Risk and Resilience: Reactions of Elderly Jewish Holocaust Survivors to Current Terrorist Events

Lamet, Ann

OBJECTIVES: Individuals who lived through World War II and directly experienced the horrors of the Holocaust did so at impressionable developmental stages. Within a risk and resilience framework, this pilot study ascertained the reactions of elderly Jewish Holocaust survivors to current terrorist events in order to identify positive outcomes and strengths as well as adverse reactions. METHODS: Unstructured, audiotaped interviews were conducted with five elderly Jewish women. Themes were derived through content analysis. RESULTS: Increased symptoms of post-traumatic stress remained with the Holocaust survivors after the September 11th event. Extracted themes included paralleling the present with the past and reliving the past, empathy with current victims, reawakening and awakening, and hope for the future generations. These themes appear to support a strong sense of self which reflects ability to be resilient in the face of current adversity. CONCLUSIONS: Knowledge gained will assist health care professionals in developing more complete assessments of survivors’ health and well-being and will improve interventions with others who have experienced adversity at a developmentally impressionable age.

KEY WORDS: Holocaust Survivors; Resilience; Risk Factors.

Since September 11, 2001, people who experienced the trauma of the Holocaust have again been living through tumultuous times. Holocaust survivors lived through World War II and experienced or witnessed devastating events at impressionable developmental stages. The purpose of this study was to gain an understanding of the reactions of elderly Jewish Holocaust survivors to current terrorist events, including the tragedy that occurred on September 11, 2001 in this country as well as more recent bombings in Israel. Although intuitively one would expect negative consequences or a reopening of the wound, this study sought to identify positive outcomes and strengths as well as adverse effects.

SIGNIFICANCE

As a result of Nazi genocide, 12 million people perished in the Holocaust. Of this group, 6 million Jewish individuals died in this atrocity, of whom over 1 million were children. The second largest population of elderly Jewish Holocaust survivors within the United States reside in south Florida. Therefore, information gained from this study and subsequent research will be beneficial to nurses and other health and human service providers as they interact with and plan interventions that are targeted to this large elderly population. Moreover, since this population has had past and current experience with adversity, knowledge gained from this group may shed light on particular risks and vulnerabilities as well as protective factors and competencies (Dyer & McGuinness, 1996) which may be useful in working with other populations who experience traumatic or challenging events. Studying reactions of Holocaust Survivors to terrorist events is timely. This group of people who underwent adversities provide exemplar cases that can help illuminate mechanisms of how people cope or do not cope under extreme circumstances.

THEORETICAL FOUNDATION

Psychosocial Development

Erickson’s (1959) theory on psychosocial development identifies developmental tasks in each phase of the life cycle that reflect cultural and societal influences. Each of the eight stages represents a crisis that has an impact upon development of the person’s ego. During each developmental stage of a person’s life cycle, certain goals should be achieved. These developmental tasks are important for future adaptation. Erickson identified the following successful and unsuccessful outcomes of developmental tasks: (a) basic trust versus mistrust, (b) autonomy versus shame and doubt, (c) initiative versus guilt, (d) industry versus inferiority, (e) identity versus identity diffusion, (f) intimacy versus isolation, (g) generativity versus stagnation, and (h) integrity versus despair.

Older adulthood is the time for reviewing the past, a process which brings together previous stages of life. This process of life review should result in ego integrity if one “has taken care of things and people and has adapted to the triumphs and disappointments of being” (Erickson, 1959, p. 98). These self-processes may place heavy demands on elderly Holocaust survivors. Survivors need to resolve the devastating repercussions of evil-inflicted loss, suffering, guilt, mourning, humiliation, and rage as a precursor to reconciliation of self (Krystal, 1981, 1991). Although long-standing memories of trauma may be severely intrusive, they are important for maintaining an integrated self. Thus, Holocaust survivors may face greater mental health challenges in their elderly years.

