Ministry with Victims of Trauma, Especially from War

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Ministry with Victims ofTrauma, Especially
from War

• Jeffrey Cohen
• Rabbi DD DMin BCC FRSA

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• unique histories
• impact of early life trauma
• post war years of immigration, adaptation
• now aging

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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

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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

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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

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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

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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

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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

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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

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Traditional Process

• Event or Trigger
• Potential Reaction
• Reason

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Potential Triggers for Holocaust Survivors

• Event or Trigger
• Potential Reaction
• Reason
• Possible Responses

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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
• Patient encouraged to put ID bracelet on
  themselves
• 2 ID bracelets used

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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

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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

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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