Abstract

Genocide continues to scar individuals and societies globally. While its consequences are often discussed in terms of physical injuries and territorial losses, the psychological aftermath of genocide is frequently the lesser-explored terrain. The spectrum of psychological trauma that emerges from genocide is vast and includes many conditions, such as Post-Traumatic Stress Disorder (PTSD), survivor guilt, intergenerational trauma, and separation anxiety/trauma. 

Post-Traumatic Stress Disorder (PTSD) is arguably the most well-known and is characterised by symptoms such as flashbacks, nightmares, and anxiety. Survivor guilt often stems from hearing about or witnessing a loved one’s death and thinking more could have been done to save the lives cut short, or that one’s own life should have ended as well; this experience is often correlated with social isolation and depression. Intergenerational trauma occurs when trauma experienced directly is passed indirectly to subsequent generations (e.g., children, grandchildren, and beyond), affecting their perceptions of safety, tolerance towards others (especially of a specific race), or even self-worth. Separation anxiety/trauma, possibly the least researched impact of genocide, often materialises in situations where a parent and child, or two loved ones, are forcibly separated, resulting in forms of intense anxiety, recurring distress, and even physical ailments such as nausea. 

This research paper aims to comprehensively examine the existence of these psychological traumas. Through an in-depth investigation, this study will explore the symptoms, causes, impacts, and types of psychological effects. Drawing on data collected from survivors, as well as empirical studies of past genocides, this paper will also examine how psychological burdens of genocide manifest and impact people’s daily lives. Additionally, we will elaborate on existing solutions and treatments of Post-Traumatic Stress Disorder (PTSD), survivor guilt, intergenerational trauma, and separation trauma, providing a glimpse into the enduring psychological impact of genocide on individuals and communities, as well as the complexities of trauma transmission, coping mechanisms, and pathways to healing.

Introduction

Genocides stand among the gravest crimes in the world. As stated in Article II of the ‘Convention on the Prevention and Punishment of the Crime of Genocide’ by the United Nations, genocide happens when certain acts are committed against a national, ethnic, racial, or religious group with the intent to eliminate them in whole or in part. These acts include the killing of individuals or groups, or causing serious bodily or mental harm to members of a group (Matheson et al., 2022). 

Genocides can manifest on various scales. History’s most known genocides are extensive mass killings with mass burials, including the Rwandan genocide and the Holocaust. The Rwandan genocide in itself saw the murder of 1 million people out of the 7.5 million total population (Dyregrov et al., 2000). The Holocaust, one of the most well-known genocides, refers to the murder of 6 million Jews. These acts not only violate human rights but also leave deep scars on both the nation’s societal fabric and its people. 

Beyond the physical toll on citizens, population demographics, poverty rates, and territorial integrity, genocide inflicts enduring psychological trauma on its victims, spanning generations. This psychological impact manifests both collectively and individually. We will explore four prominent manifestations of trauma: Post-Traumatic Stress Disorder (PTSD), survivor guilt, intergenerational trauma, and separation trauma. 

Post-Traumatic Stress Disorder (PTSD) stands as one of the most researched psychological impacts of genocide. In the aftermath of the Rwandan genocide, approximately 25% of postgenocide Rwanda, or a total of 2,957 out of 11,746 of the population, suffered from PTSD (Musanabaganwa et al., 2021). This disorder consists of a wide umbrella of symptoms, often manifesting in nightmares, panic attacks, and flashbacks. Similarly, survivor guilt symptoms include recurring flashbacks, heightened irritability, and social isolation. Furthermore, survivor guilt has links with suicidality and is also often connected to intense cases of PTSD (Bistas et al., 2023). Intergenerational trauma ensues when residual pain from past experiences influences the lives of survivors, slowly shaping the values that they teach their children and affecting their development across five domains: safety, trust, esteem, intimacy, and control (Mangassarian, 2016). Conversely, separation trauma/anxiety manifests because of the forced separation of loved ones, leading to intense distress and pervasive worry. All four of these psychological impacts have been identified in the lived experiences of survivors of genocide, shadowing their actions, behaviour, and more importantly, mental health. Moreover, manifestations can create long-term impacts that burden the health and life of not only the direct survivors, but also their families and communities. 