Trauma may be reactivated by other aspects of the normal aging process such as increased illness and frailty, dependency, isolation, institutionalization, loss of loved ones, and impending death (Schmotkin, Blumstein, & Modan, 2003). These experiences may mirror traumatic memories of similar themes earlier in the life cycle and hinder adaptation to old age (Danieli, 1981; Harel, 1995; Safford, 1995; Schmotkin et al., 2003). In addition to the greater sensitivity to the normal late life processes, elderly Holocaust survivors do appear to be particularly vulnerable to prolonged stress and retraumatization (Krystal, 1995; Landau & Litwin, 2000; Valent, 1995). For example, elderly survivors in Israel demonstrated more psychological distress and symptoms of post-traumatic stress disorder than controls during the Gulf War when faced with missile strikes and the threat of poisonous gas (Robinson, Hemmendinger, Netanel, Rappaport, & Gal, 1994; Soloman & Prager, 1992).

Remembering the past also contains other cumulative life experiences since the initial adversity, and the influence of these experiences on current resolution of developmental tasks should be considered. Research has shown that accumulation of both positive and negative life events allow for many pathways of resilience and risk among people who suffered from adversity in their past (Singer, Ryff, Carr, & Magee, 1998; Turner & Lloyd, 1995).

Risk and Resilience

According to Dyer and McGuinness (1996), resilience is a global term describing a process whereby people bounce back from adversity and go on with their lives. It is conceptualized as a dynamic process involving the interplay between both risk and protective processes, internal and external to the individual, that act to mitigate the effects of an adverse life event (Rutter, 1985, 1999) as well as a host of other biological, psychological, social, and other environmental influences (Fraser, Richman, & Galinsky, 1999). Resilience does not so much equate with invulnerability to stress but rather an ability to recover from negative events (Garmezy, 1991) and go on to achieve positive and unexpected outcomes in the face of adversity. Resilience, described as “normal development under difficult conditions” (Fonagy, Steele, Steele, Higgitt, & Target, 1994, p. 233), is closely tied to developmental tasks across the lifespan.

In the examination of characteristics of resilience, age of the victim at the time of the adversarial event is one factor that is associated with more positive outcomes. For example, it has been demonstrated that despite cultural differences and the nature of events, children who are exposed to adversity are more resilient in the long-term than adults who are exposed to the same adversity (Green et al., 1994; Green et al., 1997; Lev-Weisel & Amir, 2000; Robinson, Rapaport-Bar-Sever, & Rapaport, 1994; Sack et al., 1995). Evidence has illustrated that unlike adult survivors of the Holocaust, child survivors in adulthood generally demonstrate well-being, good adjustment, and positive family ties despite any symptoms they may have (Cohen, Brom, & Dasberg, 2001; Robinson et al., 1994; Sigal & Weinfeld, 2001). It is important to note that resilience is context specific; more specifically, resilience in one area of functioning is not necessarily indicative of resilience in all areas (Rutter, 1993).

Risk, the probability of the likelihood of a future event given a certain condition or set of conditions, has been defined in a number of ways. For our purposes, risk “denotes the fact that a group of people with a similar characteristic is more likely than others in the population at large to develop a problem” (Fraser et al., 1999, p. 132) (e.g., Holocaust survivors may have a greater probability of having poor long-term outcomes than non-survivors). Risk can also defined probabilistically as any influence that increases the likelihood of the onset or maintenance of a problem state (Coie et al., 1993; Fraser et al., 1999). Further, it can be applied to influences that cause digression to a more serious state, as in relapse or the recurrence of symptoms after remission (Fraser et al., 1999; Kirby & Fraser, 1997). Risk factors are markers or correlates of risk. They may be individual characteristics (i.e., traits prior to and after the Holocaust, gender), specific life experiences or events (i.e., the Holocaust, other more recent terrorist events and retraumatization, aging), or contextual factors (i.e., postwar environment).

