Caring for Aging Holocaust Survivors and Subsequent Generations

It is now more than 65 years since the end of the second World War and the liberation of Auschwitz. The Holocaust, the systematic state-sponsored genocide of six million Jews, was a watershed event in modern human history and has challenged pre-existing ideas of the social, cultural, and psychological analysis of human behavior (Marcus & Wineman, 1985). Psychoanalysis has failed to address the transformational nature of this event. It has become clear, for example, that the analytic concepts of regression, identification with the aggressor, and survivor guilt are far too broad or simplistic to explain survivors' problems or guide their care. Equally significant, there has never been a group of genocide survivors who lived to this geriatric age, creating a situation for which professionals have limited experience.

Writing about "Caring for Aging Holocaust Survivors and Subsequent Generations" is a daunting task. The first problem one confronts is that the classification "Holocaust survivor" is extremely inexact. The term "survivor" in reference to the Holocaust broadly refers to any Jew threatened by the Nazi occupation during the second World War. But the level and type of victimization and the terrors and atrocities experienced and witnessed vary from person to person. "Survivor" can refer to a person incarcerated within a concentration camp, confined to a ghetto, forced to work in a labor camp, or compelled to hide under a false identity. It can signify a refugee or a child sent away in the Kindertransport. Concentration camp prisoners brought differing strengths and weaknesses to the camps and those fortunate enough to survive confronted and experienced atrocities in individualized ways. Those who suffered the isolation and fear associated with being in hiding might have suffered them alone, with their families, or with "righteous gentiles" who at great risk to themselves and their own families demonstrated an incomparable compassion and decency. Survivors of ghettoization suffered the ghetto's own destructive elements, as well as its own opportunities for heroic and caring acts. Some lived in swamps and forests where they fought and killed Nazis and collaborators, but where they also suffered enormous losses.

Survivors have had different post-Holocaust experiences. While some prospered and had children and grandchildren, others were unable to live successfully in the post-Holocaust world. Some have been able to discuss their horrifying experiences with family, friends, and mental health professionals, but others have never discussed these with anyone. Some were overwhelmed with guilt, and some felt lucky to survive. Finally, some show astounding resilience, while others simply cannot overcome their wartime experiences.

Most living survivors of the Holocaust were children during the time of the Shoah (the Hebrew word for the Holocaust). A child survivor differs from an adolescent and an adult survivor. When treating or caring for Holocaust survivors, it is important to remember that one treats patients who suffered individually—one does not treat a group.

This paper reviews the literature addressing clinical experiences in the care of survivors and subsequent generations. It is designed as a general guide about what to explore and what to look for when treating people who endured the Holocaust. Treatments must not stigmatize a group that has already suffered unthinkable hardships by creating stereotypes of pathology. Equally important, practitioners must remain aware that survivors may present with special problems and concerns. It is impossible to imagine that anyone who is subject to the threat of sudden death at the whim of perpetrators, who experiences the destruction of their families, their homes, and their countries, and who were referred to as vermin and treated worse than animals can survive unharmed. There are conditions that are overrepresented in this group based not only on past but also on current experiences. As survivors age and become cognitively impaired, they are destined to remember terrible things that they repressed previously. Nursing homes and other closed ("totalitarian") facilities, certain sights and odors, and the "intrusion" of increasing numbers of doctors into their lives will often affect survivors in apparently "unusual" but not surprising ways.

In this essay, I first review the significance of the concepts of trauma...