Anselm Kiefer
Memoir: Carl Rosenkilde, MD, PhD
Education of a gentile on the history of the Holocaust
I grew up in Denmark, a nation that had been under
“friendly” German occupation during World War II.
The war ended 3 years before I was born. When my
fourth grade history teacher asked the class to vote
on whether a captured war criminal should be prosecuted,
I argued, perhaps from my Christian background,
that he should be freed and forgiven the sins
belonging to a distant past.
During medical training in the Bronx, I examined
an elderly patient who had a number tattooed on her
forearm. That first encounter with a Holocaust survivor
disturbed my sense of a period in history presumably
completed and best forgotten. Years later, I
became intensively involved with Holocaust patients,
and my understanding of history changed.
Wiedergutmachung, a German reparations program
initiated soon after the war, reimburses Holocaust
survivors whom German consulate doctors
have diagnosed with disabilities arising from persecution
during the National Socialist regime. Neurologists
usually did the early evaluations; apparently,
they were considered appropriate experts for conditions
that today are recognized as primarily psychiatric.
As a neurologist in the New York area who
could speak German, I was approached to evaluate
survivors.
In 1995, I started seeing two or three such patients
every month. I read voluminous medical
records, all in German, dating from the 1950s to the
present. Review boards in Germany had made “final”
decisions regarding level of compensation. My role
was to look for weaknesses in the original arguments,
identify any overlooked, related diagnosis or
exacerbation of the original condition, and submit
my conclusions for re-review.
I found an ally in time lapsed. There appeared to
be a new compassion, a “new morality.” New assistance
programs had been created. The definition of a
survivor had been revised. Diagnoses, too, had
changed with time.
It is absurd to believe that suffering can be measured
by duration or nature of torture. Nevertheless,
physicians in the past had concluded that a few
months spent in a concentration camp was insufficient
time to meet the threshold for suffering. No one
would dare to make that claim today. That a few
days in a camp counted as suffering, however, was
not universally endorsed.
It is difficult to ignore momentary horror that has
led to a lifetime of recurring memories. Various Holocaust
survivors told me what they had seen: children
being thrown out of an upstairs window into a
truck, a newborn being torn apart in front of the
mother and other inmates, a baby tossed into the air
and caught on a bayonet. Some repeatedly relived
their own near-execution, which had been aborted
for a variety of reasons—an air attack, a whim, the
interference of another soldier. Sometimes, the execution
had been formally completed, but the victim
had survived.
Many of the patients had lived in three or four
countries en route to the United States. These postwar
displacements also contributed to Holocaust suffering.
Emigrants needed to learn new languages
late in life. They were penniless and had no education
of use. The jobs they could find, such as custodian
or dressmaker, required little education and
were poorly paid. One survivor had 13 different jobs
in just a few years because he was unable to take
orders. Some began to receive disability compensation
after a few years in the United States.
Many passed through Auschwitz. They were selected
for survival because of their youth and
strength. Many more perished because they were
slightly too old or too young. As a result, the age
range of most survivors I have examined is narrow
and surprisingly low—68 to 76 years of age. The
youngest was nearly of my own generation and
brought “history” uncomfortably close. He had no
Holocaust memories at all but had been repeatedly
displaced, finally arriving in the United States to
start elementary school at age 13.
From concentration camps now familiar to us, survivors
were sent for slave labor at sites whose names
mean nothing to us today. Often, even they did not
know where they worked. Many recall the death
marches from camp to camp when the approach of
allied forces led to evacuation of inmates. Many perished
from exhaustion, exposure, or execution on the
roadside. After liberation, some stayed in camps as
displaced persons. Some became relatively independent
in cities while awaiting permission to emigrate.
When they returned to their hometowns, they found
few or no family members.
I ask, “How did you survive?” The question triggers
concrete answers: “I was tall for my age.” “I was
told not to hold my child.” “I was blonde and did not
look Jewish; I pinched my cheeks and looked good.”
“A supervisor at work liked me and gave me extra
food.” “Mom wanted me to and she protected me.”
“Eating as much grass as I could find, like the cows.”