According to several authors, protective factors are conceptually distinct entities that modify risk in several ways to enhance or hinder the development and maintenance of resilience (Bryant, West, & Windle, 1997; Coie et al., 1993; Fraser et al., 1999; Jessor, Van Den Bos, & Vanderryn, 1997; Rutter, 1987). They directly compensate for risk by decreasing a reaction to an adverse life event or a disorder by mediating the chains of risk and protection. Alternately, protective factors may provide resistance to risk by “buffering” or moderating the relationship between risk factors and the adverse life events or a disorder.

Protective factors may become relevant as sources of resilience at any stage of a person’s life (Rutter, 1985). Selected protective factors have been related to resilient individuals in other adversities and may have relevance to survivors of the Holocaust. Two 30 year follow-up studies of child Holocaust survivors in orphanages found that in adulthood they were functioning well in their social, vocational, and family lives (Hemmendinger, 1994; Moskovitz, 1985; Robinson & Hemmendinger, 1982). The commonality between these two groups was social support, or the persistence of one or more caring people over a number of years, despite the survivor’s initial hostile behavior. The researchers also noted the ability of these individuals to reach out to others to obtain support through networks of informal relationships (Hemmendinger, 1994; Robinson & Hemmendinger, 1982). Coping styles, particularly repression, have also been cited as a protective factor (Pennebaker, 1985; Yehuda, Schmeider, Siever, Binder-Byrnes, & Elkin, 1997). It may be that the ability to repress their negative childhood experiences facilitated long-term adaptation of these Holocaust survivors (Bybee, Karmer, & Zigler, 1997; Sigal & Weinfeld, 2001). Sigal and Weinfeld (2001) have also suggested that the successful adaptation of younger groups of Holocaust survivors may be due, in part, to the differences in their social and cognitive development at the time of the Holocaust.

The schematic diagram depicts the proposed links between selected concepts from both of the theoretical frameworks utilized in this paper (see Figure 1). Erickson’s theory on psychosocial development spans a person’s life cycle and is depicted by the horizontal line. This lifespan is characterized by normal developmental tasks and “usual situational Stressors.” In the lifespan of Holocaust survivors, however, it is well documented that extreme adverse life events also occurred at critical time points. In the late 1930’s and early 1940’s, during the early developmental life stages (i.e., childhood, adolescence, and young adulthood) of many Holocaust survivors, World War II erupted, and the horrific threat of Jewish genocide was imposed upon them. Survival became their major concern amidst starvation, separation from family, forced labor, and mass murders. Genetic endowment, temperament, familial factors, and developmental skills and competencies that characterized resilient functioning in these individuals prior to their internment may have improved their chances of survival, despite exposure to extraordinary risks. However, other factors such as postwar environment, psychohistory, and mechanisms of defense, particularly repression may have also influenced further adjustment of Holocaust survivors (Sigal, 1998).

In the year 2001, when many of these same Holocaust survivors reached the developmental stage of older adulthood, they were again confronted with an extraordinary adversarial life event: The terrorist attacks on the World Trade Center as well as bombings in Israel, to which many Jewish survivors feel a particular emotional attachment. In the context of retraumatization, achieving resilience within this context would be dependent on resolution of other developmental tasks, postwar adjustment, and the interaction of current risk and protective factors.

LITERATURE REVIEW

Responses to adversity may be viewed in the context of life-course development and may be influenced by the developmental stages in which they occur (Elder & Clipp, 1988). It could be argued that exposure to extreme situations in childhood or adolescence would have a more pervasive effect on personality than trauma experienced in adulthood (Kahana, 1992). For some, adversity may have a steeling or strengthening effect rather than a scarring effect on one’s personality (Anthony, 1974; Rutter, 1985). This may result in the gradual accumulation of personal coping resources over an individual’s life (Erikson, 1950). Thus, in the elderly, successful resolution of each crisis, whether developmental or traumatic, may lead to coping resources that can be mobilized in subsequent crises, leading to a sense of efficacy and ego integrity in later life (Moos & Billings, 1982).

