Videotestimony Study of Chronically Hospitalized Holocaust Survivors in Psychiatric Institutions in Israel

–Phase II–

An Interdisciplinary In-depth Analysis of the Videotestimonies Obtained in Phase I

Theoretical Considerations

This is the first in depth study ever conducted with a group of severely traumatized patients who had been chronically hospitalized in psychiatric facilities. The application of extensive psychiatric and psychological testing, of the videotestimony intervention, of qualitative interdisciplinary evaluation and formulation and of content analysis is also most likely a first time occurrence in this population. Psychoanalytic theory and psychoanalytic listening are the bedrock from which both the research questions will be adapted and research methodologies shall flow. The significance of this study lies not only in developing, adapting and testing new methodologies but also in the scientific and clinical questions it addresses such as the relation between trauma and psychosis, the differential diagnosis between traumatic psychosis and schizophrenia and the efficacy of videotestimonies as a treatment intervention. 

Phase II

Phase II of this study will move beyond the traditional clinical and psychiatric research perspectives in an attempt to widen the scope of the entire project by opening the clinical study of Phase I to other disciplines, such as social sciences and cultural studies. We postulate (drawing again on psychoanalytic theory) that the major historical cataclysmic events of the twentieth century (World War, Genocide) create a tear in the social link between people (Davoine / Gaudillière) – on an intra-psychic, familial, communal and societal level. This tear is so fundamental that it precludes its own representation, through processes of symbolization, speech and narrative formation, which are predicated on the intactness of the social link and on the intra- and interpersonal dialogue the social link engenders. As a consequence of massive historical trauma representation is replaced by erasure, by an absence of experience and of narrative, and ultimately by silence. As we look in the Holocaust survivors who participated in this study, at the most severe (living) psychological casualties of genocide, the question arises whether they represent the ultimate in such erasure of experience and narrative, the extreme on the spectrum of speechlessness and silence. To asses the extent and evaluate the specific nature of such erasure, to grasp its phenomenology and detect the behaviors in which it manifests itself in the audiovisual texts of the testimonies, experts from disciplines other then psychiatry will be brought in to create research perspectives and to apply methodologies from their respective disciplines, best suited to describe and measure these phenomena.

Research Methodology

The research modus of Phase II will be interdisciplinary, drawing on a variety of content analysis techniques developed in the fields of psychoanalysis, social science and cultural studies. The project will likely draw on several sub-disciplines such as speech pathology, linguistics and media analysis. It will include an analysis of the non-verbal communication of the interviewees. What follows is the description of several studies already underway or in their planning stage.

Since September 2006, a group of German psychoanalysts affiliated with the Sigmund Freud Institut (Frankfurt a.M.) and Kassel University- Drs. Marianne Leuzinger, Andreas Hamburger and Werner Bohleber, have been working on developing a clinical conceptual research model for the study of the phenomenology of traumatic psychosis that can be applied to the video testimonies of the chronically hospitalized Holocaust survivors. The next meeting of the work took place on March 9-11, 2007 in Frankfurt a.M. Germany.

Through the participation of the Sigmund Freud Institut and of Kassel University, a systematic analysis of the video testimonies obtained in Phase I, based on a psychoanalytic group rating design, will be accomplished. We will address the question: How do trauma and psychosis interrelate 1) in the context of the traumatically inhibited processes of narrativization of life histories and 2) in the transference distortion of the diagnostic- therapeutic relationship created in the testimony. This research is aimed to shed light as well on the problem of the origination of the traumatic psychosis and that of the chronicity of its endurance.

An accompanying meta-analytic literature research will lead to the formulation of a comparative research design that will include a control group in Israel composed of chronically hospitalized psychotic patients who are not Holocaust survivors. All the empirical research instruments applied to the interviews in Phase I as well as the above mentioned psychoanalytic group rating design will be applied to the control group subjects as well, so as to make a scientifically valid comparison possible.

Furthermore, to provide an additional context, historic research will be done on the individual and social context of the relocation of psychotic patients in the years 1948-1955 from Germany to Israel. The combined research results will lead to a tentative re-narrativization of the denied and de-narrativized life histories of the chronically psychotic Holocaust survivors and to an empiric as well as qualitative description of the traumatic psychosis as a nosological category.

In a separate project, analysis of content and of affect regulation using Glaser’s grounded theory is currently being applied by psychoanalyst Suzanne Kaplan, Ph.D. of Stockholm University to the study of a number of video testimonies which have been transcribed and translated into English. Dr. Kaplan has started her work in the project in January 2006. Glaser’s grounded theory offers a theoretical framework allowing an analysis of data, which is not guided by preconceived hypotheses but which, on the contrary, generates hypotheses and eventually concepts in its process. Some of the research variables to be considered in the content analysis of the video testimonies are the use of silence (including duration, positioning, and intent of silence), the use of nonverbal communication (gesticulations as meaning), the use of space, and the construction of narrative (use of first/third person for emotional distancing, active or passive verbs, attempts at “objectification” etc.). Glaser’s grounded theory method can generate quantitative data to be analyzed further in statistical and graphical reports to demonstrate a variety of patterns and relationships. In addition, it can produce qualitative results, which can be examined further for patterns and relationships. Content analysis of the narratives may help to discern a “key moment,” that is, a moment of awareness where the narrative is “unlocked.”

A third approach, already underway (Robin Kowalski, PhD, Clemson University, Clemson, S.C., U.S.A.) is conducting a linguistic analysis of the video testimony narratives by using Jannie Pennebaker’s Linguistic Inquiry and Word Count Strategy (LIWC 2001). The LIWC analyses the affective, cognitive and structural elements of written text on a word by word basis; Kowalski in her study is applying LIWC to examine differences in structure and affect accompanying the narratives of the chronically hospitalized patient group and of a control group, i.e. video testimonies of non-psychotic Holocaust survivors.