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The Difficulties Of Ageing Are Intensified For Holocaust Survivors

April 11, 2010 – 12:09 pm4 Comments

Holocaust survivors raise unique issues in the world of geriatrics

Holocaust survivors raise unique issues in the world of geriatrics

By Liz Paratz

The image of the Holocaust survivor who started afresh in the aftermath of the camps is familiar and powerful. We see it in films, in literature, and in our own families. The degree of transformation in these survivors – from dehumanization to success in a foreign country – is so compelling that it’s understandable why the media tend to focus in on such stories.

But that image of ‘the Holocaust survivor’ is beginning to change. As Holocaust survivors age, a number of unprecedented care issues arise. And, as Australia experiences the first waves of ‘the grey tsunami’, providing good care for Holocaust survivors raises unique issues within the world of geriatrics. Given that Australia is home to the second-largest per capita Holocaust survivor population in the world, we have an inescapable duty to recognize and work with these issues.

The worst-case scenario is often acknowledged to be the Holocaust survivor who develops dementia. For these people, dementia is a shocking blow. With 60 years between themselves and the Holocaust, a degree of distance and protection has been piled up, padded with human and material achievements.

But then memories of each achievement are steadily stripped away as the decades roll back. Inexorably, the survivor sees themself slipping back towards that horror-decade, the 1940s.

As they take the tumbling unstoppable journey they frequently revert to their mother-tongue, be it Yiddish, Polish or Russian. This rips apart their social support structure as children and grandchildren may now be unable to comfort them, and they cannot easily communicate their needs to medical staff.

But even for survivors who don’t develop dementia, there are still plenty of problems.

Doctors have identified an increase in post-traumatic stress disorder symptoms in Holocaust survivors as they age. This rise has been partially attributed to retirement and increased isolation, providing more time for reflection. Additionally, loss of independence may play a role. Much of the survivor population’s fear and anxiety about ageing is considered to be largely linked to Holocaust experiences.

For example, given that in the camps any sign of weakness could mean death, it is understandable that survivors experience out-of-proportion anxiety around issues like deafness and walking problems.

For these survivors, normal ageing processes like illness, frailty, dependency, and isolation provide cues to past trauma. Events such as the deaths of close friends, and awareness that one’s own death is approaching may further sharpen the grief, fear and mourning.

Some researchers declare that, ‘in the eyes of some survivors, Auschwitz was like a medical operation and the killing program was led by doctors, from beginning to end.’  But this version of ‘medicine’ as seen in the camps, and remembered by the survivors, was distorted and nightmarish.

Hence today ‘hospitalization…frequently brings about delusions of being in camp again. Survivors are once again confined and must submit to the humiliation of being helpless and being told what to do “for their own good”’. Other identified stressors associated with hospitalization or moving to a nursing home are ‘absence of family members; absence of personal belongings; lack of privacy; and invasion of one’s body by medical examinations and procedures’.

Unfortunately, as the survivors age, the number of diseases from which they suffer increases – and therefore so does their need for hospitalization.

Sometimes their co-morbidities are medical complications of the Holocaust. For example, young girls who survived the Holocaust now, as elderly women, have much higher rates of osteoporosis due to severe starvation at a critical time for bone development. Long-term alterations in the levels of stress hormones have also been tied to an increased risk of cardiac disease in survivors.

In other cases the Holocaust history may not be responsible for the disease process, yet can still affect prognosis. Survivor patients with cancer cope worse with their disease, and survivors with chronic pain suffer higher pain intensity and rates of depression.

Exposure to the medical environment may re-awaken terrible memories. The traumatic cues linked to the pseudo-scientific institutionalized nature of the camps may cause survivors to present as ‘difficult patients’ when in a hospital or nursing-home.

For example, receiving injections may trigger fears of being lethally injected with phenol.  Being taken by a nurse to shower may provoke extreme anxiety about lack of control, and flash-backs to what ‘being taken to shower’ meant in the camps. Losing weight as part of a generalized disease process or due to swallowing problems may also create great fear, as survivors fear they are starving to death like friends and family did in the war.

This fear of the medical system may have unfortunate consequences. A study in the Medical Journal of Australia* found that the Metropolitan Ambulance Service consistently recorded an inappropriately low number of call-outs by Holocaust survivors with chest pain during the 1990s. This was theorized to be due to survivors’ fear of calling a uniformed external agency who would take the patient away. For too many, this cut too close to suffocated memories of deportations.

In that specific case, the solution was the creation of Hatzolah, a Jewish first-responder service. This is practically a perfect example of creatively and sensitively meeting the unique needs of Holocaust survivors.