Trends in Empirical Evidence: From Psychopathology to Strengths

Since World War II, there has been an unfolding of research that has been strongly influenced by a psychopathology-dominated approach. Although these investigations were vital to the treatment of survivors and their families, many studies overlooked the functions of adaptability, resourcefulness, and growth in survivors’ lives (Shmotkin & Lomranz, 1998). Initial studies focusing on adult survivors characterized the “survivor syndrome” and documented other pervasive psychological and physical damages (Chodoff, 1963; Eitinger, 1964; Niederland, 1968). Later investigations on adults validated that exposure to prolonged, excessive adversity does have sustained negative effects on the psychological functioning, physical health, and longevity of survivors of the Holocaust (Carmil & Carel, 1986; Eaton, Sigal, & Weinfeld, 1982; Eitinger & Strom, 1981; Levav & Abramson, 1984). In contrast, other studies have indicated that some survivors did not show serious psychological impairment in comparison to control groups (Harel, Kahana, & Kahana, 1988; Leon et. al, 1981; Shanan, 1989). In fact, some early studies found survivors to be higher in certain coping strategies (Harel et. al., 1988), selected aspects of social interaction (Harel et. al., 1993), and hope (Carmil & Breznitz, 1991) than comparison groups. Most recently, there has been an emergence of studies which document the substantial contributions that Holocaust survivors have made to their communities (Gibarovitch, 1994; Helmreich, 1990) as well as investigations of positive outcomes across different domains of functioning in this population (Cohen et al., 2001; Sigal & Weinfeld, 2001).

Studies on Risk and Resilience in Elderly Holocaust Survivors

Thus, the interplay of risk and resilience in these survivors that is reflected in diverse research findings illustrates how the damages of traumatization coexist with effective coping with life. Consistent with the notion that resilience is contextual, Holocaust survivors have been shown to vary in their ability to adapt across domains of functioning.

Using a randomized community sample in Israel 50 years after the Holocaust, Cohen et al. (2001) utilized a controlled double-blind design to ascertain the level of psychological distress, post-traumatic symptoms, achievement motivation and the person’s cognitive outlook on self and world. The sample consisted of an experimental group of 50 participants who had been exposed to Nazi occupation and genocide and 50 participants who had no direct exposure to the Holocaust. Major findings showed that although the psychological distress scores for survivors were somewhat higher than the controls, there were no significant differences and they were within normal limits. Scores on post-traumatic symptoms were significantly higher in the survivors than the control group, yet lower than scores of psychiatric outpatients. Results also showed that survivors were more highly motivated to achieve because of fear of failure yet were similar to controls in relation to the subjective importance of success. Interestingly, survivors perceived that there is justice in the world, that people can control the world by their actions, and that luck plays an important role in their lives to a greater degree than did the control group.

Lev-Wiesel and Amir (2000) conducted a study to assess the long-term impact of different Holocaust experience settings (i.e., Catholic institutions, Christian foster families, concentration camps, and hiding in the woods and/or with partisans) on Post Traumatic Stress Disorder (PTSD) symptoms, psychological distress, personal resources, and quality of life in Holocaust survivors who were children during World War II. The community sample consisted of 77 men and 93 women who were recruited primarily from two “hidden children” organization lists in Israel. Results showed that survivors who had been with foster families scored significantly higher on several of the distress measures, whereas survivors who had been in the woods and/or with partisans scored significantly higher on several of the positive measures such as quality of life, potency, and self-identity. Utilizing developmental theory and sense of control, the authors conjectured that living with foster families involved substituting one family for another. Some families were nurturing while others were cruel. In addition, being forced to assume a new identity, and later, at the end of the war, being forced to become Jewish again, were likely to have harmed the children’s basic sense of belonging and self identity. Alternately, those who were hiding in the woods and/or with partisans were actively involved in coping with life threats and, to a certain degree, were in control of their lives. Thus, type of traumatic experience setting during the Holocaust differentially influenced the well-being of individuals who were children during World War II 55 years after the end of the war.

