John J. Sigal

Unwanted infants: Psychological and physical consequences of inadequate orphanage care 50 years later

Studies of the effects in middle-aged adults of institutionalization at birth or early childhood are rare. The results of this study show that members of a randomly selected, middle-aged group of orphans, most of whom were institutionalized at birth, were significantly more psychosocially dysfunctional and had significantly more chronic illnesses that could be stress related than a randomly selected, matched community sample.

Do Children Cope Better Than Adults with Potentially Traumatic Stress? A 40-Year Follow-Up of Holocaust Survivors

Abstract Anecdotal reports suggest that child survivors of the Nazi persecution are functioning well as adults. Ratings of their parents by a randomly selected community sample of young adult Ashkenazi Jews on a scale that measured Schizoid, Paranoid, Depressive/Masochistic and Type A/Normal Aggressive symptoms permitted verification of these reports. Among the parents were groups who were children, adolescents, or young adults in 1945, at the end of World War II. Child-survivor parents did not differ from native-born parents on these measures 40 years later, whereas, consistent with the empirical findings of others, survivors who were adolescents or young adults at the end of the war manifested more paranoid and depressive/masochistic symptoms than native-born parents. To explain this possible greater long-term resilience among those who were child survivors, reference is made to later caretakers, endowment, cognitive and social development, and psychodynamics.

Grandchildren of survivors: can negative effects of prolonged exposure to excessive stress be observed two generations later?

Some studies have demonstrated negative psychological repercussions on children of parents who experienced extreme, prolonged stress. To determine whether such effects might continue in the third generation, we examined the presenting complaints of patients in a child psychiatry clinic who could be reliably identified as: (i) children whose parents were native born but who had at least one grandparent who was a survivor of the Nazi persecution (Index 1, N = 58); (ii) other children who had at least one parent and one grandparent who was a survivor (Index 2, N = 11); (iii) children of other immigrant grandparents (N = 28); (iv) children with four native born grandparents (N = 30). All other grandparents and parents were native born. All families were of the same ethnic group. Index 2 children manifested more difficulties related to school performance, but the small size of the sample precludes generalization. Although the Index 1 children did not have different types of behavioural disturbances, the size of the Index (1 + 2) group (N = 69) relative to the comparison groups was 300% greater than expected on the basis of community population estimates. Implications of this finding are discussed.

Depressive symptoms in relation to physical functioning in pulmonary hypertension.

OBJECTIVE To investigate the association between depressive symptoms and physical functioning in pulmonary hypertension (PH) patients. METHODS Fifty-two patients diagnosed with precapillary or postcapillary PH completed self-report questionnaires of depressive symptoms and physical functioning. Cardiac catheterization reports of patients were reviewed for hemodynamic variables. RESULTS Physical functioning was significantly associated with depressive symptoms on bivariate analysis. On multivariate analysis, after controlling for demographic and hemodynamic variables, depressive symptoms accounted for 9% of variance in physical functioning. CONCLUSION The association of depressive symptoms with decreased physical functioning in PH patients indicates the need for longitudinal research regarding the possible effect of depression on disease outcomes in this population.

Concentration Camp Survival: A Pilot Study of Effects on the Second Generation

Clinical observations of the families of concentration camp survivors presenting at a psychiatric outpatient department in a general hospital suggested that they manifested certain common characteristics distinguishing them from the general clinical population. These observations were subjected to a more systematic study. All the case material used in this study was taken from intake histories and diagnostic summaries. In the concentration camp families at least one parent had been in concentration camps during the war or had, up to the time of forced separation, been in close personal contact with members of his immediate family who eventually perished in the camps. All these families were Jewish. The control group consisted of families in which the parents were Jews of Central and Eastern European origin who did not have either of the two experiences listed as criteria for inclusion in the concentration camp group. As compared to the control families, the concentration camp parents manifested greater difficulties in self-control and in being able to control their children, and they showed a greater degree of overvaluation of the child. In families with more than one child, the children displayed a significantly greater degree of rivalry. No significant difference was found in the rate of occurrence of school problems but these tended to be less frequent in the concentration camp families. Examination of subgroups within the concentration camp group revealed that the most significant effects appeared to be attributable to the insurmountable process of mourning and the emotionally depleted state of the parents. The effects of concentration camps may conceivably manifest themselves in psychologically disturbed functioning of future generations.

