Abstract
This study interrogates the historical methodology that underpins research undertaken by historians writing about mental health in the postwar world. I question their near-exclusive reliance on medical elites’ studies, correspondence and reports, and call instead for a closer analysis of the experiences of front-line workers, including social workers and nurses, to better understand the social, political, cultural, economic and gender dynamics that shape the diagnosis and treatment of civilian wartime trauma. Drawing upon the case reports and correspondence of a psychiatric social worker who counselled Holocaust survivors in a Displaced Persons camp in the American Zone of Allied-occupied Germany, I use this article as an opportunity to rethink how we write about the history of trauma and mental health.
In the wake of the Second World War, former political prisoners, slave labourers, POWs and concentration camp survivors poured into Displaced Persons Camps in Germany, Austria and Italy. In the DP camps, the story goes, foreign relief workers with whom they interacted possessed neither the resources nor expertise to offer psychological care. United Nations Relief and Rehabilitation Administration (UNRRA) personnel were instructed to limit their counselling of DPs to the topics of housing, resettlement and reuniting families. Recreational and vocational training, they insisted, would have sufficient therapeutic effect. 1 While mental health professionals attended immediately to the wartime trauma of children, sustained attention to impact of wartime trauma on adults began in the mid-1950s and only accelerated in the 1960s, when Holocaust survivors turned to psychologists and psychiatrists to help them gain restitution from the German government. These medical professionals, historians have argued, laid the foundations for the formulation of post-traumatic stress disorder as a diagnosis. 2
This article challenges this genealogy of trauma in the wake of the Second World War. It does so by interrogating the very historical methodology that underpins much of the research undertaken by historians of mental health in the postwar world. In reconstructing the production of knowledge around the diagnosis and treatment of wartime civilian trauma, most historians rely on the exchanges of medical elites in professional journals, conference proceedings and commissioned reports, ignoring the experiences of front-line workers, including social workers and nurses. 3 Esteemed psychologists and psychiatrists dropped in and out of Europe's DP camps, offering brief reports and recommendations. 4 It was relief workers who had the most contact with patients, and who implemented, and at times invented, therapeutic interventions. A closer look at the lives of relief workers in DP camps reveals that some of them questioned the widespread belief among medical elites that the mental health challenges of DPs were the product of childhood trauma and abnormal relations with parents. They argued instead that wartime experiences were the crucial factor in explaining the mental health struggles of DPs, and in doing so, pioneered approaches taken by psychiatrists and psychologists in the 1960s fighting for Holocaust survivor compensation.
Listening more closely to the voices of relief workers also provides historians with a view from below of how mental health issues were grappled with on the ground. 5 Psychological knowledge was not simply produced and transmitted from above, nor were relief workers only attentive to the voices of medical elites. They had to contend with military officials, UNRRA and International Refugee Organization (IRO) administrators, local physicians and political activists among the DP population – all of whom had their own agendas that shaped how they assessed and treated the emotional challenges faced by DPs. Reconstructing their debates, I argue, offers historians an unprecedented view into the social, political, cultural, economic and gender dynamics that shape the diagnosis and treatment of civilian wartime trauma.
I will make the case for this methodological approach by focusing on one case study. In September 1945, 36-year-old Becky Althoff became the first mental health counsellor hired by a postwar humanitarian relief organization to provide psychological assistance to Jewish DPs. She attempted to implement an ambitious therapeutic program to reach all Jewish refugees swelling Europe's DP camps. Althoff left historians with a treasure trove of sources including correspondence and reports to US Military and UNRRA officials, project proposals, and, perhaps most importantly, detailed case reports of Holocaust survivors who, under her care, received psychological counselling. These case reports provide a vivid portrait of the eclectic psychological theories and techniques she deployed, and cast into sharp relief the battles waged by aid and US military officials, relief workers and DP camp inhabitants to define, diagnose and treat the psychological challenges of Holocaust survivors. In doing so, this article provides an important contribution to the study of civilian wartime trauma in the immediate wake of the Second World War – a topic that has received little historical attention in comparison to the wartime trauma of combatants. 6
Althoff was employed by the American Joint Distribution Committee (JDC), a Jewish humanitarian organization founded during the First World War to provide humanitarian relief to Jewish wartime refugees. In the wake of the Holocaust, the JDC became the main Jewish agency to provide support to Jews living in DP camps, helping them re-establish their lives in Europe or, in most cases, emigrate from the continent. While much of the support they provided was material, they also sought to promote the physical and psychological ‘rehabilitation’ of Holocaust survivors. 7 JDC officials were far from alone in their concern about the psychological state of the Third Reich's victims. During the wartime years, several British and American psychologists searched for tools to psychologically rehabilitate civilians, particularly refugee children. 8 In August 1944, as Allied forces closed in on Nazi-occupied Europe, the recently-created UNRRA gathered a team of psychologists, psychiatrists and social workers to address the anticipated ‘psychological problems’ of DPs. Foreshadowing the UNRRA and Allied forces’ initial approach to Jewish refugees, their reports drew no distinction between the wartime experiences of Jews and non-Jews. Moreover, the focus of their reports was on the repatriation of refugees – a prospect that terrified most Jewish refugees, victims of antisemitism in their former places of residence. 9 Those few psychologists who acknowledged the distinct experiences of Jews under Nazi rule often vilified them. 10 The German-Jewish émigré psychologist Bruno Bettelheim hypothesized that the wartime experiences of Jews had unleashed primitive psychological behaviours that rendered them selfish, belligerent and morally corrupt. Those who survived Nazi concentration and death camps did so, he argued, because they adopted the values of their tormentors. 11 Many British and American army officers offered similar assessments of the psychological state of Jewish DPs. 12 These reports affirmed longstanding antisemitic stereotypes: Jews were immoral, dangerous and not to be trusted.
