Exploring Holocaust Survivors Lifelong Coping Processes

Irina Koll

A Dissertation Submitted to the Faculty of

The Chicago School Of Professional Psychology

In Partial Fulfillment of the Requirements

For the Degree of Doctor of Psychology

August 21, 2014

 UMI Number: 3643978

All rights reserved

INFORMATION TO ALL USERS

The quality of this reproduction is dependent upon the quality of the copy submitted.

In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.

UMI 3643978
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
Microform Edition ProQuest LLC.
All rights reserved. This work is protected against
unauthorized copying under Title 17, United States Code

ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346


Unpublished Work

Copyright (2014) by Irina Koll

All Rights Reserved.

ii


Exploring Holocaust Survivors Lifelong Coping Processes

______________________________________________________________________________

A Dissertation Submitted to the Faculty of

The Chicago School Of Professional Psychology
In Partial Fulfillment of the Requirements
For the Degree of Doctor of Psychology
______________________________________________________________________________

Irina Koll

2014

Approved by:

______________________________________________________________________________
Donald Schultz, PhD, Chairperson
Program Faculty, The Chicago School of Professional Psychology

______________________________________________________________________________
Sean Sterling, PhD, Member
Chair, Applied Clinical Psychology, The Chicago School of Professional Psychology

iii


Acknowledgements

I wish to thank my esteemed professors, colleagues, and friends for their continued

support, guidance, and encouragement throughout this process.

I wish to extend my warm and sincere thanks to my parents for their love, motivation,

and most importantly their belief in me in seeing this work through.

And above all, I wish to thank my wonderful and supportive partner, who has helped me

through the thick and the thin to accomplish this journey. Without him, I dont think I would

have been able to finish this.

iv


Abstract

Because the worlds adult population over the age of 60 will double from 605 million to 2 billion

between 2000 and 2050, it is becoming increasingly important to understand this older adult

population as well as the social, economic, and psychological implications this has for various

families and society. Identifying and implementing therapeutic interventions that help maximize

the capacity for better living and functioning for older adults may help to prolong their lives. Past

research has identified that survivors of the Holocaust have suffered long lasting psychological,

physical, mental, and social impairments that have affected their level of functioning in lifelong

situations. However, this study has sought to use a qualitative approach to understand the

adaptive and resilient coping strategies among older adults. It was hypothesized that studying

Holocaust survivors adaptive coping experiences may provide unique and relevant information

about trauma, resilience, and adaptation that can provide further guidance with working with

WWII veterans, Holocaust survivors, and survivors of genocides; and that it might to lead to

improving older adults quality of life. The results of this study show that there are various

significant adaptive coping strategies among older adults including, but not limited to,

psychological inner strengths, external factors including social and peer support, healthy

environmental surroundings, belonging to a specific community or group, strong maternal

influence, importance of interpersonal relationships, proactive positive attitude, religious

freedom, and the impact of medicinal and medical advancements that have contributed to their

increased quality of life.

Table of Contents

Copyright.ii

Signature Pageiii

Acknowledgements.iv

Abstract....v

List of Tables..ix

Chapter 1: Nature of the Proposed Study1

Background of the Problem.1

Problem Statement...3

Purpose Statement3

Research Questions..4

Application of Results..4

Theoretical Framework5

Definition of Terms..6

Outline of Remaining Chapters...6

Chapter 2: Review of the Literature8

Chapter Overview8

Review of Historical Background9

Review of Current Research Literature.13

Research on Coping Strategies..23

Theoretical Perspective..28

Evaluation of Research Literature and Summery..32

Chapter 3: Research Design and Method...34

vi


Problem Statement 34

Objectives and Rationale...34

Research Plan.35

Participants.35

Instrumentation..36

Data Processing..36

Ethical Assurances.37

Chapter 4: Analysis and Results38

Analysis.38

Participants.39

Findings.40

Theme Presentations..41

Summary48

Chapter 5: Discussion of Results...49

Resilience...49

Strong Maternal Influence.50

Freedom from Oppression.....51

Importance of Interpersonal/Family Relationships....53

Success in Healthy Aging..53

Implication of Results54

Contributions of the Study.56

Cultural Influence..57

Limitations.58
vii


Recommendations..59

Conclusion.59

References..61

Appendix A: Interview Questions.....65

Appendix B: Consent Form.......66

viii


List of Tables

Table 1: Participant Demographics...39

Table 2: Theme Results..41

ix


Chapter 1: Nature of the Proposed Study

Background of the Problem

The Holocaust refers to the persecution and murder of approximately six million Jews by

the Nazi regime during World War II, solely because of their cultural, social, ethnic, and

religious affiliations (Barel, Sagi-Schwartz, Van IJzendoorn, & Bakermans-Kranenburg, 2010).