In a related vein on differential outcomes, Shmotkin and Lomranz (1998) examined the level of adjustment among Holocaust survivors by a multidimensional assessment of subjective well-being. Participants were elderly Israeli Holocaust survivors incidentally included in a life-span study (group 1) or purposely approached for studying Holocaust survivors (group 2). Comparison groups included those who had immigrated to Israel before World War II with either their parents undergoing or not undergoing the Holocaust (group 3). The last comparison group had immigrated after the war with parents not undergoing the Holocaust (group 4). Results showed that group 1 still bore the psychological scars privately while leading normal, although less happy lives; whereas survivors in group 2 were more ready to bear witness to the experience of the Holocaust while personally feeling remarkably positive about themselves. The high rate of survivors in group 2 that reported some partisan-related activity during World War II suggested a lifelong mode of combining activity and self assurance.

Kahana et al. (1989) discussed the idea that Holocaust survivors are better prepared to meet other difficult situations in life, having overcome fears and tragedies, since survival strategies are learned. Some survivors are strengthened by experience rather than being beaten down. In a subsequent study, Kahana (1992) surveyed 150 aging Holocaust survivors in Israel and in the United States as well as 150 matched controls in both countries and collected data on physical health, mental health indices, morale, and social functioning. Results showed that psychosomatic symptoms and psychological distress scores were elevated coupled with decreased morale scores in the survivor group. On the optimistism items, however, there were no significant differences between the survivors and the control group. Results regarding social functioning showed a sharp contrast between survivors and the control group. Survivors had significantly greater income, superior job histories, greater residential stability, lower divorce rates, and greater feelings of responsibility toward their community. Their social functioning was an amazing testimony to the survivors’ resilience and their ability to cope with the adaptive tasks of life. Regarding the influence of the Holocaust trauma on coping with aging, 46% of survivors viewed themselves as negatively affected, but almost as many reported strengths and positive features. Kahana concluded that the survivor’s ability to cope with trauma enhances a sense of competence, and that adaptability and achievement among Holocaust survivors persist well into later life.

Thus, Holocaust survivors are not a homogeneous group, and they vary in their post traumatic developmental adaptation due to multiple determinants that occurred in the immediate period following the Holocaust as well as for those that happened many years later (Harel, 1995; Shmotkin & Lomranz, 1998). Their developmental status appears to be a culmination of long-term effects of extreme trauma, extensive efforts to rebuild their lives, and the current aging processes (Shmotkin et al., 2003).

METHOD

In this qualitative pilot study, Holocaust survivors who were older than 65 were interviewed regarding their reactions to September 11 and to recent terrorist events in Israel. After receiving approval for the study from an Institutional Review Board for the Protection of Human Subjects, unstructured, audiotaped interviews were conducted with a convenience sample of five elderly Jewish women in south Florida. Arrangements for interviews were based on the participants’ choice of times and settings (e.g., their homes, their offices, a room in the synagogue). Every effort was made to ensure the participants’ privacy and comfort. Each interview took between 1 and 2 hours to complete. Initially, participants were asked a grand tour question: “What have been your reactions to the recent terrorist events both in the United States and in Israel?” Follow-up probes were then used to identify more specific reactions and responses. For example, participants were asked: “Have you noticed any change in your physical health or symptoms during the past 5 to 6 months?”, “Have you noticed any emotional changes?”, “Have you noticed any changes in your relationships?”, “Are there any other ways you think you have been affected by the current world events?”, and “How do you think what you lived through as a child or young adult has influenced your reactions to current world events?”. At any point during the interview, whenever a participant seemed to be particularly uncomfortable or showed signs of stress, she was given the opportunity to stop the interview. A respected community leader at a local Synagogue who has had experience providing spiritual and psychological counseling was prepared for referrals, but no such referrals were needed or made. Audiotapes were transcribed verbatim; however, measures were taken to disguise the identity of the participants. Tapes were destroyed immediately following transcription.