On a death march, the brother of a survivor dragged
him and punched him in the nose when he gave up
and wanted to die.
Less frequently, the answer is philosophical or religious
in tenor: “God wanted it.” “To be punished for
surviving.” “To tell about it.”
Sometimes it is a bewildered “I don’t know,” or an
agitated wail: “Why, why, why? . . . I cannot understand
why. . .. It would have been better to have
been shot.”
Surviving the Holocaust with a recognized disability
did not always involve a stay in a concentration
camp. Sarah A. (all names have been changed) was
13 when German forces occupied Poland in 1939.
She escaped the ghetto and hid with her father and a
sister for 21⁄2 years. Her father dug caves in the
woods and found food meant for farm animals. When
he returned to their hometown and tried to reclaim
their house, land, and property, his neighbors killed
him. The children fled again. The patient survived
by eating leaves, stealing chicken feed, and drinking
from brooks. Entertainment was “counting lice.”
Consulate physicians agreed that Sarah had a
mild disability related to persecution. They based a
diagnosis of developmental personality disorder on
loss of parents, separation from family, and living
under inhumane conditions during critical developmental
periods in childhood and adolescence. Later
in life, Sarah developed an obsessive-compulsive syndrome
with excessive attention to details, circumstantial
speech, and intolerance of deviations from
usual habits.
For some Holocaust victims, seemingly good deeds
proved illusory. At times, protectors were abusers
and Samaritans proved to be hypocrites. The Savior
may have been Lucifer in disguise.
As a young girl, Anna B. avoided deportation to a
concentration camp. She survived in the basement of
a gentile family that risked their lives by hiding her.
I was the first person to whom she revealed that she
was required to provide sexual favors for the head of
the household, her savior.
Maria C. was not permitted to attend school after
1938, when she was 10. Her father was deported to
Auschwitz, and the family was scattered. At 14, she
was briefly placed in hiding in a French brothel but
would not cooperate with her saviors. She found
compassionate refuge in a convent. Now, she attends
synagogue only on the High Holy Days because she
has “lost faith.”
Maria cries daily and “cannot be with people.”
Fear incarcerates her in her own home. She has
nightmares about her father and wonders, over and
over, “Where did he burn? Which oven?” She cannot
pass a Catholic church without praying not to burn
in Hell. Notions of crematoria and Hell have fused.
Indeed, she now lives in a hell.
Holocaust medicine was not “evidence-based.”
Most patients were evaluated in the 1950s and
1960s. Some diagnoses established then, such as
neurasthenia and migrainous personality disorder,
are now considered inappropriate or obsolete. Others
have no simple translation. It is common to find quotations
from Goethe and Schiller in the conclusions.
Subtle physical evidence of a vegetative disorder—
eyelid and hand tremors, skin irritability, sweaty
palms—was regarded as significant. Duodenal ulcer,
hypertension, asthma, and eczema were often considered
to be related to persecution. Even if patients
had suffered extensive persecution, reporting a normal
mental status, mood, and affect was invariably
unfavorable to their applications for compensation.
Physicians who detected symptom embellishment
and magnification sometimes rejected applications.
Debate ensued, with reconsideration of hysteria as
consistent with the applicant’s diagnosis related to
persecution. The doctors who denied disability
claims were not necessarily callous or insensitive;
they were trying to reach conclusions that made
sense in the framework of their time.
Clara D.’s application was initially rejected because
of her diagnosis: “constitutional psychoneurotic
reactions” in a patient with “affect-labile
personality type.” She discontinued her education at
age 16 because of racial persecution and was incarcerated
in April 1944, when she was 18. After a short
stay in Auschwitz, she worked 12-hour shifts in an
ammunition factory for 9 months. At least once, she
was battered severely on the head and suffered a
loss of consciousness. After the war she was treated
for “exhaustion.” No other family members survived.
Clara is moody, suffers from insomnia and nightmares,
and has numerous psychosomatic complaints.
Her headaches last throughout every day. They become
worse with her increasingly frequent Holocaust
memories. There are no other triggers. She does not
abuse pain medications; she finds them ineffective. A
Mini-Mental State Examination is abnormal, with
impaired short-term memory, calculations, and copying
of a geometric figure.