The atrocities of the Nazis against Jews during the war eliminated Jewish communities almost

entirely. The victims suffered inhumane conditions in concentration camps, where they endured

continuous threats to life, life-threatening diseases, depersonalization, and loss of many if not all

of their significant others. Aside from concentration camps, many other Jews were living in

hiding and evacuation under false identities, in fear of discovery, spending months and years in

primitive and inhumane conditions (Barel et al., 2010; Cohen, 1991; Van der Hal-Van Raalte,

Van IJzendoorn, & Bakermans-Kranenburg, 2007).

In addition, these childhood survivors survived the horrors of persecution, death, and

losses, separation from their family, neglect, and extreme famine and starvation during their first

and most critical developmental years (Van der Hal-Van Raalte et al., 2007). These childhood

survivors had to endure feelings of helplessness and hopelessness as they were confronted from

the earliest age with their parents struggle to escape annihilation without the fundamental basic

protection and safety they so desperately needed. Much of these childrens sole survival was

entrusted to the care of strangers once they were separated from their parents. After the war was

over, those who survived had to further face separations as they were reclaimed by their

estranged parents from the caretakers or came to the devastating realization that their family did

not survive. Also, many parents were too weak and mentally exhausted after the war to be able to

take proper care of their children (Van der Hal-Van Raalte et al., 2007). Recently orphaned child
1


survivors after the Holocaust had to deal with adjustment and were confronted with the havoc the

Holocaust had wrought on their family, social, psychological, and cultural structures (Van der

Hal-Van Raalte et al., 2007). Furthermore, they also had to readjust to their lives, now dealing

with postwar symptoms of trauma, grief and losses, cultural and identity displacement, related

medical and physical conditions, emotional and personality problems and survival guilt.

Holocaust survivors in aging. There is a fundamental agreement among researchers

that survivors have suffered long lasting psychological, physical, mental, and social impairments

that have affected their level of functioning in most life situations (Landau & Litwin, 2000).

However, what is surprising is how there are a large number of elderly Holocaust survivors who

have been able to become well-adjusted individuals (Landau & Litwin, 2000). These survivors

have managed to cope with their traumatic experiences in older age as they are now facing new

and recurrent trauma of transitioning into late adulthood.

As Holocaust survivors face old age, many conditions can reactivate their feelings of the

past associated with trauma they endured in childhood (Cohen, 1991). Institutional care and

placement in nursing homes may bring up feelings of dislocation within unfamiliar surroundings.

A hospitalization experience may associate a survivor with parallel experience while being in a

concentration camp (Cohen, 1991, p. 227). Cohen (1991) also stated that physical deterioration,

illness, and loss of bodily functioning may conjure up feelings of helplessness that these

survivors suffered under the regime of the Nazis. Also, as the childhood survivors now face older

age, the transition of aging can mean significant physical, mental, social, and mental change.

Furthermore, this life role transition stage can mean losses and bereavement, loneliness,

institutional care, caregiver distress, separation from adult children, memory impairment and
2


many other factors associated with old age. Cohen stated that, for the survivor, aging may be

seen as a traumatic experience in its self; however, research has indicated that despite the

transitioning into late adulthood, older survivors have shown the capacity for strength and

further insight needs to be shed on what these strengths may be (Cohen, 1991, p. 231).

Problem Statement

Holocaust survivors have survived unthinkable and unimaginable hardships. There is no

question that they have dealt with horrific trauma and suffering. Little is known about their

adaptive coping mechanisms dealing with trauma in old age. What are their primary positive

coping mechanisms? There is a lack of research on aging Holocaust survivors and their coping

strategies. More insight needs to be gained on this topic.