This study aims to show the extent of these repercussions on the lives of survivors – from causes to consequences, as well as how they reappear later in life to underscore the enduring impact of genocide on individuals and communities alike. 

Survivor Guilt

Survivor guilt is a psychological condition commonly associated with those who have witnessed irreversible tragedies that involve the occurrence of death. Current analysis regarding trauma-exposed populations reveals a clear correlation between declining mental health and the subconscious guilt experienced by survivors, often of various forms of war or brutal offences. Murray (2018) conducted research to address its prevalence in clinical samples, where 90% of survivors reported feelings that resemble emotional distress and negative self-appraisal. A critical review of survivor guilt by Juni (2016), conducted through the lens of the Holocaust, complies with such findings. Guilt is precisely characterised by the immoralities one ascribes to oneself, building an evaluative image that disproportionately tilts towards the negatives (Tangney et al., 2003). To further expound on this notion, guilt sprouts from an innate sense of responsibility despite the survivors having zero power over the deaths of others (Tangney et al., 2003). 

Compared to other post-traumatic disorders, research literature rarely encompasses the intricacies of the condition’s symptoms, such as survivor guilt. Few have attempted to study the experience thoroughly, though the familiarity of the concept has risen publicly in past decades. According to DSM-III, it was once a classified symptom of PTSD; however, the relevance of PTSD models when applied to survivor’s guilt is somewhat debatable as the diagnostic criteria of survivor guilt extends beyond a mere subset of PTSD. According to Murray et al. (2021), “one may ruminate about a death but not intrusively re-experience it.” It is important to note that this article only addresses the term ‘survivor guilt’ in situations where others have died, more specifically tailoring its effects to past genocides, while previous papers have generalised the term in an attempt to explain guilt stimulated by less severe situations.

Theories

“I am living a life that should not be lived. That’s where my guilt comes from because he took my place, because he stepped into my shoes and it should’ve been me, it would’ve been me…” 

These were the exact words quoted from a participant in a qualitative analysis conducted by Pethania et al. (2018) in relation to survivor guilt. The submissive nature of such irrationalities that constantly disturbs the survivors as they try to make sense of their survival is a vivid illustration of their persistent guilt and disentitlement to life as concluded by the study. Participants often perceived themselves as undeserving of their current life when comparing themselves to the deceased. Guilt patterns appear to be the strongest in communal relationships, characterised by the identification of commonalities (Baumeister & Leary, 1994). Applying this to the previous study conducted by Pethania et al. (2018), the feeling of unfairness when survivors view themselves to be ‘in the same boat’ as the deceased is what ultimately leads to strong conviction and a sense of disbelief. Participants often reported feeling less entitled to ‘living’ – “I kind of feel like it was my fault really” – thus, many describe a state of merely ‘existing’ rather than truly ‘feeling alive’.

Features

Two core features of the psychological impacts of genocide are downward social comparisons and the constant pursuit of equity amongst a mutual group that experienced the same trauma. Interpersonal attachments are essential for human motivation (to survive in a satisfactory manner); belonging acts as a basis for emotional patterns (Baumeister & Leary, 1995). By ‘existing’ while others had their lives cut short, their sense of belonging is incomplete, especially when survivors tend to ruminate and engage in frequent comparisons. When over-benefited, many view this to be a social handicap, where one tends to minimise their visibility as being positively discriminated (Coleman et al, 1988). Survivor guilt arises from a deep sense of helplessness where survivors simply don’t have the power to hide such visibilities. To many survivors, they perceive survival as being fundamentally ‘wrong’ (Pethania et al, 2018).

Treatments

Guilt shouldn’t be solely described as a psychological concept; it also branches into morality. Survivor guilt occurs when such moralities are challenged yet no pragmatic procedure can resolve the conflict. Interventions can be offered as a stand-alone treatment or integrated into Cognitive Behavioural Therapy (CBT) (Murray et al., 2021). 