JDC leaders worked tirelessly to convince the UNRRA and Allied Army officials to recognize Jews as a unique, largely ‘non-repatriable’ refugee group, and frequently warned that UNRRA and Allied Army policies were causing deep psychological damage to Jewish DPs. In early July 1945, two JDC officials accompanied US government representative Earl G. Harrison on a tour of 30 DP camps. The resulting Harrison Report, published in August, called for immediate changes in the treatment of Jewish DPs and urged US and British officials to provide them with immigration opportunities, particularly to Palestine. Between August and October, the US Army established DP camps exclusively for Jews, increased their food rations and improved their living conditions. 13 By October, the US Army transferred control of all DP camps in the American zone of occupation to the UNRRA and permitted the JDC to send relief workers to provide direct aid to Jewish DPs.
JDC leaders believed that their mission would only be successful if their relief workers could change the attitudes towards Jews held by US military personnel and UNRRA relief workers in DP camps. It is against this backdrop that they sought out a mental health specialist to join their relief team. Such a specialist could draw upon their expertise to provide ‘scientific’ proof that Holocaust survivors’ morale and behaviour would only improve if the UNRRA and US Army changed their living conditions. They also sought a specialist with training as an intermediary between individuals and government agencies, who could help non-Jewish officials better understand the needs and behaviours of survivors. JDC leaders also hoped that such a specialist would have the training to take on multiple roles at once, including offering preliminary diagnoses of patients, connecting them to resources for support, and lobbying on their behalf. With no more than several dozen JDC workers posted to DP camps to support tens of thousands of Jewish survivors, professional dexterity was an asset.
Becky Althoff possessed these skills. Little documentary evidence remains to reconstruct her personal life prior to her appointment by the JDC. Born in the Russian Empire in 1909 – by her own account, in a ‘mud thatched hovel…covered with snow six months of the year’ 14 – she was an infant when she immigrated with her family to New York City's Lower East side. In 1934, at the age of 25, she completed an undergraduate degree in psychology and sociology. In the decade that followed, Althoff worked for New York City's Department of Welfare, investigating claims of child neglect and abuse. 15 In 1944, at the age of 35, Althoff enrolled in a Masters of Social Work program at Columbia University. That same year, the US Army hired her as a psychiatric consultant for the Women's Army Corps. Soon after, she was chosen to oversee thousands of psychiatric screenings for recent military conscripts.
Althoff's fluency in Yiddish and experience working for the US Army made her an ideal candidate to serve as an intermediary between Jewish DPs and non-Jewish relief workers and military personnel. Her training, too, was an asset: Althoff specialized in psychiatric social work. The field of psychiatric social work emerged during the First World War, when newly founded hospitals and clinics for American shell-shocked soldiers brought psychiatrists into closer contact with social workers. Several prominent psychiatrists promoted the view that social workers could help them better understand their patient's social environment, and in turn, formulate a more accurate diagnosis and treatment plan. Psychiatric social workers would also help the patient implement the treatment plan, ensuring that, if need be, they drew upon family, social relationships and community resources for assistance. 16 This new partnership between psychiatrists and social workers led to the creation of psychiatric social work training programs in several US cities. As these programs expanded in the 1920s, their creators called for psychiatric social workers to take on a greater role in the therapeutic treatment of their clients. Drawing upon Freudian ideas, they insisted that the task of psychiatric social workers was not simply to coordinate services or ‘manipulate’ the environment of their clients, but rather to uncover the impact of the unconscious on their clients’ motivation and behaviour. They embraced Freud's belief that talk therapy could uncover the impact of the unconscious, and insisted that clients with this newfound knowledge would be better equipped to improve their lives. 17
No sooner had she signed her contract with the JDC in September 1945, Althoff presented the relief agency with its first detailed plan for the psychological rehabilitation of Holocaust survivors. Her plan was built on several assumptions informed by her work as a psychiatric social worker. First, she insisted that no program to rehabilitate or resettle Holocaust survivors would succeed without relief workers and army officials, who were ‘hopelessly unaware of the meaning of traumatic experiences,’ learning about their psychological profile and needs. 18 Psychiatric screenings of survivors, she insisted, would help non-Jewish officials better understand Jewish DPs. A screening assessing psychological abnormalities, she explained, could also be used to grant or refuse the requests of individual survivors to live outside of DP camps in German towns or cities, be reunited with relatives in other DP Camps, or gain an immigration visa abroad. UNRRA relief workers reading her proposal would have heard echoes of their own officials’ insistence that the main purpose of psychologically assessing DPs was to prevent refugees with ‘disturbances of a mental or emotional nature’ from damaging camp order and morale. 19 Althoff insisted, however, that the primary goal of these screenings was not to detect psychological abnormalities, but rather to promote psychological healing. Only once relief workers conducted detailed interviews with survivors could they determine their capacity to ‘utilize camp resources, limited as they are’ to begin their emotional recovery. 20
Drawing upon her psychiatric social work training, Althoff also hoped to convince relief workers that psychotherapy was an effective and essential tool to rehabilitate Holocaust survivors. She insisted that the psychological profile of survivors was not set in stone. She believed that talk therapy had the capacity to teach survivors to mobilize their ‘inner resources’ to adjust to life in the DPs camp, and to assume greater ‘individual responsibility’ for their lives. 21 Althoff drew this belief from her training in American social casework, which emphasized, above and beyond all else, teaching individuals to be self-sufficient. 22 Another assumption underpinning Althoff's project and informed by her psychiatric social work training was that the psychological assessment and treatment of survivors should not be the preserve of a medical elite. Rather, Althoff insisted that DP camp residents had the capacity to engage in this work, provided they received training to do so. She also insisted that psychological aid should not be confined to hospitals or convalescent homes, but rather available throughout DPs centres across the Allied zones.
