discussions

of clinical experiences. The essence of arguments about its hypothesised influence relates

to the degree to which survivors had recovered from, or processed, their traumatic

experiences during the Holocaust, as well as the extent to which they suffered from

unresolved mourning. A negative relationship between the post-war delay in birth and the

extent to which children of survivors suffer from symptomatology was proposed but never

assessed directly.

Within this thesis, the issue of post-war delay in birth was assessed indirectly via

meta-regression, as well as directly within an empirical study. While results from the meta-

regressions largely supported the assertion that shorter delays in birth are associated with

higher levels of symptoms among children of survivors, the results from the empirical

study, where significant, tended to suggest the opposite.

However, the effects of post-war delay in birth of children of survivors also related

to their children’s (that is, the grandchildren of survivors) perceptions of them as parents.

Specifically, sons of survivors who were born after a longer delay were viewed as more

encouraging of their children’s independence, and family expressiveness and cohesion were

also inversely related to delay in birth. Therefore the delay in the birth of children of

survivors may well have a bearing not only on their level of symptomatology, but also on

the way in which they interact and relate with their children.

Analysis of the influence of post-trauma delay in birth of children of trauma

survivors is by no means definitive if it is based solely on the results of the meta-analyses


333

and empirical study reported in this thesis. The findings reported in this thesis, on this

issue, certainly highlight the need for survivors/victims of trauma to be encouraged to allow

themselves time to process and recuperate from their ordeal before embarking on the

already stressful role of parenthood.

16.2.4. – The Compounding Traumatic Impact among Survivor Dyads

An interesting finding is that among two survivor or child-of-survivor parent families, both

survivor or child-of-survivor mothers and survivor or child-of-fathers are rated as colder,

more ambivalent and less encouraging of independence/autonomy than when the other

parent is not a survivor or child-of-survivors. In other words, while survivor or child of

survivor parents are viewed more negatively than non-survivor or non-child-of-survivor

parents, in general, the effect of the other parent also being a survivor or descended from

survivors further compounds the negative perceptions of the parents.

Of course, it cannot be known for sure whether it is the children’s perceptions that

are being affected or whether survivor or child-of-survivor-parents truly are colder, more

ambivalent and less encouraging of independence if they are part of a survivor or child-of-

survivor couple. What is interesting is the idea that each individual within the family

system has the ability to not only affect the system as a whole but potentially other

individuals within the system. Truly no survivor or descendant of survivors can be

understood within an individual vacuum – they must be considered within their family

historical context.

16.2.5. – The Influence of Post-war Settlement Location on post-Holocaust

Symptomatology

After the end of the war, Holocaust survivors settled all over the world. Some remained in

Europe, but others moved to far away continents such as America or Australia, while others

moved to Israel. Differences in post-war adjustment related to post-war settlement location

have barely been examined in the literature. This omission is startling given the

acknowledgement by many in the trauma field that the recovery environment of trauma

survivor can be very important in determining how well they recover (B. L. Green et al.,

1985; Wilson, 1989).

In the current thesis, the influence of post-war settlement location on survivor’s

psychological health was examined indirectly via sub-set meta-analyses (comparing groups

of studies based on the country in which they were conducted) as well as directly via the


334

empirical study. While the sub-set meta-analyses largely afforded comparisons between

survivors who settled in America to those who settled in Israel, the empirical study

presented the first comparison of survivors who settled in America to those who settled in

Australia or New Zealand. Within the empirical study it was the survivors who settled in

Australia or New Zealand who reported higher depression and anxiety and statistically

significantly higher levels of PTSD symptoms than those who settled in America.

The first conclusion may well be to suggest that survivors who settled in Australia

or New Zealand were not received as well as they were in America. However, another

possibility exists. Could it be that the survivors (or at least the participants in the empirical

study) who settled in Australia were the more traumatised to begin with? Survivors often

talk about wanting to get as far away from Europe as possible. Is the distance between

Europe and a survivors’ choice of post-war settlement location directly related to the

severity of their traumatic experiences and/or the severity of symptomatology they

experienced as a result?

16.2.6. – The Case of the Grandchildren of Holocaust Survivors

Grandchildren of Holocaust survivors are only now just reaching adulthood in large enough

numbers to enable relatively large-scale studies of their psychological health. A lay person

might be forgiven for assuming that, two generations on, the grandchildren of survivors

should be no different to other members of the general population. However the results

from both the meta-analyses and the empirical study conducted for this thesis suggest that

the legacy of the Holocaust continues to be felt.

The fact that both meta-analytic results, as well as results of the empirical study

conducted for the current thesis, suggest an upturn in symptom prevalence and severity for

this group is a worrying finding. Is this finding reflective of a pattern in the wider

community, or does it belie a resurgence of the impact of ancestral trauma? Certainly with

each generational separation from the Holocaust, there are more and more intervening non-

Holocaust related traumas and events that could impinge on the incidence of symptoms and

this must be borne in mind. However, this upturn was not only noted in the empirical study

when comparing grandchildren to the previous generations. It was also seen in the meta-

analyses which compared them to members of their own generation who do not have

survivor ancestors and found greater disparity between grandchildren of survivors and their

contemporaries than between children of survivors and their contemporaries. This suggests


335

that this upturn in symptoms is not merely reflecting a community-wide generational

pattern, but possibly a genuine increase in symptoms related to survivor ancestry.

One possible explanation is that grandchildren of survivors are disproportionately

more despairing about the current world climate within the context of the knowledge of the

suffering of their own family members. Does the knowledge of the Holocaust, or more

specifically the knowledge of how individuals were affected by it, impel the grandchild of

survivors to greater anxiety about its repetition or repetition of like-suffering around the

world?

Krasnostein (2006) conducted a number of workshops with grandchildren of

survivors and found that issues pertaining to the Holocaust still resonate profoundly for this

generation. She notes that grandchildren in the workshop groups commented on many

difficulties associated with their identity as a grandchild of Holocaust survivors such as

“the need for inner healing and family healing, dealing with anger, wanting to right the

wrongs, denying effects, dealing with Holocaust denial, feeling burdened with the

responsibility of carrying on the legacy, pondering notions of control, guilt, pressure to

achieve and of course dealing with the good old fashioned persecution complex.” Many

think about “existential concepts such as If it weren’t for Hitler I wouldn’t be me as Hitler

was my grandparent’s matchmaker (Krasnostein, 2006).”

16.3. – Revised Model of the Differential Impact of Holocaust Trauma across Three

Generations

The Model of the Differential Impact of Holocaust Trauma across Three Generations was

formulated and tested via meta-analysis and empirical study over the course of the current

thesis. Table 16.1 reports on the hypotheses regarding the role of influential psychological

processes and family interaction processes/potential modes of trauma transmission. As can

be seen, these hypotheses were generally supported by the results of the empirical study.


336

Table 16.1. Status of Hypotheses relating to relationships between model variables Model Hypotheses Empirical Study Findings MH1: Negative/dysfunctional coping strategies will be positively related to negative psychological symptoms and negatively related to positive psychological dimensions, while positive/functional coping strategies will be negatively related to negative psychological symptoms and positively related to positive psychological dimensions.

This hypothesis was supported. The 14 coping strategies measured by the COPE were combined into maladaptive coping and adaptive coping composites. Maladaptive coping strategies were found to be stronger predictors of scores on psychological impact variables than adaptive coping strategies.

MH2: Strength of belief that the world is benevolent and meaningful will be negatively related to negative psychological symptoms and positively related to positive psychological dimensions.

This hypothesis was supported. A belief in world benevolence (that the world is a kind and caring place) was more strongly related to psychological impact variables than world meaningfulness (that the world is an understandable and predictable place).

MH3: Posttraumatic growth aspects will co-exist with negative psychological symptoms (in other words posttraumatic growth and negative psychological symptoms will be positively related).

This hypothesis was supported in relation to scores on the IES-R which measures PTSD symptoms; however there was a negative correlation with depression, particularly with the personal strength growth aspect.

MH4: Negative parent-child attachment dimensions such as the degree of coldness and ambivalence will be positively associated with negative psychological symptoms and negatively associated with positive psychological symptoms and positive parent-child attachment dimensions such as perceived parental warmth will be negatively associated with negative psychological symptoms and positively associated with positive psychological dimensions.

Parental warmth was uniformly related to decreases in negative symptomatology while parental coldness and ambivalence were uniformly related to increases in symptom levels. There was a much stronger relationship with maternal dimensions as opposed to paternal dimensions.

MH5: A curvilinear/U-shaped relationship will exist between negative psychological symptoms and family cohesion (with very low and very high cohesion associated with higher symptom levels than mid-range scores) and an inverted U-shaped relationship will exist between positive psychological dimensions and family cohesion.

U-shaped relationships were noted for depression and anxiety among children of survivors, however linear relationships were noted for negative attachment dimensions and adaptive coping strategies (negative linear relationships) and positive attachment dimensions and belief in world benevolence (positive linear relationships).

MH6: The degree to which parents are encouraging of their children’s attempts to establish independence will be negatively associated with negative psychological symptoms and positively associated with positive psychological dimensions.

Maternal encouragement of independence was negatively related to depression and negative attachment dimensions and positively related to positive attachment dimensions and belief in world benevolence. This parenting dimension was not as strongly related to children’s scores as the parental attachment dimensions of warmth, coldness and ambivalence.

MH7: General communicativeness within the family unit will be negatively associated with negative psychological symptoms and positively associated with positive psychological dimensions.

This hypothesis was supported although the strength of these relationships was not as strong as for other variables.

MH8: Negative modes of communicating about the Holocaust, such as guilt-inducing, indirect and non-verbal will be positively associated with negative psychological symptoms and negatively associated with positive psychological symptoms and positive modes of communicating about the Holocaust, such as frequent, willing and open discussion will be negatively associated with negative psychological symptoms and positively associated with positive psychological dimensions.

The communication modes of affective communication (particularly maternal) and non-verbal communication about the Holocaust were the most strongly related to children of survivor’s scores on psychological impact variables. As predicted these negative modes of communication were associated with increased negative symptoms and decreased scores on positive variables.

Mediation of the relationship between parent and child scores on psychological impact variables by parent-child attachment, family cohesion, parental encouragement of child’s independence, family communication and communication about the Holocaust.

Unable to test the mediation due to inadequate sample numbers.


337

Figure 16.1 presents the revised version of the model as it stands at the conclusion

of the assessments conducted in the current thesis. A rank ordering of the importance of

influential psychological processes, proposed transmission modes and demographic

variables in predicting the psychological impact of the Holocaust on survivors and

descendants was achieved. It is acknowledged that other processes may also play a role in

determining the psychological health of survivors and their descendants. Certainly there

are other dimensions of family environment which could be measured, as well as other

influential cognitive processes. An exhaustive list of such variables was not included in

this thesis. The main focus was on exploring the demographic variables that potentially

moderate not only the impact of the Holocaust on survivors, but also the way they

interacted with their children and therefore the transmission of trauma across generational

boundaries. While the current thesis examined many demographic variables (a number of

which had either been inadequately assessed or not assessed at all in the existing literature)

there are a number of variables that could not be analysed due to lack of data or small

sample sizes. The demographic variables mentioned within the anecdotal literature that

could not be analysed have been noted in the version of the model in Figure 16.1.


338

Psychological

Impacts of the Holocaust


Ranking of Modes of Intergenerational Transmission of

Trauma

Ranking of Demographic Moderators




1st G

ener

atio

n (S

urviv

ors)





(1) Nature of experiences (2) Country of origin (3) Loss of family during the Holocaust (4) Post-war settlement location (5) Age during the Holocaust (in 1945) (6) Gender (7) Length of time before resettlement Unable to test: Reason for persecution Time lapse

2nd G

ener

atio

n (C

hild

ren

of S

urviv

ors)




(1) Parent country of origin (2) Parent nature of Holocaust experiences (3) Parent loss of family during the Holocaust (4) Survivor Parent gender (5) Parent post-war settlement location (7) Parent age during the Holocaust (in 1945) (8) Number of survivor parents

Unable to test: Reason for persecution of parent/s

(6) Post-war delay in birth (9) Birth order (10) Birth before or after parent settlement outside of Europe (11) Gender

•

(1) Parent-Child Attachment (especially maternal) (2) Family Cohesion (3) Communication about Holocaust experiences (specifically via affective or non-verbal modes) (4) Encouragement of Independence (maternal) (5) General Family Communication

3rd G

ener

atio

n (G

rand

-chi

ldre

n of

Sur

vivor

s)




(3) Number of survivor grandparents (4) Grandparent post-war settlement location Unable to test: Grandparent age during the Holocaust Grandparent gender Grandparent type/nature of Holocaust experiences Grandparent loss of family Grandparent country of origin Length of time before grandparent resettlement/time spent by grandparent in displaced persons camps Reason for persecution of grandparent/s

(1) Number of child of survivor parents (6) Delay between the end of the war and the birth of parents (5) Parent gender Unable to test: Birth of parent/s before or after survivor grandparent/s emigration Parent birth order

(7) Birth order (2) Gender

(1) Parent-Child Attachment (especially maternal) (2) Family Cohesion (3) Encouragement of Independence (maternal) (4) General Family Communication

Figure 16.1. Revised Model of the Differential Impact of Holocaust Trauma across Three Generations


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One of the initial stated aims of this thesis was to recognise the most vulnerable

subgroups of the survivor and descendant populations. While Figure 16.1 denotes the

importance of the demographic factors, it does not delineate which demographic groups are

more affected than others. Tables 16.2 to 16.4 provide a visual representation of the most

vulnerable and most resilient subgroups relating to the demographic variables examined in

this thesis. Table 16.2 Delineation of most and least affected demographic subgroups of survivors Demographic Variable Least affected Subgroups Most affected Subgroups Holocaust experiences In hiding, escaped, partisan Concentration/Labour Camp Gender Males Females Survival of other family members Some surviving family members Sole survivor Experience of Holocaust alone or with family

Always with at least one family member

Spent some time without any family members

Post-war settlement location America Australia Age Younger survivors Older survivors Country of origin Belgium, Netherlands Hungary, Poland, Lithuania, Ukraine Table 16.3 Delineation of most and least affected demographic subgroups of children of survivors Demographic Variable Least affected Subgroups Most affected subgroups Gender Males Females Number of survivor parents One Two Gender of survivor parent Mother Father Post-war delay in birth Ambiguous results Birth order Middle order Survivor parent country of origin Belgium, Netherlands Hungary, Poland, Lithuania, Ukraine Survivor parent survival of family members

Some surviving family members Sole survivor

Survivor parent nature of Holocaust experiences

Non-camp Camp

Table 16.4 Delineation of most and least affected demographic subgroups of grandchildren of survivors Demographic Variable Least affected Subgroups Most affected subgroups Number of survivor grandparents One survivor grandparent Four survivor grandparents Number of child of survivor parents One Two Gender Males Females Birth order Middle order

16.4. – Applicability and Adequacy of Existing Trauma Theory in Explaining Post-

Holocaust Adaptation among Survivors

Green, Wilson and Lindy’s (1985) Working Model for the Processing of a Traumatic Event

and Wilson’s (1989) Person-Environment Interaction Theory of Traumatic Stress Reactions

were referred to in the Model of the Differential Impact of the Holocaust across Three

Generations which was developed and refined through the course of the current thesis. In


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particular, these two theories were used as a basis to explain differences in post-Holocaust

adjustment among the survivor population: the people who were directly traumatised by the

Holocaust.

Green et al. (1985) and Wilson (1989) listed numerous elements/dimensions of a

traumatic experience that may explain differences in the extent to which the trauma

victim/survivor suffers from negative psychological symptoms after the traumatic event/s.

Green et al.’s (1985) model referred to aspects of the traumatic experience, such as the

degree of bereavement and the role of the survivor. In addition, they included elements of

the “recovery environment” such as intactness of community, societal attitudes, and

cultural characteristics. Wilson’s theory (1989) included a much more detailed list of

“environmental and situational variables” from which the demographic variables, included

in the Model of the Differential Impact of the Holocaust across Three Generations, were

additionally adapted. Many of the dimensions listed in both models/theories were

applicable to all Holocaust survivors (such as life threat, exposure to death/dying, whether

the trauma was a community-based/collective trauma, whether the trauma was natural or

“man-made”, and whether the trauma consisted of single or multiple stressors) and so were

not included in the Model of the Differential Impact of the Holocaust across Three

Generations developed in the current thesis.

The demographic/situational variables representing specific elements of a traumatic

experience (presented in Green et al.’s (1985) and/or Wilson’s (1989) theories) that could

be used to differentiate subgroups of Holocaust survivors were included in the Model of the

Differential Impact of the Holocaust across Three Generations developed in the current

thesis. Each of these dimensions that could be applied to the Holocaust survivor population

will be discussed in turn. These dimensions are presented in Table 16.5 Table 16.5. Elements from Green et al.’s (1985) and/or Wilson’s (1989) theories applied to the model of Holocaust trauma developed in the current thesis

Green et al (1985) Wilson (1989) Included in current thesis model as… Degree of bereavement Degree of bereavement Sole survivor status Alone or with others Time spent without family members Role in trauma Nature of Holocaust experiences Intactness of community, Societal attitudes

Impact on community, Cultural rituals for recovery, Societal attitudes

Country of origin

Both Green et al. (1985) and Wilson (1989) cited the degree of bereavement as a

consequence of the traumatic experience as being related to post-traumatic adjustment.


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Degree of bereavement within a traumatic experience was certainly found to be of high

importance in determining post-traumatic symptomatology within the Holocaust survivor

population in this PhD research. In addition to bereavement, Wilson (1989) cites whether

the trauma victim/survivor was alone or with others during their traumatic experience as an

important variable. By definition, Holocaust survivors experienced the Holocaust with

others and not alone; however, within the current thesis this concept was narrowly and

specifically measured in terms of whether the survivor was alone for any part of their

wartime experiences or whether they were always with other family members. This

variable, along with the related bereavement issue (as measured in the current thesis’

empirical study as whether the survivor was the sole survivor of their family) proved to be

an important determinant of post-Holocaust well-being.

Green et al. (1985) and Wilson (1989) also referred to a trauma victim/survivors’

role during the traumatic experience as being important. This has been borne out in

research with other populations, with respect to the benefits of an active versus a passive

role among displaced civilians versus political prisoners in the former Soviet state of

Georgia (Makhashvili et al., 2005) and Lithuania (Kazlauskas et al., 2005), survivors of

industrial accidents (Weisaeth, 2005) and bushfires (Parslow, 2005). In the one study

located that considered this issue among Holocaust survivors, Favaro et al. (1999) found

compatible results (see Chapter Eight, Section 8.2). It was not possible to directly measure

this concept within the empirical study presented in the current thesis because all the camp

survivors, who participated in the study, were interned for ethnic/religious reasons,

therefore providing no sub-group interned for active resistance of the Nazi regime. It is

regrettable that this issue could not be explored further within the Holocaust survivor

sample in the current thesis. Future researchers are encouraged to follow up on this

important dimension of traumatic experience within the Holocaust survivor population.

In addition, Green et al. (1985) and Wilson (1989) included a number of

dimensions which are defined by/related to a survivor’s country of origin. Specifically

these variables are the location of the survivor during the trauma, the duration/severity of

the trauma and the impact on the community (Wilson, 1989), intactness of community, and

cultural characteristics (B. L. Green et al., 1985). As was discussed in Chapter Four,

Section 4.4, a survivor’s country of origin had implications for the number of years they

endured persecution, the speed with which persecution was enacted (or in other words the


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number of intervening stages, particularly a gradual removal of civil liberties and

ghettoisation, before camp incarceration). The results pertaining to country of origin of

survivors in the empirical study presented in the current thesis are quite compelling and

country of origin was ranked in the top three demographic variables in terms of the extent

to which they related to psychological health. The finding that survivors from Hungary

tended to generally present with higher symptomatology levels points to the speed of

persecution enactment being of more importance than the duration of the persecution.

Survivors from Hungary were hurriedly moved into ghettos and many by-passed these

altogether to be moved straight to concentration camps from 1944 onwards. Survivors

from Eastern European countries endured a period of what might be labelled as restriction

of movement and living standards, followed by months or even years of ghettoisation

before being moved through the camp system. Wilson’s (1989) inclusion of the impact on

the community and what Green et al. (1985) label as the intactness of the community is also

to some extent measurable by the survivor’s country of origin, since survivors from

Western European countries overall were more able and willing to return to their

communities than those from Eastern European countries. Clearly, Holocaust survivor

country of origin and the highly related concept of speed of persecution enactment are

important determinants of post-war adjustment. It is believed that the empirical study in

the current thesis represents the first detailed assessment of the impact of country of origin

among Holocaust survivors, which given its revealed importance, leaves a gaping hole in

the Holocaust literature on a possibly extremely important factor.

Within the “post-trauma milieu” or “recovery environment”, Wilson (1989) lists

cultural rituals for recovery, while both Wilson (1989) and Green et al. (1985) cite societal

attitudes towards the event as important elements. Post-war settlement location was a

variable included in the current thesis’ Model of the Differential Impact of the Holocaust

across Three Generations which indirectly examines these elements. Certainly cultural

rituals for recovery were much more readily available to survivors in Israel than those who

settled in other countries. As was outlined in Chapter Four, Section 4.9.3, events such as

Yom Hoshoah provided survivors in Israel with a number of opportunities to participate in

collective mourning and recognition, and therefore receive validation of their suffering

during the war. Such opportunities were not available to the same extent to survivors who

settled elsewhere. The meta-analytic results addressing post-war settlement location


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(Chapter Eight, Section 8.8) were somewhat ambiguous with survey and incidence studies

suggesting opposing findings.

Unfortunately, it was not possible to compare survivors who settled in Israel to

those who settled elsewhere as part of the empirical study because only one survivor

participant was an Israeli resident. Interestingly, the one recent study to compare survivors

in Israel to those who settled in America (Kahana et al., 2005) found that survivors in Israel

scored uniformly lower than survivors in America on psychopathology measures. Given

that the number of society level rituals for recovery are much more prevalent in Israel, one

could hazard the suggestion that such aids have proved helpful; especially given the

continuing dangers of living in Israel (with countless wars and terrorism campaigns

between Israelis and Palestinians and surrounding Arab nations), one might predict that

survivors there would score higher on such measures than those who settled elsewhere.

Both Green et al. (1985) and Wilson (1989) also included coping strategies as

important determinants in post-trauma adjustment as well, and coping strategies were

included in the Model of the Differential Impact of the Holocaust across Three Generations

as influential psychological processes. As would be predicted by both models and a large

body of literature in the field, coping strategies were found to relate strongly to the

psychological health of survivors. In particular it was found that the use of maladaptive

coping strategies was much more strongly predictive of psychological symptom levels than

adaptive coping strategies were. The inclusion of coping strategies as an important variable

in predicting post-traumatic psychological health is vindicated for both Green et al. (1985)

and Wilson (1989) as well as the Model of the Differential Impact of the Holocaust across

Three Generations. Future research is encouraged to further delineate the specific coping

strategies that are the most predictive. The empirical study reported in the current thesis

collapsed the coping strategies measured into maladaptive and adaptive coping strategies

because of sample size restrictions.

Green et al.’s (1985) specification of post-traumatic growth as being diametrically

opposed to pathological outcomes, however, was not supported by the findings of the

current research, or indeed by numerous other studies within the literature (Cadell et al.,

2003; Laufer & Solomon, 2006; McGrath & Linley, 2006; Morris et al., 2005). Indeed,

posttraumatic growth was found to co-exist with negative symptomatology. This

relationship does appear paradoxical on the surface and it is understandable that one might


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theorise that posttraumatic growth and pathological outcomes are polar opposites. It seems

that if a traumatic event is sufficiently traumatising that it leads to chronic symptomatology,

it is also such a watershed moment in the victim/survivor’s life that it becomes a moment of

epiphany leading to sometimes dramatic changes in a person’s priorities.

16.5. – Contributions to Trauma Theory by the Research Presented in the Current Thesis

The inclusion of world assumptions as a potential influential psychological process in the

author’s Model of the Differential Impact of the Holocaust across Three Generations lead

to the uncovering of the important role this construct plays in affecting psychological

health. Indeed the strength of belief a person holds in the world as a kind and caring and

predictable and fair place were revealed to be more important in determining scores on

psychological impact variables than the use of adaptive coping strategies. This finding held

true for all three generations tested in the empirical study.

Experiencing a traumatic event/series of events as overwhelming as the Holocaust

inevitably must lead to some degree of shattering of world assumptions. The world was

proven to not be a kind and caring place and certainly the tenet that only bad things happen

to bad people and that when negative events befall a person they do so in a predictable way

could no longer be believed by a persecuted person during the Holocaust. Remarkably,

many of the survivors who participated in the empirical study presented in the current thesis

recorded relatively strong beliefs in world assumptions. It is not known whether these

survivors maintained their world assumptions during the Holocaust or have gradually built

them up again in the post-Holocaust years. Either way, this suggests somewhat of a

triumph of the human spirit. However, some sub-groups of the survivor population had

much weaker beliefs in the world assumptions and it was these groups who also suffer

more from negative symptomatology. Clearly, the degree to which survivors' world

assumptions could be maintained or rebuilt are important determinants of the extent to

which they suffer from post-traumatic symptomatology. The transference/applicability of

this finding to other trauma populations is highly probable and is an area that warrants

further investigation.

While a number of the demographic and situational variables presented in Green,

Wilson and Lindy’s (1985) Working Model for the Processing of a Traumatic Event and

Wilson’s (1989) Person-Environment Interaction Theory of Traumatic Stress Reactions

could be applied to the Holocaust survivor population there are a number of more


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Holocaust-specific dimensions that needed to be included in the Model of the Differential

Impact of the Holocaust across Three Generations.

The ranking of demographic/situational variables, in terms of their relationship to

psychological health and functioning among survivors, is something not presented by other

trauma models attempting to explain differential post-trauma adjustment. Other models

have tended to simply list such elements rather than determining which have more weight

in determining post-traumatic mental health. The ranking of the three elements intrinsic to

the Holocaust experience itself, namely nature of Holocaust experiences, loss of family and

country of origin point to the overarching importance of elements of the traumatic

experience. However, it is interesting to note that the post-war settlement location of

survivors was ranked as more important in explaining symptom levels than fundamental

demographic variables such as gender and age during the Holocaust. This suggests that the

post-traumatic environment and the differing receptions afforded to survivors of trauma can

be quite a powerful factor in explaining post-trauma adjustment.

