Post on 14-Dec-2015
“Ministry with Victims ofTrauma,
Especially from War”
Jeffrey CohenRabbi DD DMin BCC FRSA
• unique histories
• impact of early life trauma
• post war years of immigration, adaptation
• now aging
The Pastoral Process
• each story is unique
• each person is different
• there are no rules or guidelines to follow when caring for aging Survivors
• there are certain vulnerabilities and attitudes
Vulnerability to loss and illness
• Holocaust Survivors may be particularly vulnerability to experiences that are part of the aging process, – loss, – separation, – illness or – institutionalization
• there was no opportunity to grieve or mourn
Need to “bear witness”
• Survivors want to ensure that the Holocaust not be forgotten by future generations
• need to bear witness and document personal testimonials
• Survivors are ‘living witnesses’ but not necessarily historians
Absence of Kin
• Aging Survivors without kin may be a group at risk
• truly alone in the world- may rely on other survivors who constituted their ‘substitute’ families
Attitudes to doctors/health care professionals
• Doctors in the Concentration camps performed selections – supervised the killings in gas chambers – ordered, directed and carried out direct killing
of debilitated patients by means of phenol injections
– doctors selected people to participate in a range of medical experiments in the name of research
Attitudes to Institutionalization
• For many this is not the first experience with the loss of home, family, community, privacy and freedom
• Memories of transportation to camps and ghettos may be reawakened
Environmental Factors that Trigger Difficult Memories
• Reminders of the trauma of the Holocaust are always present – different ones for different people
• Caregivers need to be aware of the more common triggers, and appreciate that even common triggers recall unique and different memories
Traditional Process
• Event or Trigger
• Potential Reaction
• Reason
Potential Triggers for Holocaust Survivors- an Example
• Event or Trigger – ER- identity bracelet with patient number
• Potential Reaction– Screaming/ Uncooperative
• Reason – Nazis dehumanised by referring only by number-
also many have numbers tatooed on arm
• Possible Responses 1. Patient encouraged to put ID bracelet on
themselves2. 2 ID bracelets used
Theological Reflections
• Speak in their language not yours
• Pastoral Paradigm
• Reconciliation Therapy
Trauma and War
• Initial focus on survivors of the Shoah (Holocaust)
• Realised that both those who fought as well as those who were victims carried “baggage”
• Multifaceted challenge
Applicability beyond the sample
• both Veterans and Holocaust Survivors exhibit most of the same physical symptoms of ageing
• They cannot always be easily identified in an emergency setting where much of this care occurs
• focus of triage is on immediate clinical care while psychological trauma and its associated behavioural manifestations are not always easily distinguished in this environment
Implications for Care
• stress experienced by patients is compounded in staff who have not had the training or developed the processes or institutional experience to effectively manage patients with these issues
• Co-morbid factors such as dementia are also complicating the provision of care to those patients exhibiting trauma-related symptoms
• the range of behaviours exhibited by these patients in selected clinical and non-clinical contexts (e.g. aggression, food hoarding, fear of personnel) as well as the problems associated with issues around decision-making, existing co-morbid conditions, appropriate referral mechanisms