Upon her arrival to the American Zone in Germany in January 1946, Althoff spent several days at a DP hospital in St. Ottilien, a former Benedictine monastery in southern Germany. The UNRRA then transferred her to Föhrenwald DP Camp. Located some 30 km from Munich near the town of Wolfratshausen, Föhrenwald was transformed by the US Army from a factory and forced labour camp into a DP camp shortly after liberation. It became a camp exclusively for Jewish DPs in October 1945. Upon Althoff's arrival, just over 5000 Holocaust survivors, primarily from Poland and Hungary, lived in Föhrenwald. Living conditions were better than in most DP camps, yet Föhrenwald, like other camps, lacked sufficient personnel and supplies to adequately provide for DPs. 23 Twelve UNRRA relief workers, half of whom were Jewish, were responsible for running the camp under the supervision of the US Military. The director of the camp expressed indifference to Althoff's psychological plan, while the camp's principal welfare officer opposed it outright. Several weeks later, however, the director of the camp was replaced by Henry Cohen, a 24-year-old American Jew who had served in the US Army. While interactions between senior JDC and UNRRA officials, as historians have noted, were often tense, Cohen's support for Althoff's plan demonstrates that not all UNRRA officials on the ground were hostile towards the JDC, and that local personnel could have a profound impact on the development of policy within individual DP camps. 24 To further lay the groundwork for her psychological screening and therapeutic program, Althoff built relationships with other leaders within the camp's complex relief ecosystem. They included UNRRA doctors, US military officials and representatives of the Jewish Agency for Palestine, who promoted the Zionist movement among survivors and sought to facilitate their emigration to Mandate Palestine.
Above all, Althoff was preoccupied with gaining the trust of DPs. She knew this was no easy task. The camp contained a multitude of different and sometimes competing interest groups. Polish Jews, Hungarian Jews, Hasidic Jews, Zionist youth movements, Red Army veteran amputees, parents of young children – all of these groups had organized lobbying committees. Althoff tried to tailor her messaging to each group. She attended meeting after meeting of the camp's survivor committees. One of the ways she tried to endear herself was by addressing them in Yiddish. 25 Members of the audience, she later recalled, would then approach her for assistance. Within one month of her stay in Föhrenwald, Althoff began to report success. Her office, she gushed, was crowded with survivors seeking assistance: ‘I am considered something of a doctor or professor…even the UNRRA, as well as the JDC are amazed at the alacrity with which these deprived and beaten people have been able to accept such a service.’ 26 Indeed, Föhrenwald's UNRRA relief workers reported to their headquarters that Althoff's services were ‘most valuable’ and ‘utilized extensively in cases of general emotional disturbances.’ 27 Viewing Althoff as a vital colleague, they insisted that her focus on psychological support allowed them to better meet the UNRRA's main goals for welfare counselling, which focused on locating relatives, physical health, vocational training, repatriation or emigration. 28
Althoff knew that survivors’ requests for her assistance did not always mean they sought mental health care. ‘I must always make clear,’ she confessed, ‘that I have nothing tangible to give. Neither food, nor clothing, nor money or even passports to America, just an hour in which they can talk and discuss their own problems.’ 29 Whatever goals survivors had in mind when approaching Althoff, the result was a psychotherapy session, in which Althoff would try to understand and improve their inner emotional lives. By May 1946, she had counselled nearly 70 Holocaust survivors. 30
Althoff wrote detailed reports of these interactions. Historians of social work rightly caution against reading case reports as transparent windows into the emotional lives of their subjects. 31 Althoff's case reports were dramatized explanations, crafted to convince UNRRA and JDC officials that her plan for a large-scale program to psychologically assist Jewish DPs was necessary and viable. 32 If historians bear this in mind when reading these case studies, they can gain valuable insights into the dynamics that shaped relief workers’ assumptions and approaches to survivors’ psychological healing.
During the Second World War, most psychologists and psychiatrists studying the effects of the war on mental health took an interest in combat soldiers, rather than civilians. British and American medical professionals diagnosed soldiers’ psychological breakdowns as ‘war neuroses,’ and attributed their mental decline to heredity and early childhood events, rather than wartime experiences. Drawing upon Freudian psychodynamic theory, they proposed that war neuroses would be triggered by unconscious conflicts between instinctual urges and the demands of the battlefield. Soldiers predisposed to breakdown would then convert their rage, sadness or fear into debilitating physical symptoms. Freud's impact could also be felt in treatment approaches to war neurosis. Using talk therapy as treatment, psychologists asked soldiers to recount and ‘relive’ their traumatic experiences, believing that doing so would release patients’ unconscious pain, and allow them to move forward. 33 As we’ll see, Althoff clearly drew upon the diagnostic and treatment approaches of psychologists treating war combatants, but also differed from them in significant ways.