The final diagnosis came from a physician who
had never seen her: migraine in a woman with migrainous
personality disorder. He rejected organic
brain syndrome because of normal skull radiographs
and neurologic examination. He also stated that her
Holocaust experiences were less intense and of
shorter duration “than usually seen.”
A contemporary diagnosis is still not simple to
make: her headaches have tension and vascular features.
Brain imaging studies are not available, but
there is evidence of a mild organic brain syndrome.
The concept of migrainous personality has disappeared
from most current textbooks and the Diagnostic
and Statistical Manual of Mental Disorders.
No clear relationship exists between migraine and
neurosis.
I submit a diagnosis of post-traumatic stress disorder
associated with anxiety, depression, and
chronic headaches, perhaps related in part to head
injury, with a significant disability from persecution
since 1945.
Rather than magnifying symptoms, some patients
de-emphasize them. Mark F. was a slave laborer in a
coal mine. When the handle of his shovel broke, he
asked for a new shovel and got it, but at roll call
after work, his number was called: he was to be
executed for sabotage. When he stepped forward and
kneeled down in semidarkness, the gunshot hit his
shoulder, not his head. He pretended to be dead and
was later treated in the infirmary. He praises the
work of the physicians—including a smiling Dr.
Mengele!—who saved him. Despite severe pain and
weakness of the right shoulder, he was able to return
to work. He learned “not to show fear,” “to bite my
lips,” and “never to ask or beg.” He survived by
learning emotional withdrawal and denial of emotions
incompatible with survival.
Still a tall, strong, highly intelligent, articulate
man, Mark seems unable to express any emotions.
He smilingly describes his execution and other narrow
escapes from death. He says, “It is a funny
thing” when reporting profoundly disturbing experiences.
His voice stays cheerful and calm. He never
expected kindness from government agencies and
was content with a disability based on a chronic
shoulder injury.
My examination shows nerve injury never diagnosed
in the past. His tinnitus, hearing loss, and
recurring vertigo may be related to previous head
trauma. Surprisingly, developmental personality aberration
and post-traumatic stress disorder have
gone unrecognized. He had never reported the “crying
inside,” the nightmares. A neurologist or psychiatrist
had never evaluated him. The shoulder “was
it.” He “didn’t like to complain,” having learned under
threat of death not to. He has not helped his
compensation case by underreporting his symptoms.
Survivors with traumatic brain injury, often also
diagnosed with epilepsy, have done particularly
poorly. They have had menial jobs, broken marriages,
and poor relationships with their children.
They have withdrawn from religion, have had few or
no friends, and are maladjusted, agitated, and angry.
They exhibit mild dementia and spells of various
types. Their complaints include pains, aches, dizziness,
visual disturbances, ringing in the ears, and
hearing problems that worsen at a faster rate than is
commonly seen in concentration camp survivors.
My recommendations for increased compensation
are fairly straightforward, particularly when the patients
have longstanding focal neurologic deficits and
abnormal EEGs. MRI or CT studies were not available
during the initial assessments and are not easy
to justify now.
My appointments with survivors usually last an
hour and a half. It is difficult to maintain composure
when patients start to cry, as they often do. Dictating
the reports in private often triggers an ineffable
sadness. I, too, have had nightmares of being executed,
being pursued, and living in hiding. This was
for me a new kind of syndrome by proxy, a vicarious
or virtual Holocaust experience. Such secondary syndromes
are common and well known in the children
of survivors.
So many survivors grew up without parental guidance,
without role models, and without having experienced
love during formative years. As parents
themselves, they do not know what parenting involves.
There are numerous examples of disrupted
family contacts with complete alienation.
Holocaust survivors show different types of deterioration
with aging, likely related to past abuses. Dementia,
pseudodementia, movement disorders, and
obsessive-compulsive syndrome develop frequently,
perhaps as late consequences of head injury, beatings,
severe nutritional deficiencies, starvation, extremes
of temperature, exposure to chemicals, or
some combination of these.
