Over the last several months, international media coverage has been replete with the unsettling images of the unprecedented wave of terrorist attacks in Israel. These attacks are perpetrated by Arab and Israeli-Arab civilians and target Israeli civilians in the streets, in stores, and at bus stops, creating a scenario whereby no place is safe.
This situation is reminiscent of the persecution of Jews in Europe before and during WWII, and is re-traumatizing for those who experienced genocidal persecution in their earlier years. For Holocaust survivors living in Israel and elsewhere, the perception of renewed attacks on Jewish people, of threat to the survival of the Jewish State, and of a world that seems yet again indifferent, evokes increased anxiety.
Do previous traumatic experiences have inoculating effects, enabling survivors to better cope with different types of stress, or do these experiences lead instead to greater sensitivity and higher risk for post-traumatic reactions? Evidence suggests that people who suffered extreme stress are more vulnerable to future stress. This increased vulnerability is especially evident as people age.
Traumatization in earlier life phases constitutes a risk factor for late onset of Post Traumatic Stress Disorder (PTSD). Life review processes, less distraction by work and family, and losses that often accompany old age contribute to the re-surfacing of previously warded-off memories, anxiety and depression. New stressors that are similar to the original trauma can be particularly troubling.
The missile attacks on Israel during the Persian Gulf War evoked more intense psychological distress among Holocaust survivors than among other groups in Israeli society. Similarly, Holocaust survivors in New York had more post-traumatic symptoms than other elderly peers after the 9/11 attack. The intensity of post-traumatic reactions in response to the 9/11 attack and the Oklahoma City bombing was also related to previous levels of traumatic exposure among other US-resident immigrant groups.
Lifelong effects persist among those who experienced severe adverse events during childhood. Those who were children in Europe during WWII show higher levels of PTSD, anxiety and depressive symptoms decades later. In fact, PTSD levels were twice as high among elderly Jewish child Holocaust survivors in comparison to non-Jewish Polish peers, illustrating the impact of the persecution and traumatic losses they suffered, as well as the other stressors of war.
Despite their traumatization, Holocaust survivors have demonstrated remarkable resilience. Studies have found no real differences between survivors and their non-survivor peers in many other spheres of life, including general well-being, physical health, psychological well-being, and coping capacities. Yet, distinct vulnerabilities of Holocaust survivors were evidenced, particularly in elevated post-traumatic symptoms.
While older survivors in New York had elevated post-traumatic symptoms after 9/11, they were also more resilient than their similarly aged non-survivor peers. Life experience can also confer protection in the face of new threats. This mixed picture of adaptive capacities and post-traumatic reactions reflects the complexity of resilience, which should be treated as a continuum. Someone can be resilient to varying degrees across multiple spheres. Vulnerabilities and adaptive capacities co-exist, “braided” together.
Strategies identified as most effective in coping with PTSD include cognitive re-appraisal, distraction and social connection. The aim of interventions with Holocaust survivors experiencing re-activation of post-traumatic distress should be to help them achieve a cognitive shift in attention, memory and expectations from the negative toward the positive, from their vulnerabilities to their resilient capacities. In essence, we need to help the survivors remember the lessons of their life experiences.
Survivors have witnessed two great miracles in their lifetime: the defeat of Nazi Germany, and the establishment of the State of Israel. The experience of having witnessed unlikely deliverance which was deemed almost impossible is part of what Holocaust survivors have to offer the rest of us. We need to provide them the opportunity to be reminded of their valuable experiences and personal resources, as well as avenues to share them with family and community.
Social engagement and support are crucial in the quality of adaptation during and following stressful events. It is therefore critical to offer opportunities for social connection for the elderly, who are already a vulnerable population. In New York after 9/11, participation of the elderly in settings such as community centers nearly doubled, indicating the need for social contact during difficult times. Supportive services in community-based settings, case management programs and social adult day programs, where older adults attend for reasons other than mental health treatment, are extremely valuable.
Faced with feelings of helplessness, even modest efforts can have a significant impact: self-care, including proper attention to eating right, sleeping well, and limiting excessive exposure to the news, is important. Constructive distractions from negative thoughts towards strengths include mediation, prayer, exercise, creative activities, or any other form of re-charging and enhancing well-being.
As Chanukah approaches, we need to be reminded to keep our own little light aglow, as we are each a part of a bigger light that is stronger in its unity.