Using her case reports, Althoff sought, first and foremost, to convince her readers of the power of individualized psychotherapy to heal the psychic wounds of Holocaust survivors. To persuade officials that psychotherapy was critical to survivor recovery, Althoff first had to demonstrate one of the core assumptions of psychoanalysis: that physical symptoms and behaviours were frequently the product of unconscious inner conflicts. In case after case, she recounted how survivors complained of chronic colds, frequent headaches, sore throats, dizziness and racing hearts. When she referred them to UNRRA doctors, they reported that no ‘organic’ underlying cause could be found. In one case, Althoff attributed the physical distress of a teenager to her years of hiding under a false passport, surviving concentration camps, and discovering that all her family and relatives had been murdered. ‘The significance of her symptoms,’ Althoff continued, ‘were the result of inner conflict which had been converted into functional disability.’ 34 In other case studies, she demonstrated how inner conflict, borne of wartime trauma, led to abnormal behaviour. In one case, Althoff described a young girl who had watched helplessly as Catholic Polish civilians murdered her mother. 35 Having fled with her father to Föhrenwald, she suffered from depression and amnesia, and would only play with much younger children. Here, Althoff reported, the forces of the unconscious were at work: ‘the daughter,’ she wrote, ‘is giving love and attention to younger children, playing the role of the mother whom she lost.’ 36 These examples illustrate a critical difference between Althoff's approach to trauma and those of contemporary medical professionals treating combat soldiers: in her view, it was wartime experience, rather than a ‘predisposing’ personality type or early childhood experiences in peacetime, that was the primary cause of psychological disturbance.
Althoff's hypotheses about her patients’ unconscious conflicts were not just for her case report's readers – they were directly communicated to survivors under her care. She sought to demonstrate the healing power of sharing this knowledge during a therapeutic interaction. This process, known by psychoanalysts as ‘interpretation,’ was a core component of psychotherapeutic practice. 37 Althoff insisted that when psychotherapists gave survivors insight into the unconscious causes of their behaviour, it would be the catalyst for behavioural change. To demonstrate this process, Althoff described Shule, ‘an emaciated, married man of thirty-three’ who had physically assaulted a hospital nurse who tried to feed him potatoes. Althoff's report focused on his wartime experiences. He recounted ‘being hounded from ghetto to ghetto,’ escaping to Soviet-controlled territory in the east, and serving in the Red Army. Several months before his arrival in Föhrenwald, he met and married a woman ten years younger than him. Upon arriving in the DP camp, he became ill, and she refused to visit him in the hospital. ‘Neighbours of the house,’ Althoff reported, told him that she was unfaithful, ‘and he was ashamed and humiliated that this should happen to him.’ Althoff began the process of interpretation: ‘We wondered if, because he was really mad about his wife, he had not substituted the nurse, and pushed her instead. We explained that sometimes, when people were hurt, they take out their anger on others.’ Althoff reported that the patient's anger towards the nurse immediately subsided, and in a subsequent visit, ‘they seemed to get along quite well.’ 38
Althoff also sought to demonstrate how the mere act of talking about their physical and emotional suffering – independent of the therapist's interpretation – held therapeutic power for survivors. In the case studies above, as elsewhere, Althoff argued that her patients’ improvement in behaviour corresponded to their willingness to share their internal experience. Althoff was promoting the psychoanalytic belief that emotional release, or catharsis, was necessary in order to relieve the unconscious of conflicts, gain new insights, and bring about positive change. Abram, described as an ‘extremely well-developed physically’ young man with an ‘aggressive, over-assured manner,’ was one such individual. On the surface, he appeared to be a normal young man, ‘engaged to a young pleasant Jewish girl’ and employed by the camp's Jewish police. A different man emerged in the privacy of his therapy session. When the war ended, he was the only survivor in his family of ten. ‘He promised himself,’ Althoff reported, ‘he would avenge the death of his relatives and his own sufferings at the first opportunity.’ After liberation, he described restless nights suffering from nightmares, and an ‘inner urge’ that he yearned to ‘quiet.’ ‘He knew where one German lived by himself. He stealthily approached him and beat him with his fists, but he still felt unavenged. He found a nearby axe and described in detail how he killed the man with the axe in cold blood with his own hands. He said after he saw the lacerated corpse he felt better and went home.’ 39
In recent years, historians have examined cases of Jewish DPs engaging in acts of vengeance against German civilians and resorting to violence when they felt threatened by them. 40 US Army officials were constantly on the lookout for any sign of Jewish violent action. In May 1946, Althoff informed Föhrenwald's UNRRA's director that US Army officials had blocked a procession of uniformed socialist Zionist youth marching on International Workers Day. Defending the Zionist youth, she explained to the ‘rather antagonistic’ army officials that ‘our own boy scouts in America often met in a similar manner.’ 41 Three weeks later, Jewish DPs from the camp beat up several German car passengers following a rumour that two Jews had been kidnapped in nearby Wolfratshausen.