Ella G., who is only 69, locks her door “a hundred
times every day.” She is afraid that someone may
come and kill her. She has no surviving family members.
Her husband has divorced her. She joins in no
gatherings other than during synagogue. Intrusive
memories have replaced any feelings of happiness: a
soldier at Auschwitz promised a piece of bread to
whoever could catch his hat in the air. The Jewish
girl who “won” was shot in the head and died. Ella is
“a prisoner of those memories. The older I get, the
worse it gets.” She is amazed that, nevertheless, her
body is “as strong as iron.”
Adam H. has never eaten in a restaurant. He believes
that someone may spit in the soup. He does
not eat salami, fearing that “somebody may have
urinated on the meat.” His wife cooks everything
from basic ingredients.
Teresa I., 86, has been evaluated for involuntary
compulsive movements diagnosed as part of an agitated
depression. She constantly rearranges objects
in the house. Every morning, she spends 2 hours
cleaning the bathroom and washing her hands. She
frequently interrupts my neurologic examination by
involuntary rocking, keeping her head between her
knees. Her intellectual ability is normal. She erupts
in crying spells when we touch on matters concerning
her perished family.
Herbert J., only 72, wanders back and forth in my
office, mumbling confusedly. Was he hit in the head?
“Yes.” Did he pass out? “Yes.” He recalls names of
the camps. He becomes increasingly upset when I
use my reflex hammer. During sensory testing with
a safety pin, he starts to cry.
Does living in constant fear and witnessing executions
predispose to dementia? Does post-traumatic
stress disorder lead in time to movement disorders,
compulsions, and obsessions?
I do not offer therapeutic options for the survivors.
I am not their treating physician. Antidepressants
and antianxiety medications had already been prescribed
and nearly always discontinued. There is no
drug treatment for loss of the sense of trust and
safety.
These patients have often told me what they never
before had shared with anyone. The telling may have
helped. My “treatments,” though, are recommendations
for increases in disability payments. Although I
try to be objective, there have been just two instances
in which I suggested no increase in level of
disability. One survivor, back from his honeymoon,
brought along his new wife and a happy, tanned
face. I felt guilty, describing his joys and excellent
adjustment.
My Holocaust records are piled in my attic. They
do not need to be alphabetized. The patients do not
call for refills; they do not ask for transfer of records;
there are no insurance issues. The pile grows more
slowly, by only two cases last year. The new moralism
has undoubtedly played a role. Perhaps the German
government has decided to increase payments
to most or all remaining survivors, avoiding red tape.
A stressful trip to face an authority figure and relive
past suffering may no longer be necessary. Or perhaps
I was found not sufficiently impartial. Certainly,
there are fewer survivors, fewer applications.
I have never once received feedback on my consultations.
No one told me to write more or less. No one
said that I may have misunderstood a judgment from
the past or that a particular issue was not well addressed.
My calls to the consulate never led to information
about an outcome. Final decisions are made
by local courts in Germany and not transmitted
back.
My early, ignorant ideas about “distant” historical
atrocities have changed. History, I discovered,
does not consist of discrete events detached from
the present. It has not ended. It is continuous and
in progress. History is also living, suffering people,
both the survivors and the children shaped in their
image.
My ideas about the perpetrators of crimes committed
in the name of fatherland, religion, or race have
also changed. My Christian upbringing tells me to
forgive: if anyone smites me on my right cheek, I
should turn the other to him also; I should “resist not
evil.” I cannot forgive any war criminal. I shall resist
evil.
Survivors’ memories become distorted, fade, and
vanish. I am trying to remember. I need to recognize
the self-serving savior and the smile of evil—to do
what I can to prevent the repetition of atrocity.
These victims must never be forgotten.
Acknowledgment
Dedicated to Elie Wiesel, who has helped us all remember.
Profound thanks to Orly Avitzur, MD, MBA, who insisted that I write
this essay.
April (2 of 2) 2004 NEUROLOGY 62 1449-1451
Downloaded from www.neurology.org by CARL ROSENKILDE on April 23, 2011
All pictures are by Anselm Kiefer. He has not approved their use in this piece
about the Holocaust.