Continually working with data helps speculation about possible connections. The data were organized to reveal patterns easily and to facilitate the search for unity (Morse, 1991). Major themes were extracted, producing full descriptions that were rich with detail. To comprehend people, one must understand them in their own context, in the world in which they are enmeshed. The psychosocial nature of the interview questions addressed how people lived through various circumstances. The focus was on awareness, meanings, and consequences affecting health and quality of life (Boyd & Munhall, 1993).

In qualitative research, the quality and adequacy of the data are important. Lincoln and Cuba (1985) addressed the issue of the trustworthiness of qualitative data. They described four types of trustworthiness applicable to qualitative studies, which are credibility, applicability, consistency, and neutrality. Reporting the interviewees’ perspectives as clearly as possible helps increase credibility. Findings that can be applied to other situational contexts or groups affects applicability. The use of consistency to evaluate trustworthiness refers to assuring that if the study was repeated with the same interviewees or in a similar context, findings would be consistent. Variations in experience are expected, as opposed to identical replication; this emphasizes the uniqueness of humans. Prolonged contact and long periods of observation with the subject also increases trustworthiness; to support trustworthiness, the interviewer has had extensive experience in interviewing Holocaust survivors in other research contexts (Morse & Field, 1995).

MAJOR THEMES

Paralleling the Present with the Past and Reliving the Past

All of the women interviewed almost immediately began to compare the events that took place on September 11th with the events that took place 55 years ago and relived their own past. For example, one woman explained:

The Taliban and all of those things, I call it Hitlerism with a different reason. This was hate, and that was hate. You know that Hitler wanted to take over. [What was] done to us was because we are Jews. This is painful. September 11th – I am not minimizing the tragedy. There is great suffering like we felt-but it is different. We were tortured and suffered for years. Another woman relayed, “For survivors, it is like a hit for the second time.”

All the survivors except for one were accustomed to telling their stories to others for the purpose of public education. This one woman began to tell her story out loud for the very first time:

This tragedy from September IP has awakened my pain. This is the first time, really, that I am speaking to someone about my past. I never told my children how we lived in hell, the pain we lived through, because I saw no point. . . What is the point in telling children to feel sorry for me.

After drawing parallels between the past and present, all of the women moved on to reliving the past. One woman vividly recalled:

I can remember as a young girl, the Germans came in, and they asked the family to go outside. They took out a match and lit the beard of my grandfather. When he started covering his beard with his hand to protect from a burn, he was beaten. We, as young children, were watching this, and they brought us out to show what they were doing to a Jew. Just picture this for a moment.

Similarly, another woman tearfully remembered:

And then there were days that they decided that this was going to be a day to kill Jews. On one morning, with fear in our hearts, we are trying to all squeeze in the back room of an apartment. This mother who had no children for 18 years [who had her infant with her] was with us when the Germans came in to look for Jews. Mothers did not know what to do with their small children, but to hide them . . . There were twins in bed hidden with the bedspread and quilt. They [the Germans] pulled the quilt off the bed and saw these two small children, and they shot them immediately. This infant that was with us started to cry from the noise. Our good fortune was that the mother with her child in her arms was at the opposite side of the entrance, which was hidden. While the child was crying, we all tried to put a hand on the child’s mouth to keep the child quiet. After it got quiet, we realized the Germans left, and the mother tried to wake up the child but she realized that the child was not alive.

Participants’ identities were tied up with the events of the Holocaust. Who they are today was strongly connected to where they were during their formative years. For example, one woman revealed, “My whole family was destroyed. My only sister, a wife, she was on the Exodus. We are walking history. I was a fighter in the actual resistance.”

