“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