Purpose Statement

The purpose of this phenomenological study will be to explore the lived subjective

experiences of positive coping strategies among aging Holocaust survivors with recurrent

trauma. Recurrent trauma is defined as any new stressors, distress, or mental illnesses that have

contributed to the recurrent traumatic event(s). This can be a medical condition (e.g., recurrent

cancer, stroke etc.), any cognitive disorders (dementia or Alzheimers disease), or anxiety or

mood disorders. The participants in this study are European female and male Holocaust survivors

who have lived through the Holocaust (19391945).

Research Questions

The following research questions guided the study:

1. What are the lived subjective experiences of Holocaust survivors now in older age?

2. How does the previous experience (surviving the Holocaust) relate to current

transitioning to late adulthood?

3. What mechanisms do these individuals (report) have helped them to cope with their

trauma then and now?

4. How did these mechanisms help these individuals deal with their trauma during old

age?

Application of Results

Understanding survivors lifelong coping process would contribute to the field of

psychotherapy by providing information on what helps survivors of the Holocaust be successful

in coping over a lifetime (Shelli & Baum, 2000).

The knowledge about the adaptation and coping of aging Holocaust survivors years after

the Holocaust may provide a further guide with working with survivors of other genocides.

In addition, studying Holocaust survivors experiences may provide unique and relevant

information about trauma, resilience, and adaptation. Its position as the most extreme form of

widely experienced trauma makes it useful for the study of resiliency characteristics across

different types of traumas (Ayalon, 2005, p. 348).

Theoretical Framework

Existentialism. A human beings paramount struggle is with existence and the ultimate

concerns of the human condition with its emphasis on death, freedom, isolation, and

meaninglessness (Yalom, 1980). Individuals search for some meaning to their lives while

establishing a sense of being, an authenticity that recognizes their ultimate uniqueness while

remaining true to themselves (Corsini & Wedding, 2008). The psychotherapist assists individuals

in accepting their feelings rather than trying to change them as if there is something wrong.

Existential psychotherapy also adheres to the principle that individuals are responsible for

who they are and what they becomeone cannot blame God, parents, teachers, employers or

circumstances (Corsini & Wedding, 2008). The existential psychotherapist is not overly

concerned with the clients past but instead, with the choices to be made in the present and

future.

Using an existential approach while interviewing and interpreting Holocaust survivors

testimonies might be a beneficial approach since it would address their lived subjective

experiences through the here and now. Zimberoff and Hartman stated, The effective therapist

must empower the client to make clear choices, and then acknowledge and honor those choices,

setting aside his/her own agenda for that clients therapeutic experience or outcome (2003). In

this case, the therapist would interpret and acknowledge what choices the patient has made to

adapting to the pain and suffering they are currently enduring. In addition, the

interpreter/interviewer will honor those choices without changing the outcome of their lived

experience.

Definition of Terms

Coping strategies: Holocaust survivors present and most contributing to positive

adaptive coping mechanisms.

Holocaust: The current study will explore the Holocaust that took place between 1939

and 1945 in Eastern Europe and Russia.

Holocaust survivors: Survivors of the Holocaust who endured pain and suffering in

concentration camps and/or in hiding from the Nazi regime.

Recurrent trauma: Recurrent trauma is defined as any new trauma that the aging

Holocaust survivor is facing in the present day. These could be psychosocial stressors such as

inadequate social support, discord with family or caregiver, insufficient financial resources,

insufficient healthcare, life role transitions and language barriers etc.

Other factors could be distress caused by mental illnesses that have contributed to the

recurrent traumatic event(s) including dementia, Alzheimers disease or other cognitive

limitations, mood disorders (major depression, grief, etc.) and anxiety disorders as associated

with older age. Medical conditions or physical impairments could be contributing factors to new

trauma (e.g., recurrent cancer, partial blindness, stroke, nutritional deficits, sleep disturbance

etc.).

Trauma: Psychological and physical trauma inflicted by Nazis regime against Jewish

people endured during World War II.