Empathy with Current Victims

Many times during the interviews, the women expressed a connection with the victims of September 11th and current terrorist events as well as their family and friends. For example, one woman poignantly stated, “I compare the people to ourselves, what we lived through.” Another woman elaborated:

I felt terribly, terribly sorry for the survivors and, of course, also for the ones that were killed. Children lost their parents, and parents lost their children. I know that the pain of a child [who lost a parent] is indescribable. We, as survivors, know the pain so much more. We watched our parents suffer physical and emotional pain. I came from a family of three children, and we were separated everyone in a different direction.

Reawakening and Awakening

For the women who were interviewed, talking about their reactions to September 11th and current terrorist events brought back the pain from their past. For instance, one woman commented, “I realize by talking to you that the pain came back so much more after this tragedy of September 11th.” Four of the elderly Holocaust survivors expressed “shock” or “disbelief” regarding the tragic events that took place September 11th in this country, and all of the survivors expressed emotional pain. One woman described her reaction to the event as “absolutely excruciating”. Another woman reported, “I am extremely tense and depressed. I am worn out. I just can’t relax.” Another woman lamented:

Our nerves are shot, over the repetition over and over again. I cry very easily. So I sit down and start talking and become very emotional. I jump from one part [topic] to another. The emotions carry me that way.

Yet another woman expounded:

Of course, I am nervous, a little bit more than before [September 11th], but I call it normal. I was a little nervous, I was concerned. I have a sadness, a deep sadness . . . I was really angry. I was a young girl growing up, and I was angry. Why does it happen? What did we do? You know, like everything was blamed on the Jews. We were Polish citizens, like we are now American citizens. It is our country where we live, we pay taxes, we are part of it.

Three of the women admitted to crying more since the events that occurred in this country as well as in Israel. Two of the survivors became quite teary during the interviews but wanted to continue talking.

Not only did these women experience reawakening of painful memories, they also repeatedly referred to sleep disturbances or awakenings. For example, one woman painfully volunteered the following:

The sleep it comes. I have it off and on. This [the nightmares] is still from the war, you know. Like Germans come in and try to corner me, always I get out, but in your sleep you feel horrible . . . I dream constantly about German big bullies, they try to crawl in me. I try to get out always, and I do get out.

Another woman elaborated:

I get up at night, sometimes tired from this sleep after this excitement. They are after me with the guns, and I am running. But I feel this is normal because I have been through this. I was in danger constantly.

The women interviewed in this study relayed how their problems sleeping were exacerbated by the recent terrorist events. For example, one woman reported, “I am extremely, extremely tired. I don’t sleep. I am worn out. I have nightmares, now more often than before.”

Hope for the Future/Caring

Despite the tragedies that befell the Holocaust survivors at very significant developmental life stages, including the recent terrorist events that occurred in their later years when they are dealing with age associated losses, they still had a semblance of hope and caring for the future. One woman relayed , “I was impressed with his speech [Gephart], how he appealed to the people. Let’s get together. Let’s work together. He said, ‘In tragedy, God is near, dignity for all.’ This has such very deep meaning when a person is in need.”

Despite the differences and circumstances surrounding the tragic events of the Holocaust, September 11th, and current terrorist events, there was a keen sense of positiveness for the future. As one woman elaborated:

I hoped with all my might they would go in the right direction . . . our President, I think he does a great job. I had great hope that he would do a good job. I feel that we have the biggest military might in the world and, hopefully, we will use it in the right way.

Four of the women interviewed worked for the Holocaust Documentation and Education Center, Incorporated. Four of the women volunteered their services, which in itself speaks to their hope of the future. For example, one woman commented, “Life is so short, and you leave a legacy to your kids and people who are around you”. Yet another woman followed up, “I want to tell them [the school children] my side of the story. I think I made a difference with the children. I am going on the March of the Living with these kids to Poland.” The last woman crystallized the strong sense of identity shared by all women in the study in very simple terms, “There are priorities and then there are priorities. Do you understand? Your family, your children, your grandchildren are the most important things. The little things that used to bother [me] don’t now.”