It is important to acknowledge that a population of survivors of a large scale state-

based traumatic event or period such as the Nazi Holocaust, or indeed more recent

analogous attempted genocides, will not react and recover in a uniform or homogenous way

and should not be treated as such. Sub-groups and experience subsets will be related to

differing levels of vulnerability and resilience. The key is to develop a framework to help

identify them so that help can be targeted and to be open to the idea that differences will

occur.

Within the Holocaust survivor group, particular vulnerability appears to lie with

survivors of camp internment (as opposed to survivors who were in hiding or had other

non-camp experiences), and the experience of at least part of the Holocaust without family

members. That different traumatic events/sequences of events were experienced by

survivors of different nationalities and that post-war adjustment also differs by this was

hinted at, with data pointing to Hungarian survivors and their descendants evidencing the

highest symptom levels. However, given the small sample sizes these results are based on,

once groups were sub-divided by country of origin, it is not wise to make a definitive

statement on this variable until further data is available to confirm the findings presented in

the current thesis.


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The vulnerability of highly bereaved and camp survivor subgroups translates into

vulnerability for their children in a relatively uniform way. This is perhaps not surprising

since these survivor subgroups are also rated more negatively by their children in terms of

family dynamics and communication about the Holocaust.

16.6. – Applicability of Attachment and Family Systems Theory in Understanding the

Intergenerational Transmission of Holocaust Trauma

The results of both the meta-analyses and the empirical study reported in the current thesis

certainly point to the necessity of appreciating the family background of descendants of

Holocaust survivors in understanding their presenting symptomatology. The basic tenet of

family systems theory (P. Minuchin, 1985) that an individual must be considered within the

context of their family system is highly relevant for descendants of survivors. This is

particularly pertinent when one is reminded that elements of survivor parent’s Holocaust

experience were the highest ranked demographic variables in explaining the symptom

levels of children of survivors, and the extent of survivor ancestry was also the highest

ranked demographic variable for the grandchildren of survivors. There has never been a

stronger example of how a traumatised person also affects the family system of which they

are a member – the negative fall out from which reverberates for generations.

The importance of the parent-child attachment relationship in influencing future

symptomatology levels among the grown-up children was also supported in the empirical

study conducted for the current thesis. Perceived parental (in particular maternal) warmth

was consistently related to a decrease in symptom levels, while parental (in particular

maternal) coldness and ambivalence were related to an increase in symptom levels. Indeed,

parent-child attachment dimensions were the most strongly related to the levels of

symptomatology experienced/reported by the grown-up children of survivors. Evidence for

the strong relationship between parent-child attachment and future symptom levels among

children within the general population has been consolidated within the literature, and the

findings of the empirical study in the current thesis further cement the base of proof.

A note should be included here that Wilson (1989) referred to an intensification of

developmental stages as being a consequence of experiencing a traumatic event. This is

akin to what many have argued is iconic of Holocaust survivor families – that the making

and breaking of ties within these families is particularly difficult (Kellerman, 2001b; Wardi,

1994). The separation-individuation stage (where young adult children move to assert their


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independence from their family of origin culminating in their physical move from the

family home) was tacitly measured in the empirical study via the measurement of parental

encouragement of independence. While this variable was statistically significantly related

to a number of symptom variables, it was ranked third behind parent-child attachment

dimensions and family cohesion in terms of the strength of its relationship with

psychological impact variables among survivor descendants.

It should also be noted that the relationships between symptomatology and family

interaction variables (and the stronger influence of the maternal line) found among the

survivor population in the current thesis are not necessarily different from the relationships

between these variables in the normal population. Chapter Three discussed the

relationships between family interaction variables and symptom levels among the general

population. The findings of the current thesis serve to highlight that traumas can impact on

family interaction variables (directly and indirectly) and that, when these are affected in a

negative way, they have the predictable negative effects on the children of that family.

Indeed, what we know about the relationships between family environment and mental

health makes the transmission of the impact of Holocaust or any other trauma highly

predictable.

16.7. – Key Role played by Communication about Holocaust Experiences

What is also apparent when examining the family interaction patterns within survivor

families is the key role played by communication about Holocaust experiences on the part

of survivors. Undoubtedly, experiencing the Holocaust led its traumatised survivors to

interact with their children in a different way (either more withdrawn or more clingy) than

they would have had they not gone through that trauma. However, open communication

about one’s experiences during the Holocaust helped survivors’ children understand why

their parents behaved and responded in the way they did and thus served to ameliorate the

detrimental effects of these negative family dynamics.

Communication about the Holocaust between survivors and their children plays a

vital part in determining the psychological health of the children. Indeed, communication

about the Holocaust was ranked as more important in determining children of survivors’

symptom levels than general communication within their family of origin within the

empirical study conducted for the current thesis. It is the extent and way in which their

survivor parents spoke to them about their Holocaust experiences which is more important


348

than their communication about anything else. Clearly, open discussion about Holocaust

experiences helps children of survivors to understand why their survivor parents behave

and react the way they do. A lack of ambiguity in these areas is helpful in ensuring that

children of survivors do not develop generalised objectless anxieties and helps them to

understand why their parents may be over-protective and clingy. Perhaps what is more

important is the way in which the Holocaust is discussed – particularly given that the use of

affect-laden communication was the most important of the Holocaust communication

modes measured in the empirical study.

Certainly children of survivors have a strong yearning to know and understand the

details of their survivor parents’ experiences. The popularity and success of survivor-

descendant dialogue workshops which have been conducted in numerous countries attests

both to the children of survivors’ need for clarity and the epiphanies that arise from open

communication about Holocaust trauma. Participation in such workshops can help to

remove ambiguities experienced by children of survivors created by their survivor parents’

non-verbal messages (Halasz, Nahum, Wein, & Valent, 2006).

The experiences of survivors and their descendants in relation to disclosure about

Holocaust trauma are very useful lessons for clinicians working with survivors of more

recent traumas. Not only can open discussion about trauma be a helpful and cathartic

experience for the victim/survivor (Finkelstein & Levy, 2006), but it can also help

minimise the transmission of traumatic impact through the generations by leaving the

survivors in better psychological shape to face the parental role. In addition, survivors can

be taught how their silence, which they may interpret as being protective of their children,

can actually be more harmful than being open and honest with their children. Telling their

children about their traumatic experiences, in the amount of detail that the child is,

developmentally, able to understand and absorb is in many cases the best course of action.

16.8. – Contemporary Needs

As was discussed in Chapter One, while the Nazi Holocaust ended over 60 years ago, it

continues to be a relevant area to research because of the emerging needs of the aging

survivor population. Many survivors are now so frail that they require specialised care

which can only be provided institutionally. Holocaust survivors quite often find the

regimented atmosphere of a nursing home frightening, as it is reminiscent of life in ghettos

or camps. Staff in nursing homes with survivor residents need to be aware of these


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“trigger” circumstances to help minimise negative symptoms among aging survivors.

Diminishing health can be particularly anxiety-provoking for survivors, given that one’s

survival during the Holocaust was heavily reliant on physical fitness (Williams, 1993), both

in terms of getting through the selection process and long-term ability to cope with the

physical hardships of hunger, disease and excessive labour.

With age [my survivor father] has become more anxious, especially over insignificant matters and the memories of the camp are more with him now as he gets older. A child of survivors

If the theorised u-shaped curvilinear relationship between time lapse since the

Holocaust and symptoms experienced by survivors is true, then we are coming into (and are

to a large extent already in) a time when aging survivors are increasingly suffering from the

recurrence, and for some the first emergence, of depressive, anxiety, paranoid and intrusion

symptoms. Support for the notion of such a curvilinear trend was found for depression

levels among survivors via a meta-regression looking at time lapse since the end of the war

(see Chapter Eight, Section 8.7) although it was less straight forward for other variables.

When this upturn in symptoms is coupled with the anxiety provoked by failing physical

health and the negative connotations associated with that for survivors (Williams, 1993),

the aging process is potentially very traumatic for Holocaust survivors. Sixty years on, the

legacy of the Holocaust still requires the attention of professionals in the counselling and

aged-car spheres. The unique problems faced by aging Holocaust survivors as they move

into aged care facilities, as well as the increase or emergence of psychological symptoms,

has been acknowledged in recent print (e.g., an article in the Weekend Australian Magazine

on 31 March 2007 (F. Harari, 2007) and television media coverage (e.g., an episode of the

ABC [Australian Broadcasting Corporation] program Compass which addressed Holocaust

survivors with Alzheimer’s which aired on 22 October 2006 (see webpage –

http://www.abc.net.au/compass/s1748774.htm ). Indeed, many aged care facilities have

been forced to implement programs focussing on the specific needs of Holocaust survivor

residents (e.g., the Sir Moses Montefiore Jewish Home in Hunters Hills, Sydney [as

featured in the aforementioned ABC Compass program]).

Children of survivors also face difficult times as they are confronted by the decline

in their parent’s health and imminent death. The death of the majority of extended family

members during the Holocaust means that not only did survivors not have their parents to


350

turn to, but their children did not have their grandparents. They did not have the

opportunity to watch their grandparents age or have the experience of mourning their death

of old age. This makes the death of survivor parents all the more difficult for their children

to deal with.

My mother’s death was extremely traumatic and I believe this was because I never had any experience of death. I never knew any one in my family who was older than my parents. A child of survivors

Quite apart from the continuing needs of survivors and descendants of survivors of

the Holocaust, research into the effects of the Holocaust serves to highlight the current and

future needs of survivors of more recent genocidal actions such as those in the former

Yugoslav states, the African countries of Rwanda and Sudan and Asian countries such as

Cambodia and indeed any civilian population in a war-torn country such as Iraq or

Afghanistan. Given the long ranging effects that have resulted from the Nazi Holocaust,

clearly mental health professionals will be dealing with the survivors and descendants of

these more recent state-based traumas for many years to come.

16.9 – Clinical Significance and Applications

This thesis provides numerous lessons to be noted by clinicians providing therapy and other

support services to Holocaust survivors and descendants. Many have been learnt already

from clinical experience with survivor and descendant clients. However, it is important to

have this knowledge backed up by solid empirical evidence.

Clearly among the survivor generation itself, the Holocaust has been a central and

defining experience in their life, which continues to reverberate powerfully. Despite the

small sample of survivors who participated in the empirical study conducted for the current

thesis (and the associated statistical power issues) variables relating to elements of their

Holocaust experiences were found to explain up to 60% of the variation in their scores on

psychopathological and psycho-social adjustment variables. Time spent alone (without

family members) was clearly an important element of Holocaust trauma explaining up to

32% of variation in scores. Exploration of issues such as perceived abandonment, isolation

and separation anxiety are the obvious areas that spring to mind when contemplating

application to a clinical/therapeutic setting.

By breaking the Holocaust experience into traumatic elements, it has been possible

to identify the most traumatising aspects or combination of aspects of Holocaust trauma.


351

While the variables studied in the current thesis are specific to the Nazi Holocaust, many

elements are readily transferable to recent attempted genocides. The identification of

highly traumatising sub-elements of Holocaust trauma can be used to help target limited

therapeutic/counselling resources for these more recent survivors. For example, the results

of the current research would suggest, that survivors who have no surviving family

members or who spent part of their traumatic experiences alone will, potentially, in general,

be more needing of therapeutic help because they are more likely to suffer from higher

symptom levels. Such survivors could easily be identified via initial screening interviews.

An educational/therapeutic module could be developed for survivors who become

parents to increase their awareness of the effects of their trauma on their parental modes.

Survivors could be taught about concepts such as developmental abilities to understand and

process details of a traumatic narrative. They could be made aware of the potential

negative effects of ambiguous reactional behaviours (for example fear reactions for which

the stimuli is unclear to the child leading to potential generalised anxiety).

However, in cases where it was not possible to try to prevent the trauma-infused

parenting styles of survivors it is potentially possible to try to ameliorate its after-effects on

the children. Certainly both prior anecdotal literature as well as the findings of the current

thesis’s empirical study point to the influential role of ambiguous and emotive

communication about Holocaust experiences by survivor parents to their children.

Exploration of these communication modes and attempts to clarify ambiguous messages

can go a long way in helping children of survivors understand their family environment as

well as potentially alleviate the aftereffects of this family environment (such as increased

anxiety and problems within interpersonal relationships). The success of workshops in this

area alluded to previously suggest that group therapy sessions with children of survivors

have been and will continue to be useful therapeutic techniques.

In terms of influential psychological process mechanisms identified and studied

within the current thesis, therapists can be more aware of the affected cognitions such as

weakened world assumptions which may potentially be targeted during therapy with

survivors and descendants. Direct experience of the Holocaust and even the knowledge

that close family members experienced the Holocaust are readily understood reasons for a

weakening of world assumptions. Strengthening of world assumptions is an area that

clinicians may explore as an indirect way of reducing psychopathological symptoms.


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Exploration of Holocaust issues should be one of the major tasks in any therapy

with descendant of survivor clients, with the caveat of course that the client is willing to

further explore feelings related to this major event. The analyses presented in the current

thesis point to the continuing importance of the Holocaust legacy in shaping descendant’s

identity and psychological health and functioning.

16.10. – Methodological Issues of the Current Thesis

The current thesis is comprised of two sections of research. The first involved meta-

analyses of data from the literature and the second involved an empirical study. The main

point of caution that can be made about the meta-analytic results is the impossibility of

being able to say for certain that all relevant studies were included. While relatively

exhaustive efforts were made to locate both published and unpublished data, it is

acknowledged that some may have not been obtained. It should be noted that in addition to

the stringent efforts made to locate studies, calculations of Fail Safe Ns (which provide an

estimate of the number of studies with contradictory findings necessary to alter the meta-

analytic result) were also made. The Fail Safe Ns gave the reader an idea of the stability of

the findings of the meta-analysis and the likelihood of the results being inaccurate if all

relevant studies were not included. Certainly it is acknowledged that even with meta-

analyses, the state of evidence in the literature pertaining to a number of variables remained

unclear. In many cases this is due to inconsistent operationalisation of variables

(especially demographic variables) and/or inadequate data.

There are a number of shortcomings of the empirical study conducted for the

current thesis which need reiterating. The most obvious point to make is the small sample

sizes on which analyses were based. When analyses depend on drilling down to sub-groups

of samples, it is impossible to maintain adequate power to conduct multivariate statistical

tests and so univariate and bivariate analyses were used. Obviously a multivariate approach

would be preferable to clarify the truly unique contribution of all the variables included in

the Model of the Differential Impact of the Holocaust across Three Generations. While

inter-relationships between demographic variables were carefully screened and controlled

for, where necessary, via relevant analysis techniques such as partial correlations and

ANCOVAs, it is acknowledged that this approach is not a replacement for a more robust

multivariate approach with a larger sample size. However, with the aging of the survivor


353

population the chances of obtaining large survivor samples for survey research, such as was

conducted for the current thesis, are rapidly diminishing.

Another issue pertaining to the sample of the empirical study is the degree to

which it is representative of the survivor and descendant populations. While attempts were

made to obtain participants from a range of different sources, it still must be acknowledged

that participants had to volunteer to participate and had to be either a member of a group or

exposed to media coverage regarding the study. The costs involved in attempting to obtain

a large enough random sample of survivors and descendants (for example via a much larger

community based study with screening questions for identification) were prohibitive for a

PhD research project. While such a method would be preferable, the findings based on

volunteer samples can also aid our understanding of the impacts of the Holocaust, as long

as the sampling methods used are taken into account by the reader.

The amount of information supplied by grandchildren of survivors about their

survivor ancestors made it impossible to analyse the effects of specific elements of their

survivor grandparents’ Holocaust experiences on their generation. Given the strength of

association between the elements of survivors’ experiences and the psychological health of

their children, it would be most desirable to be able to test if the ranking of these Holocaust

experience dimensions is repeated for the grandchildren of survivor generation. The fact

that the number of survivor grandparents and the number of child of survivor parents that a

grandchild of survivor has were both in the top three highest ranked demographic variable

in explaining that generation’s symptom levels points to the continuing strong influence of

survivor ancestry one generation further removed.

The failure to obtain non-Jewish survivors (or descendants of non-Jewish survivors)

was also particularly frustrating, given the efforts to obtain such participants by the author

(refer to Appendix H for the organisations contacted). If a group of non-Jewish survivors

had been obtained, in particular those who were interned in camps for political opposition

to the Nazi regime, or a group of survivors who had survived in hiding by seeking out there

own food and shelter, an analysis of the importance of active versus passive roles could

have been conducted. Given the pattern of study findings with other populations pointing

to the importance of active versus passive roles in traumatic experiences it is believed this

could have proved an important distinction among Holocaust survivors. It is still believed

by the current author that non-Jewish survivors who were persecuted because of active


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resistance to the Nazi regime will evidence lower symptom levels than those persecuted

purely based on their ethnicity or religions (as was the case for Jews and Gypsies). It

would also be of interest to compare survivors who were in hiding based on whether they

were hidden by others and dependent on them for food and safety, or whether they survived

in hiding and sought food and necessities for themselves.

In an attempt to reduce the size of the questionnaire booklet to be completed by

participants of the empirical study, only some subscales of a number of measures were

used. Specifically, this refers to the use of only the cohesion and expressiveness subscales

of the Family Environment Scale, the Fostering of Autonomy Scale of the Parental

Attachment Questionnaire, and the belief in world benevolence and belief in world

meaningfulness subscales of the World Assumptions Scale. Given the small sample sizes

obtained for the empirical study, and the impossibility of multivariate analyses with the

obtained data, the addition of extra variables/subscales would have made the ensuing

collection of univariate analyses very jumbled indeed. The subscales were chosen to

narrow in on specific facets of survivor family experiences as outlined in the literature. It

must be said that the main focus was not to make an exhaustive list of the influential

psychological processes and transmission processes that could impinge on survivor and

descendant psychological health. Rather, the aim was more to develop a “bare bones”

model of these processes, with the focal point being more on the role of demographic

variables in moderating the effects and transmission of Holocaust trauma. Therefore, it is

acknowledged that there are possibly additional variables that could be considered

influential psychological processes or family interaction/transmission processes that are

worthy of consideration, in obtaining a more complete picture of the processes which lead

to intergenerational trauma transmission.

While discussing the measures used in the empirical study, a cautionary note must

be reiterated in relation to three of the scales used. The internal consistency reliabilities for

the empirical study sample for the Posttraumatic Vulnerability Scale (PTV), the cohesion

subscale of the Family Environment Scale (FES) and a few of the subscales of the

Holocaust Communication Questionnaire (HCQ) were lower than would have been desired.

It must be acknowledged that previous research indicated both the PTV and the cohesion

subscale of the FES to be of sound reliability, while the HCQ had not been analyses for

reliability prior to its use in this study. Therefore, the knowledge of their lower reliability


355

in the current study could not have been known apriori. Because of the exploratory nature

of the empirical study, and the central role hypothesised by communication about the

Holocaust on the part of survivors to their children, it was felt that to leave the HCQ could

not be left out of the analysis. The central role that family cohesion was hypothesised to

play (and was discovered to play) in terms of trauma transmission meant that the omission

of the FES cohesion subscale would have left its role uncovered. The PTV measure upon

examination of its items was found to have high face/construct validity in relation to the

specific fears regarding safety so often reported in the Holocaust survivor literature.

However, it is obviously acknowledged that caution should be used when considering using

the PTV in future research. Perhaps if another measure could be located or created that

examined similar issues, the two measures could be used in unison to provide a back up

source of data if the PTV was found to have low reliability in a given study. One of the

main problems of the HCQ is the small number of items which load onto the subscales

(ranging between 1 and 5 items). There is certainly scope to expand the measure, to

perhaps pick up on more of the subtle nuances of communication that are not currently

measured by the scale. To increase the number of items loading on each subscale can only

have a positive influence on its internal consistency. Certainly replication of the results

obtained in this study using an alternative measure of family cohesion would not be hard

given the number of measures of this construct in existence.

It was originally envisaged that the empirical study would be able to examine the

relationships between all the variables in the Model of the Differential Impact of the

Holocaust across Three Generations by having a large enough sample of survivor families

for which at least one member from each generation had participated. Unfortunately,

despite the efforts of the author and many participants to encourage family members to

participate in the study, there were an insufficient number of families for which three or

even two generations were represented in the sample. It was still possible to examine the

effects of ancestral demographic variables, as these details were provided by participants

themselves. However, it was not possible to examine the relationships between ancestor

and descendant scores on psychological impact and influential psychological process

variables from the Model of the Differential Impact of the Holocaust across Three

Generations. While relationships between parental pathology and offspring pathology had

been established within the general population and the Holocaust survivor population in


356

previous research (Keinan et al., 1988; Major, 1990; Schwartz et al., 1994; Yehuda et al.,

2001), it would have been desirable to replicate this finding within the current thesis’

empirical study data set.

However, despite the shortcomings noted in this section, this thesis adds

significantly to the literature with regard to the impact of Holocaust survivors and

descendants. These methodological issues do little to detract from the validity of the

findings reported in the current thesis. They largely reflect additional variables that require

consideration rather than suggesting the findings based on the variables assessable are not

relatively robust.

16.11. – Future Research Directions

While the research in the current thesis has filled some of the gaps in the available

knowledge about the impact of the Holocaust on survivors and descendants, there is still

much that could be uncovered. It seems that the more research that is conducted in this

area, the more questions arise.

An area that could not be addressed in the current thesis but which is considered

potentially important by the current author is an examination of active versus passive roles

during the Holocaust on post-war psychological health. Delineation of a range of active

versus passive roles and experiences during the Holocaust is possible and the Holocaust

provides an ideal opportunity to examine this issue further.

The area of communication about the Holocaust can certainly be researched in more

depth. Now that the grandchildren of survivors are coming into adulthood in large

numbers, the issue of how they learn about their survivor grandparents’ experiences and the

impact of this knowledge needs to be addressed. This generation will be the last to have

direct contact with the survivor generation; indeed some of the grandchildren generation

may not have had direct contact with their survivor grandparents. Is the turning point in the

measurable transmission of Holocaust trauma the point at which direct contact with the

survivor generation ends? Are there differences between grandchildren who had contact

with their survivor grandparents and who perhaps heard the Holocaust stories first hand,

and grandchildren who merely found out about a grandparents’ Holocaust experiences after

their death? Does the knowledge of ancestral impact have as strong an affect, if the

survivors’ grandchildren never had any direct contact or interaction with their survivor

grandparents? Krasnostein (2006) said of grandchildren of survivors:


357

We are the pivotal generation, willing to look at the effects of the Holocaust with a different and perhaps more distant view than our parents, the second generation, and our survivor grandparents are able to. However, one level of tension exists because even though there is more distance, we are still so close because it happened to our family.

If discernible differences between children and grandchildren of survivors and the

general population are present, at which point do these differences disappear and the

descendants essentially “normalise”? Only when this question is answered can we truly

know the full extent of the reverberating effect of the Holocaust.

The construct of world assumptions as explained in Janoff-Bulman’s (1992) Theory

of Shattered Assumptions is one that is currently under-researched with the survivor and

descendant populations. In particular, it would be of interest to explore the relationship

between survivor parent and offspring’s’ world assumptions. To what extent is a person’s

world view inherited from their parents, and when that view is largely negative, is it

possible for the children to revise their own world view and to what degree? Is the

relationship between parental and offspring scores on pathology measures mediated by

strength of belief in world assumptions?

Given that survivors’ loss of family was revealed as very important in both their

own and their children’s psychological health, a future study could perhaps address this

issue more directly by using a measure of unresolved mourning. Such a measure was

considered for the empirical study but abandoned due to fears that response bias would

render the results meaningless. If a measure of response bias could be incorporated, then it

would be useful to explore this issue in more depth with survivors.

The Model of Differential Impact of Holocaust Trauma across Three Generations

developed and tested over the course of the current thesis could be readily adapted and

applied to survivors of more recent large scale state-based traumas. Many of the

demographic variables (such as loss of family, age, country or perhaps region of origin) are

readily transferable, while others (such as the nature of experiences) would have to be

moulded to fit the specific trauma set being examined. The focus should be on determining

the specific elements of the trauma itself and how these may differ. The main aim of this

process is to identify the most vulnerable demographic sub-groups so that psychological

help, if limited, can be more effectively targeted at those likely to need it the most. The

model can be used to help inform both survivors and mental health professionals the way in


358

which parent-child and whole family interaction patterns can be affected with the hope that

this awareness can help minimise the transmission of trauma to the children of those

affected.

16.12. – Conclusions

To the first question: “How could it have happened?” we respond with guilty silence and to the last one: “Could it happen again?” we nod in shame. Kellerman (2006b, p. 30)

From examining the research that has been conducted to date with Holocaust survivors and

their descendants in detail, it is apparent that many opportunities to gain knowledge were

squandered. Minimal research was conducted in the immediate aftermath of the Holocaust

and it was not until decades later that methodologically sound studies were conducted.

Data on factors that have since been shown to be influential in determining post-Holocaust

adjustment were not consistently collected or analysed. Because of this, research such as

that conducted for the current thesis, has had to play “data collection catch-up” with a

rapidly diminishing population before the opportunity to study survivors is lost forever.

We have not even “scratched the surface” when it comes to understanding the role of

factors such as cultural differences, country of origin, reasons for persecution and the

hypothesised protection of active roles have on post-Holocaust adjustment.

We live in a world where men, women and children continue to be subjected to state

or community-based traumas. It is imperative that we take the lessons learned from the

Holocaust survivor population and use them as guiding principles in helping the survivors

of more recent traumas. In the many areas where our knowledge regarding the Holocaust is

lacking, we need to conduct methodologically sound, large scale, longitudinal studies with

survivors of more recent-state based traumas, so that we can more accurately understand

their long-term prognosis and the factors that underpin it.

We need to ensure that immediate and continuing psychological help and

monitoring is available to these survivors. We need to approach this task with the

knowledge of how the impacts of these traumas can be passed on through the generations.

If we have been unable to help the survivors to the level we would like, then we need to be

willing to educate the subsequent generations to help them understand their parents’ and

ancestors’ behaviours and attitudes so the likelihood of dysfunctional parenting patterns

being repeated for many generations can be minimised.


