- Deutschsprachige Gesellschaft für Psychotraumatologie e.V [DeGPT].
German Society for Psychotraumatology
URL http://www.degpt.de/
VIVO
Headquarter "Eremo delle Grotte"
Casella Postale no 17
Castelplanio Stazione
Regione Marche
60032 Ancona
Italy
Phone +49 (172) 635-7359 (English, German)
Phone +39 (335) 610-3475 (Italian)
Email info@vivo.net
URL http://www.vivofoundation.net/index.php
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Margarethe Schauer and Thomas Elbert, Konstanz
Traumatization following organized violence and genocide A report on the third annual meeting of the German Society for Psychotraumatology [DeGPT], April 27-29, 2001, University of Konstanz
Pre-convention symposium "Survivors of the Holocaust – late life effects of prior psychotrauma", April 27th, Center for Psychiatry, Reichenau, Germany
Launched and Organized by
VIVO Foundation, Italy.
The Scientific and Organizing Committee of the 3rd Annual Meeting of the German Society for Psychotraumatology was headed by the Psychotraumatology Working Group of the Clinical and Behavioral Neuroscience Unit at the University of Konstanz, Prof. Thomas Elbert and Prof. Brigitte Rockstroh.
The scientific advisory board consisted of the following international experts:
Anke Ehlers, Oxford, United Kingdom
Ulrike Ehlert, Zürich, Switzerland
Friedhelm Lamprecht, Hannover, Germany
Peter Lang, Gainesville FL, USA
Brigitte Lueger-Schuster, Wien, Austria
Andreas Maercker, Dresden, Germany
Walton T. Roth, Stanford, CA, USA
Harald Freyberger, Greifswald, Germany
In response to the invitation to host this years Annual Meeting of the German Speaking Society (Germany/Switzerland/Austria), the working group on psychotraumatology at the University of Konstanz explicitly focused on the topic of traumatization following organized violence and genocide. The scientific committee decided to tackle the psychological impact and consequences of the genocidal war during the Nazi Regime, as well as the current incidences of state sponsored violence. Many of the invited lectures and other conference contributions were dedicated to this topic.
A special full day symposium on the psychological consequences of the Nazi-Holocaust opened the conference. Since bridging the gap between scientific knowledge and practical intervention is one of the main goals of the symposium’s co-organizer, the NGO VIVO, the hosts wanted to provide a platform for discourse and exchange not only between scientists, but amongst the entire field of experts concerned with psychotrauma. Researchers, practitioners and professionals working with traumatized people and their families were invited to participate in this three-day meeting. As a special guest, VIVO invited Inger Agger from Denmark, one of the rare experts who combine science and field work on traumatic stress. Inger Agger gave in her lecture "therapeutic challenges in the aftermath of war and political violence" a provoking and sound overview on the state-of-the-art of current psychosocial interventions and their weaknesses. In the symposium "traumatization following war, terror and persecution" (chaired by: Frank Neuner & Maggie Schauer, University of Konstanz) a wide range of data were presented on the scope and nature of traumatization and suffering of civilians, gathered in post-war communities, i.e. Former Yugoslavia, World War II refugees, survivors of organized violence from different African countries. The presentations also compared the usefulness of different treatment approaches. Even though, the DeGPT society’s members are mainly experts in the field of clinical psychology and psychopathology, the discussion highlighted that their investigations and treatment efforts to help survivors of genocide, imperatively demands to incorporate issues of human rights, culture and the current political context. Collective recognition of human rights violations that members of a persecuted group have experienced is vital, as is the regaining of personal dignity and satisfaction of the need for justice.
A main challenge for the young German Society for Psychotraumatology was however to get past the threshold of silence in relation to the discussion on psychopathology as a late life effect of the holocaust experience. At the pre-convention symposium, which was entirely dedicated to the survivors of the holocaust and their problems in late-life, the organizers of the Holocaust-symposium (Thomas Elbert, University Konstanz, & Maggie Schauer, Vivo) gave a brief introduction, placing the Holocaust experience in a broader frame of organized violence and ethnic cleansing, when giving an overview on the topic of psychotrauma and posttraumatic stress disorder: "psychological consequences of genocide". Leaving the center stage to expert survivors, learning from their autobiographical traumatic experiences and their post-traumatic growth, not talking about, but instead talking with survivors, was the most important goal of the symposium.