On the individual level, one has to accept the existential and irreversible nature of such deaths, while developing self-forgiveness. Murray et al. (2021) analysed that some individuals believe reducing their feelings of guilt is a form of disrespect and they deserve to feel guilty as they are the over-benefited group. 

Survivor guilt is empathy-based guilt, thus distinguishing empathetic emotions from guilt is also largely necessary, as often empathy builds up to form guilt (O’Connor et al., 2011). Currently, empathy abides by social discipline so the challenge moving forward is for survivors to perceive their feelings of depression as empathetic instead of long-lasting guilt. This is where a therapist may aid in the replacement of submissive irrationalities experienced by patients (Murray et al., 2021). Correction of irrational beliefs is the primary task of cognitive therapy for trauma-related guilt (CT-TRG) (Kubany & Manke, 1995). Involvement of psychoeducation helps survivors rebuild their view surrounding responsibility and wrongdoings (Kubany & Manke, 1995).

Challenging Social Norms

On a broader level, social norms are “the unwritten rules of beliefs, attitudes, and behaviours that we expect (from individuals) in society” (Peck 2021), whilst conformity is a prominent group behaviour characterised by compliance with stated guidelines, sometimes enforced by law. Individual’s actions are a result of not only moral considerations but also observation, as proposed by the social learning theory (Bandura, 1977). When a majority experiences survivor guilt, the guilt is likely to pass on to other survivors. To prevent this negative conformity, individualism has to be rebuilt (Okochu, 2017). Once again, this is an area where therapists may provide knowledge regarding the disadvantages of lingering in a state of guilt.

Separation Trauma/Anxiety

Global media tends to focus on national displacement; however, the number of internally displaced peoples has been rising at an increasing rate, creating a more local, as well as international, problem. Displacements may lead to a range of circumstances; from camps where citizens are recorded and documented, to the forced movement of a family to a new home within or outside of the country. A growing number of scientists theorise that the level of displacement is proportional to the intensity of violence (Sasse, 2020; Moore & Shellman, 2006; Davenport et al., 2003; Ball et al., 2002; Cohen & Deng, 1998; Schmeidl, 1997; Weiner, 1996; Zolberg et al., 1989; Stanley, 1987). This migration can also be the response to destruction or loss of economic stability. Displacement often leads to separation of families when part of a family unit must flee to protect themselves while others are required to remain in the native country to fight in the conflict. These factors lead to the forceful removal of important support in an individual’s life and can cause emotional damage that lasts long beyond the closure of any particular conflict.

Effects on Children

During traumatic experiences of separation and displacement, children often face extreme reactions, whether in the immediate aftermath or at a later time. At the time of a tragic event, children commonly experience symptoms such as elevated levels of aggression, disinterest in activities, increased dependence on others, heightened amounts of crying, and symptoms of psychosomatic disorder. As for long lasting effects, children face much higher levels of PTSD, depression, and anxiety as they process their experiences. Another burden stems from the loss of familiar places, as this increases levels of stress and uncertainty (Bürgin et al., 2022). In preschool aged children, self-blame results from both the inability to reason the cause of conflicts and to conceptualise roles. Children of seven to eleven years of age share a similar developmental struggle of not fully comprehending the reasoning behind events, though they do have a stronger sense of perspective. These children often have high levels of anxiety and fear, as well as dependence on parental figures, and a reluctance to participate in education. Children of twelve or more years of age tend to have a greater understanding of the conflict. This often leads to a confinement of feelings within themselves in order to not appear as an additional burden. Contrastingly, others feel large amounts of anger and become resistant to their parents. Across all age groups, the sudden need for relocation creates instability and fear that can stunt the psychological and neurological development of these children (Joshi & Fayyad, 2015). 