Seven institutionalized children and their adaptation in late adulthood: the children of Duplessis (Les Enfants de Duplessis)

Abstract War, societal and familial upheaval, disease, and natural disasters have resulted in orphaned children throughout time. One societal response to providing care for orphans has been institutionalization or the orphanage. We studied a sample of adults, known as les enfants de Duplessis or Duplessiss children, who were raised in Quebec institutions from birth onward and followed up in late adulthood. Systematic study indicated a high prevalence of adverse outcomes and found high levels of gross psychological trauma and adversity which, moderated by the childhood strengths of the individuals, had adverse effects on adult outcome (Sigal, Perry, Rossignol, & Ouimet, 2003; Perry, Sigal, Boucher, Paré, & Ouimet, 2005a; Perry, Sigal, Boucher, Paré, Ouimet, Norman, & Henry, 2005b). This report describes the experiences of seven individuals in the institutions and their subsequent life history and current functioning. The individual cases reflect a wide range of childhood strengths and experiences of trauma and other adversity in relationship to adult caretakers. While the group overall appears to have had seriously diminished functioning in late adulthood, several individuals had positive outcomes. We hope that by highlighting the potentially adverse effects of institutional rearing on subsequent development into late adulthood, these stories may inform those concerned with the care of orphans.

Personal strengths and traumatic experiences among institutionalized children given up at birth (Les Enfants de Duplessis--Duplessis' children): II: Adaptation in late adulthood.

In a companion article, we retrospectively examined the childhood strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions. This article examines the relationship of their early experiences to functioning and symptoms in later adulthood. The same follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included assessments of their current symptoms and functioning. The mean adult Social and Occupational Functioning Score (57.8; 95% CI, 54.7–61.0) indicated moderate difficulty. Psychiatric symptoms were significantly higher than in a matched population survey sample from Quebec. Mean overall defensive functioning indicated a neurotic (inhibited) level. Total trauma and childhood strengths predicted adult outcomes, but childhood strengths moderated the effects of trauma. Institutionalization of children—if unavoidable—must build in effective safeguards against adverse experiences, especially among children with few strengths, and foster childrens strengths to avoid impaired adult outcomes.

Effects of parents' and pediatricians' worry concerning severe gastroenteritis in early childhood on later disturbances in the child's behavior*

Probands who had been hospitalized for gastroenteritis between the ages of 2 and 5 years were studied at the ages of 8 to 12 years. More conduct problems and a tendency to excessive dependence were found (1) in probands who were severely ill by objective criteria than were others and (2) in probands whose parents were specifically worried that their child might die as a result of the illness. General worry in the parents had different consequences. Other data suggest that pediatricians, because they are no longer worried about the illness after the child is discharged, may be failing to take appropriate preventative measures at opportune moments in the years following the hospitalization.

How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study.

Abstract The means used by cancer patients to cope with each of three death anxieties (i.e., fear of pain and suffering, loneliness, and the unknown) that contribute to their psychological distress have rarely been examined. Differences between cancer patients with Stage I or II disease (Group 1) and Stage III or IV disease (Group 2) were explored. T-tests revealed no difference between the groups. Age-controlled Pearson correlations were used to determine the relationship between all three death anxieties, and some recognized coping devices used by cancer patients, namely, coping styles, optimism, and religiosity/spirituality. Results showed that, for Group 1, avoidant coping correlated positively with fear of the unknown, and social diversion correlated positively with fear of pain and suffering. As for similarities between groups, with the exception of fear of pain and suffering for Group 2, emotion-focused coping correlated positively with all three death anxieties, and optimism correlated negatively with fear of the unknown. The advantage for researchers and clinicians of including measures or evaluation of the death anxieties in their considerations of the psychological distress of cancer patients is discussed.

Personal strengths and traumatic experiences among institutionalized children given up at birth (les enfants de duplessis-duplessis' children) : I: Early experiences

We examined childhood and early adult strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions into early adulthood. A follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included retrospective assessments of childhood experiences. Most participants reported multiple early adverse experiences, including, in descending order, unfair rules and excessive punishment, physical abuse, emotional neglect, witnessing violence, verbal abuse, physical neglect, sexual abuse, and serious illness. Adverse experiences were mainly due to lay caretakers, not peers or nuns. Twelve childhood strengths, such as self-protectiveness and athletic talent, were scored at each of four age periods, yielding a median score equivalent to one strength at each period. Over half had significant childhood attachments, but of limited intimacy. Childhood variables correlated with their respective variables in later adulthood. Overall, these older adults reported a high prevalence of adverse or traumatic childhood experiences, counterbalanced by modest levels of individual strengths and attachment relationships. Institutionalization of children—if unavoidable—must build in effective safeguards against adverse experiences.