DISCUSSION

Most research on Holocaust survivors has been from a psychopathological perspective. In contrast, this pilot study utilized a developmental framework that took into account resilience as well as risk. September 11th and current terrorist events did have an adverse impact on these women’s lives, but the participants’ stories were not all gloom and doom. Extracted themes included paralleling the present with the past and reliving the past, empathy with current victims, reawakening and awakening, and hope for future generations.

The themes of (a) paralleling the present with the past and reliving the past, and (b) reawakening and awakening are related to risk. For example, paralleling the present with the past is consistent with literature that has documented that Holocaust survivors do appear to be particularly vulnerable to retraumatization; reliving the past is consistent with reports in the literature of emergence of intrusive memories when adversarial events occur. Examples of reawakening and awakening clearly demonstrated the presence of symptoms of anxiety, depression, and sleep disturbances that are associated with post-traumatic stress and were identified in other studies of Holocaust survivors who were exposed to war-like situations. However, as evidenced by the narratives, these symptoms did not reach the threshold of clinical significance. Moreover, as indicated by the participants’ work in educating the public about the Holocaust, it is striking how these women have been able to incorporate all of their life experiences and successfully meet the developmental task of integrity versus despair.

Resilience was exemplified by the themes of (a) empathy with the current victims, and (b) hope for the future. Because of their past trauma, participants were able to reach beyond their own experiences and understand the pain of others. Resilience is a rebounding toward the direction of life. This process was strongly exemplified in the participants’ positive beliefs about the future.

A sense of self can be thought of as one’s unique path in life with an appreciation of what has transpired. The thread of enduring values weaves the foundational fabric for sense of self. The participants’ work in passing on their historical heritage, sharing their experiences, and paying tribute to those who were lost provides a venue for other generations to acknowledge what was in the past and what should be in the future. The themes identified in this pilot study that integrate negative and positive experiences suggest a strong sense of self which tips the balance between risk and resilience.

Practice efforts should focus on issues related to the equal valence of Holocaust experiences and the vicissitudes of the aging process in this population. Counseling with elderly Holocaust survivors requires an exquisite sensitivity to their ability to tolerate past experiences. Thus, for many, while it may be difficult to tell their stories, they experience a catharsis and a purpose in giving their testimony (Brandler, 2000). For others, the telling is just too difficult to bear or the trusting too difficult to achieve (Chodoff, 1981). Drawing from the findings in the current study, assessment of the strengths of elderly survivors and utilization of these strengths to promote functioning is an area that has received little notice.

In the arena of future research, other aspects of the theoretical framework hold promise for clarifying the relationship between risk and resilience in this population. For example, age and developmental level of the survivor at the time of the Holocaust in relation to current outcomes may shed more light on protective factors as sources of resilience. Effects of gender on long-term outcomes of elderly survivors may illuminate more potent risk factors. Assessing the long-term impact of different Holocaust experience settings may expand the notion of “identity formation” within adversity and how this accounts for positive outcomes and strengths as well as adverse effects.

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Ann Lamet, ARNP, MS

Janyce G. Dyer, DNSc, CRNP, CS

ACKNOWLEDGMENTS: The authors wish to acknowledge Dr. Carrol Gold and Dr. Carol A. (“Pat”) Patdaughter for their methodological guidance, comments on previous drafts of this paper, and editorial assistance.

Ann Lamet, ARNP, MS, PhD Candidate and Assistant Professor, School of Nursing, and Janyce G. Dyer, DNSc, CRNP, Professor, Graduate Programs in Nursing, both with Barry University, Miami Shores, FL.

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Correspondence: Models of Letter-Writing from the Middle Ages to the Nineteenth Century. - Review