Other ways to soften survivors’ experience of ageing and medical interventions include providing Yiddish/ Russian/ Polish interpreters, maintaining a familiar environment and staff insofar as possible, providing medications in oral rather than intravenous or parenteral form and, if possible, even trying to avoid placing cannulae (drips).

Providing baths rather than showers, and organizing regular nutritional counselling around supporting the patient’s weight are further measures reported to significantly boost patients’ sense of autonomy and wellbeing.

Most of these successful medical interventions are simple and relatively inexpensive. From the community side, what can we do non-medically to deal with this phenomenon of ‘late effects of the Holocaust’ ?

Perhaps one of the best approaches we can take is recognizing, discussing and identifying all the complications, individual fears and stressors. With a better database of knowledge on this phenomenon, we can then more confidently explain to medical professionals the desirability of taking a full ‘Holocaust history’ in survivors, and the real need to develop sensitive and appropriate care plans.

* Chan T, Braitberg G et al, Hatzolah Emergency Medical Responder Service : To Save A Life, MJA 2007 ; 186 (12) ; 639-42

* Image from www.wacoisd.org

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  • Sam says:

    “we can then more confidently explain to medical professionals the desirability of taking a full ‘Holocaust history’ in survivors, and the real need to develop sensitive and appropriate care plans.”

    In a perfect world the above is what we should all strive for. With respect to medical professionals and allied health care people, those that are not Jewish have limited or even no real knowledge of what the survivors have endured. (First hand experience with a clinical psych. who of all professionals should know, or make the effort to learn). 
    Maybe it is good case for trying for a for a mature age Jewish health professional if that option is available when seeking treatment for Holocaust survivors.
    Interestingly the keynote speaker at the Yom Ha Shoah commemoration in Perth told the story of his parents, both survivors, where for a long time he did not know his Mother’s story as she was still too overwhelmed  by the enormity of the memory of earlier events. This is a such a common story if you ask the second generation.
    It is not all that likely that survivors can articulate what happened to them at that time to relative strangers (even their GP) judging from what I have seen amongst my family and relatives.

  • Liz says:

    Hi Sam,

    I definitely agree re your point about the difficulty of survivors articulating their experiences and fears, especially to non-family.

    There are 2 points that I think  can maybe help out in this situation….

    1) a ‘Holocaust history’ may not contain the minutiae of what happened to the person during each year of the Holocaust and in-depth recountings of traumatic experiences. Rather, it may already help just to know that the patient was in the Shoah and that this raises the chances of certain medical conditions (ie, osteoporosis) and certain concerns (ie, re showering, nutrition, injections). Many medical professionals do not ask an elderly person with a Polish or Yiddish accent where they were during WWII – completely understandable given the brevity of the usual consultation and the usual wealth of current health issues to cover. But just noting this fact may help channel treatment and understanding of the patient’s issues down a slightly different path.

    2) In terms of ‘building data’, most of the articles describing psychological distress in Holocaust survivors are retrospective, ie describing past events. It is difficult to predict what will distress someone until the time comes even if their Holocaust experience is known in detail, since everyone reacts differently to a situation. Discussion and data collection could therefore be a retrospective exercise, with second- and third-generation discussing experiences that have arisen and stressors they have noted with their parents and grandparents. Collection of these stories could then help build a greater picture of what things are common and need to be particularly recognized in our survivor community.

  • Sam says:

    Hi Liz,

    I recently had an experience with my Father-in-law which illustrated quite dramatically that you cannot predict what will stress out a survivor, and that they would likely all react differently.  One of the results of the concentration camp experience was that many were not quite sure of their real age after the Shoah.    Assoc. Prof Mark Baker described how this was the case with his father, and was likely caused by the need to lie about one’s age in various circumstances to avoid being placed in the line marked for death.
    My Father-in-law thinks he is older by 2 years than the age confidently given for him by his older sister. We were having a discussion about events in his life in the early 1940’s to try and determine who was in fact correct.  Then he said that one time he dressed in clothes to make him look older than he was. I replied back that this would not really support his contention for being older than the age given by his sister, and was not very heplful.  He became quite distressed and was very upset with me, as he went on to explain that this had probably saved his life and I had no regard whether he had got through what was evidently a significant crisis. Happily we smoothed out the misunderstanding soon after, but it was deeply upsetting for him. 

  • Rabbi Pinchos Woolstone says:

    Here in New York there are psychiatrists and other mental health professionals who have development tailor made responses for the therapeutic needs of Holocaust survivors.
    The Ohel organization would be a good place to contact for further information

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