Margot Wicki-Schwarzschild a survivor of Camp de Gurs and deported at age 9, is today a psychiatric nurse by profession and a mother of a deeply affected "second generation" child. She gave an impressive account of her own suffering and how her experiences in the concentration camp have impacted her later life. Matei Gall, a Romanian survivor of the concentration camp Wapniarka, likewise reported his most terrifying and victimizing life-events during Nazi- and Communist persecution. Mr. Gall quoted from his autobiography called "Finsternis" (Darkness) with clarity and openness. He neither hid the feelings he experienced during the traumatic events, nor the intrusive symptoms he and other peer-victims suffered later in life. The fact, that a survivor of the Holocaust genocide, without clinical or psychological intentions or interests, frankly and unwavering spoke out at the conference, naturally seems to stop the dispute of psychological practitioners on whether describing severe symptoms as a consequence of traumatic exposure is harmful and stigmatizing to survivors. Unintentionally, Matei Gall’s contribution directly targeted the often-present dilemma of clinicians, and the past failures of dealing systematically and scientifically with the psychological long-term effects of the Holocaust.
As expected, the conference discussion then entered the currently ongoing debate on the "medicalization" of the survivor’s response. Although, the posttraumatic symptomatology (e.g. intrusive re-experiencing, somatization following chronic hyperarousal, immense avoidance efforts including cognitive avoidance and dissociation, depression and suicidal ideation) was first described as "survivor syndrome" or "lager syndrome" in individuals persecuted by the Nazis and imprisoned in concentration- and extermination-camps, the documented descriptions of problems decreased dramatically when the syndrome in the 1980’s was included in the diagnostic manual (DSM) as "posttraumatic stress disorder". In respect to the man-made atrocities experienced by the holocaust survivors, labeling their suffering as a disorder was felt as undermining the person’s dignity. Inherited guilt, shame and the experience of carrying great responsibility led to a paralysis of the German speaking clinicians when dealing with holocaust survivors. However, the alleged "protection" of the victim’s feelings, when avoiding to care for and work with holocaust survivors like any other clients created a new form of conspiracy of silence. Rarely the survivors wish to stay silent; fact is that often there is nobody who listens, nobody who facilitates disclosure. Even psychotherapists turn(ed) away shocked. Due to the horrifying effect of their emotional experiences and the political sensitivity of this sphere, survivors of genocide and their wounds (gr. trauma) are still neglected. The discussion around "minimizing by medicalizing" and the accusation of exporting western clinical concepts to developing countries and arenas of war, namely to avoid universal definitions of the problems as symptoms and to avoid cross-cultural scientific investigations, may be nothing else than a modern way of denial. In contrast, a growing body of evidence is amounting, that when it comes to being terrified and helpless during the experiencing or the witnessing of a life-threatening horror, human response is unified across cultures and independent from religion, ethnic group or geographical home. More and more, recent scientific literature shows, that there are considerable similarities and consistencies in the clinical manifestations of psychopathology across different genocide survivor groups, consistencies that outweigh cultural and ethnic differences.
Jürgen Matthäus from the United States Holocaust Memorial in Washington, USA, summarized in his invited lecture the types of trauma suffered by the Holocaust victims during World War II. He gave a detailed overview from a historical point of view, linking personal suffering to a collective and present perspective. Comprehensively breaking down the different forms of traumatizations along the time-line in a chronological and qualitative way, helped the audience’s recollection and raised awareness to look at the entire picture of persecution, terror, humiliation and loss rather than the abstract concept of a traumatic event.
Zahava Solomon, invited from VIVO as a guest speaker at the symposium from the University of Tel Aviv, Israel, whose scientific investigations are dedicated since decades to the psychological consequences of the holocaust experience congratulated the meeting for it’s braveness to expose itself to possible criticism, when including this topic in the convention agenda. She explained, citing from her studies, that survivors are at a high risk to develop chronic, delayed and reactivated PTSD, complex PTSD, physical diseases, accelerated aging and that they have a heightened vulnerability to stress. In elderly survivors the natural reviewing process of one’s life, the many losses suffered, the retirement from profession and the deterioration of health can amount in a severe crisis. Illness in Holocaust survivors reactivates worthlessness, helplessness and fear of annihilation, as Solomon pointed out. The aging survivors on the other hand sometimes manage for the first time to overcome avoidance and denial, to recognize and accept their traumatic experiences. Only in late life victims often mourn their losses, this may bring symptoms to the surface. When confronted with war threats again, Holocaust survivors perceive higher levels of danger, experience more emotional distress, and have higher levels of both trait and state anxiety than the elderly without Holocaust background.