It is against this backdrop that we can better understand Althoff's psychological assessments. In many of the case studies examined thus far, Althoff focused on aggression as the primary mental disturbance of young survivor men. She sought to demonstrate that her therapeutic program could help tame them and reduce their rage. The power of psychotherapy, she argued, was its power to reveal to DP officials and leaders individuals who represented a social menace. What was critical to note, she insisted, was that the very act of sharing his experiences seemed to mitigate any potential threat Abram posed. She noted, ‘He said that it had done him good to tell this story as he had told no one else. Since then [emphasis mine] he has had no desire to commit a crime of such bestiality. He sleeps well and conforms to the usual normal routines.’ 42
Abram's case study also casts into sharp relief the role that gender played in shaping relief workers’ approach to the mental health of DPs. 43 Althoff saw value in using traditional ideas about masculinity to help survivors move forward with their lives. When 23-year-old Moshe confessed to being haunted in the daytime by visions of his murdered mother, she concluded that he suffered from ‘excessive attachment to his mother’ and urged him to grow up and ‘take on the social thinking and mores’ of young men his age. Here is Althoff describing the patient in a follow-up visit: ‘He had been thinking about our conversation and realized that perhaps some of his own depression was his own fault. A man has to control himself, he had demonstrated his ability to take it in the Russian Army, and he felt he could get well and make something of himself, yet.’ She applauded Moshe's invocation of masculine ideals: real men who controlled their emotions and could ‘take it’ would have a better chance of recovering. 44
Gendered assumptions also played a significant role in Althoff's description, diagnosis and treatment of women. She described Jewish women survivors from Eastern Europe as ‘primitive,’ ‘emotional,’ ‘voluble’ and ‘with limited understanding.’ 45 Like many mental health professionals of the era, she placed the burden of responsibility for childhood care and development exclusively upon mothers. 46 ‘[W]hat appears to be a problem of the child,’ she opined in one report, ‘is really one of the mother, and… it is difficult to separate the two.’ 47 Psychiatrists and psychologists insisted that a mother's love was the only way to produce healthy personalities, but simultaneously warned that overprotective mothers hampered their children's development. In the 1940s, several American psychiatrists claimed that the most important factor predisposing US soldiers to psychologically break down was their dysfunctional relationships with their mothers. 48 We can see traces of this approach in Althoff's depiction of Jewish mothers. In her case studies on the prospect of family separation, she only focused on the impact of children being separated from their mothers. The only Jewish parents Althoff criticized for being ‘over-attached’ or overanxious about their children were women.
Althoff's case reports were more kind to adolescent girls. Other relief workers in the DP camps – typically male – warned of the alleged sexual voraciousness of young Jewish women. 49 A report on Jewish women from Bergen Belsen DP camp, for example, concluded that ‘sexual irregularity has reached appalling proportions…the best and most moral [women] perished. Many girls give themselves up to debauch without restraint.’ 50 The report insisted that motherhood would restore their mental health. Althoff neither pathologized young Jewish DP women's sexual behaviour nor prescribed motherhood as a psychologically healing treatment. While she accepted that women played a critical role in childhood development, she bemoaned the pressure on young Jewish DP women to step into the role of mother to the children of deceased parents or siblings. 51 Above all, Althoff sought to provide better institutional support for young women to move forward with their lives. Many of the psychological problems they faced, she argued, were the result of the camp director's decision to only run one trade school in the camp, a tailoring program catering to men. 52 Althoff called on the UNRRA to create special educational and vocational programs to train adolescent Jewish women to become welfare workers, nursing aides and recreation leaders. She also urged the UNRRA to train survivor women to become psychiatric social workers who could bring ‘affection and attention’ to those suffering from ‘mild psycho-neuroses.’ 53
Althoff's call for providing better opportunities to survivor women was just one way in which she used her case studies to shed light on what she perceived to be the major shortcomings of mental health care for Holocaust survivors. Her critiques illustrate how the provision of mental health care for Holocaust survivors was profoundly influenced by the terror of the recent past, the socioeconomic conditions of the present, and raging battles concerning the political future of Jewish DPs.
Historians have observed that Jewish and German civilians in the Allied Zone interacted more than initially presumed. Many Holocaust survivors, for example, interacted with German civilians through trading and selling goods on the black market. 54 These interactions, a source of deep ambivalence for many Jews, also extended into the medical sphere. One of the main issues Althoff wrestled with was the extent to which relief workers should rely on German doctors to provide mental health care to Holocaust survivors. Strapped of resources and personnel, relief organizations in DP camps employed survivors as physicians, nurses and other medical personnel. DP camp administrators, however, often distrusted survivors’ expertize and feared that their wartime experiences diminished their capacity to care for patients. 55 To many relief workers, there was little choice but to turn to German doctors.