359

The world needs to understand that the effects of state-base trauma are long-lasting

both for the individuals directly effected as well as their descendants, for potentially more

generations to come. They also need to acknowledge that not all people will react and/or

recover from such experiences in the same way. It is the role of researchers in the areas of

psychology, psychiatry and social work to educate the world as to the nature of this

reverberating traumatic impact in the hope that more attention will be focussed on large

scale persecution and traumatisation of civilian populations and that more will be done to

stop and prevent it. Unfortunately, the effects of recent large scale community persecutions

and “ethnic cleansings” (such as in the former Yugoslav states, Rwanda, Cambodia and

very recently in Darfur in the Sudan) are already providing psychologists with an ever-

growing group of survivors and potentially traumatised descendants.

While the Nazi Holocaust has provided us with evidence of long-lasting negative

effects of survival, there is also something heartening to take from encounters with

survivors. That is that while they have suffered psychologically because of their Holocaust

experiences (to differing degrees) they have also to a large extent been able to lead

relatively successful and productive lives in their post-Holocaust years. This fact

demonstrates the strength of the human spirit to overcome even the most horrific traumas.

After a while you find you can smile again and you live again and you think to yourself I am still alive… Jozefa Lurie, a survivor

Figure 16.2. Polish prisoners in Dachau toast their liberation from the camp (circa April/May 1945) Source: United States Holocaust Memorial Museum Photo Archive (Photograph # 83818) Note. The views or opinions expressed in this thesis, and the context in which the image is used, do not necessarily reflect the views or policy of, nor imply approval or endorsement by, the United States Holocaust Memorial Museum.


360

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383

Appendix A – Studies included in meta-analyses of Holocaust survivors versus control/comparison groups with meta-regression and subset meta-analysis inclusions

Table AA.1. Holocaust Survivors versus Controls/Comparisons on Depression Questionnaires

Author/s and Year Country study conducted in

Measure of Depression Used

Holocaust Survivor Group Comparison Group t-test and effect size included in

meta-analysis

Meta-regressions Subset Meta-Analyses Sample

Source Statistics Demographics Sample Source

Statistics


Israel Symptom Checklist - 90 Survivor Groups

M = 0.85 SD = 0.74

N = 43 M age = 64.86 53% Female

Pre-WWII Immigrants and Israeli Born

M = 0.51 SD = 0.57 N = 44

t = 2.37 * g = 0.51

Age in 1945 Time lapse % Female

Israel Survivor Group


Israel Negative Affect Schedule Community (non-CC)

M = 2.92 SD = 0.61

N = 30 50% Female

Pre and Post War Immigrants

M = 2.27 SD = 0.59 N = 30

t = 4.12 *** g = 1.08

Time lapse % Female

Community Israel


Israel Negative Affect Schedule Community (CC)

M = 3.26 SD = 0.54

N = 30 50% Female

Pre and Post War Immigrants

M = 2.27 SD = 0.59 N = 30

t = 6.67 *** g = 1.75

Time lapse % Female

Community Israel

Brody (1999) - Average

America Geriatric Depression Scale and Structured Clinical Interview for DSM-IV – Depression

Not specified (non-CC)

N = 15 M age = 70.20 53% Female

Pre-WWII Immigrants

N = 10

t = 1.34 ns g = 0.45


Community America

Brody (1999) - Average

America Geriatric Depression Scale and Structured Clinical Interview for DSM-IV – Depression

Not specified (CC)

N = 15 M age = 71.80 6% Female

Pre-WWII Immigrants

N = 10

t = 1.80 ns g = 0.63

Time lapse % Female

Community Israel

Conn, Clarke and Reekum - Averaged (2000)

Canada Geriatric Depression Scale and Hamilton Depression Rating Scale

Clinical N = 108

M age = 74.41 65% Female

Non-survivor patients NOS

N = 335

t = 0.62 ns g = 0.07


Clinical America

Cordell (1980) America Heimler Scale of Social Functioning – Depression Subscale

Survivor Groups

M = 8.00 SD = 4.54 N = 20


Non-survivor Jews

M = 4.70 SD = 4.06 N = 16

t = 2.36 * g = 0.75


Survivor Group America

Finer-Greenberg – Average (1987)

America Cognitive Checklist and SCL-90-R

Groups N = 29 M age = 63.93 Age range = 17

Pre-WWII Immigrants

N = 25

t = 2.53 * g = 0.66

Age in 1945 Time lapse

Survivor Groups America

Joffe, Brodaty, Luscombe and Ehrlich (2003) - Average

Australia Brief Psychiatric Rating Scale – Withdrawn Depression and General Health Questionnaire – Severe Depression

Community N = 100 M age = 74.10 59% Female

Pre-WWII Immigrants

N = 50

t = 2.54 * g = 0.41


Community America


Australia Brief Psychiatric Rating Scale – Withdrawn Depression and General Health Questionnaire – Severe Depression

Community N = 100 M age = 74.10 59% Female

Australian or English Born

N = 50

t = 5.46 *** g = 0.73


Community America


384




meta-analysis



Statistics

Kahana, Harel and Kahana (1989)

America Symptom Checklist – 90 - Revised

Community N = 168

Pre-WWII Immigrants

N = 156

t = 1.97 * g = 0.22

Time lapse Community America


America Symptom Checklist – 90 – Revised

Community M = 25.82 SD = 10.67

N = 150 Pre-WWII Immigrants

M = 20.74 SD = 7.49 N = 150

T = 4.76 *** G = 0.55



Israel Symptom Checklist – 90 - Revised



M = 17.21 SD = 4.85 N = 150

T = 5.40 *** G = 0.63

Time lapse Community Israel

Landau and Litwin (2000)

Israel Zung Self-Rating Depression Scale

Community (Males)

M = 47.30 SD = 14.00 N = 59


Pre-WWII Immigrants (Males)

M = 46.20 SD = 13.60 N = 52

t = 0.42 ns g = 0.08


Community Israel Males vs controls



Community (Females)

M = 57.40 SD = 15.40

N = 32 M age = 80.90 100% Females

Pre-WWII Immigrants (Females)

M = 51.70 SD = 15.00 N = 51

t = 1.64 ns g = 0.37


Community Israel Females vs controls


America Minnesota Multiphasic Personality Inventory Depression Subscale

Community (Females non-CC)

M = 62.67 SD = 9.62

N = 9 100% Females


M = 58.92 SD = 9.48 N = 12

t = 0.84 ns g = 0.38

Time lapse % Female

Community America Females vs controls



Community (Males CC)

M = 64.27 SD = 11.69

N = 11 0% Female


M = 60.17 SD = 8.09 N = 9

t = 0.88 ns g = 0.38

Time lapse % Female

Community America Males vs controls



Community (Males non-CC)

M = 66.33 SD = 7.31

N = 6 0% Female


M = 60.17 SD = 8.09 N = 9

t = 1.42 ns g = 0.74

% Female Time lapse since 1945



America Minnesota Multiphasic Personality Inventory

Community (Females CC)

M = 60.25 SD = 10.85

N = 16 100% Female


M = 58.92 SD = 9.48 N = 12

t = 0.33 ns g = 0.13

% Female Time lapse since 1945


Lowin (1983)

America Symptom Checklist - 90 Groups M = 0.98 SD = 0.73

N = 31 52% Female

Non-survivor Jews NOS

M = 0.86 SD = 0.73 N = 70

t = 0.76 ns g = 0.17

% Female Time lapse

Survivor group America

Nadler and Ben-Shushan (1989) - Average

Israel Clinical Analysis Questionnaire – B – D2 Suicidal Depression, D4 Anxious Depression and D5 Low Energy Depression

Community N = 34 Age range = 6 50% Female

Pre-WWII Immigrants

N = 34

t = 5.03 *** g = 1.24

% Female Time lapse

Community Israel


385




meta-analysis



Statistics

Shmotkin and Lomranz (1998)

Israel Affect Balance Scale Community (Group 2 sample)

M = 1.65 SD = 0.54

N = 85 M age = 70.20 Age range = 31 45% Female

Post-WWII Immigrants

M = 1.60 SD = 0.56 N = 75

t = 0.57 ns g = 0.09


Community Israel


Israel Affect Balance Scale Community (Group 2 sample)

M = 1.65 SD = 0.54


Pre-WWII Immigrants

M = 1.59 SD = 0.68 N = 154

t = 0.75 ns g = 0.09


Community Israel


Israel Affect Balance Scale Community (Group 1 Sample)

M = 1.73 SD = 0.64



M = 1.60 SD = 0.56 N = 75

t = 1.61 ns g = 0.21


Community Israel


Israel Affect Balance Scale Community (Group 1 Sample)

M = 1.73 SD = 0.64


Pre-WWII Immigrants

M = 1.59 SD = 0.68 N = 154

t = 1.93 ns g = 0.21


Community Israel

Shmotkin, Blumstein and Modan (2003)

Israel Centre for Epidemiologic Studies Depressed Mood Scale

Community

M = 0.78 SD = 0.44 N = 126



M = 0.88 SD = 0.45 N = 145

t = -1.84 ns g = -0.22


Community Israel

Shmotkin, Blumstein and Modan (2003)

Israel Centre for Epidemiologic Studies Depressed Mood Scale


N = 126 M age = 83.8 32% Female

Pre-WWII Immigrants

M = 0.69 SD = 0.41 N = 206

t = 1.85 ns g = 0.21


Community Israel

Yaari, Eisenberg, Adler and Birkhan (1999) - Average

Israel Beck Depression Inventory and Symptom Checklist - 90

Clinical N = 33 M age = 67.90 73% Female

Pre-WWII Immigrants

N = 33

t = 3.08 ** g = 0.76


Clinical Israel

Yehuda, Kahana, Southwick and Giller Jr (1994)

America Symptom Checklist - 90 Community (with PTSD)

M = 19.45 SD = 9.65

N = 11

Not specified M = 5.11 SD = 4.14 N = 14

t = 4.40 *** g = 1.96


Yehuda, Kahana, Southwick and Giller Jr (1994)

America Symptom Checklist - 90 Community (without PTSD)

M = 7.90 SD = 8.14

N = 12


t = 1.03 ns g = 0.43


Notes. Conn, Clarke and Reekum (2000) measured depression levels of their HS sample both before and after extended stays in a clinical facility. Only the baseline measure of depression (that is before treatment) was included in the meta-analysis. Kahana, Harel and Kahana (1989) quoted no descriptive statistics but noted that the difference between their Holocaust survivor group and their control group was statistically significant at the 0.05 level. A t-score was thus derived based on this significance level and the sample sizes. The effect size was then calculated using the formula to convert a t score to a d. Shmotkin and Lomranz (1998) had two separate groups of Holocaust survivors. Group one was derived by fortune through a lifespan study which happened to include survivors in its sample and group two consisted of survivors purposefully recruited for this and other studies on the Holocaust survivor population. HS = Holocaust Survivors; NOS = Not otherwise specified; CC = Concentration Camp *p < .05. **p < .01. ***p < .001


386

Table AA.2. Holocaust Survivors versus Controls/Comparisons on Incidence of Depression Author/s and

Year Country study conducted in

Criteria for diagnosis/inclusion in

incidence

Holocaust Survivor Group Comparison Group Odds ratio included in

meta-analysis

Meta-regressions

Sub-set meta-analyses Sample

Source Statistics Demographics Sample Source Statistics

Antonovsky, Maoz, Dowty and Wijsenbeer (1971)

Israel Negative Mood Community Female 61% N = 74 100% Female

NOS Female

46% N = 208

1.81 * Time lapse % Female

Israel Females vs controls

Carmil and Carel (1986)

Israel Frequent Depression Community NOS 33%

N = 2,159 37% Female

Pre-war Immigrants

27% N = 1,150


Israel

Eaton, Sigal and Weinfeld (1982)

Canada Average incidence of depressive symptoms on Langner Scale

Community 24% N = 135 73% Female


18% N = 133

1.40 Time lapse % Female

Canada

Klein, Beersheba, Zellermayer and Shanan (1963)

Israel Incidence of depression, apathy and dysphoria in files (1955-1961)

Clinical 52% N = 50 66% Female


30% N = 40


Israel

Matussek (1975)

Germany, Israel and America

Depressed Mood mentioned in Psychological Interview

Compensation Files

43% N = 144

Terno, Barak, Hadjez, Elizur and Szor (1998)

Israel Affective disorder diagnosis



17% N = 30


Israel

*p < .05. **p < .01. ***p < .001 Notes. The Holocaust survivor group in Antonovsky et al.’s (1971) study was defined as those who indicated they had spent time in a concentration camp. The control group therefore potentially included subjects who had endured other Holocaust experiences such as ghettoisation or living in hiding. This should be borne in mind when interpreting these results. The results of Matussek’s (1975) study were not included in the calculation of the meta-analytic odds ratio but were used to calculate the average incidence.

NOS = Not otherwise specified


387

Table AA.3. Holocaust Survivors versus Controls/Comparisons on Anxiety Questionnaires

Author/s and Year Country study

conducted in

Measure of Anxiety Used

Holocaust Survivor Group Comparison Group t-test and effect size included in meta-analysis

Meta-regressions

Subset Meta-Analyses Sample Source

Statistics Demographics Sample

Source Statistics


Israel SCL-90 – Anxiety Survivor Groups

M = 0.67 SD = 0.52

N = 43 M age = 64.86 53% Female

Immigrants and Native born Israelis

M = 0.38 SD = 0.41 N = 44

t = 2.85 ** Age in 1945 Time lapse % Female

Survivor Group Israel

Dor-Shav (1978) – Average

Israel 16PF – Tense Subscale and Worried Subscale

Community N = 32

Non-survivors NOS

N = 11

g = 0.07 Time lapse Community Israel

Finer-Greenberg (1987) - Average

America SCL-90-R and Cognitive Checklist

Survivor Groups

N = 29 M age = 63.93 Age range = 17

Pre-WWII Immigrants

N = 25

g = 0.62

Age in 1945 Time lapse

Survivor Groups America


Australia General Health Questionnaire – Anxiety and Insomnia


N = 100 M age = 74.10 59% Female

Australian or English Born

M = 0.80 SD = 1.50 N = 50

t = 11.47 *** g = 1.42


Community America


Australia General Health Questionnaire – Anxiety and Insomnia


N = 100 M age = 74.10 59% Female

Pre-WWII Immigrants

M = 0.80 SD = 1.60 N = 50

t = 7.20 *** g = 0.34


Community America


America SCL-90-R – Anxiety Community N = 168

Pre-WWII Immigrants

N = 156

t = 1.97 * g = 0.22






M = 13.15 SD = 4.17 N = 150

t= 7.07 *** g = 0.82




Pre-WWII Immigrants

M = 12.92 SD = 3.61 N = 150

t = 5.83 *** g = 0.67

Lavie and Kaminer (1996)

Israel MMPI Not specified (Well adjusted)

M = 12.70 SD = 5.60

N = 12 M age = 62.70 58% Female

Israeli born M = 16.30 SD = 7.30 N = 10

t = -1.22 ns g = - 0.54


Community Israel

Lavie and Kaminer (1996)

Israel MMPI Not specified (Less adjusted)

M = 25.40 SD = 8.50

N = 11 M age = 57.50 55% Female

Israeli born M = 16.30 SD = 7.30 N = 10

t = 2.51 * g = 1.10


Community Israel

Lowin (1983) - Average

America SCL-90 – Anxiety Subscale and Phobic Anxiety Subscale

Survivor Groups

N = 31 52% Female

Non-survivor Jews

N = 70 g = 0.65 Time lapse % Female



388


conducted in

Measure of Anxiety Used


Meta-regressions

Subset Meta-Analyses Sample Source

Statistics Demographics Sample

Source Statistics

Sagi-Schwartz, van IJzendoorn, Grossmann, Joels, Grossmann, Scharf, Koren-Karie, Alkalay (2003) - Average

Israel Endler Multidimensional Anxiety Scale – Cognitive Worry Subscale and Autonomic Worry Subscale

Community (Females)

N = 48 M age = 65.50 100% Female


N = 50

g = 0.30 Age in 1945 Time lapse % Female

Community Israel Females vs controls

Yaari, Eisenberg, Adler and Birkhan (1999) - Average

Israel SCL-90 – Anxiety and Phobic Anxiety

Clinical (Pain Clinic)

N = 33 M age = 67.90 73% Female

Pre-WWII Immigrants

N = 33 M age = 69.00


Clinical Israel

Notes. Sagi-Schwartz et al. (2003) included no data and stated that the difference between the groups was not significant. Therefore zero was inserted into the analysis as the t score and the d score for the cognitive worry scale as this is the only unbiased estimate that can be made (see method chapter). An F score was quoted for the result based on the autonomic worry scale. This was converted to a t score by calculating the square root. Kahana et al. (1989) also cited no data but state that the Holocaust survivor group had scores statistically significantly higher than the control group. Therefore the t score associated with a significance of 0.05 was substituted in the analysis and used to derive an effect size, or d, for the meta-analysis. *p < .05. **p < .01. ***p < .001 Table AA.4. Holocaust Survivors versus Controls/Comparisons on Incidence of Anxiety Author/s and Year Country study

conducted in Criteria for

diagnosis/inclusion in incidence


meta-analysis

Meta-regressions

Sub-set meta-analyses Sample Source Statistics Demographics Sample Source Statistics

Antonovsky, Maoz, Dowty and Wijsenbeer (1971)

Israel Negative Worries Community Female 56% N = 77 100% Female

NOS Female

30% N = 210


Israel Females vs controls


Israel Frequent Anxiety Community NOS 54%

N = 2,159 37% Female

Pre-war Immigrants

50% N = 1,150


Israel

Eaton, Sigal and Weinfeld (1982)

Canada Average incidence of anxiety symptoms on Langner Scale

Community 30% N = 135 73% Female


24% N = 133


Canada


Israel Incidence of anxiety phenomena in files (1955-1961)



20% N = 40


Israel

Matussek (1975) Germany, Israel and America

Paranoid Ideation mentioned in Psychological Interview

Compensation Files

23% N = 144

Notes. The Holocaust survivor group in Antonovsky et al.’s (1971) study was defined as those who indicated they had spent time in a concentration camp. The control group therefore potentially included subjects who had endured other Holocaust experiences such as ghettoisation or living in hiding. This should be borne in mind when interpreting these results. The results of Matussek’s (1975) study were not included in the calculation of the meta-analytic odds ratio but were used to calculate the average incidence. *p < .05. **p < .01. ***p < .001 NOS = Not otherwise specified


389

Table AA.5. Holocaust Survivors versus Controls/Comparisons on Paranoia Questionnaires Author/s and


Measure of Paranoia Used


Meta-regressions

Subset Meta-Analyses HS

Sample

Statistics Demographics Sample Source

Statistics

Cordell (1980) America Heimler Scale of Social Functioning - Paranoid Ideation

Survivor Groups N = 20 M age = 58.25 55% Female

Non-survivor Jews

N = 20 t = 0.00 g = 0.00



Dor-Shav (1978)

Israel 16PF- Suspiciousness Scale


N = 32

Non-survivors NOS

M = 11.80 SD = 4.02 N = 11

t = -0.95 ns g = - 0.40




Community N = 168

Pre-WWII Immigrants

N = 156

t = 1.97 * g = 0.22






M = 7.19 SD = 1.68 N = 150

t = 7.56 *** g = 0.87






M = 7.78 SD = 2.65 N = 150

t = 2.31 * g = 0.27



America MMPI Community (Females non-CC)

M = 58.81 SD = 9.45

N = 16 100% Females

Pre-WWII Immigrants

M = 52.80 SD = 5.50 N = 12

t = 2.05 ns g = 0.73

Time lapse % Female



America MMPI Community (Females CC)

M = 60.00 SD = 11.40

N = 9 100% Females

Pre-WWII Immigrants

M = 52.80 SD = 5.50 N = 12

t = 1.66 ns g = 0.82

Time lapse % Female



America MMPI Community (Males CC)

M = 56.18 SD = 7.67

N = 11 0% Females

Pre-WWII Immigrants

M = 47.90 SD = 8.29 N = 9

t = 2.17 * g = 0.99

Time lapse % Female



America MMPI Community (Males non-CC)

M = 49.67 SD = 5.82

N = 6 0% Females

Pre-WWII Immigrants

M = 47.90 SD = 8.29 N = 9

t = 0.45 ns g = 0.22

Time lapse % Female


Lowin (1983) America SCL-90 Survivor Groups M = 1.04 SD = 0.84

N = 31 52% Female

Non-survivor Jews

M = 0.66 SD = 0.54 N = 70

t = 2.28 * g = 0.58

% Female Time lapse

Survivor group America

Nadler and Ben-Shushan (1989)

Israel CAQ-B Community M = 8.53 SD = 3.26

N = 34 Age range = 6 50% Female

Pre-WWII Immigrants

M = 5.56 SD = 5.60 N = 34

t = 2.63 * g = 0.64

% Female Time lapse

Community Israel


390

Author/s and


Measure of Paranoia Used


Meta-regressions

Subset Meta-Analyses HS

Sample

Statistics Demographics Sample Source

Statistics

Yaari, Eisenberg, Adler and Birkhan (1999)

Israel SCL-90 Clinical (Pain Clinic)

M = 0.70 SD = 0.70

N = 33 M age = 67.90 73% Female

Pre-WWII Immigrants

M = 0.30 SD = 0.40 N = 33

t = 2.81 ** g = 0.69


Clinical Israel

Notes. Kahana, Harel and Kahana (Kahana et al., 1989) presented no descriptive statistics but stated that the two groups were statistically significantly different at p <0.05 so a t score was derived using this probability level and the sample sizes provided. The formula presented in the methodology chapter to derive an effect size, or d, from such a score was used to enter this study into meta-analytic calculations. Cordell (1980) did not report any descriptive statistics for this measure and simply stated that there was no statistically significant difference between the groups. Therefore an effect size of zero was included in the meta-analysis for this study as the only non-biased estimate that could be made. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AA.6. Holocaust Survivors versus Controls/Comparisons on Incidence of Paranoia Author/s and Year Country study




meta-analysis

Meta-regressions



Israel Irrational Fears Community NOS 12%

N = 2,159 37% Female

Pre-war Immigrants

9% N = 1,150


Israel


Israel Incidence of suspiciousness / paranoid features in files (1955-1961)



50% N = 40


Israel


Paranoid Ideation mentioned in Psychological Interview

Compensation Files

15% N = 144

Note. The results of Matussek’s (1975) study were not included in the calculation of the meta-analytic odds ratio but were used to calculate the average incidence. *p < .05. **p < .01. ***p < .001


391

Table AA.7. Holocaust Survivors versus Controls/Comparisons on Benevolence of the World – World Assumptions Questionnaire Author/s and Year Country study

conducted in Holocaust Survivor Group Comparison Group t-test and effect

size included in meta-analysis

Meta-regressions Subset Meta-Analyses Sample Source Statistics Demographics Sample Source Statistics

Breslau (2002) America Jewish Organisations

M = 29.31

N = 67 M age = 71.7 51% Female

Non Survivor NOS

M = 30.87 N = 68

t = - 1.73 ns g = - 0.30

Age in 1945 % Female

America


Israel Non-AMCHA Client Child Survivors

M = 15.65 SD = 3.75

N = 50 Control Non-Clinical

M = 15.15 SD = 3.58 N = 50

t = 0.68 ns g = 0.14

Israel



M = 15.65 SD = 3.75

N = 50 Clinical Control M = 15.50 SD = 4.10 N = 169

t = 0.24 ns g = 0.04

Israel


Israel AMCHA Adult Survivor Clients

M = 13.75 SD = 3.71


M = 15.15 SD = 3.58 N = 50

t = - 1.99 * g = - 0.38

Israel



M = 13.75 SD = 3.71


t = - 3.03 ** g = - 0.44

Israel


Israel AMCHA Child Survivor Clients

M = 13.50 SD = 3.25

N = 28

Control Non-Clinical

M = 15.15 SD = 3.58 N = 50

t = - 2.04 * g = -0.47

Israel



M = 13.50 SD = 3.25

N = 28

Clinical Control M = 15.50 SD = 4.10 N = 169

t = - 2.85 ** g = -0.50

Israel

Cohen, Brom and Dasberg (2001)

Israel Community M = 11.80 SD = 4.10

N = 50 Mean birth year 1932 50% Female

Pre-war immigrants

M = 10.97 SD = 3.80 N = 50

t = 1.04 ns g = 0.21


Israel



N = 61 M age = 68.3 64% Female

Pre-war immigrants

M = 32.83 SD = 5.14 N = 131

t = 4.31 *** g = - 0.71


Israel

Notes. Breslau (2002) reported no standard deviations, but did report the results of significance tests and the formula to convert t to d was used to include this study in the meta-analysis. The data presented in Cohen, Brom and Dasberg (2001) and Brom, Durst and Aghassy (2002) was rescaled into the 3 scale version for comparability of results. The rescaling was conducted using instructions from Janoff-Bulman the author of the World Assumptions Scale (R. Janoff-Bulman, personal communication, July 4, 2005). *p < .05. **p < .01. ***p < .001


392

Table AA.8. Holocaust Survivors versus Controls/Comparisons on Meaningfulness of the World – World Assumptions Questionnaire Author/s and Year Country Holocaust Survivor Group Comparison Group t-test and effect



Source

Statistics Demographics Sample Source Statistics

Breslau (2002) America Jewish Organisations

M = 35.46

N = 67 M age = 71.7 51% Female

Non Survivor NOS

M = 37.92 N = 70

t = 1.45 ns g = - 0.25


America



M = 11.80 SD = 4.10


M = 10.97 SD = 4.15 N = 50

t = 1.00 ns g = 0.20

Israel



M = 11.80 SD = 4.10


t = 1.87 ns g = - 0.29

Israel



M = 10.97 SD = 3.67


M = 10.97 SD = 4.15 N = 50

t = 0.00 ns g = 0.00

Israel



M = 10.97 SD = 3.67


t = - 3.59 *** g = - 0.50

Israel



M = 10.80 SD = 3.67

N = 28

Control Non-Clinical

M = 10.97 SD = 4.15 N = 50

t = -0.18 ns g = -0.04

Israel



M = 10.80 SD = 3.67

N = 28

Clinical Control M = 13.07 SD = 4.38 N = 169

t = - 2.89 ** g = -0.53

Israel

Cohen, Brom and Dasberg (2001)