Andreas Kruse, United Nations Advisor and Program Consultant for questions related to Elderly, confirmed the U-shape of survivor’s responses. The invited gerontologist from the University of Heidelberg, Germany, presented data showing that all 248 interviewed Holocaust survivors, either having been refugees or been imprisoned in concentration and extermination camps, show spontaneous intrusive recollections as well as repeated states of fear and anxiety throughout life. Many survivors however show as well remarkable adaptive and re-integrative capacities, good social and family functioning and high socioeconomic achievements. Nevertheless, intensity of traumatic re-experiencing peaks in the late-life of both groups. Several factors responsible were discussed, like finiteness of life and memory processes. One third of the survivors reported significant post-traumatic growth, striving for a positive attitude and outlook on life, even if forgetting and healing did never happen, and was not facilitated, as most of the interviewees state.
The subsequent contributor from the University of Vienna tried to reason about this problem of how to help aging survivors. Brigitte Lueger-Schuster gave a very personal report on her project and her experiences with psychotherapeutic care of Holocaust survivors living in exile in their late life.
Andreas Maercker, the current President of the DeGPT from University of Dresden, reaching in his talk beyond World War II into the time of political terror in East Germany, finished off the symposium day with a presentation. Maercker concluded the evening with a summary plenary lecture on "psychotraumatology and posttraumatic stress disorder (PTSD) research – standards and perspectives". A plenum discussion chaired by Walton Tom Roth from the University of Stanford left the opportunity to ask questions to all the invited speakers of the day.
In the following two days the conference attendees gathered in symposia, listened to special lectures and discussed findings. International guests, each with a relevant special expertise in his/her different area were invited to supplement the scientific findings of the German speaking researchers and to open links with global work in the field.
Other contributions of this year’s meeting focused mainly on the following four areas and were integrated in corresponding symposia:
1. An urgent need was seen to discuss the special assessment and treatment needs of traumatized children (chaired by: Regine Steil, University of Jena, & Gudrun Sartory, University of Wuppertal). Predictors for PTSD in children, cognitive variables, parental behavior and the impact on the family as well as societal level were discussed, highlighted by an invited lecture from William Yule (University of London), who spoke about "PTSD in children and adolescents – it’s recognition and treatment", focusing on the developmental changes seen in young survivors as well as new treatment protocols for children after war and natural disasters.
2. A main area of research for the medical and paramedical staff was crisis interventions during acute stress (Chair: Arne Hofmann, University Köln) the risk factors, treatment implications and rehabilitative questions surrounding the care for survivors of life-threatening accidents, especially when accompanied by a substantial brain damage (Chair: Guido Flatten, University Clinic Aachen). Research efforts are directed here towards a better separability of somatic and psychic factors, since outcomes in this psychotrauma field are always confounded by a structural body and or brain damage and a physical handicap following the traumatic event.
3. The topic of traumatic life-experiences of psychiatric inpatients (Chaired by: Brigitte Rockstroh, University of Konstanz, & Klaus Hoffmann, Center for Psychiatry, Reichenau) i.e. the causal relationship between early traumatization and later outbreak of a psychopathology, a field that was for a long time neglected in the psychiatric care, has now been successfully approached in this meeting. The new findings demonstrate that patients with personality disorders, substance abuse and forensic patients show much higher traumatic incidents, i.e. emotional and physical abuse in their late childhood. Other papers presented data on the connection between life-events followed by severe depressive episodes and considerations on diagnostic and treatment implications when traumatic events are present in the biography of inpatients suffering from borderline disorder, schizophrenia or other psychosis. Multi-faceted approaches that integrate psychiatric medical care and trauma specific psychotherapeutic interventions were generally acknowledged. Finally a special symposium focused on in-patient treatment models of trauma-survivors (Chair: Ulrich Frommberger, Clinic for Psychiatry, Offenburg).