Althoff was desperate for the expertize of German doctors at a hospital in nearby Munich, and was aware that they had rebuffed the JDC's previous requests for support. Her solution was to pretend to be a US military doctor. Donning a US military uniform, she approached the director of a clinic for children with developmental delays, and commanded them to conduct physical and psychological evaluations for Jewish children. 56 Dr Marcellina von Kuenberg, a 63-year-old child psychologist and speech therapist, agreed to conduct diagnostic tests with the children and interview their parents. 57 Althoff confided to a friend, ‘I had a tough job selling her to the camp residents because she is a bona fide German.’ 58 She recounted how the aunt of an 11-year-old patient ‘was very suspicious, saying that the German doctors had taken blood from children, and that any German doctor on camp would do the same.’ 59
Whether or not Althoff had full knowledge of the horrors Nazi doctors inflicted upon Jews during the war, she recognized and acknowledged the deep fears harboured by Holocaust survivors towards German medical experts. To share her concerns about the fate of survivors forced into institutionalized care in Germany, she used the case of Szmuel, a 19-year-old jailed in Föhrenwald's prison for slapping a policeman. On her first visit to the prison, she discovered ‘a dirty, unkempt boy with many eye tics, bad teeth and facial grimaces when he spoke.’ ‘He says he is alright most of the time,’ Althoff reported, ‘but when he gets angry, he feels as if the top of his head were hammered, and he does not know what he is doing. While he talked with us, he did not stop smoking, trembling, and we noticed that his fingernails were bitten to the quick.’ Soon after, in a meeting with the camp's UNRRA director, Althoff insisted that ‘the boy was very sick mentally and emotionally, and that incarceration was only intensifying his difficulties.’ At the same time, she feared that sending Szmuel for care in a German asylum ‘would rob him of his limited contact with reality altogether.’ The camp's Jewish chief of police insisted that the young man posed a ‘threat to camp morale’ – if he was to be released from custody, it would be on the condition that he leave the camp. ‘As it is,’ Althoff concluded, ‘we had no alternative, but to permit him to leave the camp, disturbed as he was.’ 60
The young man's case, Althoff insisted, pointed to the need for a ‘mental hospital for disturbed Jewish people.’ 61 She proposed establishing a Jewish sanitorium for 50 ‘psycho-neurotic’ patients who suffered ‘severe psychological handicaps’ but were ‘not psychotic enough to warrant an asylum.’ 62 Her treatment plan, combining sedation with psychotherapy, bore striking similarities to contemporaneous treatment approaches of British psychiatrists for ‘war neuroses’ among combat soldiers. 63 The sanitorium would solve two problems: it would remove Jewish patients from the danger – imagined or not – of German physicians, and it would offer bespoke treatment to patients with mid-level psychological difficulties, preventing long-term institutionalization.
Althoff's reports also reveal how the political battles raging about the future of Jewish DPs impacted the provision of mental health care. Numerous scholars have documented Zionism's broad-sweeping appeal among Jewish DPs. 64 In both the US and British Zones, Zionists formed the core of survivors’ political leadership, and played a pivotal role in the fight for better living conditions within the DP camps, on the one hand, and emigration opportunities to Palestine, on the other. Despite the fact that nearly a quarter of Föhrenwald's population were Orthodox Jews, UNRRA officials estimated that nearly 95 per cent of the camp's population was Zionist. 65 Drawing on the voices of survivors in DP camps, scholars have highlighted the ways in which many Holocaust survivors viewed Zionism as tool to heal their psychic wounds. 66 Althoff herself testified to the therapeutic power of the Zionist movement in the DP camps. The hope of survivors to emigrate to Mandate Palestine, she wrote to a friend, was a form of ‘mass hysteria…and unless we have something more concrete and realistic to offer them, it is for the most part the only fantasy which has kept them going.’ She doubted that the Zionist hopes of survivors would be fulfilled, but insisted, ‘it would be useless and cruel to rob them of this one wish fulfilling dream.’ 67
At the same time, Althoff expressed concerns about the activities of the Zionist movement and its impact on the mental health of survivors. One of her earliest reports concerned young Jews living in Föhrenwald's Zionist agricultural training centre, Kibbutz Hochland Lager. The report offers a counterpoint to historian Avinoam Patt's observation that ‘the sense of camaraderie created by living and working together’ in these centres was ‘highly therapeutic for the young survivors.’ 68 Interviewing its members, Althoff reported that they ‘expressed much negative feelings’ about the kibbutz, ‘resented the so-called cooperative living’ and were ‘comparing it unfavourably with that of the concentration camps.’ 69 ‘Despite their chronological age of 18–25,’ she wrote to UNRRA officials, ‘I consider these people to be immature, dependent, passive individuals who appeared to have the pscyho-sexual development of 12 year olds.’ She bemoaned the ‘frightful retardation of individuality and self-expression’ on the Kibbutz, and insisted that many did not want to be there. 70
As weeks went by, Althoff voiced increasing concerns about the mental health impact of the Zionists movement's emigration campaigns. The British government offered a meagre number of Palestine immigration permits to Jewish children and women in DP camps. The Jewish Agency, which facilitated the emigration of Jewish DPs to Mandate Palestine, automatically placed Föhrenwald's Jewish orphans on the emigration list – even if they were cared for by aunts, uncles or older siblings. Jewish Agency officials presented these caregivers with a grim choice: send the children to Palestine, and risk permanent familial separation, or keep their children in the DP camps, with no prospects of emigration in sight. The agency's representatives also sent these children to Althoff for psychological assessment. In her case reports, she noted that many of the children believed they had no choice in the matter. She sought to document the traumatic impact of this potential separation. 71 A case report for a 7-year-old girl noted that ‘since the discussion of Palestine had arisen,’ she had been running a slight fever, and had difficulty eating and sleeping. When asked whether or not she and her brother would be willing to leave their aunt and cousin for Palestine, ‘She told us that she too had no one else in the world other than the two relatives, and would rather die like her mother than become separated from them.’ 72 Even Jacob, the founder of the camp's Zionist school and one of the camp's leading Zionist activists, could not bear to accept the Jewish Agency's offer to provide his wife and newborn child immigration certificates: ‘he was unwilling to contemplate the suffering that such a plan would mean to him.’ 73 Only a few short years beforehand, he and his wife had watched as Ukrainian militiamen murdered their firstborn.