N = 50 Mean birth year 1932 50% Female

Pre-war immigrants

M = 15.15 SD = 3.58 N = 50

t = 0.68 ns g = 0.14


Israel



N = 61 M age = 68.3 64% Female

Pre-war immigrants

M = 6.39 SD = 7.45 N = 131

t = 2.36 * g = 0.36


Israel

Notes. Breslau (2002) reported no standard deviations, but did report the results of significance tests and the formula to convert t to d was used to include this study in the meta-analysis. The data presented in Cohen, Brom and Dasberg (2001) and Brom, Durst and Aghassy (2002) was rescaled into the 3 scale version for comparability of results. The rescaling was conducted using instructions from Janoff-Bulman the author of the World Assumptions Scale (R. Janoff-Bulman, personal communication, July 4, 2005). *p < .05. **p < .01. ***p < .001


393

Table AA.9. Holocaust Survivors versus Controls/Comparisons on Positive Attachment/Intimacy Questionnaires Author/s and Year Country

study conducted in


Meta-regressions

Subset Meta-Analyses Measure of

Attachment Sample Source

Statistics Demographics Sample Source Statistics

Cohen, Dekel and Solomon (2002)

Israel Mikulincer Attachment Style Questionnaire – Secure Attachment Scale

Survivor Group (Non-Clinical)

M = 4.68 SD = 1.23

N = 48 M age = 60.00 50% Female

Native Born Israelis

M = 4.84 SD = 0.86 N = 43

t = -0.72 g = -0.15



Cohen, Dekel and Solomon (2002)

Israel Mikulincer Attachment Style Questionnaire – Secure Attachment Scale

Survivor Group (Clinical)

M = 4.21 SD = 1.06

N = 43 M age = 60.00 50% Female


M = 4.84 SD = 0.86 N = 43

t = -2.99 ** g = -0.65



Sagi, van Ijzendoorn, Joels and Scharf (2002)

Israel Relationship Questionnaire on Attachment Styles – Secure Attachment Scale

Community

N = 39 M age = 63.50 63% Female


N = 42 M age = 59.90

t = 0 g = 0


Israel Community

Note. Sagi, van Ijzendoorn, Joels and Scharf (2002) quote no statistics but state that the difference between the groups was not significant. In the absence of all descriptive statistics a mean difference of zero was added to the analysis as the only non-biased means of estimating a non-statistically significant difference between the groups. *p < .05. **p < .01. ***p < .001


394

Table AA.10. Holocaust Survivors versus Controls/Comparisons on Negative Attachment/Intimacy Questionnaires Author/s and Year Country study

conducted in Measure of Attachment Holocaust Survivor Group Comparison Group t-test and effect


Meta-regressions

Subset Meta-Analyses Sample


Cohen, Dekel and Solomon (2002) - Average

Israel Mikulincer Attachment Style Questionnaire – Average of Fear of Relationships, Anxious and Avoidant Attachment Scales

Survivor Group (Non-Clinical)

N = 48 M age = 60.00 50% Female


N = 43 M age = 60.00

g = -0.08 Age in 1945 Time lapse % Female


Cohen, Dekel and Solomon (2002) - Average

Israel Mikulincer Attachment Style Questionnaire – Average of Fear of Relationships, Anxious and Avoidant Attachment Scales

Survivor Group (Clinical)

N = 43 M age = 60.00 50% Female


N = 43 M age = 60.00



Sagi, van Ijzendoorn, Joels and Scharf (2002) - Average

Israel Relationship Questionnaire on Attachment Styles - Average of Dismissing, Fearful and Pre-Occupied Attachment Scales

Community

N = 39 M age = 63.50 63% Female


N = 42 M age = 59.90


Israel Community

Note. Sagi, van Ijzendoorn, Joels and Scharf (2002) quote no statistics for the fearful and pre-occupied sub-scales but state that the differences between the groups were not significant. In the absence of all descriptive statistics a mean difference of zero was added to the analysis as the only non-biased means of estimating a non-statistically significant difference between the groups on these two measures. Sagi et al. (2002) claim that a statistically significant difference was obtained for the dismissing scale with Holocaust survivors obtaining the higher score (M = 4.80, SD = 2.00 versus M = 4.00, SD = 1.90). However, they made an error in this assertion because with the t score they obtained (t = 1.88) and the associated degrees of freedom (df = 79) the critical t value required is 1.99. When re-calculated by the current author a t value of 1.82 was obtained which is also not-significant. Their main study was conducted with 48 female Holocaust survivors and 50 female controls derived from a random telephone survey of the community. For this study the Adult Attachment Interview was used. This interview categorises subjects in one of four attachment styles: secure: autonomous, insecure: dismissing, insecure: pre-occupied and insecure: cannot classify. Sagi et al. (2002) cite no percentages or frequencies but state there was no statistically significant difference in the frequency of these attachment styles between the female survivors and controls when analysed with chi-square analysis. No means or standard deviations are presented in this table as all effect sizes are based on averages of more than one negative attachment dimension measure. *p < .05. **p < .01. ***p < .001


395

Appendix B – Studies included in meta-analyses of children of Holocaust survivors versus control/comparison groups with meta-regression and subset meta-analysis inclusions

Table AB.1. Children of Holocaust Survivors versus Controls/Comparisons on Depression Questionnaires Author/s and Year Country study

conducted in Measure of

Depression used Child of Survivor Group Comparison Group t-test and

effect size included in

meta-analysis

Meta-regressions

Subset Meta-Analyses Sample Source Statistics Demographics Sample Source Statistics

Brodzki (2000) America SCL-90-R Female NOS

N = 66 M age = 37.65 Age range = 26 100% Female 50% two survivor parents

Jewish Control (parents not in Europe during WWII)

N = 65 M age = 36.27 Age range = 27

t = 1.57 ns g = 0.27

Delay in birth % Female % two survivor parents

Community Female vs controls America

Brom, Kfir and Dasberg (2001)

Israel Developed Questionnaire

Community – Female

M = 0.40 SD = 1.60

N = 28 M age = 38.90 100% Female

Jewish Control NOS – Female

M = -0.30 SD = 1.8 N = 28

t = 1.51 ns g = 0.41

Delay in birth % Female

Community Israel Female vs Control

Budick (1985) America Basic Personality Inventory

Survivor Groups M = 3.03 SD = 2.79


Pre-WWII Immigrant Parents

M = 2.28 SD = 2.35 N = 16

t = 1.31 ns g = 0.29


Survivor groups America




N = 29 M age = 32.86 Age range = 16


M = 50.81 SD = 8.14 N = 25

g = 0.04 Delay in birth Survivor groups America

Karr (1973) America MMPI Survivor Groups

M = 23.64 SD = 5.07

N = 33 M age = 23 Age range = 12 48% Female 100% two survivor parents


M = 21.41 SD = 5.10 N = 22

t = 1.56 ns g = 0.43


Survivor groups America Two survivor parents vs controls


M = 23.81 SD = 5.14



M = 21.41 SD = 5.10 N = 22

t = 1.39 ns g = 0.46


Survivor groups America One survivor parent vs controls

Keinan, Mikulincer and Rybnicki (1988)

Israel Depressive Adjective Checklist

Community N = 47 M age = 32.20 55% Female 43% two survivor parents

Not specified N = 46 M age = 31.80

t = 0.00 ns g = 0.00


Community Israel


396


Measure of Depression used

Child of Survivor Group Comparison Group t-test and effect size included in

meta-analysis

Meta-regressions



America MMPI Community (at least one non-camp survivor parent)

M = 52.60 SD = 8.32

N = 5 100% Female

Pre-WWII Immigrant Parent/s (Females)

M = 60.55 SD = 10.65 N = 9

t = -1.42 ns g = - 0.75

% Female Community America Females vs controls


America MMPI Community (at least one camp survivor parent)

M = 59.93 SD = 12.16

N = 16 0% Female

Pre-WWII Immigrant Parent/s (Males)

M = 69.14 SD = 17.15 N = 7

t = -1.20 ns g = - 0.64

% Female Community America Males vs controls



M = 62.25 SD = 16.76

N = 4 0% Female

Pre-WWII Immigrant Parent/s (Males)

M = 69.14 SD = 17.15 N = 7

t = -0.58 ns g = - 0.37




M = 56.69 SD = 9.67

N = 16 100% Female

Pre-WWII Immigrant Parent’s (Females)

M = 60.55 SD = 10.65 N = 9

t = -0.85 ns g = - 0.37


Lichtman (1983) America MMPI Community

M = 20.58 SD = 7.20

N = 21 M age = 26.1 0% two survivor parents


t = 0.19 ns g = 0.06

Delay in birth % two survivor parents

Community America One survivor parent vs controls

Lichtman (1983) America MMPI Community M = 21.01 SD = 4.46

N= 21 M age = 25.90 100% two survivor parents


t = 0.64 ns g = 0.17


Community America Two survivor parents vs controls

Lichtman (1983) America MMPI Community One or both parents were survivors who escaped

M= 22.10 SD = 5.05

N = 13 M age = 28.60


t = 1.16 ns g = 0.41

Delay in birth Community America

Lichtman (1983) America MMPI Community One or both parents were survivors in hiding

M = 23.10 SD = 7.52

N = 9 M age = 29


t = 1.04 ns g = 0.56



N = 44

Non-Survivor Jews

M = 0.89 SD = 0.62 N = 53

t = 0.66 ns g = 0.14



397




meta-analysis

Meta-regressions


Rose (1983) America Beck Depression Inventory

Survivor Groups - Jewish

M = 4.45 SD = 4.41

N = 20 M age = 28.60 65% Female 75% two survivor parents

Jewish Controls M = 4.85 SD = 4.53 N = 20

t = -0.21 ns g = - 0.07



Rose (1983) America Beck Depression Inventory

Survivor Groups Non Jewish

M = 6.06 SD = 7.06


Non-Jewish Controls

M = 4.50 SD = 7.01 N = 16

t = 0.62 ns g = 0.22



Schleuderer (1990) – Average

America Millon Clinical Multiaxial Inventory II - Dysthymic Subscale and Major Depression Subscale

Survivor Groups N = 100 M age = 33.35 64% Female 63% two survivor parents

Jewish Control NOS

N = 30

g= - 0.08 Delay in birth % Female % two survivor parents


Sigal and Weinfeld (1989)

Canada Psychiatric Epidemiology Research Instrument – Sadness


N = 122 M age = 28.70 0% Female

Native born Canadians - Males

M = 5.48 SD = 3.21 N = 99

t = -1.09 ns g = - 0.15


Community America Males vs Controls


Canada Psychiatric Epidemiology Research Instrument - Sadness

Community - Females

M = 6.63 SD = 3.38

N = 120 M age = 28.50 100% Female

Native born Canadians -Females

M = 7.05 SD = 3.55 N = 110

t = -0.91 ns g = - 0.12






N = 122 M age = 28.70 0% Females

Pre-WWII Immigrant Parents – Males

M = 4.97 SD = 3.03 N = 39

t = 0.09 ns g = 0.02






N = 120 M age = 28.50 100% Females

Pre-WWII Immigrant Parents – Females

M = 6.38 SD = 2.97 N = 37

t = 0.43 ns g = 0.08



Wanderman (1977) - Average

America Depressive Experiences Questionnaire – Efficacy, Dependency and Self-Criticism Subscales

Community – At least 1 survivor parent spent time in camp

N = 70 59% Females 29% two survivor parents


N = 32

g = 0.33 % Female % two survivor parents

Community America


398




meta-analysis

Meta-regressions



America Depressive Experiences Questionnaire – Efficacy, Dependency and Self-Criticism Subscales

Community – At least 1 survivor parent spent time in hiding

N = 29 76% Females 66% two survivor parents


N = 32

g = 0.43 % Female % two survivor parents

Community America

Woolrich (2005) America State Trait Personality Inventory

Survivor groups M = 26.17 SD = 2.29

N = 75 M age = 47.63 Age range = 22 71% Females 71% two survivor parents

Children of non-survivor East European Jews

N = 57

t = 2.31 * g = 0.40



Note. Brodzki (2000) only cited the results of the t-test and did not quote means and standard deviations for her two groups. The formula to convert a t to a d was utilised to incorporate this study into the meta-analysis. NOS = Not otherwise specified * p < 0.05, ** p < 0.01, *** p < 0.001.


399

Table AB2. Children of Holocaust Survivors versus Controls/Comparisons on Incidence of Depression Author/s and Year Country

study conducted in


incidence

Child of Survivor Group Comparison Group Odds ratio included in

meta-analysis

Meta-regressions


Major (1990; 1996)

Norway Incidence of Depressive symptoms

Entire population of children of survivors in Norway

42% N = 19 Children of Survivors who escaped to Sweden

16% N = 18

3.64 * Europe

Schwartz, Dohrenwend and Levav (1994)

Israel Average Incidence of Minor and Major Depression Diagnosis in Past Year

Population Registry which indicated both parents were Holocaust survivors

2.5% N = 147 Population Registry

3% N = 476

0.83 Israel

Yehuda, Halligan and Bierer (2001)

America Diagnosis of a depressive disorder

Community and Participants of Survivor Family Therapy Group

56% N = 93 67% Female

Non-survivor descendant Jews (American born)

13% N = 42

8.59 * % Female America

Yehuda, Schmeidler, Wainberg, Binder-Byrnes and Duvdevani (1998)

America Current diagnosis of major depression (with or without comorbid anxiety)


24%

N = 100 71% Female


9% N = 44


Zajde (1998) France Experience of depressive symptoms

Participants in discussion groups for children of survivors

30% N = 40 68% Female

% Female Europe

Notes. Yehuda, Schmeidler, Wainberg, Binder-Byrnes and Duvdevani (1998) looked at depression levels in children of survivors and controls with and without a diagnosis of PTSD. These groups were combined to provide one children of survivor group and one control group. Yehuda et al. (1998) also compared reported lifetime incidence of depression diagnosis. Among children of survivors 39% qualified for a diagnosis of depression with or without co-morbid anxiety, compared to 12% of the control group. Schwartz, Dohrenwend and Levav (1994) found that lifetime incidence rates of minor or major depression were 23% in the group of children of survivors compared to 15% of the control group (16%). Zajde (1998) did not include data for a control group and so could not be included in odds ratio or meta-analytic odds ratio analysis, however her data were added to the average incidence calculation and also the % female meta-regression. *p < .05. **p < .01. ***p < .001


400

Table AB.3. Children of Holocaust Survivors versus Controls/Comparisons on Anxiety Questionnaires


conducted in

Measure of Anxiety used

Child of Survivor Group Comparison Group t-test and effect size included in meta-analysis

Meta-regressions


Budick (1985) America Jackson's Personality Inventory

Survivor Groups

M= 10.65 SD= 3.54



M = 9.63 SD = 3.36 N = 32

t = 1.17 ns g = 0.29





Survivor Groups N = 29 M age = 32.86 Age range = 16


N = 25

g = 0.05 Delay in birth



M = 15.42 SD = 8.41



M = 12.82 SD = 6.69 N = 22

t = 1.25 ns g = 0.33




M = 16.06 SD = 9.34



M = 12.82 SD = 6.69 N = 22

t = 1.15 ns g = 0.40



Keinan, Mikulincer and Rybnicki (1988)

Israel Spielberger State Trait Anxiety Scale

Community N = 47 M age = 32.20 55% Female 43% two survivor parents

Not specified N = 46

t = 0.00 ns g = 0.00


Community Israel


M = 11.21 SD = 7.87


Not specified M = 11.18 SD = 8.56 N = 43 M age = 26.80

t = 0.02 ns g = 0.00




M = 13.46 SD = 8.60



t = 0.98 ns g = 0.26



Lichtman (1983) America MMPI Community At least one survivor parent escaped

M = 14.89 SD = 6.55

N = 13 M age = 28.6


t = 1.61 ns g = 0.45



401


conducted in



Meta-regressions


Lichtman (1983) America MMPI Community At least one survivor parent who was in hiding

M = 20.96 SD = 13.30

N = 9 M age = 29


t = 2.00 ns g = 1.03



America SCL-90 – Anxiety and Phobic Anxiety

Survivor Groups N = 44

Non-Survivor Jews

N = 53

t = 0.41 ns g = 0.10


Magids (1998) America 16PF Survivor Groups M = 6.06 SD = 1.34


Children of US Born Jewish Parents

M = 6.10 SD = 1.60 N = 50

t = -1.13 ns g = - 0.03


Rose (1983) America Spielberger Trait Anxiety Scale

Survivor Groups Jewish

M = 38.70 SD = 7.81


Jewish Controls

M = 36.65 SD = 9.83 N = 20

t = 0.71 ns g = 0.23



Rose (1983) America Spielberger Trait Anxiety Scale

Survivor Groups Non-Jewish

M = 37.71 SD = 9.95


Non-Jewish Controls

M = 35.38 SD = 10.16 N = 16

t = 0.64 ns g = 0.23



Sagi-Schwartz, van Ijzendoorn, Grossmann, Joels, Grossmann, Scharf, Koren-Karie and Alkalay (2003) - Average

Israel Endler Multidimensional Anxiety Scale – Autonomic Anxiety and Cognitive Worry subscales

Community N = 48 M age = 35.10


N = 50

g = 0.00 Community Israel

Schleuderer (1990)

America Millon Clinical Multiaxial Inventory II



Jewish Control NOS

M = 6.71 SD = 5.84 N = 30

t = -0.77 ns g = -0.15



Woolrich (2005) America State Trait Personality Inventory




M = 23.76 SD = 2.89 N = 57

t = 1.04 ns G = 0.18




402


conducted in



Meta-regressions


Zilberfein (1994) America Spielberger Trait Anxiety Scale

Clinical/ Hospital

M = 51.30 SD = 8.79

N = 38 M age = 38.20 74% Female

Jewish patients M = 42.40 SD = 9.98 N = 38

t = 3.43 *** g = 0.79


America

Note. Zilberfein (1994) provided only means, sample sizes and a probability level of p = 0.001 in her doctoral thesis. No standard deviations or t-values were presented. The TINV function in Microsoft Excel was used to derive the t-value and the t to d formula noted in the method section was used to work out the effect size for this study for the meta-analysis. Keinan et al. (1988) and Sagi-Schwartz et al. (2003) both stated only that no statistically significant difference was found between their study groups, citing no descriptive statistics. A t and d value of zero was entered into the analysis as an unbiased estimate of these values (see Chapter Six). NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001


403

Table AB4. Children of Holocaust Survivors versus Controls/Comparisons on Incidence of Anxiety Author/s and Year Country

study conducted in


incidence

Child of Survivor Group Comparison Group Odds ratio included in

meta-analysis

Meta-regressions


Major (1990; 1996)

Norway Incidence of Anxiety Symptoms

Entire population of children of survivors in Norway

16% N = 19 Children of Survivors who escaped to Sweden

8% N = 18

3.19 Europe

Schwartz, Dohrenwend and Levav (1994)

Israel Incidence of Anxiety Disorder in Past Year

Population Registry which indicated both parents were Holocaust survivors

7% N = 147 Population Registry

7% N = 476

1.00 Israel

Yehuda, Halligan and Bierer (2001)

America Diagnosis of an Anxiety disorder


28% N = 93 67% Female


10% N = 42


Yehuda, Schmeidler, Wainberg, Binder-Byrnes and Duvdevani (1998)

America Current diagnosis of anxiety with or without comorbid depression


29%

N = 100 71% Female


5% N = 44


Zajde (1998) France Experience of anxiety symptoms

Participants in discussion groups for children of survivors

70% N = 40 68% Female

% Female Europe

Notes. For Yehuda, Halligan and Bierer’s study (2001) it should be noted that these percentages were not quoted directly in the text but were presented in a graph which did not cite the specific figures. These percentages are estimates based on close examination of the graphs involved. Yehuda et al. (1998) also compared reported lifetime incidence of anxiety diagnosis. Among children of survivors 22% qualified for a diagnosis of anxiety with or without comorbid depression, compared to 7% of the control group. Schwartz, Dohrenwend and Levav (1994) found that lifetime incidence rates of anxiety disorder were 28% in the group of children of survivors compared to 16% of the control group (16%). Zajde (1998) did not include data for a control group and so could not be included in odds ratio or meta-analytic odds ratio analysis, however her data were added to the average incidence calculation and also the % female meta-regression. *p < .05. **p < .01. ***p < .001


404

Table AB.5. Children of Holocaust Survivors versus Controls/Comparisons on Paranoia Questionnaires Author/s and

Year Country

study conducted in

Measure of Paranoia used


Meta-regressions




M = 10.00 SD = 4.18


Pre-WWII Immigrants

M = 9.91 SD = 3.18 N = 22

t = 0.07 ns g = 0.02




M = 10.49 SD = 4.02


Pre-WWII Immigrants

M = 9.91 SD = 3.18 N = 22

t = 0.58 ns g = 0.15





M = 51.25 SD = 5.31

N = 4 0% Female

Pre-WWII Immigrants

M = 61.43 SD = 15.25 N = 7

t = -1.47 ns g = - 0.73




M = 53.75 SD = 8.23

N = 16 100% Female

Pre-WWII Immigrants

M = 59.33 SD = 12.13 N = 9

t = -1.17 ns g = - 0.55




M = 54.20 SD = 8.90

N = 5 100% Female

Pre-WWII Immigrants

M = 59.33 SD = 12.13 N = 9

t = -0.83 ns g = - 0.43




M = 58.06 SD = 7.69

N = 16 0% Female

Pre-WWII Immigrants

M = 61.43 SD = 15.25 N = 7

t = -0.52 ns g = - 0.32

% Male Community America Males vs controls

Lichtman (1983) America MMPI Community One or both parents were survivors who escaped

M = 8.46 SD = 3.33

N = 13 M age = 28.60


t = -0.64 ns g = - 0.21



M = 9.67 SD = 3.50



t = 0.54 ns g = 0.15




M = 9.81 SD = 4.17



t = 0.61 ns g = 0.18




405

Author/s and Year

Country study

conducted in

Measure of Paranoia used


Meta-regressions



Lichtman (1983) America MMPI Community One or both parents were survivors in hiding

M = 11.89 SD = 4.01

N = 9 M age = 29


t = 1.81 ns g = 0.78



N = 44 Non-Survivor Jews

M = 0.69 SD = 0.70 N = 53

t = 1.78 ns g = 0.37


Schleuderer (1990)


Survivor Groups

M = 23.34 SD = 12.04


Jewish Control NOS

M = 15.00 SD = 8.20 N = 30

t = 4.29 *** g = 0.73


Community America Males vs Controls

Notes. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AB.6. Children of Holocaust Survivors versus Controls/Comparisons on Benevolence of the world – World Assumptions Scale


Child of Survivor Group Comparison Group t-test and effect size included in meta-analysis Sample


Breslau (2002) America Jewish Organisations M = 31.84 N = 67 M age = 40.4

Children of non-survivors NOS

M = 31.86 N = 70

t = 0.03 ns g = 0.00

Note. Breslau (2002) did not quote standard deviations. Therefore the t to d formula was used to calculate an effect size for this study. NOS = Not otherwise specified * p < 0.05, ** p < 0.01, *** p < 0.001. Table AB.7. Children of Holocaust Survivors versus Controls/Comparisons on Meaningfulness of the world – World Assumptions Scale


Child of Survivor Group Comparison Group t-test and effect size included in meta-analysis Sample



Children of non-survivors NOS

M = 36.94 N = 70

Note. Breslau (2002) did not quote standard deviations or statistical test results for this comparison and so no effect size could be calculated. NOS = Not otherwise specified * p < 0.05, ** p < 0.01, *** p < 0.001.


406

Table AB.8. Children of Holocaust Survivors versus Controls/Comparisons on Positive Attachment/Intimacy Questionnaires Author/s and

Year Country

study conducted in

Measure of Attachment used


Meta-regressions



Budick (1985) America Jackson Personality Inventory – Interpersonal Affect subscale



Pre-war Immigrant Parents

M = 12.31 SD = 3.44 N = 32

t = 0.45 ns g = 0.11



Mazor and Tal (1996)

Israel Capacity for Intimacy Questionnaire – Total Score

Personal contacts M = 4.76 SD = 0.72

N = 70 67% Female


M = 4.99 SD = 0.47 N = 52

t = - 2.11 * g = - 0.37


Community America


Canada Openness with feelings with partner


N = 133

Native born Canadians

M = 2.74 SD = 2.36 N = 98

t = - 1.38 ns g = - 0.19

Community America


Canada Openness with feelings with partner


N = 133


M = 2.07 SD = 1.99 N = 55

t = 0.82 ns g = 0.13

Community America

Walisever (1995) America Romantic Attachment Style Questionnaire – Secure Attachment subscale

Survivor groups (Maternal grandmother died in the Holocaust)

M = 9.71 SD = 3.97

N = 70 86% two survivor parents

Pre-war immigrant parents

M = 9.96 SD = 3.74 N = 33

t = - 0.31 ns g = - 0.06

% two survivor parents


Walisever (1995) America Romantic Attachment Style Questionnaire – Secure Attachment subscale


M = 9.71 SD = 3.97


Pre-war immigrant parents (maternal grandmother died before participant was born)

M = 9.35 SD = 5.04 N = 14

t = 0.24 g = 0.09

% two survivor parents


Woolrich (2005) America Relationship Scale Questionnaire


N = 75 71% Female 71% two survivor parents


M = 3.48 SD = 0.73 N = 57

t = - 2.45 * g = - 0.43



Zilberfein (1994) America Attachment History Questionnaire – Secure attachment subscale

Clinical/ Hospital M = 4.32 N = 38 M age = 38.2 74% Female

Jewish NOS M = 4.72 N = 38

t = 1.87 g = 0.43


America

Note. Zilberfein (1994) provided only means, sample sizes and a probability level in her doctoral thesis. No standard deviations or t-values were presented. The TINV function in Microsoft Excel was used to derive the t-value and the t to d formula noted in the method section was used to work out the effect size for this study for the meta-analysis. * p < 0.05, ** p < 0.01, *** p < 0.001.