4. Psycho-physiologic and behavioral neuroscience findings of the German speaking researchers’ were presented in the symposium on neurobiology of posttraumatic stress disorder (Chaired by: Ulrike Ehlert, University of Zürich, & Michael Kellner, University of Hamburg). Attendees and contributors worked on the questions related to psychobiologic etiology, vulnerability and resilience towards developing PTSD as well as psychoendocrinologic changes after traumatic life events and persecution and peripheral psychophysiologic measures as determinants of treatment success. Frauke Teegen (University of Hamburg) chaired a session on "specific groups at high risk for PTSD".
The high impact, the aftermath and the most successful treatment approaches during and after natural disasters were demonstrated in an invited lecture given by Metin Basoglu from Istanbul, Turkey. Basoglu gave an extensive and provocative survey summarizing a series of investigations in the treatment and assessment of earthquake survivors. Survivors in disaster regions were screened finding a 47 percent prevalence of PTSD and 33 percent of major depression. The group around Basoglu successfully developed a brief psychological treatment based on cognitive behavioral principles, with interesting implications for mental health care delivery services in the aftermath of major disasters.
The Third Annual Meeting of the German Society for Psychotraumatology (DeGPT) finished successfully, leaving the organizers and hopefully also all attendees with a sense of satisfaction for having opened up new areas for further discussion and research and at the same time being able to confirm common findings in the research of traumatic stress.
We would like to explicitly thank GERO Switzerland e.V. (Gerontological Economic Research Organization: http://www.gero.org/index.htm) for the support and scientific cooperation.
We would furthermore like to express our gratefulness and share the success of the conference with
-E. Schauer, the Executive Director of VIVO (http://www.vivo.net) for the substantial contribution and input to the scientific agenda;
-the scientific and organizing committee, headed by B. Rockstroh and F. Neuner for contributing with their expert knowledge on clinical psychology and psychotrauma;
-the organizing team at the Center for Psychiatry, Reichenau (http://zpr.uni-konstanz.de/), headed by W. Klimm, doing the utmost for making sure that things run smoothly.
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Short biographical note
Dr. Maggie Schauer is a Clinical Psychologist specialized in the field of Psychotraumatology and Post-traumatic Stress Disorder (PTSD). She has worked both, in research and clinical settings (university &rehabilitation) and in field missions in disaster areas. The latter includes work in Macedonia during the Kosovo crisis and scientific studies in Uganda with Sudanese refugees. Currently she is working as a Clinical Psychologist and Researcher at the University of Konstanz, Germany where she cooperates in projects investigating possible treatments for survivors of extreme and/or prolonged stress (e.g. after torture, genocide, childhood sexual abuse) and forensic populations. Furthermore she is working as a Research Associate at the Fear and Anxiety Clinic of the National Institute of Mental Health (NIMH) of the University of Florida in Gainesville, USA, investigating PTSD. Maggie Schauer is heading the scientific committee of the international Organization for Psychotraumatology VIVO.
Dr. Thomas Elbert is Full Professor for Clinical Psychology, Behavioral Neuroscience and Biomagnetism at the University of Konstanz. Holding a national (Thomas Elbert is a member of the German Academy of Science/Berlin) and international reputation in the field of behavioral neuroscience, having published more than 200 papers, with a substantial number in high-wire journals such as Science, Nature and PNAS, he is heading the Psychotraumatology Unit at the University Konstanz.
Dr. Maggie Schauer
Director of the Scientific Committee VIVO
Email Maggie.schauer@vivo.net
and
Department of Psychology
University Konstanz
Fach D-25
78457 Konstanz
Germany
URL http://www.clinical-psychology.uni-konstanz.de/
Email Margarete.Schauer@uni-konstanz.de
Mobile +49 (172) 6357359
Fax. +49 (7531) 88-2891
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Citation Maggie Schauer & Thomas Elbert, Traumatization following organized violence and genocide. Report on the third annual meeting of the German Society for Psychotraumatology [DeGPT], April 27-29, 2001, University of Konstanz . In: TRN-Newsletter 2, Hamburg Institute for Social Research, June 2004.
URL http://www.TraumaResearch.net/net2/confrep2/schauer.htm
Copyright © 2004, Maggie Schauer, Thomas Elbert and TRN-Newsletter, all rights reserved. This work may be copied for non-profit educational use if proper credit is given to the author and the trauma newsletter. For other permission questions, please contact via email the editor Cornelia.Berens@his-online.de
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