Althoff's encounters with Jacob revealed another troubling aspect of political life in Föhrenwald. As part of their global campaign for a Jewish State in Palestine, many Zionist leaders refused to endorse emigration opportunities elsewhere. Overseas agencies working in the DP camps accused Zionists of trying to prevent Jews from emigrating to Britain, Australia or the United States. 74 In November 1945, Föhrenwald's UNRRA officials reported that a group of Jewish children in the camp who longed to emigrate to England were holding secret meetings because they feared the camp's Zionists would ‘take every step, passive and active, necessary to prevent the children going to England.’ 75 Althoff saw these conflicts play out in real time and warned JDC leaders of the psychological consequences for Holocaust survivors. When a cousin in the United States offered to write an affidavit on Jacob's behalf, he decided to try and emigrate with his family to the United States. Word got out among the camp's Zionist activists that Jacob had made this decision. Posters appeared throughout the camp saying that those who accepted US visas were ‘traitors to the cause.’ 76 He arrived to his appointment with Althoff with symptoms of an anxiety attack. Begging her to help expedite his visa to the United States, he claimed that several Zionists in the camp were threatening to physically harm him and his family. Initially, Althoff believed he was exaggerating. Another JDC official confirmed that he was, indeed, in danger. Ultimately, Jewish Agency representatives condemned the posters. Jacob eventually managed to leave with his family to the United States. For all of the Zionist movement's promises that it had therapeutic value, Althoff sought to make clear to her case study readers that the movement's activity in the DP camps had the potential to both psychologically help and harm Holocaust survivors.
By the end of 1946, Althoff achieved many of her objectives for her pilot mental health program in Föhrenwald. Her UNRRA colleagues viewed her work as indispensable and approved her proposal to train Holocaust survivor women to serve as welfare aides. Holocaust survivors constantly sought out Althoff's counselling services. However satisfied she may have been with these accomplishments, her ambitions extended far beyond Föhrenwald. Althoff was not alone in her call to provide mental health care to all Jewish DPs. In September 1946, at the invitation of the JDC, Austrian-born Jewish American psychiatrist Paul Friedman visited several DP camps. He recommended psychological care start from the moment survivors arrived. 77 One year later, Dr Jacob Golub, a key figure in the JDC's Medical Department, urged the organization to send a team of American psychiatrists, psychologists and psychiatric social workers to DP camps, where they would train Holocaust survivor medical professionals to run mental health clinics. 78 Yet none of these calls were met with action. Ultimately, JDC and UNRRA leaders rejected their proposals – including those of Althoff.
One of the barriers to the JDC developing a mental health program was the UNRRA, whose leaders insisted that psychological counselling should only be deployed to maintain camp order, support emigration and repatriation. 79 In her first assignment at St. Ottilien, UNRRA doctors rejected Althoff's plan on the grounds that the DP population was too transient for relief workers to attempt meaningful and sustained psychological interventions. 80 Others objected to Althoff's call to place women psychiatric social workers in every DP camp and train Holocaust survivors to become mental health welfare workers. Dr Leo Srole, an American Jewish sociologist working for the UNRRA, urged JDC officials to exercise ‘serious caution’ against the use of therapeutic techniques ‘by the uninitiated.’ 81 He may have had survivors’ wellbeing in mind, but other considerations may have been at play. As the work of historians Roy Lubove and Elizabeth Lunbeck has shown, medical doctors had long invoked fears about ‘insufficient expertise’ – particularly against women health care workers – as a gatekeeping strategy to preserve their own professional power. 82 Longstanding suspicions of Eastern European medical expertise also led JDC and UNRRA medical personnel to express reservations about allowing Holocaust survivor doctors, nurses and other health care workers to practice their professions in the DP camps. 83 These reservations proved too powerful for Althoff to overcome.
Althoff's plan for a Jewish mental health sanatorium was also met with opposition. In May 1946, Beverly Diamond, a consultant to the UNRRA on ‘Jewish affairs,’ justified her rejection of Althoff's proposal by arguing that institutionalization was a ‘European idea, and carried with it a stigma,’ which would ultimately be ‘detrimental to the cure of neuroses.’ She insisted that it would be best if ‘the emotionally disturbed were treated in their own environment.’ Althoff retorted that American social workers’ faith in treatment within the community was entirely misguided in the context of postwar Europe. In the American case, she explained, ‘the community was of course a normal one as we think of it, with the usual supportive elements of family, friends, recreation, etc.’ 84 Nothing was normal about life in DP camps. Althoff's hopes for a mobile mental health clinic to travel throughout the DP camps were also unfulfilled.
Althoff worked as a psychiatric social worker exclusively in Föhrenwald and returned to the United States in February 1947. When JDC officials wrote recommendation letters on her behalf, they insisted that they would have been happy to rehire her. 85 Decisions taken by the JDC in 1947, however, suggest that they were sceptical about the efficacy of her activities and proposals. While the JDC hired a handful of psychiatric social workers, they were relegated to submitting lengthy surveys and evaluations of already existing services, rather than directly engaging in therapeutic work. Individualized psychotherapy, as envisaged by Althoff, was not among the services funded by the JDC.