Outline of Remaining Chapters

Chapter 2 will review recent literature involving World War II Holocaust survivors and

the trauma associated with their suffering. Chapter 3 will explore how the study was conducted
6


through objectives and their rationales, research plan, participants, instrumentation, data

processing, and ethical assurances. Chapter 4 will examine the facts obtained from the current

study. Chapter 5 will examine the interpretation of the presenting results, what was and wasnt

achieved, and the implications of the study.

Chapter 2: Review of the Literature

Chapter Overview

This chapter will review the literature involving World War II Holocaust survivors and

the trauma associated with their suffering. The ultimate objective is to explore the lived

subjective experience of primary positive coping strategies among aging Holocaust survivors

with recurrent trauma. The first theme examined will be the original theory of trauma and it will

be discussed and reviewed to gain a better perspective of a Holocausts survivors original

trauma. The second theme is an exploration in looking at the survivors trauma after the

Holocaust. A distinction in literature will be made between the current research on productive

resilient functioning after trauma and research on deterioration after exposure to trauma. This

theme will provide a demonstration to evidence how there is a shortening of research on adaptive

and positive functioning after trauma with aging Holocaust survivors. The third theme is coping

strategies associated with physical and psychological abuse or trauma. This will provide a

broadening view on how people cope after surviving psychological and physical distress.

Ultimately, this will help the researcher gain perspective on what the current research shows

regarding positive coping strategies among survivors of trauma in aging. The fourth theme is an

existential approach to interpret and analyze the lived subjective experience of aged Holocaust

survivors testimonies of their description of positive coping strategies. Existential theorists,

including Viktor Frankl, will be reviewed and discussed. In summary, the following sections will

provide a background and context for what the researcher will conduct for this dissertation.

Review of Historical Background

Research on the original theory of trauma. The following section will review the

original theory of trauma. Understanding the phenomenology of trauma will ultimately give way

to conceptualizing and appreciating how Holocaust survivors survived the traumatic experience.

Exploring trauma literature can give insight to the depth of the traumatic experience from

childhood into adulthood and later stages of life.

The traditional basis of psychological trauma research is the work of Sigmund Freud.

Reisner (2003) stated that Freuds earliest definition of trauma is any impression which the

nervous system has difficulty in disposing of by means of associative thinking or of motor

reaction becomes a psychical trauma (as cited in Freud & Breuer, 1893, p. 154). Furthermore,

Freud saw trauma as a foreign body to the mind that would leave a residue which would

continue to have its effects long after the event in the form of hysterical symptoms, leading

Freud to conclude that hysterics suffer from reminiscences (Reisner, 2003). Later on,

according to Reisner (2003), Freud stated that an experience was traumatic because it was

overwhelming to the dominant mass of ideas constituting the ego (Freud & Breuer, 1893, p.

116). Freuds theory was that trauma was the result of an interaction of self and environment, a

crisis of experience and meaning, and not solely on the result of an environmental impingement

on the weakened ego (Reisner, 2003). In Freuds view, it leaves human beings to face the

problem that what we call trauma is, in a sense, not trauma but life, and that we are who we are

because of the opportunities that trauma gives us, that we exist as humans to make the most of

our difficulties, not to sustain the fantasy that it is desirable, or even possible, to undo them

(Reisner, 2003).

Huopainen (2002) stated that Breuer and Freud (1893, pp. 56) classified single and

cumulative traumatic experiences: In the case of common hysteria, it not infrequently happens

that, instead of a single, major trauma, we find a number of partial traumas forming a group of

provoking causes. According to Huopainen (2002), Freud stated that the problem is not so

much caused by a specific event, but rather by the effect of such an event, which continues after

the moment of the event itself (as cited in Freud & Breuer, 1893). Freuds contribution to the

field gave evidence that one has to pay attention to the quality of childhood attachment

relationships to understand the current integrative capacity of the patient's ego (Huopainen,

2002). In addition, (as cited in Breuer & Freud, 1893) Freud correctly assumed that hysterical

symptoms and fantasies can be caused by any unprocessed traumatic experiences (Huopainen,

2002).

Huopainen also stated that based on early work, it can be concluded that a child can

undergo trauma by observing violence between his parents, by hostile divorce proceedings or by

the untreated emotional consequences of his mother's miscarriage or other loss of child (2002).