Effects on Adults

Separation not only affects children but also has a large impact on adults who faced separation either during wartime or experienced trauma earlier in their lives. The actual act of removal can be very traumatising; however, much of the turmoil these adults face is a direct result of the burdens placed upon them to support their families in a new place. One study follows the prevalence of depression within a group of adults who had experienced different forms of displacement during World War II (Pesonen et al., 2007). This included participants who had spent time in foster care without the presence of a parental figure and those who were separated from their fathers, as they remained behind to fight. Pesonen et al., (2007) discovered that symptoms of depression were much more apparent in those who had experienced longer durations of separation; however, depression was prevalent both in people separated from their father figures and those placed in foster care. 

In another experiment involving displaced survivors of the war in Bosnia, 11 years after the conflict took place, researchers found higher levels of mental illness and distress than in the general population (Comtesse et al., 2019). Displaced people were found to experience and express hostility years after the conflict, potentially as a result of being socialised in a place of extreme aggression and violence. Citizens who chose, or were forced, to flee during the time of war displayed a more significant prevalence of mental illness; however, those who stayed in their home countries experienced a much more consistent level of mental challenges (Comtesse et al., 2019).

PTSD

Symptoms

Post-Traumatic Stress Disorder (PTSD) is a disorder that often occurs in the aftermath of a traumatic experience such as being the victim of genocide. PTSD is characterised by intrusive, negative memories of the traumatic experience, usually in the form of nightmares or flashbacks; a loss of interest in doing things once enjoyed; changes in behaviour, often involving aggressive outbursts; and the tendency to repress the traumatic experience and refrain from discussions about it. 

Symptoms of PTSD can be categorised as the following (Walton et al., 2017):

• Re-experiencing the traumatic event, 
• avoiding anything that might trigger the traumatic event, and 
• reacting to triggers with a fight-or-flight response. 

In some cases, specific phobias may be developed towards specific objects or situations that may remind the victim of the traumatic experience. 

Shame is also an inseparable part of PTSD symptoms, with victims often feeling shameful about the traumatic event or their opinions concerning it. Feelings of shame and guilt often have a direct relationship with the severity of the symptoms; shame caused by a traumatic experience can lead to social withdrawal, negatively affecting the victim’s personal relationships (Budden et al., 2012). PTSD may lead to a high risk of suicidal thoughts or actions, as well as self-harming behaviours (Auxéméry et al., 2018). Research has shown that out of 183 participants who experienced a traumatic event, 79.0% of them were diagnosed with varying symptoms of PTSD (Walton et al., 2017). 

Treatments

Cognitive behavioural therapy (CBT) is considered to be an effective method of treating PTSD, as well as depression and other anxiety disorders (Kaczkurkin et al., 2015). CBT helps the patient find relationships between their thoughts, feelings, and behaviours. It attempts to recognise the troubled thinking patterns caused by the patient’s disorder (Stallard, 2022). 

Prolonged exposure therapy (PE) incorporates recalling vivid images from the patient’s traumatic event, and then describing them aloud to the therapist. PE aims at having the patient digest the traumatic experience, and having new perspectives on oneself, as well as trying to shift negative perceptions to positive or neutral ones (Kaczkurkin et al., 2015). PE patients of PTSD are also advised to visit places or perform safe activities which were avoided beforehand (Kaczkurkin et al., 2015). An analysis of the effectiveness of Prolonged Exposure therapy showed significant improvement in patients of PTSD, however not more significant than other methods of treatment (Kaczkurkin et al., 2015).

Genocides’ Survivors

In the Holocaust, many concentration camp survivors were diagnosed with PTSD and other clinical disorders. Those diagnosed experienced nightmares about the traumatic experience, a tendency to avoid discussions about the event, and triggered fight-or-flight situations after the traumatic event. Those symptoms were present even after more than seventy years (Braker, 2023). A study conducted shows that out of 124 concentration camp survivors, the majority, if not all of them, experienced recurring symptoms of PTSD (Kuch et al., 1992). In addition, the Rwandan Genocide, or the Genocide against the Tutsi, resulted in one million deaths, with the majority of the survivors carrying the burden of PTSD (Musanabaganwa et al., 2020). 