407

Table AB.9. Children of Holocaust Survivors versus Controls/Comparisons on Negative Attachment/Intimacy Questionnaires Author/s and

Year Country

study conducted in



Meta-regressions



Blank (1996) - Average

America Bell Object Relations Inventory – Egocentricity, Social Insecurity, Alienation and Insecure Attachment subscales

Survivor groups N = 35 M age = 34 66% Female 86% two survivor parents

Mixture of pre-war immigrant and American born parents

N = 33 g = 0.27 Delay in birth % Female


Budick (1985) America Personality Research Form – Succorance subscale




M = 10.65 SD = 3.58 N = 32

t = - 2.07 * g = - 0.52



Gertler (1986) - Average

America Inventory of Interpersonal Problems (author created) – Dependency, Independency and Intimacy subscales

Community N = 36 0% two survivor parents

American born parents

N = 49 g = - 0.20 % two survivor parents






N = 37 g = 0.11 % two survivor parents





American born parents




408

Author/s and Year

Country study

conducted in



Meta-regressions







N = 37 g = 0.03 % two survivor parents


Schneider (1996) - Average

America Bell Object Relations Inventory – Alienation, Egocentricity, Insecure Attachment and Social Incompetence subscales and Fear of Intimacy Scale

Survivor Groups N = 57 M age = 42 100% Female 100% two survivor parents

Mixture of pre-war immigrant parents and American born parents

N = 45 g = 0.34 Delay in birth % Female % two survivor parents

Survivor Groups America Females vs controls Two survivor parents vs controls

Sigal and Weinfeld (1989) - Average

Canada Dependence on partner and need for warmth and affection from partner

Community N = 133

Native born Canadians

N = 98 g = - 0.07

Community America

Sigal and Weinfeld (1989) - Average

Canada Dependence on partner and need for warmth and affection from partner

Community N = 133


N = 55 g = - 0.03 Community America

Tytell (1998) America Fear of Intimacy Scale


N = 60 100% female 67% two survivor parents

Non-survivor parents NOS

M = 69.55 SD = 21.67 N = 57

t = 0.83 ns g = 0.15

% Female % two survivor parents

Survivor Groups America Females vs controls

Walisever (1995) - Average

America Romantic Attachment Style Questionnaire – Ambivalent and avoidant attachment subscales



Pre-war immigrant parents (maternal grandmother died before participant was born)




409

Author/s and Year

Country study

conducted in



Meta-regressions









Woolrich - Average

Relationship Style Questionnaire – Dismissive, Fear and Pre-occupied subscales

N = 75 71% Female 71% two survivor parents

N = 57 g = 0.34

Note. Schneider (1996) quoted no means or standard deviations and only a probability level for the Fear of Intimacy scale. The TINV function in Microsoft Excel was used to a derive a t score and the t to d formula was then used to calculate an effect size so that this result could contribute to the Schneider (1996) – Average effect size quoted in this table. Table AB.10. Children of Holocaust Survivors versus Controls/Comparisons on Incidence of Insecure Attachment



incidence

Child of Survivor Group Comparison Group Odds ratio included in meta-analysis Sample Source Statistics Demographics Sample Source Statistics

Sagi-Schwartz, van IJzendoorn, Grossmann, Joels, Grossmann, Scharf, Koren-Karie and Alkalay (2003)

Israel Categorisation as insecurely attached by Adult Attachment Interview

Community 68% N = 48 M age = 35.10 37% Female


42% N = 50

2.99 *

* p < 0.05, ** p < 0.01, *** p < 0.001.


410

Appendix C – Studies included in meta-analyses of grandchildren of Holocaust survivors versus control/comparison groups Table AC.1. Grandchildren of Holocaust Survivors versus Controls/Comparisons on Depression Questionnaires



Grandchild of Survivor Group

Comparison Group t-test and effect size included in meta-

analysis Sample Source Statistics Demographics Sample Source Statistics Ganz (2002) America Symptom Checklist – 90

- Revised Community M = 58.14

SD = 9.55 N = 30 M age = 27.40

Grandchildren of American Born Grandparents

M = 58.80 SD = 9.91 N = 30

t = - 0.26 ns g = - 0.07

Wetter (1998) Israel Beck Depression Inventory

Community

M = 9.95 SD = 4.35

N = 40 M age = 23.30 53% Female

Grandchildren of Pre- or Post War Non-Survivor Immigrants

M = 6.62 SD = 3.03 N = 34

t = 3.69 *** g = 0.84

*p < .05. **p < .01. ***p < .001 Table AC.2. Grandchildren of Holocaust versus Controls/Comparisons on Anxiety Questionnaires

Author/s and Year Country Measure of anxiety used Grandchild of Survivor Group

Comparison Group t-test and effect size included in meta-

analysis Sample Source Statistics Demographics Sample Source Statistics Ganz (2002) America Symptom Checklist – 90

- Revised Community M = 56.41

SD = 12.33 N = 30 M age = 27.40


M = 56.73 SD = 11.96 N = 30

t = - 0.10 ns g = - 0.03

Rubenstein (1981) America Louisville Behavior Checklist – Fear Scale

Community 1 HSGP

M = 52.14 SD = 9.91

N = 24 M age = 6.90

By referral from Survivor Families NOS

M = 49.20 SD = 11.54 N = 12

t = 0.73 ns g = 0.27

Rubenstein (1981) America Louisville Behavior Checklist – Fear Scale

Community 2 HSGP

M = 54.20 SD = 13.55

N = 15 M age = 8.20

By referral from Survivor Families NOS

M = 49.20 SD = 11.54 N = 12

t = 1.00 ns g = 0 .38

Wetter (1998) Israel Spielberger Trait Anxiety Scale

Community

M = 43.50 SD = 13.40

N = 40 M age = 23.30 53% Female

Grandchildren of Pre- or Post War Non-Survivor Immigrants

M = 32.30 SD = 9.10 N = 34

t = 4.20 *** g = 0.96

*p < .05. **p < .01. ***p < .001


411

Table AC.3. Grandchildren of Holocaust Survivors versus Controls/Comparisons on Paranoia Questionnaires Author/s and Year Country study

conducted in Measure of paranoia

used GCOHS Group

Control Group t-test and effect

size included in meta-analysis Sample Source Statistics Demographics Sample Source Statistics

Ganz (2002) America Symptom Checklist – 90 - Revised


N = 30 M age = 27.40


M = 58.20 SD = 10.98 N = 30

t = - 0.90 ns g = - 0.23

*p < .05. **p < .01. ***p < .001 Table AC.4. Grandchildren of Holocaust Survivors versus Controls/Comparisons on Positive Attachment/Intimacy Questionnaires


Measure of Attachment

Grandchild of Survivor Group

Comparison Group t-test and effect size included in meta-analysis Sample Source Statistics Demographics Sample Source Statistics

Gopen (2001) - Average

America Perceived Relationships Quality Components Inventory – Intimacy and Trust

N = 30

Survivor Groups N = 70

g = - 0.47

Walisever (1995) America Romantic Attachment Style Questionnaire – Secure Attachment

M = 10.27 SD = 3.69

N = 11

Survivor Groups - Maternal Grandmother died before participant was born

M = 12.00 SD = 2.94 N = 10

t = - 1.14 ns g = - 0.49

Walisever (1995) America Romantic Attachment Style Questionnaire – Secure Attachment

M = 10.27 SD = 3.69

N = 11


M = 10.80 SD = 2.68 N = 5

t = - 0.30 ns g = - 0.15

*p < .05. **p < .01. ***p < .001


412

Table AC.5. Grandchildren of Holocaust Survivors versus Controls/Comparisons on Negative Attachment/Intimacy Questionnaires Author/s and Year Country Measure of

Attachment Grandchild of Survivor Group

Comparison Group t-test and effect

size included in meta-analysis Sample Source Statistics Demographics Sample Source Statistics


America Romantic Attachment Style Questionnaire – Ambivalent and Avoidant Attachment Subscales


N = 11

Pre-War Immigrant Grandparents - Maternal Grandmother died before participant was born

N = 5

g = 0.84


America Romantic Attachment Style Questionnaire – Ambivalent and Avoidant Attachment Subscales


N = 11

Pre-War Immigrant Grandparents – Maternal Grandmother still alive

N = 10

g = 0.23

Note. No descriptive data or t-test results are reported in this table as only average effect sizes are included in the analysis. *p < .05. **p < .01. ***p < .001


413

Appendix D – Studies included in meta-analyses of male versus female Holocaust survivors Table AD.1. Male versus Female Holocaust survivors on Depression Questionnaires Author/s and Year Country

study conducted

in


Sample Source Nature of Groups Male Survivor Group Female Survivor Group t-test and effect size included in meta-analysis

Statistics Demographics Statistics Demographics

Jurkowitz (1996) America Centre for Epidemiologic Studies Depressed Mood Scale

Community Holocaust survivors NOS M = 15.34 SD = 9.47

N = 17 M age = 76.00

M = 22.78 SD = 14.43

N = 74 M age = 72.25

t = -2.56 * g = - 0.54




N = 59 M age = 79.90

M = 57.40 SD = 15.40

N = 32 M age = 80.90

t = -3.04 ** g = - 0.79


America MMPI Community Interned in Concentration Camp

M = 64.27 SD = 11.69

N = 11

M = 60.25 SD = 10.85

N = 16

t = 0.87 ns g = 0.36


America MMPI Community Other Holocaust experience

M = 66.33 SD = 7.31

N = 6

M = 62.67 SD = 9.62

N = 9

t = 0.78 ns g = 0.39

Rozen (1983) America Beck Depression Inventory


N = 43 M age = 63.72

M = 11.75 SD = 6.55

N = 57 M age = 60.27

t = -1.88 ns g = - 0.38

Note. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.2. Male versus Female Holocaust Survivors on Incidence of Depression



incidence

Sample Source Male Survivor Group

Female Survivor Group Odds ratio included in meta-analysis

Statistics Demographics Statistics Demographics Carmil and Carel (1986) Israel Frequent Depression Community NOS 23%

N = 1,366 50% N = 793 3.31 *



Compensation Files in Regional Indemnification Office in Munich dated up to 1960

28% N = 107 38% N = 37 1.56

NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001


414

Table AD.3. Male versus Female Holocaust survivors on Anxiety Questionnaires Author/s and Year Country

study conducted

in




Rozen (1983) America Spielberger Trait Anxiety Scale


N = 43 M age = 63.72

M = 45.32 SD = 9.4

N = 57 M age = 60.27

t = -3.14 ** g = - 0.64

Note. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.4. Male versus Female Holocaust Survivors on Incidence of Anxiety



incidence



Statistics Demographics Statistics Demographics Carmil and Carel (1986) Israel Frequent Anxiety Community NOS 46%

N = 1,366 68% N = 793 2.52 *



Compensation Files in Regional Indemnification Office in Munich dated up to 1960

33% N = 107 46% N = 37 1.84

NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.5. Male versus Female Holocaust survivors on Paranoia Questionnaires Author/s and Year Country

study conducted

in





America MMPI Community Interned in Concentration Camp

M = 56.18 SD = 7.67

N = 11

M = 58.81 SD = 9.45

N = 16

t = - 0.76 ns g = - 0.30


America MMPI Community Other Holocaust experience

M = 49.67 SD = 5.82

N = 6

M = 60.00 SD = 11.42

N = 9

t = - 2.15 ns g = - 1.01

*p < .05. **p < .01. ***p < .001


415

Table AD.6. Male versus Female Holocaust Survivors on Incidence of Paranoia Author/s and Year Country study





Statistics Demographics Statistics Demographics Carmil and Carel (1986) Israel Presence of Irrational

Fears Community NOS 7%

N = 1,366 18% N = 793 2.90 *

NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.7. Male versus Female Holocaust survivors on the intrusion subscale of the Impact of Events Scale


Sample Source Nature of Groups Male Survivor Group Female Survivor Group t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics

Silow (1993) America Survivor Groups Holocaust survivors NOS M = 16.00 SD = 12.30

N = 17

M = 15.10 SD = 10.00

N = 21

t = 0.24 ns g = 0.08

Note. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.8. Male versus Female Holocaust survivors on Avoidance Subscale of the Impact of Events Scale


Sample Source Nature of Groups Male Survivor Group Female Survivor Group t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics

Silow (1993) America Survivor Groups Holocaust survivors NOS M = 25.70 SD = 8.20

N = 17

M = 26.80 SD = 5.60

N = 21

t = -0.46 ns g = - 0.16

Note. NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001 Table AD.9. Male versus Female Holocaust Survivors on Incidence of PTSD



incidence



Statistics Demographics Statistics Demographics Landau and Litwin (2000)

Israel PTSD Diagnosis Community 27% N = 59 19% N = 32 1.61

*p < .05. **p < .01. ***p < .001


416

Appendix E – Studies included in children with one versus two Holocaust survivor parents meta-analyses Table AE.1. Children with one versus two Holocaust survivor parents on depression questionnaires Author/s and Year Country

study conducted in

Measure of depression used Sample Source Nature of Groups

Children of One Survivor Parent Group

Children of Two Survivor Parents Group t-test and effect size included in meta-analysis Statistics Demographics Statistics Demographics

Brodzki (2000) America SCL-90-R Not specified Female N = 33 N =33 t = -1.94 ns g = - 0.48

Karr (1973) America MMPI Survivor Groups M = 23.81 SD = 5.14

N = 16 M age = 22 Age range = 10

M = 23.64 SD = 5.07

N = 33 M age = 23 Age range = 12

t = 0.11 ns g = 0.03

Lichtman (1983) America MMPI Community M = 20.58 SD = 7.20

N = 21 M age = 26.1

M = 21.01 SD = 4.46

N = 21 M age = 25.90

t = -0.23 ns g = - 0.07

Schleuderer (1990) - Average

America Millon Clinical Multiaxial Inventory II - Dysthymic and Major Depressive Subscales

Survivor Groups Survivor mother versus two survivor parents

N = 12

N = 63

g = - 0.24


America Millon Clinical Multiaxial Inventory II - Dysthymic and Major Depressive Subscales

Survivor Groups

Survivor father versus two survivor parents

N = 12

N = 63

g = - 0.09

Note. Brodzki (2000) only cited the results of the t-test and did not quote means and standard deviations for her two groups. The formula to convert a t to a d was utilised to incorporate this study into the meta-analysis. * p < 0.05, ** p < 0.01, *** p < 0.001 Table AE.2. Children with one versus two Holocaust survivor parents on anxiety questionnaires Author/s and


Measure of anxiety used Sample Source

Nature of Groups Children of One Survivor Parent Group



M = 16.06 SD = 9.34

N = 16 M age = 22.00 Age range = 10

M = 15.42 SD = 8.41

N = 33 M age = 23.00 Age range = 12

t = 0.23 ns g = 0.07

Lichtman (1983)

America MMPI Community M = 13.46 SD = 8.60

N = 21 M age = 26.10

M = 11.21 SD = 7.87

N = 21 M age = 25.90

t = 0.86 ns g = 0.27

Schleuderer (1990)


Survivor Groups Survivor mother versus two survivor parents

M = 4.33 SD = 4.29

N = 12

M = 6.08 SD = 7.35

N = 63

t = -1.10 ns g = - 0.25

Schleuderer (1990)


Survivor Groups


M = 5.48 SD = 7.17

N = 25

M = 6.08 SD = 7.35

N = 63

t = -0.35 ns g = - 0.08


417

Table AE.3. Children with one versus two Holocaust survivor parents on paranoia questionnaires Author/s and


Measure of paranoia used Sample Source

Nature of Groups Children of One Survivor Parent Group


Karr (1973) America MMPI Survivor Groups 1 HSP versus 2 HSP

M = 10.00 SD = 4.18

N = 16 M age = 22.00 Age range = 10

M = 10.49 SD = 4.02

N = 33 M age = 23.00 Age range = 12

t = -0.38 ns g = - 0.12

Lichtman (1983)

America MMPI Community 1 HSP versus 2 HSP

M = 9.81 SD = 4.17

N = 21 M age = 26.10

M = 9.67 SD = 3.50

N = 21 M age = 25.90

t = 0.12 ns g = 0.04

Schleuderer (1990)


Survivor Groups

Survivor mother versus two survivor parents

M = 24.08 SD = 15.12

N = 12

M = 22.46 SD = 11.43

N = 63

t = 0.34 ns g = 0.13

Schleuderer (1990)


Survivor Groups


M = 25.20 SD = 12.23

N = 25

M = 22.46 SD = 11.43

N = 63

t = 0.95 ns g = =0.23

Table AE.4. Children with one versus two Holocaust survivor parents on negative attachment/intimacy questionnaires


Measure of attachment used Sample Source Children of One Survivor Parent Group




Community N = 36 N = 62 g = - 0.06

* p < 0.05, ** p < 0.01, *** p < 0.001.


418

Appendix F – Studies included in male versus female children of Holocaust survivors meta-analyses Table AF.1. Male versus female children of Holocaust survivors on depression questionnaires

Author/s and Year

Country study

conducted in

Measure of depression used

Sample Source Nature of Groups

Male children of survivors

Female children of survivors t-test and effect size included in meta-analysis Statistics Demographics Statistics Demographics


Survivor Groups Survivor parent aged 13-18 between 1939-1945

M = 2.63 SD = 2.92

N = 8 M age = 31.50 Age range = 12

M = 2.38 SD = 1.51

N = 8 M age = 26.60 Age range = 11

t = 0.20 ns g = 0.10


Survivor Groups Survivor parent aged 19 or over between 1939-1945

M = 3.75 SD = 2.50

N = 8 M age = 32.38 Age range = 13

M = 3.38 SD = 4.00

N = 8 M age = 31.50 Age range = 11

t = 0.21 ns g = 0.11

Eskin (1996) America Center for Epidemiologic Studies Depressed Mood Scale

Community Children of survivors NOS

M = 31.20 SD = 8.30

N = 15

M = 32.30 SD = 9.90

N = 34

t = -0.39 ns g = - 0.11

Jurkowitz (1996) America Center for Epidemiologic Studies Depressed Mood Scale

Community Children of survivors NOS

M = 8.30 SD = 6.39

N = 20

M = 11.01 SD = 9.79

N = 71

t = -1.44 ns g = - 0.29

Karr (1973) America MMPI Survivor Groups Two survivor parents M = 20.94 SD = 4.04

N = 17 M age = 21.94 Age range = 12

M = 26.50 SD = 4.56

N = 16 M age = 23.38 Age range = 6

t = -3.58 *** g = - 1.26

Karr (1973) America MMPI Survivor Groups One survivor parent M = 23.60 SD = 5.61

N = 10 M age = 23.20 Age range = 12

M = 24.17 SD = 4.22

N = 6 M age = 21.86 Age range = 5

t = -0.21 ns g = - 0.10


America MMPI Community Survivor parent in concentration camp

M = 59.93 SD = 12.16

N = 16

M = 56.69 SD = 9.67

N = 16

t = 0.81 ns g = 0.29


America MMPI Community Survivor parent with non-camp Holocaust experiences

M = 62.25 SD = 16.76

N = 4

M = 52.60 SD = 8.32

N = 5

t = 0.92 ns g = 0.68

Lichtman (1983) America MMPI Community One or both survivor parents were in hiding

M = 20.86 SD = 8.10

N = 7 M age = 28.00

M = 28.00 SD = 4.24

N = 2 M age = 29.00

t = -1.33 ns g = - 0.83

Lichtman (1983) America MMPI Community Two survivor parents M = 19.25 SD = 3.20

N = 8 M age = 29.10

M = 22.31 SD = 5.17

N = 13 M age = 25.90

t = -1.59 ns g = - 0.65

Lichtman (1983) America MMPI Community One survivor parent M = 19.90 SD = 2.81

N = 10 M age = 25.80

M = 21.10 SD = 9.81

N = 11 M age = 26.10

t = -0.37 ns g = - 0.15

Lichtman (1983) America MMPI Community One or both survivor parents escaped

M = 22.20 SD = 3.70

N = 5 M age = 27.80

M = 22.25 SD = 5.85

N = 8 M age = 28.60

t = -0.02 ns g = - 0.01


419

Author/s and Year

Country study

conducted in

Measure of depression used

Sample Source Nature of Groups




America Millon Clinical Multiaxial Inventory II – Dysthymic and Major Depressive Subscales

Survivor Groups Children of survivors NOS

N = 36

N = 64

g = - 0.15

Schulman (1987) - Average

America Depressive Experiences Questionnaire – Dependency, Self-criticism and Efficacy Subscales

Survivor Groups Children of Survivors NOS

N = 10

N = 10

g = 0.24

Schwarz (1986) America SCL-90 Survivor Groups Children of Survivors NOS

N = 53

N = 17

t = 0.00 ns g = 0.00


Canada Psychiatric Epidemiology Research Instrument – Sadness Subscale

Community Children of Survivors NOS

M = 5.02 SD = 2.94

N = 122 M age = 28.70

M = 6.63 SD = 3.38

N = 120 M age = 28.50

t = -3.93 ** g = - 0.54



Community At least one survivor parent spent time in hiding

N = 7 M age = 20.00 Age range = 12

N = 22 M age = 20.00 Age range = 12

g = - 0.22



Community At least one survivor parent spent time in a camp

N = 29 M age = 20.00 Age range = 12

N = 41 M age = 20.00 Age range = 12

g = - 0.39

Note. Schwarz (1986) cited no descriptive data and simply stated that no statistically significant difference was found between the two groups. A t and d value of 0 was therefore entered into the analysis as the only unbiased estimate of a non-statistically significant difference (see Chapter Six for more details). NOS = Not otherwise specified *p < .05. **p < .01. ***p < .001


420

Table AF.2. Male versus female children of Holocaust survivors on anxiety questionnaires Author/s and


Measure of anxiety used

Sample Source

Nature of Groups Male children of survivors



Survivor Groups Survivor parent age 13-18 between 1939-1945

M = 11.12 SD = 3.04

N = 8 M age = 31.50 Age range = 12

M = 9.63 SD = 3.20

N = 8 M age = 26.60 Age range = 11

t = 0.89 ns g = 0.45


Survivor Groups Survivor parent aged 19 or over between 1939-1945

M = 11.00 SD = 3.89

N = 8 M age = 32.38 Age range = 13

M = 10.87 SD = 4.39

N = 8 M age = 31.5 Age range = 11

t = 0.06 ns g = 0.03

Gertz (1986) America Spielberger Trait Anxiety Inventory


N = 20 M = 41.85 SD = 12.08

N = 28 t = - 0.18 ns g = - 0.05

Gertz (1986) America Spielberger Trait Anxiety Inventory


N = 32 M = 42.78 SD = 8.72

N = 32 t = - 1.12 ns g = - 0.28


N = 17 M age = 21.94 Age range = 12

M = 17.69 SD = 5.92

N = 16 M age = 23.38 Age range = 6

t = -1.52 ns g = - 0.52


N = 10 M age = 23.20 Age range = 12

M = 15.83 SD = 7.65

N = 6 M age = 21.86 Age range = 5

t = -0.75 ns g = - 0.37

Lichtman (1983)

America MMPI Community One survivor parent M = 9.50 SD = 6.35

N = 10 M age = 25.80

M = 16.91 SD = 10.05

N = 11 M age = 26.10

t = -1.94 ns g = - 0.84

Lichtman (1983)

America MMPI Community Two survivor parents M = 8.38 SD = 6.37

N = 8 M age = 29.10

M = 13.14 SD = 8.79

N = 13 M age = 25.90

t = -1.37 ns g = - 0.57

Lichtman (1983)

America MMPI Community One or two survivor parents in hiding

M = 18.43 SD = 14.89

N = 7 M age = 28.00

M = 25.50 SD = 7.78

N = 2 M age = 29.00

t = -0.72 ns g = - 0.45

Lichtman (1983)

America MMPI Community One or two survivor parents who escaped

M = 15.80 SD = 6.46

N = 5 M age = 27.80

M = 14.63 SD = 6.51

N = 8 M age = 28.60

t = 0.29 ns g = 0.17

Schleuderer (1990)


Survivor Groups Children of survivors NOS

M = 5.14 SD = 7.67

N = 36

M = 6.05 SD = 6.67

N = 64 t = -0.59 ns g = - 0.13

Schwarz (1986)

America SCL-90 Survivor Groups Two survivor parents (at lest one survived camps)

N = 53 N = 17 t = 0.00 ns g = 0.00

Note. Schwarz (1986) quoted no descriptive data, merely citing that no statistically significant difference was found between her two study groups. The unbiased estimate t and d value of zero was inserted into analysis. NOS = Not otherwise specified


421

Table AF3. Male versus female children of survivors on incidence of anxiety Author/s and Year Country study



Sample Source


Female children of survivors Odds ratio included in meta-analysis

Statistics Demographics Statistics Demographics Yehuda, Halligan and Bierer (2001)

America Diagnosis of an Anxiety disorder


29% N = 31 27% N = 62 1.08

Table AF.4. Male versus female children of Holocaust survivors on paranoia questionnaires Author/s and Year Country study

conducted in Measure of paranoia

used Sample Source


Female children of survivors t-test and

effect size included in meta-analysis



N = 10 M age = 23.20 Age range = 12

M = 11.50 SD = 2.22

N = 6 M age = 21.86 Age range = 5

t = -1.29 ns g = - 0.56


N = 17 M age = 21.94 Age range = 12

M = 10.56 SD = 3.12

N = 16 M age = 23.38 Age range = 6

t = -0.10 ns g = - 0.04


America MMPI Community At least one survivor parent with non-camp Holocaust experience

M = 51.25 SD = 5.31

N = 4

M = 54.20 SD = 8.90

N = 5

t = -0.55 ns g = - 0.35


America MMPI Community At least one survivor parent who was in a concentration camp

M = 58.06 SD = 7.69

N = 16

M = 53.75 SD = 8.23

N = 16

t = 1.48 ns g = 0.53

Lichtman (1983) America MMPI Community One or two survivor parents who were in hiding