Also, a child can be traumatized by physical abuse, a parents existing dissociative disorder or

other psychopathology, or by abandonment and neglect and so forth (Huopainen, 2002).

As stated by Freud, Among solutions to universal traumas the one most adversely

affected by unintegrated traumatic experiences in childhood is ones way of relating to

separateness, which also influences ones solutions to the Oedipus complex and ones way of

relating to sexuality and to death (Huopainen, 2002, p. 98). This type of separateness is

necessary to the childs stage of development to instill normal emotional development and

independency. Huopainen went on to argue that if a childs separation is blocked by traumatic

events the child will initially go into archaic hysteria due to insufficient help to self-regulation
10


by the adult, affects are too powerful traumatizing for the childs mind to endure. Thus, the child

is forced to foreclose the affects from his/her mind instantaneously, so that hardly any

experiential knowledge of them remains in the mind (2002, p. 98). Ultimately this archaic

hysteria will have long lasting consequences on the childs developmental and psychosocial

ability to be able to cope with possible recurrent traumatic experiences in his or her later life

(Huopianen, 2002).

Krystal (1978), psychoanalytically studying the child, offered more insight regarding a

childs traumatic state. Krystal (1978) stated that what we observe in the direct aftereffects of

severe childhood trauma in adults is a lifelong dread of the return of the traumatic state and an

expectation of it (Retrieved January 10, 2011). Also, emotions are often experienced as what he

termed as trauma screens and that there is a fear of one's emotions and an impairment of

affect tolerance (Krystal, 1978). Krystal also argued that among these disturbances there is also

a general and lifelong anhedonia which is an impairment of the ability to experience

gratification, which becomes interwoven into a variety of masochistic problems (1978).

The author also writes about the prevention of severe childhood trauma. Krystal stated,

that regarding the childs traumatization, the mother can be properly described as functioning as

a temporary stimulus barrier or protective shield. Furthermore, Krystal argued that a mothers

ability to prevent childhood psychic trauma is much less than we would wish and this

biotrauma is an inevitable development. Krystal stated, Our need to deny this helplessness in

preventing the traumatic experiences in our children inclines us to deny their occurrence and to

talk about the silent nature of childhood trauma (1978). Krystals theory implies that without

the mother acting as protective shield the child may become distressed and unable to bear the

effects of the traumatic event. This can, in theory, give evidence to show the impact of the
11


distress on the Holocaust child survivor who may not have had any parental and nurturing

contact during the Nazi occupation.

The author also offers an interesting perspective about the transition from childhood

trauma into adult trauma and how the adult may cope with trauma in the current day. Krystal

pointed out that in some psychotic states it can be concluded that adults can come close to the

degree of horror and overwhelmed state as we can assume the child goes through in regards to

the traumatic state (1978). Krystal added, In states of prolonged torture and other externally and

internally caused panic states which combine suffering with total helplessness and reach the

catatonoid states, the existence of a traumatic state frequently cannot be questioned (1978).

However, the author argued, there are significant differences during the adult and child traumatic

state. One of the factors that Krystal pointed out that accounts for this difference is the structure

of the adult psyche. Krystal stated that the adult psyche contains all the resources for trauma

prevention, which is referred to as the stimulus barrier (1978). Krystal notes that in the adult

traumatic state the observing ego is retained and that this implies that the self-observing

functions develop. These traumatic experiences and states can be utilized for the development of

trauma signals which are the ultimate emergency response mobilizing alarm which may

function later as trauma prevention (1978). Krystal concluded that these trauma signals can

mobilize a persons defenses, or they may be involved in obtaining help from others.

Krystal also assesses the subjective experience in the adults traumatic state. The author

states that in the psychoanalytic literature, trauma is referred to as feeling of helplessness in the

face of overwhelming danger and is seen as a paralyzing, immobilizing, or rendering to a state

of helplessness, ranging from numbness to an emotional storm in affects and behavior (Krystal,

1978). In addition, Krystal included the disorganization of feelings, thoughts and behavior, as
12


well as physical symptoms that reflect the automatic dysfunction. This state is what the author

termed as the adult type of psychic trauma as distinguished from the infantile one.