The JDC's increasing reluctance to invest in mental health care also reflected changes in the international community's approach to Europe's DPs. The IRO, which replaced the UNRRA as the administrator of Europe's DP camps in January 1947, drastically cut funding for the camps and their relief workers, insisting instead that they focus on refugee resettlement. JDC officials significantly reduced their budget for operations in DP camps and intensified their efforts to resettle Jewish refugees. 86 Against this backdrop, the head of the JDC's medical program in Germany concluded that ‘social casework to assist the adaptation of individuals to [their] environment’ was fruitless and impractical. 87
If JDC officials were sceptical of psychological services, so too were many survivors. While survivors spoke fondly of Althoff in Föhrenwald DP camp's newspaper and yearbook, and, decades later, in memoirs and interviews, they never mentioned her work as a mental health counsellor. 88 We have already seen how many survivors who approached Althoff for assistance sought food, improved living quarters, or help with emigration, rather than psychological care. 89 DPs had good reason to be wary of approaching relief workers for psychological aid. Relief agency medical examination questionnaires, as well as those of governments taking in Jewish refugees, frequently asked whether the candidate had suffered from mental illness or had experienced a nervous breakdown. 90 Survivors feared that any display of emotional or psychological vulnerability would diminish their chances of emigration. Even if members of Föhrenwald's DP community were willing to take the risk of seeking psychological assistance, they would have had to speak English or Yiddish in order to interact with Althoff. Given that nearly half of Föhrenwald's DP population came from Hungary, and that many of the camp's Polish Jewish children only spoke Polish or Russian, many may have not been able to access the mental health support she provided. 91
That is not to say that Jewish DPs did not seek support for the psychological challenges they faced in the wake of the Holocaust. When they sought support, it was primarily from other Holocaust survivors. 92 As historians Margarete Feinstein and Boaz Cohen have demonstrated, survivor communities across DP Camps developed a range of communal rituals, including commemorations of the dead, historical commissions and theatrical performances, to help give voice to their grief. 93 DP leaders also envisioned survivor-led Zionist youth movements and sports organizations as a means to improve the psychological health of survivors. 94
By the early 1950s, most Jewish DPs had emigrated from Germany, with approximately 136,000 arriving in Israel, 80,000 in the United States and 20,000 in other countries including South Africa, Canada and Australia. In 1953, Germany's remaining Jewish DPs were moved to Föhrenwald, bringing the camp's population to 2000. Government officials and relief workers dubbed them the ‘hard core’ because of their health problems or criminal records which prevented them from gaining admission to other countries. It would take another four years for Föhrenwald's last DP to leave, bringing an end to the camp's 12 years as a place of Jewish refuge. 95
Many of the DP camp's relief workers shifted their focus to integrating Holocaust survivors into their new countries. Althoff took up a position in New York's Jewish Family Service, where she was tasked with helping survivor children adjust to life in the United States. The few resources available for survivors’ psychological support in the United States were directed towards children and adolescents. Early researchers documenting survivors’ postwar psychological struggles shared this focus. In 1948, when Althoff decided to publish an article in the Journal of Social Casework on her experiences in Föhrenwald, she made only passing reference to her work with adults. The professional rules for writing a scholarly casework analysis limited her capacity to capture her varied encounters with survivors. The genre typically called for caseworkers to present composite portraits of the groups with whom they worked. In order to make her work legible to her professional peers, Althoff created two composite portraits. There was the male survivor adolescent – secretive, suspicious, and excessively hostile – and his female counterpart, ‘unusually fat…slow and unresponsive.’ 96 Two years beforehand, Althoff used her case studies to plead to any official who would listen to see the unique life experiences of each Holocaust survivor; acknowledge the impact of the DP camp's living conditions on their mental health; and offer them individualized therapeutic care. These calls all but disappeared in Althoff's article. In the name of scientific research, Holocaust survivors’ lives were flattened into ‘personality types,’ the social, political and economic forces influencing their emotions, beliefs and behaviours erased.
Such studies have served as the primary source base from which historians have attempted to reconstruct the history of mental health care among civilian victims of wartime trauma. This article has tried to demonstrate how much is lost when historians solely adopt this approach. Althoff's correspondence and case reports upend scholarly narratives about the creation and transmission of medical knowledge about wartime trauma. The ‘view from below’ shows us that relief workers in the DP camps experimented with and pioneered treatment approaches that would only be championed by medical elites as coherent medical knowledge years later. In contrast to static ‘social types’ presented in research journals, these sources introduce historians to the myriad of individuals in DP camps – at times cooperating, at other times, competing – as they grappled with the diagnosis and treatment of civilians’ mental health in the wake of wartime trauma. Their debates provide an unprecedented view into the political, economic, cultural and gendered dynamics that shaped the provision of mental health care in DP camps.
For now, Althoff remains a lonely voice among Europe's postwar relief workers. Future historians will mine the sources of other relief workers who left behind reports and correspondence documenting their efforts. They will also draw from the voices of survivors themselves, whether through the newspapers, diaries and correspondence produced during their time in DP camps, or retrospective accounts such as oral histories and memoirs. Historians will also benefit from comparing the approaches to the mental health of wartime refugees within the American, British, French and Soviet-controlled areas of postwar Europe. Only then will historians be able to reconstruct the story of Displaced Persons’ encounters with mental health care, and the wider reverberations these encounters had on the psychological treatment of civilian victims of wartime trauma.