M = 10.71 SD = 3.59

N = 7 M age = 28.00

M = 16.00 SD = 2.83

N = 2 M age = 29.00

t = -1.66 ns g = - 1.34

Lichtman (1983) America MMPI Community Two survivor parents M = 8.88 SD = 2.17

N = 8 M age = 29.1

M = 10.15 SD = 4.12

N = 13 M age = 25.90

t = -0.89 ns g = - 0.35

Lichtman (1983) America MMPI Community One survivor parent M = 9.10 SD = 2.34

N = 10 M age = 25.80

M = 10.46 SD = 5.41

N = 11 M age = 26.10

t = -0.72 ns g = - 0.31

Lichtman (1983) America MMPI Community One or two survivor parents who escaped

M = 11.00 SD = 2.92

N = 5 M age = 27.80

M = 6.88 SD = 2.59

N = 8 M age = 28.60

t = 2.35 * g = 1.42

Schleuderer (1990) America Millon Clinical Multiaxial Inventory II


N = 36

M = 22.77 SD = 10.52

N = 64

t = 2.48 * g = 0.57

Schwarz (1986) America SCL-90 Survivor Groups

Two survivor parents (at lest one survived camps)

N = 53

N = 17

t = 0.00 ns g = 0.00

Note. Schwarz (1986) provided no descriptive data and stated that no statistically significant difference was found between the two groups. A t and d score of 0 was therefore used for the meta-analysis. NOS = Not otherwise specified p < .05. **p < .01. ***p < .001


422

Table AF.5. Male versus female children of Holocaust survivors on positive attachment/intimacy questionnaires Author/s and Year

Country study conducted in

Measure of attachment used

Sample Source


Female children of survivors t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics Budick (1985)

America Jackson Personality Inventory – Interpersonal Affect subscale

Survivor Groups Survivor parent aged 13-18 between 1939 and 1945

M = 11.25 SD = 3.41

N = 8 M age = 31.5

M = 13.37 SD = 5.80

N = 8 M age = 26.6

t = - 0.83 ns g = - 0.42

Budick (1985)

America Jackson Personality Inventory – Interpersonal Affect subscale

Survivor Groups Survivor parent aged over 19 between 1939 and 1945

M = 11.87 SD = 3.91

N = 8 M age = 32.38

M = 14.50 SD = 3.63

N = 8 M age = 31.5

t = - 1.31 ns g = - 0.66

Table AF.6. Male versus female children of Holocaust survivors on negative attachment/intimacy questionnaires Author/s and



Sample Source


Female children of survivors t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics Budick (1985)

America Personality Research Form - Succorance

Survivor Groups Survivor parent aged 13-18 between 1939 and 1945

M = 6.25 SD = 3.62

N = 8 M age = 31.5

M = 9.50 SD = 3.55

N = 8 M age = 26.6

t = - 1.70 ns g = - 0.86

Budick (1985)

America Personality Research Form - Succorance

Survivor Groups Survivor parent aged over 19 between 1939 and 1945

M = 11.87 SD = 3.91

N = 8 M age = 32.38

M = 14.50 SD = 3.63

N = 8 M age = 31.5

t = - 0.80 ns g = - 0.40



Community One survivor parent N = 14 N = 22 g = - 0.16



Community Two survivor parents N = 20 N = 42 g = 0.12


423

Appendix G – Studies included in intergenerational comparison meta-analyses Table AG.1. Holocaust survivors versus children of Holocaust survivors on depression questionnaires


conducted in

Measure of depression used Sample Source Holocaust Survivors

Children of Survivors t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics Finer-Greenberg – Average (1987)


Survivor Groups N = 29 N = 29 g = 0.20

Jurkowitz (1996) America Center for Epidemiologic Studies Depressed Mood Scale


N = 91 M age = 72.9 Age range = 26

M = 10.41 SD = 9.20

N = 91

t = 6.25 *** g = 0.93


N = 31 M age = 60.06 Age range = 23

M = 0.99 SD = 0.78

N = 44 t = - 0.03 ns g = - 0.01

* p < 0.05, ** p < 0.01, *** p < 0.001. Table AG.2. Holocaust survivors versus children of Holocaust survivors on anxiety questionnaires


conducted in

Measure of anxiety used Sample Source Holocaust Survivors


analysis Statistics Demographics Statistics Demographics Finer-Greenberg – Average (1987)


Survivor Groups N = 29 N = 29 g = 0.34


America SCL-90 – Anxiety and Phobic Anxiety Subscales

Survivor Groups N = 31 M age = 60.06 Age range = 23

N = 44 g = 0.41

Table AG.3. Holocaust survivors versus children of Holocaust survivors on paranoia questionnaires


conducted in

Measure of paranoia used Sample Source Holocaust Survivors


analysis Statistics Demographics Statistics Demographics Lowin (1983) America SCL-90 Survivor Groups M = 1.04

SD = 0.84 N = 31 M age = 60.06 Age range = 23

M = 0.95 SD = 0.75

N = 44 t = 0.48 ns g = 0.11

* p < 0.05, ** p < 0.01, *** p < 0.001. Table AG.4. Holocaust survivors versus children of Holocaust survivors on the assumption of world benevolence – World Assumptions Scale


Sample Source Holocaust Survivors


analysis Statistics Demographics Statistics Demographics Breslau (2002) America Jewish Organisations M = 29.31 N = 67

M age = 71.7 M = 31.84 N = 67

M = 40.4 t = 2.58 * g = 0.45

Breslau (2002) did not quote standard deviations. Therefore the t to d formula was used to calculate an effect size for this study. * p < 0.05, ** p < 0.01, *** p < 0.001.


424

Table AG.5. Holocaust survivors versus children of Holocaust survivors on the assumption of world meaningfulness – World Assumptions Scale Author/s and Year Country study

conducted in Sample Source Holocaust Survivors

Children of Survivors t-test and effect size

included in meta-analysis Statistics Demographics Statistics Demographics


M = 38.82 N = 67 M = 40.4

Note. Breslau (2002) did not quote standard deviations or statistical test results for this comparison and so no effect size could be calculated. Table AG.6. Children of Holocaust survivors versus grandchildren of Holocaust survivors on depression questionnaires


conducted in

Measure of depression used Sample Source Children of Survivors

Grandchildren of Survivors t-test and effect size included in meta-

analysis Statistics Demographics Statistics Demographics Jurkowitz (1996) America Center for Epidemiologic

Studies Depressed Mood Scale


N = 91

M = 10.78 SD = 8.40

N = 91 t = - 0.28 g = - 0.04

Table AG.7. Children of Holocaust survivors versus grandchildren of Holocaust survivors on positive attachment/intimacy questionnaires


conducted in


Sample Source Children of Survivors


analysis Statistics Demographics Statistics Demographics Walisever (1995) America Romantic Attachment Style

Questionnaire – Secure attachment subscale


M = 9.71 SD = 3.97

N = 70

M = 10.27 SD = 3.69

N = 11 t = - 0.44 g = - 0.14

Table AG.7. Children of Holocaust survivors versus grandchildren of Holocaust survivors on negative attachment/intimacy questionnaires


conducted in

Measure of depression used Sample Source Children of Survivors


analysis Statistics Demographics Statistics Demographics Walisever (1995) - Average



N = 70

N = 11 g = 0.12

* p < 0.05, ** p < 0.01, *** p < 0.001.


425

Appendix H – Sources of Help in Reaching Potential Study Participants Table AH.1. Organisations contacted as potential sources of study participants

Type of Group Region/Country of Operation

Organisation Name Form of Help Provided

Survivor and descendant email list

Worldwide All Generations Email to list 09/2005

Survivor Organisation

Austria AMCHA - National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation – Austrian Branch

No response


Germany AMCHA - National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation – German Branch

No response


Israel AMCHA - National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation

Mentioned to members 11/2005


The Netherlands AMCHA - National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation – Dutch Branch

No response


Italy ANEI – Associazione Nazionale Ex Internati Italian Camp Survivors

No response


Italy ANPI National Italian Partisans Association

No response

Jewish Organisation

Australia Australasian Union of Jewish Students – Head Office

No response

Jewish Organisation

Australia Australasian Union of Jewish Students – New Zealand Branch

Agreed to put notice in newsletter but did not eventuate

Jewish Organisation

Australia Australasian Union of Jewish Students – South Australian Branch

Agreed to email members – unsure if this eventuated

Jewish Organisation

Australia Australasian Union of Jewish Students – Western Australian Branch

Email to members 12/2004


Australia Australian Association of Jewish Holocaust Survivors and Descendants (but also non-Jewish) – based in Sydney

Hard copy questionnaires given to museum volunteers and article in issue of magazine Zachor 01/2005


England Child Survivors’ Association of Great Britain

Mentioned at meeting 08/2005

Survivor Organisations

America Contacted Rick Landman – president of a number of survivor groups

Refusal of help


Australia Descendants of the Shoah Inc. – based in Melbourne

Email to members 11/2004 02/2005

Communist Party Germany Deutsche Kommunistische Partei No response

http://www.anei.it/


426




France Fédération Nationale des Déportés et Internés Résistants et Patriotes (National Federation of Deported and Imprisoned Resistance Fighters and Patriots)

No response


Israel Friends of the Ghetto Fighter’s House Agreed to put notice on website but never eventuated


Israel Friends of the Ghetto Fighters House Agreed to put notice on website but never eventuated

Survivor Group Argentina Generaciones de la Shoá en Argentina (Generations of the Shoah in Argentina)

No response


Worldwide Generations of the Shoah, International Notice in web-based newsletter 12/2004 01/2005 02/2005

Survivor Website Worldwide Gyor Website – For survivors originating from Hungary

Notice on website 04/2005

Conference/ Gathering

Worldwide International and Multi-Generational Gathering of Holocaust Survivors and their Families at Yad Vashem, Jerusalem Marking 60 Years Since the End of World War II 4-9 May 2005

Refusal of help

Survivor Group Netherlands Joodse Oorlogs Kinderen (Association of Jewish War Children – The Netherlands)

No response


Israel Korets Organisation Mentioned at meeting in June 2005

Jewish Organisation

Australia March of the Living – Australia Email to 2004 and 2005 alumni, notice and article in newsletter, mentioned at meeting

Jewish Organisation

Worldwide March of the Living – International Head Office

No response


Australia Melbourne Jewish Holocaust Museum and Research Centre

No response

Jewish Email List New Zealand NZ-JEWISH-L Email to list 12/2004

Communist Party France Parti Communiste Francais No response Survivor Organisation

UK/Worldwide Pink Triangle Coalition (for survivors persecuted because of homosexuality)

No response

Generic Group

Australia Polish Association of Queensland No response

Archive Worldwide Survivors of the Shoah Visual History Foundation

No response


UK The Association of Jewish Refugees No response

Survivor Group UK The Holocaust Survivors’ Centre

No response


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Ukraine Ukrainian Center for Holocaust Studies Director = Dr Anatoly Podolsky

No response

Jewish Organisation

UK Union of Jewish Students No response


USA United States Memorial Holocaust Museum – Survivor Group

Mentioned at meeting of survivors 01/2005


Worldwide World Federation of Jewish Child Survivors of the Holocaust

Forwarded to members and led to listing on All Generations email list 09/2005

Table AH.2. Details of media coverage which led to interest in study participation Article/Interview Date Coverage Print Daily Telegraph, p. 2, Learning from survivors 27 January 2005 New South Wales Westside News, p. 4, Studying Holocaust 2 February 2005 Brisbane Western Suburbs Australian Jewish News, p. 8, Holocaust descendants sought for new study

4 February 2005 Australia

Inside QUT (Issue 251), p. 7, Holocaust’s hold 8 March 2005 Internal to Queensland University of Technology

Courier Mail, p. 39. Trauma ripples through generations

4 May 2005 Queensland

Adult March of the Living Newsletter (Australian edition) – pp. 11- 14, A second and third generation biography

25 September 2005

Australian March of the Living Alumni

Radio 4QR - afternoon, 5 minute spot with Spencer Howsen on family Holocaust story and PhD research

27 January 2005 Brisbane

4BC - evening, 10 minute spot with Tony Monroe on family Holocaust story and PhD research

27 January 2005 Brisbane

2SM - 5 minute spot on PhD research 27 January 2005 Sydney 666 - afternoon, 5 minute spot with Louise Marr on family Holocaust story and PhD research

27 January 2005 Canberra

6PR - evening, 5 minute spot on family Holocaust story and PhD research.

1 February 2005 Perth


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Appendix I – Informed Consent Information Package

The Differential Impact of Holocaust Trauma across Three Generations – Survivors, their Children and Grandchildren

Chief Investigator – Janine Beck (PhD Student)

Principal Supervisor – Dr Poppy Liossis Associate Supervisor – Adjunct Associate Professor Kathryn Gow

School of Psychology and Counselling, Faculty of Health, Queensland University of Technology

Description This project is being conducted as part of Ms Beck’s doctoral research. You have been sent this questionnaire package because you have contacted Ms Beck and indicated your willingness to participate in this study. Alternatively, it has been sent to you by an organisation of which you are a member. If this is the case, it is the organisation that has conducted the mail out and your contact details have not been forwarded to Ms Beck, so please be assured that your anonymity and confidentiality have been maintained. Participants can be Holocaust survivors, children of Holocaust survivors and grandchildren of Holocaust survivors. For the purposes of this study a Holocaust survivor is defined as anyone who lived in a country occupied by Nazi Germany before and/or during World War II and was subject to some form of persecution. A child of a survivor must have at least one parent who meets the above criteria and must have been born after the war ended. If you were born during the war you are considered a survivor rather than a child of a survivor. A grandchild of a survivor must have at least one grandparent who meets the Holocaust survivor criteria. This research project assesses psychological well-being as well as family interactions within Holocaust survivor families. Participation involves the completion of the enclosed questionnaire booklet. It is anticipated that this will take you approximately 45 minutes to 1 hour. Feel free to have a look at the questionnaires before you start. Multiple members of the same family are encouraged to complete the questionnaires as it is of interest to look at survivor families rather than individuals. Please bear in mind that participants must be aged 18 years or over as the questionnaires are only applicable to adults. Included in this package is a questionnaire booklet for each of the three generations (unless you have specified they are not required). Complete the one which is appropriate for you and pass on the others to members of your family who are willing to participate. You can photocopy extra copies if needed or contact Ms Beck for extra copies if more than one person from each generation is willing to complete the questionnaire. Please feel free to mention the study to any friends who fall into one of the participant categories. If they express any interest they can obtain a copy of this


429

package from you or contact Ms Beck and she will forward one to them. Please make sure that you make these information sheets available to any person you give questionnaires to. This will enable them to make an informed decision about their willingness to participate. If no other member of your family is willing or able to complete the questionnaire booklet, individual responses are still valued so please still forward your completed questionnaire. If you are a child or grandchild of survivors it would be very helpful however if you could complete a demographics questionnaire about your parents and/or grandparents. Further instructions relating to this appear in your questionnaire booklet. Returning completed questionnaires When you have completed the questionnaire booklet please send it back to Ms Beck using one of the following methods:

o Australian participants please use the reply paid envelope enclosed. o International participants please take the postage coupons enclosed to a

post office where you can redeem them for the postage required to post the questionnaires.

o If you are completing an electronic version of this questionnaire, please

email it directly to Ms Beck at [email protected] Expected benefits Although you will not directly benefit from participating in this research, your contribution will help highlight the strengths and weaknesses of Holocaust Survivors and their descendants as well as identifying sub-groups in particular need of help. Information derived from this study may also help to target particularly vulnerable sub-groups among other traumatised populations. Risks While it is not anticipated that any participant will be adversely affected by completing this questionnaire it must be acknowledged that some questions may be upsetting for some respondents. In particular, Holocaust survivors are asked for some details of their experiences as well as some thoughts and feelings about how their experiences currently affect them. If you experience any distress as a result of your participation in this project, you can contact Ms Beck who can refer you to a counsellor or support group in your local area. Confidentiality Largely, participants’ can be assured of their anonymity. However, because Ms Beck is interested in collecting questionnaires from multiple members of the one Holocaust

mailto:[email protected]


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survivor family it will be necessary to link questionnaires of family members. This will be done via the provision of dates of birth of all family members. This will enable the linking of questionnaires while still ensuring relative anonymity of participants. Apart from this questionnaire linking process, no identifying information will be collected. Only Ms Beck will have access to the completed questionnaires which will be kept under lock and key. No identifying information will be published as only statistics relating to the whole group of participants is of interest. Voluntary participation Please be aware that your participation in this study is completely voluntary and you are under no obligation to complete the enclosed questionnaires or forward them to Ms Beck. Your consent to participate will be inferred when you return a completed questionnaire. While it will be helpful if you are able to answer all the questions within the questionnaires, please do not feel obligated to answer any which offend you or you find too distressing. Questions / further information If you would like more information about this research study please contact Ms Beck. A summary of the results of this study will also be available on request. Email – [email protected] Address – Janine Beck, School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine, 4034, Queensland, Australia Telephone – 617 3864 4685 (For International Callers), 07 3864 4685 (For Australian Callers) Translations The questionnaire package is provided in English or Hebrew. If you or members of your family who have also agreed to participate are unable to complete the questionnaires in English or Hebrew please contact Ms Beck. Please specify the language of translation desired and she will forward a translated questionnaire package if she has one in that language. Concerns / complaints If you have any concerns or complaints about the ethical conduct of this project please contact the Queensland University of Technology Research Ethics Officer. Email – [email protected] Address – Research Ethics Officer, Office of Research, O Block Podium, QUT GP Campus, GPO Box 2434, Brisbane 4001, Queensland, Australia. Telephone – 617 3864 2340 (For International callers), 07 3864 2340 (For Australian callers).




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Appendix J – Multi-lingual Introduction to Study

English My name is Janine Beck and I am a PhD student conducting a worldwide research study addressing differences in psychological well being and interpersonal variables among Holocaust survivors, their children and grandchildren. The information about the study and the enclosed questionnaires are provided in English. If you are not comfortable reading this information or answering questionnaires in English but might be interested in participating in the research please contact me for a translation of this information. You can contact me by email ([email protected]) or mail (School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland, Australia). Simply tell me which language you would like the translation in and your return address (email or mail) for me to send it back to you. If you then decide to participate a translated questionnaire booklet can also be provided. Thank you. Janine Beck. Deutsch Mein Name ist Janine Beck und ich bin PhD Student und Leiter einer weltweiten Forschungsstudie über die Unterschiede im psychologischen Wohlergehen und Erscheinungsbild von Holocoust überlebten, deren Kindern und Enkelkindern. Die Informationen über die Studie und der beigelegte Fragebogen sind in Englisch. Sollten Sie Schwierigkeiten haben die Informationen zu verstehen aber sie in der Beteiligung in der Forschung interessiert sind, setzen Sie sich bitte mit mir für eine Übersetzung dieser Informationen in Verbindung. Sie können sich per e-mail ([email protected]) oder der post (School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland, Australia) mit mir in Verbindung setzen. Lassen sie mich einfach wissen in welcher Sprache Sie gerne die Übersetzung hätten und legen sie ihre Adresse (Adresse oder e-mail Adresse) bei, so dass wir Sie ihnen zurück schicken können. Wenn Sie sich zu einer Teilnahme entscheiden, können sie ebenfalls einen übersetzten Fragebogen erhalten. Vielen Dank. Janine Beck. Francais Je m’appelle Janine Beck et je suis étudiante d’un doctorat. Je fais des researches dans le monde entire sur les différences de bien être psychologique entre les survivants du Holocaust, leurs enfants, et leurs petits-enfants. L’information au sujet de l’étude et les questionnaires ci-joint sont en anglais. Si vous voudriez participer à ce projet mais vous préféreriez à répondre à une questionnaire en une autre langue, je vous en prie que vous vous mettez en contact avec moi pour reçevoir une transduction de l’information et de la questionnaire. Mon adresse est [email protected] ou School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland, Australia. Simplement, dites-moi en quelle langue vous préféreriez l’information et aussi votre adresse (e-mail ou de poste). Si vous decidez à participer, je vous envoierai une questionnaire. Merci bien. Janine Beck






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Magyarul A nevem Janine Beck, a PhD.- re készülő egyetemista. Kutatási tanulmányt készitek a Holokausztot világszerte túlélők gyermekei és unokái pszichológiai egészségét és személyi változékonyságát illetően. A tanulmányozáshoz a magyarázat, úgysmint a kérdőívek persze angol nyelven készültek, de ha szívesebben szeretne e tanulmányról egy másik nyelven tájékozódni, legyen szíves azt a nyelvet is emlitve nevével és Email – vagy pósta – címével együtt az alúlírt címeim egyikére eljuttatni, hogy a kivánt nyelvére fordított adatokkal tudjak válasznolni! Azután, ha részt szeretne venni a kutatáson, szintén nyelvére leforditott és kiküldött kérdőívek kitöltésével, nagyon hálásan köszönném! Janine Beck Email: [email protected] Pósta: School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland Australia Nederlands Mijn naam is Janine Beck en ik ben een Phd (Doctor of Philosophy) student die wereldwijd wetenschappelijk onderzoek voert, wat gaat over verschillen in het psychologisch welzijn en intermenselijke variabelen tussen overlevenden van de Holocaust, hun kinderen en kleinkinderen. Informatie over de studie en de bijgesloten enquetes zijn in het Engels. Als u het moeilijk vindt om deze informatie in het Engels te lezen of de enquetes in het Engels te beantwoorden, maar u bent geinteresseerd om deel te nemen in het onderzoek, neemt u dan contact met mij op voor een vertaling van deze informatie. U kunt mij bereiken via email ([email protected]) of per post (School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland, Australia). Laat me weten in welke taal u de vertaling wenst te ontvangen, alsmede uw email adres of uw huisadres in wilt en uw adres (email of huis adres) en dan stuur ik het naar u. Mocht u dan besluit deel te nemen, dan kan eveneens een vertaalde enquete brochure verschaft worden. Dank u. Janine Beck Polska Hello, mam na imie Janine Beck i jestem studentem doktoranckim (PhD Student) przeprowadzającym globalne badania na temat różnic w psycologicznej adaptacji i personalnycn zróznicowań wśród osób, które pneżyły Holocoust, ich dzieci oraz ich wnucząt. Informaćja na temat moich badań oraz załączony kwestionariusz są w języku angielskim. Jeżeli nie czujecie się Państwo wystarczająco swobodnie odpowiadając na kwestionariusz w języku angielskim a jesteście zainteresowani moimi badaniami proszę się ze mną skontaktować w sprawie tłumaczenia, które może być zaaranżowane. Mój kontakt adres: e-mail: ([email protected]) lub pocztą (School of Psychology and Counselling, Queensland University of Technology, Beams Rd, Carseldine 4034, Queensland, Australia). Proszę mi po prostu podać język, w którym chcielibyście Państwo otrzymać tłumaczenie oraz adres, na który mogłabym je przesłać. Jezeli zdecydujecie się Państwo wziąć udział, przetłumaćzona broszurka może być równiez dostarczona. Dziękuję, Janine Beck.





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Appendix K – Depression Anxiety Stress Scales (S. H. Lovibond & P. F. Lovibond, 1995)

Please read each statement and rate how much the statement applied to you OVER THE PAST WEEK. The rating scale is as follows: 0 = Did not apply to me at all 1 = Applied to me to some degree, or some of the time 2 = Applied to me to a considerable degree, or a good part of time 3 = Applied to me very much, or most of the time Response (0-3)

Statement Subscale

1. I found myself getting upset by quite trivial things Stress 2. I was aware of dryness of my mouth Anxiety 3. I couldn't seem to experience any positive feeling at all D 4. I experienced breathing difficulty (eg, excessively rapid

breathing, breathlessness in the absence of physical exertion) Anxiety

5. I just couldn't seem to get going Depression 6. I tended to over-react to situations Stress 7. I had a feeling of shakiness (eg, legs going to give way) Anxiety 8. I found it difficult to relax Stress 9. I found myself in situations that made me so anxious I was

most relieved when they ended Anxiety

10. I felt that I had nothing to look forward to Depression 11. I found myself getting upset rather easily Stress 12. I felt that I was using a lot of nervous energy Stress 13. I felt sad and depressed Depression 14. I found myself getting impatient when I was delayed in

any way (eg, lifts, traffic lights, being kept waiting) Stress

15. I had a feeling of faintness Anxiety 16. I felt that I had lost interest in just about everything Depression 17. I felt I wasn't worth much as a person Depression 18. I felt that I was rather touchy Stress 19. I perspired noticeably (eg, hands sweaty) in the absence of

high temperatures or physical exertion Anxiety

20. I felt scared without any good reason Anxiety 21. I felt that life wasn't worthwhile Depression 22. I found it hard to wind down Stress 23. I had difficulty in swallowing Anxiety 24. I couldn't seem to get any enjoyment out of the things I did Depression 25. I was aware of the action of my heart in the absence of

physical exertion (eg, sense of heart rate increase, heart missing a beat)

Anxiety

26. I felt down-hearted and blue Depression 27. I found that I was very irritable Stress 28. I felt I was close to panic Anxiety 29. I found it hard to calm down after something upset me Stress


434

0 = Did not apply to me at all 1 = Applied to me to some degree, or some of the time 2 = Applied to me to a considerable degree, or a good part of time 3 = Applied to me very much, or most of the time Response (0-3)

Statement Subscale

30. I feared that I would be "thrown" by some trivial but unfamiliar task

Anxiety

31. I was unable to become enthusiastic about anything Depression 32. I found it difficult to tolerate interruptions to what I was

doing Stress

33. I was in a state of nervous tension Stress 34. I felt I was pretty worthless Depression 35. I was intolerant of anything that kept me from getting on

with what I was doing Stress

36. I felt terrified Anxiety 37. I could see nothing in the future to be hopeful about Depression 38. I felt that life was meaningless Depression 39. I found myself getting agitated Stress 40. I was worried about situations in which I might panic and

make a fool of myself Anxiety

41. I experienced trembling (eg, in the hands) Anxiety 42. I found it difficult to work up the initiative to do things Depression


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Appendix L – Impact of Events Scale – Revised (D. S. Weiss & Marmar, 1997)

Below is a list of difficulties people sometimes have after stressful life events. Please read each item, and then indicate how distressing each difficulty has been for you DURING THE PAST WEEK with respect to your Holocaust experiences, how much were you distressed or bothered by these difficulties?