To conclude Krystals attributing theories, the author postulated that the major difference

between the infantile and adult form of psychic trauma is its relationship to affects. Krystal

pointed out that it is the overwhelming of the ego, the surrender in total helplessness and

hopelessness, and the progression to the catatonoid state that makes a situation traumatic

(1978). The traumatic state can neither be equated with nor understood by the intense affects,

which may initiate it. This may be what Krystal referenced as to what Eissler (as cited in Eissler,

1966, p. 26) was referring to when he said: Anxiety cannot traumatize the psychic apparatus,

any more than the defense mechanism can Krystal illustrated that the statement holds true only

if one is dealing with the mature adult type of affect.

It can be noted, as pointed out in the studies, that separateness from the mother or

maternal contact can cause a state of helplessness, fear and distress on the child when the child

undergoes trauma or a trauma-like state. Weakened and strained ego, attachment from the self,

impairment of affect, absence of trauma signals and unprocessed traumatic experiences can all

hinder a persons ability to handle the effects of trauma. To assess trauma more generally to a

population, further exploration needs to be shed on the effects (of living after surviving the

traumatic experience) the Holocaust. The following section will explore Holocaust literature.

Review of Current Research Literature

Research on the effects of living after trauma: Positive functioning or deterioration.

The following section will explore what researchers have studied regarding the effects of living

13


after Holocaust trauma. The current literature of victims of the Holocaust has focused on the

negative impact of massive trauma on the victims.

Many studies focus on the negative effects of the Holocaust, but few ask whether

survivors have been able subsequently to reconstruct their lives or why they have been able to do

so (Lee, 1988, p. 71). Lee agreed with the current researcher that there are few studies that have

looked into the adaptive capabilities of Holocaust victims. Such coping strategies that Lee (1988)

found during her study were what she called reservoir of inner psychic strength. These

mechanisms as Lee pointed out were creative use of fantasy, recollecting experiences of warmth

and love, and identifying the self with a group. Lee (1988, p. 92) concluded, Although studies

that have focused on the detrimental effects of the Holocaust have been instructive, it would be

helpful for more researchers to study the positive aspects of the lives of the victims of the

Holocaust. The author went on to conclude that as Holocaust survivors are getting older there is

still much more to explore and understand about the ongoing process of massive trauma and

human capacity to heal.

Although Lees study (1988) supports the current researchers focus of topic, it does have

a few limitations. First, the study was done almost 23 years ago, and it does not state how old

were the Holocaust survivors who participated in the study although it gave evidence to the fact

that they were married with children. This is an important factor because the current study is

focusing on aging holocaust survivors who are 80 years old and older. Second, the author used

participants from certain parts of the world, not from a specific region or community. This type

of demographic could be difficult to examine if testing and comparing adaption and adjustment

to current communities since the participants are from varies communities and speak different

languages. Thirdly, the interview section consisted of questionnaires and did not focus solely on
14


interviews. And lastly, the author of the research was a survivor herself so this could have

created research bias and counter-transference issues that may have affected concluding data.

Sigal (1998) looked at varies studies in the literature regarding children who have

survived the World War II Holocaust. Sigal found that recent studies of children who have

underwent extreme atrocities during the Holocaust including malnourishment, psychological

distress, witness to horror, and emotional disturbance were now in their mid-adult stages and

married, served in the military, and portrayed no psychological and physical distress. Sigal stated

that in this type of resilience, these children showed adaptability and assertiveness, and they were

appealing to adults. The author stated that these types of coping mechanisms were established by

endowment, temperament, or familial environmental factors. Also, Sigal (1998) looked at

children who were adopted after they survived the Holocaust and found resilient coping

strategies among them. Children have varying capacities to deal with potentially traumatic

conditions and that these strengths enable them, when provided with a healthier environment, to

surmount the damaging influences of earlier development insults (as cited in Kadushin, 1976, p.

199). It is important to point out that even though this study is a compilation of studies that

provides a positive research component in studying Holocaust survivors resilience it does not

specify and examine the current Holocaust survivors coping strategies in aging.