Intergenerational Trauma

Intergenerational trauma refers to ongoing cycles of traumatic experiences, including symptoms, behaviours, and emotional distress (Yehuda et al., 2016). This phenomenon develops when the effects of trauma extend to children, grandchildren, and even great-grandchildren of the direct victims or survivors. In other words, intergenerational trauma is an inherited impact of emotional and psychological pain that includes both the direct consequences of trauma suffered by survivors as well as the indirect effects experienced by the next generations. 

Types of intergenerational trauma

Genocide-related generational trauma takes many different forms, each having different impacts on survivors and generations that follow. 

Historical trauma refers to the collective emotional and psychological traumas inherited across generations. For example, Armenian communities across the world continue to be impacted by the 1915 Armenian Genocide, in which Ottoman Turks deliberately targeted and murdered Armenians. Survivor trauma has been passed down through the generations, impacting the resilience, memory, and cultural identity of those who come after (Dadrian, 2008). 

Relational trauma is another form of generational trauma that is characterised by changes in attachment styles and family dynamics. This type of trauma occurred in the 1994 Rwandan Genocide, in which Hutu extremists murdered thousands of people who were part of the Tutsi minority. Due to the collapse of social ties and the loss of loved ones, victims and their children tend to have difficulties with trust, intimacy, and emotional control (Schaal & Elbert, 2006). 

Secondary trauma results from second-hand exposure to traumatic experiences of those who have survived. The Holocaust provides a clear example of how trauma may be transferred down through generations, causing successors of survivors to experience symptoms of post-traumatic stress disorder (PTSD) or other mental health illnesses (Yehuda et al., 2005). 

Systemic Trauma is caused by the institutional and structural oppression that oppressed groups are subjected to over generations. An example of this type of trauma is the Native American genocide in the United States, including brutality against Native Americans, forced displacement, and a purposeful change in culture. The ongoing legacy of past injustices can be observed in the disparities and marginalisation that Native American communities continue to experience (Brave Heart & DeBruyn, 1998).

Effects on Men and Women

Men and women who survive genocides often have to deal with particular, complex problems which will leave an impact on future generations. Individuals who have dealt with trauma, such as being exposed to violence, losing loved ones, and being uprooted, can have a significant negative effect on their mental health and social functioning (Klein et al., 2001). Survivors frequently suffer from existential anxiety, survivor guilt, and challenges dealing with traumatic events, which prevents their ability to heal and grow. 

Additionally, the men specifically might find it more difficult to ask for help and manage feelings if societal expectations are ‘strength’ and ‘toughness’ (Kirmayer et al., 2011). The obligation placed on men by society to repress their feelings is a problem that is deeply rooted in cultural norms and expectations. This expectation not only prevents men from getting the psychological care they need, but it also feeds a generational cycle of unresolved trauma and emotional repression. These crucial effects of societal pressure on men’s mental health underscore the persistent existence of heightened levels of distress and psychological symptoms. For example, research among Indigenous communities in Canada by Bombay et al., (2009) highlights how this expectation perpetuates a cycle of emotional suppression, leading to increased rates of depression, substance abuse, and suicide among Indigenous men.

On the other hand, women survivors of genocides face different challenges. They might have suffered increased rates of forced labor or sexual assault (Kellermann, 2001). After genocide, women may experience feelings of helplessness, remorse, and humiliation. The emotional burden placed on women by society’s expectations of them as “nurturers” and “caretakers” may also increase their sense of obligation to ensure the well-being of their family. Such challenges, more often than not, make it harder for them to give their children support and stability, which adds to the trauma which is being passed down through generations. These burdens of trauma also frequently result in complications with emotional support and communication with their children. These issues may be transmitted to the children of survivors, sometimes manifesting as mental disorders. 