0 Not at all 1 A little bit 2 Moderately 3 Quite a bit 4 Extremely

Response (0-4)

Statement Subscales

1. Any reminder brought back feelings about it Intrusion 2. I had trouble staying asleep Intrusion 3. Other things kept making me think about it Intrusion 4. I felt irritable and angry Hyper-arousal 5. I avoided letting myself get upset when I thought about it

or was reminded of it Avoidance

6. I thought about it when I didn’t mean to Intrusion 7. I felt as if it hadn’t happened or wasn’t real Avoidance 8. I stayed away from reminders about it Avoidance 9. Pictures about it popped into my mind Intrusion 10. I was jumpy and easily startled Hyper-arousal 11. I tried not to think about it Avoidance 12. I was aware that I still had a lot of feelings about it, but I

didn’t deal with them Avoidance

13. My feelings about it were kind of numb Avoidance 14. I found myself acting or feeling as though I was back at

that time Intrusion

15. I had trouble falling asleep Hyper-arousal 16. I had waves of strong feelings about it Intrusion 17. I tried to remove it from my memory Avoidance 18. I had trouble concentrating Hyper-arousal 19. Reminders of it caused me to have physical reactions,

such as sweating, trouble breathing, nausea, or a pounding heart

Hyper-arousal

20. I had dreams about it Intrusion 21. I felt watchful or on-guard Hyper-arousal 22. I tried not to talk about it Avoidance


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Appendix M – Post-Traumatic Vulnerability Scale (Shillace, 1994)

Please indicate if you believe the statements below are either true or false as they apply to you. T/F Statement 1. I have had many narrow escapes in life and I feel as though my “nine lives”

are almost used up. 2. I feel as though there is punishment “hanging over my head”, ready to drop at

any time. 3. If something terrible is going to happen, it will happen to me. 4. Taking chances for the thrill of it makes life exciting for me. 5. Regarding disappointment and tragedy, I am no longer sure that it will happen

to the other guy/gal, not me. 6. I am confident I will be spared terrible misfortunes. 7. It seems that almost everywhere I look I see danger. 8. Usually, I feel as safe when I am alone as when I am with someone. 9. I feel I have more than my share of bad luck. 10. Frequently when the telephone rings or I receive a letter I become frightened

that it will be bad news. 11. I can handle most dangers in the world. 12. I seldom worry that the people I love will get hurt or taken away from me. 13. The world seems harsh and hurtful – not helpful. 14. I often feel that something terrible is going to happen to someone close to

me. 15. I used to feel safe, but now I feel horrible things can happen to nice people,

me included. 16. I control my well-being. 17. I welcome challenges. 18. Sometimes I feel “exposed” and unprotected and that I could easily be hurt

(either physically or emotionally). 19. I feel it is important to always keep my guard up and to be alert to possible

threats. 20. I feel there are very few real threats to my safety that I cannot handle. 21. Sometimes I can’t stand being alone. 22. I get angry at family or friends who need to warn me about dangers in my

world. 23. Evil and pain are very real to me. 24. Taking risks feels good to me.


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Appendix N – Adult Attachment Scale (Collins & Read, 1990)

Please read each statement carefully and indicate how characteristic the statement is of your feelings with regard to romantic relationships. Please think about all your relationships (past and present) and respond in terms of how you generally feel in these relationships. If you have never been involved in a romantic relationship, answer in terms of how you think you would feel.

1 Not at all characteristic of me 2 . 3 . 4 . 5 Very characteristic of me

Response (1-5)

Statement Subscales

1. I find it difficult to allow myself to depend on others. Depend 2. People are never there when you need them. Depend 3. I am comfortable depending on others. Depend 4. I know that others will be there when I need them. Depend 5. I find it difficult to trust others completely. Depend 6. I am not sure that I can always depend on others to be there when

I need them. Depend

7. I do not often worry about being abandoned. Anxiety 8. I often worry that my partner does not really love me. Anxiety 9. I find others are reluctant to get as close as I would like. Anxiety 10. I often worry my partner will not want to stay with me. Anxiety 11. I want to merge completely with another person. Anxiety 12. My desire to merge sometimes scares people away. Anxiety 13. I find it relatively easy to get close to others. Close 14. I do not often worry about someone getting too close to me. Close 15. I am somewhat uncomfortable being close to others. Close 16. I am nervous when anyone gets too close Close 17. I am comfortable having others depend on me. Close 18. Often, love partners want me to be more intimate than I feel

comfortable being. Close


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Appendix O – Post-Traumatic Growth Inventory (Tedeschi & Calhoun, 1996)

Indicate for each of the statements below the degree to which these changes have occurred in your life as a result of your Holocaust experience, using the following scale: 0 = I did not experience this change as a result of my Holocaust experience 1 = I experienced this change to a very small degree as a result of my Holocaust experience. 2 = I experienced this change to a small degree as a result of my Holocaust experience. 3 = I experienced this change to a moderate degree as a result of my Holocaust experience. 4 = I experienced this change to a great degree as a result of my Holocaust experience. 5 = I experienced this change to a very great degree as a result of my Holocaust experience. Response (0-5)

Statement Subscales

1. My priorities about what is important in life. 5 2. An appreciation for the value of my own life. 5 3. I developed new interests. 2 4. A feeling of self-reliance. 3 5. A better understanding of spiritual matters. 4 6. Knowing that I can count on people in times of trouble. 1 7. I established a new path for my life. 2 8. A sense of closeness with others. 1 9. A willingness to express my emotions. 1 10. Knowing I can handle difficulties. 3 11. I’m able to do better things with my life. 2 12. Being able to accept the way things work out. 3 13. Appreciating every day. 5 14. New opportunities are available which wouldn’t have been

otherwise. 2

15. Having compassion for others. 1 16. Putting effort into my relationships. 1 17. I’m more likely to try to change things which need changing. 2 18. I have a stronger religious faith. 4 19. I discovered that I’m stronger than I thought I was. 3 20. I learned a great deal about how wonderful people are. 1 21. I accept needing others. 1 Subscales 1 = relating to others 2 = new possibilities 3 = personal strength 4 = spiritual change 5 = appreciation of life


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Appendix P – COPE – Long Version (Carver et al., 1989)

This section asks you to indicate what you generally do and feel, when you experience stressful events. Obviously, different events bring out somewhat different responses, but think about what you usually do when you are under a lot of stress. Then respond to each of the following items using the response choices listed just below. There are no "right" or "wrong" answers, so choose the most accurate answer for you--not what you think "most people" would say or do. Indicate what you usually do when you experience a stressful event.

1 = I usually don't do this at all 2 = I usually do this a little bit 3 = I usually do this a medium amount 4 = I usually do this a lot

Response (1-4)

Statement Original Subscales

Composite Subscale

1. I try to grow as a person as a result of the experience. PRG Adaptive 2. I turn to work or other substitute activities to take my mind off

things. MD Maladaptive

3. I get upset and let my emotions out. FVE Maladaptive 4. I try to get advice from someone about what to do. ISS Adaptive 5. I concentrate my efforts on doing something about it. AC Adaptive 6. I say to myself "this isn't real." D Maladaptive 7. I put my trust in God. RC Maladaptive 8. I laugh about the situation. H Adaptive 9. I admit to myself that I can't deal with it, and quit trying. BD Maladaptive 10. I restrain myself from doing anything too quickly. R Adaptive 11. I discuss my feelings with someone. ESS Adaptive 12. I use alcohol or drugs to make myself feel better. SU Maladaptive 13. I get used to the idea that it happened. A Adaptive 14. I talk to someone to find out more about the situation. ISS Adaptive 15. I keep myself from getting distracted by other thoughts or

activities. SCA Adaptive

16. I daydream about things other than this. MD Maladaptive 17. I get upset, and am really aware of it. FVE Maladaptive 18. I seek God's help. RC Maladaptive 19. I make a plan of action. P Adaptive 20. I make jokes about it. H Adaptive 21. I accept that this has happened and that it can't be changed. A Adaptive 22. I hold off doing anything about it until the situation permits. R Adaptive 23. I try to get emotional support from friends or relatives. ESS Adaptive 24. I just give up trying to reach my goal. BD Maladaptive 25. I take additional action to try to get rid of the problem. AC Adaptive 26. I try to lose myself for a while by drinking alcohol or taking

drugs. SU Maladaptive

27. I refuse to believe that it has happened. D Maladaptive 28. I let my feelings out. FVE Maladaptive 29. I try to see it in a different light, to make it seem more

positive. PRG Adaptive

30. I talk to someone who could do something concrete about the problem.

ISS Adaptive

31. I sleep more than usual. MD Maladaptive 32. I try to come up with a strategy about what to do. P Adaptive 33. I focus on dealing with this problem, and if necessary let other

things slide a little. SCA Adaptive


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1 = I usually don't do this at all 2 = I usually do this a little bit 3 = I usually do this a medium amount 4 = I usually do this a lot

Response (1-4)

Original Subscales

Composite Subscale

34. I get sympathy and understanding from someone. ESS Adaptive 35. I drink alcohol or take drugs, in order to think about it less. SU Maladaptive 36. I kid around about it. H Adaptive 37. I give up the attempt to get what I want. BD Maladaptive 38. I look for something good in what is happening. PRG Adaptive 39. I think about how I might best handle the problem. P Adaptive 40. I pretend that it hasn't really happened. D Maladaptive 41. I make sure not to make matters worse by acting too soon. R Adaptive 42. I try hard to prevent other things from interfering with my

efforts at dealing with this. SCA Adaptive

43. I go to movies or watch TV, to think about it less. MD Maladaptive 44. I accept the reality of the fact that it happened. A Adaptive 45. I ask people who have had similar experiences what they did. ISS Adaptive 46. I feel a lot of emotional distress and I find myself expressing

those feelings a lot. FVE Maladaptive

47. I take direct action to get around the problem. AC Adaptive 48. I try to find comfort in my religion. RC Maladaptive 49. I force myself to wait for the right time to do something. R Adaptive 50. I make fun of the situation. H Adaptive 51. I reduce the amount of effort I'm putting into solving the

problem. BD Maladaptive

52. I talk to someone about how I feel. ESS Adaptive 53. I use alcohol or drugs to help me get through it. SU Maladaptive 54. I learn to live with it. A Adaptive 55. I put aside other activities in order to concentrate on this. SCA Adaptive 56. I think hard about what steps to take. P Adaptive 57. I act as though it hasn't even happened. D Maladaptive 58. I do what has to be done, one step at a time. AC Adaptive 59. I learn something from the experience. PRG Adaptive 60. I pray more than usual. RC Maladaptive

PRG = Positive reinterpretation and growth AC = Active coping D = Denial RC = Religious coping H = Humour BD = Behavioral disengagement ESS = Use of emotional social support SU = Substance use A = Acceptance SCA = Suppression of competing activities P = Planning


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Appendix Q – Correlations between COPE Subscales and Psychological Impact Variables Table AQ.1. Correlation Matrix of COPE Subscales and Psychological Impact Variables for Holocaust Survivors DASS – A DASS – D IES – R Total PTV AAS – Positive AAS –

Negative PTGI

COPE – A - 0.29 - 0.06 0.19 0.05 0.14 - 0.32 0.06 COPE – AC 0.22 0.11 - 0.14 - 0.26 0.27 - 0.15 0.34 COPE – BD - 0.11 0.28 0.12 0.40 # - 0.49 * 0.10 - 0.52 * COPE – D 0.56 ** 0.42 * 0.63 ** 0.41 # - 0.25 0.14 0.15 COPE – ESS - 0.22 - 0.10 - 0.06 - 0.16 0.41 # - 0.18 - 0.15 COPE – FVE 0.28 0.40 # 0.34 0.29 - 0.12 - 0.08 - 0.05 COPE – H 0.35 0.33 0.06 0.05 0.02 - 0.23 0.01 COPE – ISS 0.19 0.11 - 0.04 - 0.33 0.47 * - 0.14 0.16 COPE – MD 0.38 # 0.29 0.55 ** 0.06 - 0.04 0.03 - 0.14 COPE – P 0.03 - 0.15 - 0.16 - 0.19 0.33 - 0.34 0.45 * COPE – PRG 0.27 0.08 - 0.17 - 0.56 ** 0.36 - 0.05 0.26 COPE – R 0.23 0.32 0.16 - 0.14 0.48 * - 0.21 0.05 COPE – RC 0.18 0.03 0.46 * 0.25 0.11 - 0.04 0.33 COPE – SCA 0.02 - 0.11 - 0.06 0.18 0.04 0.13 0.26 COPE – SU 0.08 - 0.06 - 0.06 - 0.13 - 0.04 0.43 # 0.23 Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, DASS-A, & -D – Depression Anxiety and Stress Scale – Anxiety and Depression Subscales PTV – Post-traumatic Vulnerability Scale IES-R – Impact of Events Scale-Revised – Total Score AAS – Adult Attachment Scale * p < 0.05, ** p < 0.01, *** p < 0.001. # p < 0.10, denoted when n < 30. Table AQ.2. Correlation Matrix of COPE Subscales and Psychological Impact Variables for Children of Holocaust Survivors DASS – A DASS – D PTV AAS – Positive AAS – Negative COPE – A - 0.03 - 0.15 - 0.02 0.12 - 0.10 COPE – AC - 0.23 - 0.46 *** - 0.08 0.29 * - 0.21 COPE – BD 0.24 * 0.45 *** 0.09 - 0.15 0.31 * COPE – D 0.09 - 0.02 0.25 * - 0.10 0.22 COPE – ESS 0.16 - 0.03 0.16 0.27 * 0.14 COPE – FVE 0.28 * 0.15 0.21 0.09 0.24 COPE – H - 0.20 - 0.32 ** - 0.16 0.11 - 0.18 COPE – ISS 0.08 - 0.08 0.09 0.32 ** 0.19 COPE – MD 0.10 0.19 0.29 * - 0.07 0.28 * COPE – P - 0.22 - 0.41 *** - 0.03 0.34 ** - 0.18 COPE – PRG - 0.20 - 0.40 ** - 0.21 0.45 *** - 0.03 COPE – R - 0.13 - 0.33 ** - 0.05 0.39 ** - 0.18 COPE – RC 0.12 - 0.10 0.32 ** 0.13 0.07 COPE – SCA 0.03 - 0.19 0.14 0.10 0.01 COPE – SU 0.20 0.34 ** 0.01 - 0.14 - 0.02 Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, DASS-A, & -D – Depression Anxiety and Stress Scale – Anxiety and Depression Subscales PTV – Post-traumatic Vulnerability Scale IES-R – Impact of Events Scale-Revised – Total Score AAS – Adult Attachment Scale * p < 0.05, ** p < 0.01, *** p < 0.001.


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Table AQ.3. Correlation Matrix of COPE Subscales and Psychological Impact Variables for Grandchildren of Holocaust Survivors DASS – A DASS – D PTV AAS – Positive AAS – Negative COPE – A - 0.12 - 0.26 - 0.59 ** - 0.05 0.11 COPE – AC - 0.22 - 0.32 - 0.47 * - 0.05 0.20 COPE – BD 0.26 0.44 * 0.46 * 0.05 0.06 COPE – D 0.01 0.04 - 0.08 0.12 - 0.02 COPE – ESS 0.14 0.14 0.02 - 0.11 0.49 ** COPE – FVE 0.52 ** 0.49 ** 0.32 # 0.03 0.37 # COPE – H 0.08 0.18 0.01 0.14 - 0.30 COPE – ISS 0.08 - 0.09 - 0.18 - 0.16 0.34 # COPE – MD 0.27 0.41 * 0.08 0.06 0.21 COPE – P 0.04 - 0.11 - 0.35 # - 0.01 0.12 COPE – PRG - 0.26 - 0.44 * - 0.60 ** 0.05 - 0.10 COPE – R 0.14 0.22 - 0.17 - 0.04 - 0.06 COPE – RC - 0.08 - 0.04 - 0.21 0.10 0.01 COPE – SCA 0.14 - 0.13 - 0.39 * - 0.11 0.28 COPE – SU 0.18 0.23 0.15 0.13 - 0.15 Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, DASS-A, & -D – Depression Anxiety and Stress Scale – Anxiety and Depression Subscales PTV – Post-traumatic Vulnerability Scale IES-R – Impact of Events Scale-Revised – Total Score AAS – Adult Attachment Scale * p < 0.05, ** p < 0.01, *** p < 0.001. # p < 0.10, denoted when n < 30.


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Appendix R – Benevolence and Meaningfulness Subscales of the World Assumptions Scale (Janoff-Bulman, 1996)

Using the scale below, please select the number that indicates how much you agree or disagree with each statement. 1 = strongly disagree 2 = moderately disagree 3 = slightly disagree 4 = slightly agree 5 = moderately agree 6 = strongly agree Response (1-6)

Statement Subscale

1. Misfortune is least likely to strike worthy, decent people. Meaningfulness 2. People are naturally unfriendly and unkind. Benevolence 3. Bad events are distributed to people at random. Meaningfulness 4. Human nature is basically good. Benevolence 5. The good things that happen in this world far outnumber

the bad. Benevolence

6. The course of our lives is largely determined by chance. Meaningfulness 7. Generally, people deserve what they get in this world. Meaningfulness 8. There is more good than evil in the world. Benevolence 9. People's misfortunes result from mistakes they have made. Meaningfulness 10. People don't really care what happens to the next person Benevolence 11. People will experience good fortune if they themselves

are good. Meaningfulness

12. Life is too full of uncertainties that are determined by chance.

Meaningfulness

13. By and large, good people get what they deserve in this world.

Meaningfulness

14. Through our actions we can prevent bad things from happening to us.

Meaningfulness

15. If people took preventive actions, most misfortune could be avoided.

Meaningfulness

16. In general, life is mostly a gamble. Meaningfulness 17. The world is a good place. Benevolence 18. People are basically kind and helpful. Benevolence 19. When bad things happen, it is typically because people

have not taken the necessary actions to protect themselves. Meaningfulness

20. If you look closely enough, you will see that the world is full of goodness.

Benevolence


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Appendix S – Parental Care-giving Style Questionnaire (based on Hazan and Shaver, 1986, unpublished, cited in Collins & Read, 1990)

Please read each statement carefully and indicate how characteristic the statement is of your relationship with your mother and your father in your first 16 years. Please use the following scale –

0 Not true 1 A little true 2 Somewhat true 3 Quite true 4 Very true

Response (0-4) Mother

Response (0-4) Father

Statement Subscale

1. She/he was generally warm and responsive. Warmth 2. She/he was good at knowing when to be

supportive and when to let me operate on my own. Warmth

3. Our relationship was almost always comfortable.

Warmth

4. I have no major reservations or complaints about our relationship.

Warmth

5. She/he was fairly cold and distant or rejecting. Coldness 6. She/he was not very responsive. Coldness 7. I wasn’t her/his priority; her/his concerns were

often elsewhere. Coldness

8. It’s possible that she/he would just as soon not have had me.

Coldness

9. She/he was noticeably inconsistent in her/his reactions to me.

Ambivalence

10. She/he was sometimes warm and sometimes not.

Ambivalence

11. She/he had her/his own agendas which sometimes got in the way of her/his receptiveness and responsiveness to my needs.

Ambivalence

12. She/he definitely loved me but didn’t always show it in the best way.

Ambivalence


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Appendix T – Parental Fostering of Autonomy Subscale of the Parental Attachment Questionnaire (Kenny, 1987)

The following section contains statements that describe family relationships and the kinds of feelings and experiences frequently reported by young adults. Think about how each of your parents responded to you during your late adolescence and young adulthood. For some of you this might be your current life stage. Respond to each item using the scale below. 1 = Not at all 2 = Somewhat 3 = A moderate amount 4 = Quite a bit 5 = Very much In general, my parents.... Response (1-5) Mother

Response (1-5) Father

Statement

1. Respect/ed my privacy. 2. Restrict/ed my freedom or independence 3. Take/took my opinions seriously 4. Encourage/d me to make my own decisions 5. Are/were critical of what I can do. 6. Impose/d their ideas and values on me. 7. Are/were persons to whom I can/could express differences of

opinion on important matters. 8. Provided me with the freedom to experiment and learn things

on my own. 9. Have/had trust and confidence in me. 10. Try/tried to control my life. 11. Give/gave me advice whether or not I want it. 12. Respect/ed my judgement and decisions, even if different

from what they would want. 13. Do/did things for me, which I could do for myself. 14. Treat/ed me like a younger child.


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Appendix U – Holocaust Communication Questionnaire (Lichtman, 1983)

This section refers to discussions about the Holocaust within your family when you were growing up. For each question mark an X next to the response that best fits your feelings about your parents. The first set of questions refers to both parents together while the second set on the next page asks you to think about your mother (M) and father (F) separately. Questions Subscale 1. At what age do you recall having first heard about your parents’ Holocaust experiences? 1 a. Older than 18 b. Between 14 and 18 c. Between 12 and 14 d. Between 5 and 11 e. Under 5 f. I somehow always knew about it 2. How much more aware of the Holocaust were you, as a child, as compared to your

friends/classmates who were not children of survivors? 1

a. less aware b. equally aware c. somewhat more aware d. much more aware e. no comparison – I felt I was reliving it 3. How often were Holocaust experiences discussed when your parents got together with

friends or relatives, and you were within earshot? 6, 7

a. practically/actually never b. rarely c. occasionally d. frequently e. usually 4. How often have you been made to feel guilty for having such an “easy life’ compared to

your parents’ ordeals at your age, or for complaining about things that they consider inconsequential? (i.e., “You think you have it bad? You don’t know what it is to really suffer!”).

4, 5

a. practically/actually never b. rarely c. occasionally d. frequently e. usually 5. “The gloomy, panicky atmosphere that permeated my parents’ home as I was growing up

made me fell that, in some way, the Holocaust was constantly being relived.” How often did you have this feeling, while living with your parents?

1

a. practically/actually never b. rarely c. occasionally d. frequently e. usually


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F M 6. How often have you and your mother/father discussed their experiences during the war? 3 2 a. practically/actually never b. rarely c. from time to time d. frequently e. persistently F M 7. How would you evaluate the willingness of your mother/father to tell you what happened to them

during the war? 3 2 a. would prefer not to tell at all b. unwilling to tell c. sometimes yes, sometimes no d. willing to tell e. very anxious to tell F M 8. How often have you heard statements akin to this one from your mother/father: “For this I survived

Auschwitz/Hitler!” in response to something you do (did) which upset them? 5 4 a. practically/actually never b. rarely c. occasionally d. frequently e. usually F M 9. How often have you felt like you were being lectured at, rather than spoken to, when your

mother/father spoke to you of their wartime experiences? 5 4 a. practically/actually never b. rarely c. occasionally d. frequently e. usually F M 10. How often does your mother/father refer back to their Holocaust experiences as they relate to

everyday life? (i.e., “It was thundering like this, the day we were deported from the ghetto.”). 7 6 a. practically/actually never b. rarely c. occasionally d. frequently e. usually F M 11. When my mother/father spoke of their Holocaust experiences they would usually: 9 8 a. make light of it/stress the comical or heroic aspects b. speak of it in a matter-of-fact way c. sound very sad or angry d. be on the verge of tears e. cry F M 12. Which of the following statements best reflects your knowledge of your mother’s/father’s wartime

experiences? 3 2 a. I have only a vague idea of what happened to them b. I have some idea of what transpired, but am unclear about the details and order of events c. I have a pretty good idea of what transpired, but am unclear about the details d. I have a good idea of what transpired, including most important details e. I have a very clear picture of what transpired, in detail and in correct chronological order

1 = Non-verbal presence of the Holocaust Frequent and willing discussion of the Holocaust (Mother = 2, Father = 3) Guilt-inducing communication about the Holocaust (Mother = 4, Father = 5) Indirect communication about the Holocaust (Mother = 6, Father = 7) Affective communication about the Holocaust (Mother = 8, Father = 9)


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Appendix V – Control Questionnaire for Historical Influences

The recent Indian Ocean Tsunami was a large scale event that no one could have anticipated. An event, such as this, can affect all of us on some level. In light of this we have decided to ask participants to fill out this additional page, in order to gauge the impact of these types of events. A personal and an historical timeline have been provided. What we would like you to do is to mark down both personal/significant family events, as well as historical events that you feel have had an impact on your life, and continue to influence the way you think and feel (other than the Holocaust). Against each of these events, please mark the extent to which the memory of that event impacted upon the intensity of negative thoughts and feelings at the time you filled out the questionnaire booklet. Use a scale from 1 to 10 where 1 represents a minimal impact and 10 represents an overwhelming impact. Example of Personal Timeline Birth

Event Details (Event, Year, Age, Duration if applicable) Score Parents separated, 1981, 4 years old 3 Father moved interstate, 1994, 18 years old 3 Grandfather dying, 1997, 21 years old, 4 months 4 Aunt dying, 2001, 25 years old, 3 months 4 Grandmother diagnosed with cancer, 2004, 28 years old 5 Miscarriage, 2004, 28 years old 5

Example of Historical Timeline Birth

Event Details (Event, Year, Age, Duration if applicable) Score Al Axa Intafada, 2000 - , 24 years old 4 September 11, 2001, 25 years old 4 Iraq War, April 2003 - , 27 years old - 4

Please complete the Personal and Historical Timelines on the next page in terms of your own life.


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Personal/Significant Family Member Timeline Birth

Event Details (Event, Year, Age, Duration if applicable) Score

Historical Timeline Birth

Event Details (Event, Year, Age, Duration if applicable) Score


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Appendix W – Demographic Questionnaires

Demographic Questionnaire for Holocaust Survivors

1. Date of birth. (Date/Month/Year) 2. Gender. 3. What is your first language/native tongue? 4. Country of birth. 5. Which country do you currently live in? 6. In what year did you move to this country 7. If you have lived in other countries since the war please list them and the years you moved there.

8. Do you now or have you ever lived in a Kibbutz? If yes specify for how long and if you are currently residing in one.

9. What are the dates of birth of your children and their other parent? If they have passed away please note the date or year this occurred. Please note the details of any additional children in the page margin. Date of Birth Gender Other parent’s date of birth 1. 2. 3. 4. 5. 6. 10. What is your marital status? (mark an X next to the one that applies to you) Single (never married) Married Defacto Divorced / Separated Widowed 11. If you are or were married, when did you and your spouse get together? Before World War II During World War II After World War II 12. If this is not your first marriage please note your previous marriage/s, how they ended (for example bereavement or divorce) and the dates involved

13. What is your highest level of education? No formal education Elementary/Primary school or equivalent High school or equivalent Tertiary qualification (for example university or technical college)

14. Which religion did you associate yourself with prior to the war and currently? (mark an X next to the answer that applies and write “yes” if you actively practice your religion) Prior to the war Currently Judaism Christianity Islam None (atheist) Other (please specify)


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15. What country or countries were you in during the war (1939 to 1945)?