The trauma of sexual assault also disproportionately impacts women. For example, women suffered extensive sexual abuse during the Bosnian War in Bosnia and Herzegovina, which resulted in long-lasting psychological scars and intergenerational trauma. Sackellares et al. (2005) explore the long-lasting effects of sexual violence on women’s mental health, as high rates of depression and PTSD continue long after the conflict has finished. In addition, the memory of sexual assault and forced labor ties back to previous points as it can affect family relations and prolong trauma cycles in later generations. The experiences of survivors’ children are influenced by the relationship between the challenges faced by male and female survivors, which also affect wider family dynamics. 

Effects on Children

The traumatic events of parents often lead to a variety of psychological and neurological symptoms in their children who have not directly experienced the trauma. For example, the descendants of Holocaust survivors may experience higher rates of mental health conditions such anxiety, sadness, and PTSD (Yehuda et al., 2005). In fact, according to Yehuda et al. (2016), neurobiological research has shown that children of trauma survivors have altered stress-regulating brain circuits, suggesting possible pathways for the transfer of trauma-related traits. Transgenerational transmission of trauma-related behaviours may also be influenced by epigenetic changes such DNA methylation (Yehuda & Bierer, 2008). 

These results show the complicated relationships between environmental factors and a person’s genetic makeup which influence the psychosocial and neurological consequences of those who have experienced intergenerational trauma. Targeted therapies, intended to lessen the negative effects of trauma on the mental health and general well-being of affected individuals and their offspring, can be improved through a more comprehensive understanding of underlying mechanisms.

Discussion

Though mental health impacts of war acts such as PTSD are extensively researched, there are limited treatment options for most, if not all, of the conditions stated above. PTSD is known to have the most developed treatments, ranging from cognitive behavioral therapy to prolonged exposure therapy, however, the same level of development cannot be said about the treatments for other conditions, such as survivor guilt or intergenerational trauma. More often than not, different manifestations of psychological effects of genocide are meshed together under a wide umbrella of trauma, often labelled simply as PTSD. While it is true that most genocide survivors experience a level of trauma or PTSD, PTSD manifests differently in different people, and there are also many other psychological impacts of genocide that become overlooked and under-researched. There are many common symptoms between different manifestations of PTSD, or even between PTSD and other psychological impacts such as intergenerational trauma. PTSD and intergenerational trauma can share certain symptoms – such as avoidance, outbursts, and feelings of blame – however, there is still a significant difference between general PTSD and intergenerational trauma, especially given that intergenerational trauma is secondary – the intensity, origin, and timeline of the trauma is different to general PTSD. Yet, most types of trauma are still treated by similar talking therapies. Targeted therapies for specific traumas are rare to find and often expensive or exclusive. This is especially evident in countries that lack the psychotherapeutic advancements needed to provide support for mental health outside of general counselling and therapy. Due to this, an area that could be researched on further under this topic would be the treatments and curing of these conditions, as it is important to explore more effective and accessible interventions tailored to the unique needs of those suffering from various psychological impacts of genocide.

Conclusion

In conclusion, the psychological impact of genocide is a highly complex and often overlooked aspect of its impact on individuals and communities. Conditions such as post-traumatic stress disorder (PTSD), survivor guilt, intergenerational trauma, and separation anxiety/trauma are extensively highlighted in this paper, including a range of types, symptoms, causes, and effects. By drawing on survivor testimonies and evidence, it underscores the enduring nature of psychological trauma. This paper also emphasises the available treatments and therapies, such as cognitive behavioural therapy (CBT), prolonged exposure therapy (PE), and psychoeducation, that aim to address the ongoing struggles affecting the lives of innocent people caused by the four psychological effects. 

This research begins a comprehensive investigation into the existence of psychological traumas that result from conflict and potential ways to address their causes, symptoms, and effects. Through in-depth research based on data from survivors and research on past conflicts, it is evident that the psychological effects of genocide impact the lives of individuals and communities in a broad and ongoing manner. By shedding light on these issues, this study contributes to a deeper understanding of the enduring impact of genocide, and paves the way for effective strategies for healing and recovery.

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