16. In what year did you first become subject to some form of persecution?

17. Which of the following do you feel best describes the reason for your persecution during the war? (mark an X next to all that apply) ethnic group, for example Jew, Gypsy (please specify)

political resistance (please specify)

member of Allied armed forces (please specify)

homosexuality religion, for example Jehovah’s Witness (please specify)

punishment for a “crime” (please specify)

other (please specify)

18. This question asks you to nominate experiences you may have had during the war. For each please specify the amount of time in months and years that you were in the situation, the timeframe and the relatives that were with you at the time. Circumstance Years Months Timeframe

(e.g., 1943-4) Relatives with you

Restriction of civil liberties such as curfews, freezing of bank accounts, refusal of access to shops, schools and public areas, wearing an armband etc

Residence in a ghetto (Please name)

Concentration camp prisoner (Please name camp)

Labor camp prisoner (Please name camp)

Living in hiding unaided by anyone Living in hiding with the help of others Child living under assumed identity with another family

Child in hiding in monastery or convent Adult living under assumed identity (for example with false papers)

Involvement with a partisan or resistance group (please specify where)

Subjected to medical experimentation (please specify where)

Other (please specify)


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19. If you managed to escape, where did you escape to and in what year?

20. Where were you when you were liberated/freed at the end of the war?

21. How were you or who liberated you?

22. Did you spend any time in a displaced persons’ camp? If yes, where was the camp and how long were you there (in months and years)?

23. Please indicate whether the following relatives survived or lost their lives before or during the Holocaust. (Mark an X in the box that applies) If they lost their lives during the war also note if it was as a result of Nazi persecution. Relative Before the war During the war Survived Mother Father Siblings (age and gender)

Spouse Children (age and gender)

Maternal Grandfather

Maternal Grandmother

Paternal Grandfather

Paternal Grandmother

24. To the best of your knowledge were you the sole survivor of your family?

25. If other members of your family survived, were you always with at least one of them during the war?

26. Are you a member of a survivor’s group/organisation? If yes, please give the name of the organisation and specify how long you have been a member (in years)

27. Have you had any significant traumatic events in your life since the end of the war? If yes, please specify


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28. Do you suffer from any mental illness? If yes, please specify

29. Do you suffer from any physical illness? If yes, please specify

30. Are you on any medication? If yes, please specify what it is for

31. Have you ever had or are you currently in ongoing psychiatric or psychological therapy? Please mark an X in the boxes that apply. Individual Group Both


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Demographic Questionnaire for Children of Holocaust Survivors

1. Date of birth. (Date/Month/Year) 2. Gender. 3. What is your first language/native tongue? 4. Country of birth. 5. Were you born in a displaced persons camp? 6. Which country do you currently live in? 7. If you live in a different country to the one in which you were born, in what year did you move there?

8. If you have lived in other countries since the war please list them and the years you moved there


10. What is your highest level of education? No formal education Elementary/Primary school or equivalent High school or equivalent Tertiary qualification (for example university or technical college) 11. Which religion do you currently associate yourself with? (mark an X next to the answer that applies and write “yes” if you actively practice your religion) Judaism Christianity Islam None (atheist) Other (please specify)

12. What are the dates of birth of your parents and all your siblings. If they have passed away please note the date or year they died. Please note the details of any additional siblings in the page margin. Gender (for siblings) Date of Birth Mother Father Sibling One Sibling Two Sibling Three Sibling Four Sibling Five Sibling Six 13. Do you still live with your parents? If no, how old were you when you moved out?

14. Have/did your parents remain married or did they divorce/separate? Please note the year they separated.

15. Which of your parents survived World War II in a country occupied by Nazi Germany? Mother Father Both 16. If only one parent is a survivor, in what country was your non-survivor parent born?

17. If your non-survivor parent was born before the war, what country were they in during the war?


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18. Did any of your grandparents survive the war? (mark an X against all that apply) Maternal grandmother Maternal grandfather Paternal grandmother Paternal grandfather 19. Are you named after a relative who died in the Holocaust? If yes, who?

20. What is your marital status? Single (never married) Married Defacto Divorced / Separated Widowed 21. If you are or have been married was/is your spouse also the child of survivor/s?

22. Do you have any children? If yes please list their dates of birth and gender. Gender Date of Birth Child One Child Two Child Three Child Four Child Five Child Six 23. Are you a member of a descendants of survivors’ group/organisation? If yes, please give the name of the organisation and specify how long you have been a member (in years)

24. Have you had any significant traumatic events in your life? If yes, please specify




28. Have you ever had or are you currently in ongoing psychiatric or psychological therapy? Please mark an X in the boxes that apply. Ever Currently Individual Group Both

If neither or one of your parents is not participating in this study please also fill out a demographic questionnaire about them. Fill in one for each parent that is a survivor. Please answer all questions that you are able to and write “don’t know” next to any that you are unsure about. A demographics questionnaire for survivor mother and survivor father are at the end of this booklet.


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Demographic Questionnaire about Holocaust Survivor Mother/Father (two copies were supplied – one for a survivor mother and one for a survivor father)

1. Date of birth. (Date/Month/Year) 2. Country of birth. 3. When did your mother and father get together? Before World War II During World War II After World War II 4. What country or countries was she/he in during the war (1939 to 1945)?

5. In what year did she/he first become subject to some form of persecution?

6. Which of the following do you feel best describes the reason for her/his persecution during the war? (mark an X next to all that apply) ethnic group, for example Jew, Gypsy (please specify)






7. This question asks you to nominate experiences your mother /father may have had during the war. For each please specify the amount of time in months and years that she/he was in the situation, the timeframe and the relatives that were with her/him at the time. Circumstance Years Months Timeframe

(e.g., 1943-4) Relatives with her/him









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Circumstance Years Months Timeframe



8. Where was she/he when she/he was liberated/freed at the end of the war?

9. How was she/he or who liberated her/him?

10. If she/he managed to escape, where did she /he escape to and in what year?

11. Did she/he spend any time in a displaced persons’ camp? If yes, where was the camp and how long was she/he there (in months and years)?

12. To the best of your knowledge was she/he the sole survivor of her/his family?

13. If other members of her family survived, was she/he always with at least one of them during the war?


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Demographic Questionnaire for Grandchildren of Holocaust Survivors

1. Date of birth. (Date/Month/Year) 2. Gender. 3. What is your first language/native tongue? 4. Country of birth. 5. Which country do you currently live in? 6. If you live in a different country to the one in which you were born, in what year did you move there?

7. If you have lived in other countries please list them and the years you moved there


9. What is your highest level of education? No formal education Elementary/Primary school or equivalent High school or equivalent Tertiary qualification (for example university or technical college) 10. Which religion do you currently associate yourself with? (mark an X next to the answer that applies and write “yes” if you actively practice your religion) Judaism Christianity Islam None (atheist) Other (please specify)

11. What are the dates of birth of your grandparents, parents and all your siblings? If they have passed away please note the date or year this occurred. Please note the details of any additional siblings in the page margin. Gender (for siblings) Date of Birth Maternal Grandmother Maternal Grandfather Paternal Grandmother Paternal Grandfather Mother Father Sibling One Sibling Two Sibling Three Sibling Four Sibling Five Sibling Six 12. Do you still live with your parents? If no, how old were you when you moved out?

13. Have/did your parents remain married or did they divorce/separate? Please note the year they separated.


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14. What is your marital status? Single (never married) Married Defacto Divorced / Separated Widowed 15. Which of your grandparents survived World War II in a country occupied by Nazi Germany? (mark an X next to all that apply) Maternal Grandmother Maternal Grandfather Paternal Grandmother Paternal Grandfather 16. Approximately how old were you when you first learnt about your grandparent/s’ wartime experiences? (write NA against any grandparent who is not a survivor) Maternal Grandmother Maternal Grandfather Paternal Grandmother Paternal Grandfather 17. Are you named after a relative who died in the Holocaust? If yes, who?

18. Are you a member of a descendants of survivors’ group/organisation? If yes, please give the name of the organisation and specify how long you have been a member (in years)

19. Have you had any significant traumatic events in your life? If yes, please specify




23. Have you ever had or are you currently in ongoing psychiatric or psychological therapy? Ever Currently Individual Group Both

If your parents or parent who is a child of survivors is not completing a questionnaire please complete the demographic questionnaire on their behalf. Likewise, if your survivor grandparent/s are not completing a questionnaire fill in a demographic questionnaire for them. Fill in one for each parent that is a child of a survivor and one for each grandparent who is a survivor. Please answer all questions that you are able to and write “don’t know” next to any that you are unsure about. These questionnaires can be found at the end of the booklet.


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Demographic Questionnaire for Child of Survivor Mother/Father (two of these were supplied – one for a child of survivor mother and one for a child of survivor father)

1. Date of birth. (Date/Month/Year) 2. Country of birth. 3. Was she/he born in a displaced persons camp? 4. What are the dates of birth of her/his parents and all her/his siblings? If they have passed away please note the date or year they died. Please note the details of any additional siblings in the page margin. Gender (for siblings) Date of Birth Mother Father Sibling One Sibling Two Sibling Three Sibling Four Sibling Five Sibling Six 5. Which of her/his parents survived World War II in a country occupied by Nazi Germany? Mother Father Both 6. If only one parent is a survivor, in what country was her/his non-survivor parent born?

7. If her/his non-survivor parent was born before the war, what country were they in during the war?

8. Did any of her/his grandparents survive the war? (mark an X against all that apply) Maternal grandmother Maternal grandfather Paternal grandmother Paternal grandfather 9. Is she/he named after a relative who died in the Holocaust? If yes, who?


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Demographic Questionnaire about Holocaust Survivor Grandparent (four of these were provided – one for each grandparent on maternal and paternal side)

1. Date of birth. (Date/Month/Year) 2. Country of birth. 3. When did your grandmother and grandfather get together? Before World War II During World War II After World War II 4. What country or countries was she/he in during the war (1939 to 1945)?

5. In what year did she first become subject to some form of persecution?

6. Which of the following do you feel best describes the reason for her/his persecution during the war? (mark an X next to all that apply) ethnic group, for example Jew, Gypsy (please specify)






7. This question asks you to nominate experiences your grandmother/father may have had during the war. For each please specify the amount of time in months and years that she/he was in the situation, the timeframe and the relatives that were with her/him at the time. Circumstance Years Months Timeframe










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Circumstance Years Months Timeframe


Subjected to medical experimentation (please specify where)


8. Where was she/he when she/he was liberated/freed at the end of the war?

9. How was she/he or who liberated her/him?

10. If she/he managed to escape, where did she /he escape to and in what year?

11. Did she/he spend any time in a displaced persons’ camp? If yes, where was the camp and how long was she/he there (in months and years)?

12. To the best of your knowledge was she/he the sole survivor of her family?

13. If other members of her family survived, was she/he always with at least one of them during the war?


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Appendix X – Intercorrelations between Psychological Impact Variables within the Empirical Study Sample

Table AX.1. Correlation Matrix of Psychological Impact Variables for Holocaust Survivors DASS-A DASS-D PTV IES-I IES-A IES-H AAS-D AAS-C DASS-A x DASS-D 0.76** x PTV 0.00 0.08 x IES-R-I 0.18 -0.03 0.39 # x IES-R-A 0.33 0.11 0.47* 0.85** x IES-R-H 0.60** 0.43 0.47* 0.71** 0.70** x AAS-D - 0.04 0.19 -0.46* - 0.07 - 0.03 - 0.03 x AAS-C 0.05 0.09 - 0.33 - 0.12 - 0.10 - 0.15 0.60** x AAS-A 0.02 - 0.23 - 0.16 -0.37 - 0.25 - 0.30 -0.41 - 0.25 Table AX.2. Correlation Matrix of Psychological Impact Variables for Children of Holocaust Survivors DASS-A DASS-D PTV AAS-D AAS-C DASS-A x DASS-D 0.52 *** x PTV 0.35 ** 0.33 ** x AAS-D -0.26 * -0.49 *** - 0.12 x AAS-C -0.33 ** -0.44 *** -0.25 * 0.55 *** x AAS-A 0.43 *** 0.48 *** 0.42 *** -0.35 ** -0.21 Table AX.3. Correlation Matrix of Psychological Impact Variables for Grandchildren of Holocaust Survivors DASS-A DASS-D PTV AAS-D AAS-C DASS-A x DASS-D -0.76 *** x PTV 0.61 ** 0.77 *** x AAS-D -0.45 * - 0.25 -0.39 * x AAS-C -0.33 - 0.12 - 0.28 0.75 *** x AAS-A - 0.13 0.08 0.09 - 0.20 -0.43 * Table Notes. DASS-A, & -D – Depression Anxiety and Stress Scale – Anxiety and Depression Subscales PTV – Post-traumatic Vulnerability Scale IES-R-I, -A & -H – Impact of Events Scale-Revised – Intrusion, Avoidance and Hyperarousal Subscales AAS-D, -C & -A – Adult Attachment Scale – Depend, Close and Anxiety Subscales * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30).


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Appendix Y – Intercorrelations between Influential Psychological Process Variables within the Empirical Study Sample Table AY.1. Correlation Matrix of Influential Psychological Process Variables for Holocaust Survivors A AC BD D ESS FVE H ISS MD P PRG R RC SCA SU WAS – B COPE – A x COPE – AC 0.06 x COPE – BD 0.45 * - 0.32 x COPE – D 0.06 - 0.03 0.34 x COPE – ESS 0.55 ** 0.23 0.09 - 0.11 x COPE – FVE 0.49 * 0.11 0.43 * 0.51 * 0.33 x COPE – H 0.21 0.61 ** 0.08 0.03 0.15 0.14 x COPE – ISS 0.28 0.68 *** - 0.27 0.06 0.67 *** 0.29 0.32 x COPE – MD - 0.03 - 0.13 0.04 0.33 0.16 0.12 - 0.01 0.09 x COPE – P 0.03 0.72 *** - 0.56 ** - 0.20 0.16 - 0.04 0.48 * 0.44 * - 0.25 x COPE – PRG - 0.10 0.68 *** - 0.47 * - 0.17 0.18 - 0.13 0.39 # 0.68 *** 0.02 0.60 ** x COPE – R 0.45 * 0.01 - 0.06 - 0.04 0.37 # 0.20 0.25 0.33 0.39 # - 0.05 0.09 x COPE – RC 0.35 # - 0.18 0.21 0.46 * 0.14 0.22 0.22 0.05 0.04 - 0.09 - 0.01 0.25 x COPE – SCA 0.25 0.44 * - 0.07 - 0.02 0.31 0.08 0.56 ** 0.49 * - 0.11 0.29 0.32 0.33 0.38 # x COPE – SU 0.02 - 0.07 0.11 0.27 - 0.18 - 0.04 - 0.05 - 0.01 - 0.08 - 0.35 - 0.12 0.03 0.18 0.09 x WAS – B - 0.09 - 0.45 * - 0.64 ** - 0.16 0.34 - 0.17 - 0.02 0.66 ** 0.30 0.22 0.66 ** 0.34 - 0.18 0.13 0.00 x WAS – M - 0.22 0.35 - 0.41 # 0.08 - 0.01 - 0.06 0.15 0.46 * 0.20 0.14 0.64 ** 0.44 * 0.14 0.25 0.24 0.55 ** Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, WAS = B = Assumption of world benevolence, M = Assumption of world meaningfulness * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30).


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Table AY.2. Correlation Matrix of Influential Psychological Process Variables for Children of Holocaust Survivors A AC BD D ESS FVE H ISS MD P PRG R RC SCA SU WAS – B COPE – A x COPE – AC 0.15 x COPE – BD 0.11 - 0.30 * x COPE – D - 0.05 - 0.12 0.21 x COPE – ESS 0.12 0.21 0.00 - 0.06 x COPE – FVE - 0.03 0.14 0.02 - 0.02 0.61 *** x COPE – H 0.17 0.31 ** 0.04 - 0.05 0.07 - 0.14 x COPE – ISS 0.16 0.43 *** - 0.00 - 0.11 0.79 *** 0.44 *** 0.28 * x COPE – MD 0.10 0.12 0.31 ** 0.25 * 0.23 0.22 0.18 0.33 ** x COPE – P 0.14 0.82 *** - 0.25 * - 0.16 0.41 *** 0.19 0.21 0.53 *** 0.16 x COPE – PRG 0.37 ** 0.46 *** - 0.16 - 0.09 0.25 * 0.01 0.35 ** 0.43 *** 0.14 0.42 *** x COPE – R 0.37 ** 0.23 0.12 0.18 0.11 - 0.09 0.18 0.21 0.08 0.22 0.27 * x COPE – RC 0.04 0.13 0.18 0.17 0.15 - 0.09 0.30 * 0.20 0.13 - 0.24 0.10 x COPE – SCA 0.19 0.51 *** - 0.08 - 0.00 0.27 * 0.20 0.19 0.45 *** 0.22 0.50 *** 0.29 * 0.25 * 0.08 x COPE – SU - 0.15 - 0.15 0.35 ** - 0.13 - 0.15 0.06 0.08 - 0.03 - 0.01 - 0.27 * - 0.31 * - 0.05 0.21 - 0.28 * x WAS – B 0.02 0.23 * - 0.26 * - 0.13 0.06 - 0.03 0.14 0.12 - 0.11 0.02 0.28 ** 0.07 0.09 0.13 - 0.02 x WAS – M - 0.19 - 0.03 - 0.13 0.23 0.04 - 0.11 0.06 0.04 - 0.05 0.01 0.04 0.16 0.23 0.04 0.04 0.33 ** Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, WAS = B = Assumption of world benevolence, M = Assumption of world meaningfulness * p < 0.05, ** p < 0.01, *** p < 0.001.


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Table AY.3. Correlation Matrix of Influential Psychological Process Variables for Grandchildren of Holocaust Survivors A AC BD D ESS FVE H ISS MD P PRG R RC SCA SU WAS – B COPE – A x COPE – AC 0.47 * x COPE – BD - 0.23 - 0.58 ** x COPE – D 0.05 0.01 0.33 # x COPE – ESS 0.21 0.35 # - 0.22 - 0.24 x COPE – FVE - 0.15 - 0.04 0.06 - 0.19 0.70 *** x COPE – H 0.14 0.10 0.35 # 0.38 * - 0.42 * - 0.31 x COPE – ISS 0.39 * 0.61 ** - 0.54 ** - 0.28 0.69 *** 0.34 # - 0.29 x COPE – MD 0.12 - 0.20 0.39 * 0.31 0.15 0.34 # 0.20 - 0.22 x COPE – P 0.61 ** 0.81 *** - 0.50 ** - 0.09 0.30 - 0.01 0.23 0.56 ** - 0.02 x COPE – PRG 0.59 ** 0.71 *** -0.37 # 0.15 0.14 - 0.19 0.08 0.38 * - 0.08 0.61 ** x COPE – R 0.33 # 0.27 0.07 0.34 # - 0.33 # - 0.27 0.56 ** - 0.09 0.31 0.35 # 0.29 x COPE – RC 0.33 # 0.09 - 0.14 0.23 0.21 0.04 - 0.19 0.03 0.39 * - 0.41 * 0.18 x COPE – SCA 0.61 ** 0.64 *** - 0.22 0.03 0.31 0.13 0.03 0.53 ** - 0.05 0.57 ** 0.51 ** 0.35 # 0.15 x COPE – SU 0.03 - 0.30 0.20 0.03 - 0.11 0.13 - 0.17 - 0.17 - 0.22 - 0.14 - 0.08 - 0.05 - 0.07 - 0.18 x WAS – B 0.06 0.37 # - 0.26 0.08 0.05 - 0.10 - 0.12 0.16 0.02 0.07 0.51 ** 0.05 0.24 0.14 0.00 x WAS – M - 0.04 0.41 * - 0.43 * 0.11 0.20 0.04 - 0.13 0.28 - 0.11 0.16 0.22 0.00 0.00 0.14 - 0.20 0.47 * Notes. COPE = A = Acceptance, AC = Active coping, BD = Behavioural disengagement, D = Denial, ESS = Use of emotional social support, FVE = Focus on and venting of emotions, H = Humour, ISS = Use of instrumental social support, MD = Mental disengagement, P = Planning, PRG = Positive reinterpretation and growth, R = Restraint, RC = Religious coping, SCA = Suppression of competing activities, SU = Substance use, WAS = B = Assumption of world benevolence, M = Assumption of world meaningfulness * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30).


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Appendix Z – Intercorrelations between Family Interaction/Trauma Transmission Variables within the Empirical Study Sample Table AZ.1. Correlation matrix of Family Interaction/Trauma Transmission Variables for Children of Holocaust Survivor Families of Origin (as rated by Children of Holocaust survivors) C E FA FFW FG FI MA MFW MG MI NV PFA-F PFA-M FA FC FW MA MC FES – C x FES – E 0.55 *** x HCQ – FA - 0.04 - 0.08 x HCQ – FFW 0.23 0.26 * - 0.16 x HCQ – FG - 0.18 - 0.08 0.09 0.10 x HCQ - FI 0.27 * 0.24 - 0.20 0.50 *** 0.09 x HCQ – MA - 0.24 - 0.20 0.03 0.14 - 0.05 - 0.07 x HCQ – MFW - 0.07 0.19 - 0.23 0.17 - 0.01 0.11 0.01 x HCQ – MG -0.40 ** - 0.26 * - 0.04 0.12 0.50 *** 0.15 0.12 0.14 x HCQ – MI - 0.01 0.21 - 0.41 ** 0.18 0.01 0.33 * 0.13 0.62 *** 0.16 x HCQ – NV - 0.17 - 0.12 0.04 0.15 0.24 0.30 * 0.01 0.10 0.34 * 0.12 x PAQ-PFA – F 0.49 *** 0.47 *** - 0.33 * 0.09 - 0.42 ** 0.15 - 0.03 0.27 - 0.38 ** 0.33 * - 0.15 x PAQ-PFA– M 0.55 *** 0.47 *** - 0.19 0.13 - 0.41 ** 0.09 - 0.15 0.19 - 0.55 *** 0.17 - 0.36 ** 0.60 *** x PCS – FA - 0.54 *** - 0.42 ** 0.25 - 0.12 0.11 - 0.14 0.07 - 0.17 0.04 - 0.25 - 0.12 - 0.59 *** - 0.29 * x PCS – FC - 0.58 *** - 0.31 * 0.10 - 0.37 ** 0.18 -- 0.22 - 0.13 - 0.16 0.17 - 0.19 0.02 - 0.62 *** - 0.36 ** 0.62 *** x PCS – FW 0.70 *** 0.52 *** - 0.16 0.18 - 0.33 * 0.13 - 0.05 0.10 - 0.32 * 0.12 - 0.10 0.69 *** 0.38 ** - 0.71 *** - 0.73 *** x PCS - MA - 0.63 *** - 0.42 *** - 0.10 - 0.19 0.17 - 0.02 0.01 - 0.14 0.46 *** - 0.02 0.26 * - 0.30 * - 0.69 *** 0.35 ** 0.35 ** - 0.38 ** x PCS – MC - 0.52 *** - 0.34 ** - 0.04 - 0.15 0.17 - 0.06 - 0.06 - 0.20 0.36 ** - 0.10 0.30 * - 0.44 *** - 0.55 *** 0.32 * 0.58 *** - 0.43 *** 0.58 *** x PCS – MW 0.65 *** 0.56 *** 0.04 0.18 - 0.16 0.03 0.01 0.24 - 0.41 ** 0.03 - 0.32 ** 0.43 *** 0.38 ** - 0.39 ** - 0.41 ** 0.57 *** - 0.81 *** - 0.70 *** Notes. FES-C, -E = Family Cohesion Scale Cohesion and Expressiveness Subscales, HCQ = Holocaust Communication Questionnaire (FA = Father affective, FFW = Father frequent and willing, FG = Father guilt-inducing, FI = Father indirect, MA = Mother affective, MFW = Mother frequent and willing, MG = Mother guilt-inducing, MI = Mother indirect, NV = Non-verbal) PAQ- PFA = Parental Attachment Questionnaire – Parental Fostering of Autonomy Subscale – Mother and Father, PCS-W, -C, -A = Parental Caregiving Style Questionnaire Warmth, Coldness and Ambivalence Subscales – Mother and Father * p < 0.05, ** p < 0.01, *** p < 0.001 Table AZ.2. Correlation matrix of Family Interaction/Trauma Transmission Variables for Grandchildren of Holocaust Survivor Families of Origin (as rated by Grandchildren of Holocaust survivors) FES – C FES – E PAQ-PFA – F PAQ-PFA– M PCS – FA PCS – FC PCS – FW PCS – MA PCS – MC FES – C x FES – E 0.14 x PAQ-PFA – F 0.29 0.35 # x PAQ-PFA– M 0.51 ** 0.27 0.65 *** x PCS – FA - 0.69 *** - 0.40 * - 0.49 * - 0.40 * x PCS – FC - 0.70 *** - 0.22 - 0.30 - 0.32 0.76 *** x PCS – FW 0.51 ** 0.33 0.51 ** 0.31 - 0.79 *** - 0.68 *** x PCS - MA - 0.70 *** - 0.41 * - 0.42 * - 0.73 *** 0.66 *** - 0.33 - 0.40 * x PCS – MC - 0.58 ** - 0.48 * - 0.29 - 0.62 *** 0.54 ** 0.41* - 0.42 * 0.77 *** x PCS – MW 0.55 ** 0.52 ** 0.41 * 0.75 *** - 0.62 ** - 0.39 * 0.50 ** - 0.85 *** - 0.87 *** Notes. FES-C, -E = Family Cohesion Scale Cohesion and Expressiveness Subscales, PAQ- PFA = Parental Attachment Questionnaire – Parental Fostering of Autonomy Subscale – Mother and Father, PCS-W, -C, -A = Parental Caregiving Style Questionnaire Warmth, Coldness and Ambivalence Subscales – Mother and Father * p < 0.05, ** p < 0.01, *** p < 0.001, # p < 0.10 (denoted only when n < 30).

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THE DIFFERENTIAL IMPACT OF HOLOCAUST TRAUMA ACROSS … · Holocaust survivors, and the differential intergenerational transmission of this trauma to survivors’ children and grandchildrenwere