Suedfelds (2003) study was another investigation looking at specific and general

attributional patterns of Holocaust survivors. The author, using Attributional Style

Questionnaires, explored Holocaust survivors responses and compared them to age-matched

Jewish respondents who were safe from Nazi persecution. The author found that survivors

mentioned a significantly higher amount of external factors (help from others and luck) of

survival than internal factors (psychological inner strength). The study found that survivors
15


were more likely to mention help from others: social support generally, help from family

members and friends, and help from Gentiles (Suedfeld, 2003, p. 137). Another category that

half of the survivors mentioned were luck, fate, chance, or God which the author noted

compatible with previous research. This study illustrated many interesting and positive findings

to the Holocaust research although it did have some limitations. As the author pointed out,

Recruiting respondents at survivor gatherings results in data from people who are sufficiently

healthy (mentally and physically), energetic, interested, and financially secure to attend such

gatheringsin addition, participants in survivor gatherings tend to be busy with workshops,

lectures, social events, and informal discussions. Only those who have the time and motivation

take the trouble to fill out questionnaires, especially those that like the ASQ require the

respondent to follow a relatively long and complicated procedure (Suedfeld, 2003, p. 137).

Studies on deterioration after the Holocaust. There have many studies done on

Holocaust survivors and the effects of their traumatic experiences. One author has dedicated the

following research on the challenges of exploring survivors positive coping strategies.

Ayalons (2005) study looked at the challenges associated with studying Holocaust

survivors resilience. The study found that while there is enough research about survivors

trauma or posttraumatic stress disorder, there is by far a lack of research done on their healthy

and productive life. In addition, the study went on to explore that by studying those who were

able to resume productive functioning following exposure to severe traumas is as important as

studying the pathological aspects associated with trauma, because it provides information about

the adaptive nature of human beings Ayalon (2005, p. 349). It is important to note that this

study represents a framework of what needs to be addressed and studied in the research realm
16


within this population, because there is a lack of research done on coping mechanisms among

aging Holocaust survivors.

Furthermore, the study mentioned that psychiatrists conducted the majority of research

that was done on the Holocaust survivors, thus giving evidence that survivors who sought

psychiatric help were the most primary used subjects since they were the most easily accessible

for research purposes. Another contributing factor is that some of the research on resilience and

adaptation was based on case studies or qualitative interviews that were often combined with

personal experiences of the authors and there was a minimal attempt to systematically identify

factors associated with resilience (Ayalon, 2005, p. 353). Therefore, as the study pointed out,

research in nonclinical populations is much needed. Research on personality characteristics,

coping style, social context, and cultural background of Holocaust survivors is also lacking and

needed in the research realm (Ayalon, 2005). All of these contributing factors show evidence that

there have not been sufficient data on aging Holocaust survivors adaptation mechanisms to

trauma in a nonclinical setting.

There is a tendency in the literature to focus on victims of trauma and how they have

been able to cope with their psychological distress as soon as the World War II was over. Such

studies in the literature are limiting because the population from which they are drawn tends to

be only adolescents and young adults. This type of research does not identify adaptive coping

strategies among aging survivors of World War II.

Goldenbergs study (2009) on immediate postwar coping strategies of adolescent

survivors of the Holocaust examined coping strategies that survivors relied on. The study found

that the major coping strategies used in the immediate postwar period were social support,

community with other survivors, revenge, and the pursuit of justice (Goldenberg, 2009).
17


However, this study was solely about adolescents and their immediate coping strategies dealing

with their current trauma after the Holocaust was over. Also, even though this study had a

nonclinical sample, it consisted of people who were willing to talk about their experiences, and it

is therefore biased on the healthier end of the continuum of the Holocaust survivor

(Goldenberg, 2009). In addition, this study is based on showing accounts given 50 years after the

actual events, so detailed description of their immediate coping methods may not be as accurate

as one might hope it to be. This study once again evidenced that there is data lacking among

aging Holocaust survivors who now are facing with recurrent trauma, leaving the same

pondering question to the researcher: What are their current coping strategies?

Another leaning, in the literature, is to look for and to find psychological and

physiological disturbances and to focus on these solely. The assumption as speculated in the

research is that most Holocaust survivors who are now facing old age have psychologically and

physically deteriorated. The majority of work in the literature has been negative in the sense that

they stress on the fact that survivors have not been able to cope with their hardships and trauma

associated with World War II.

In a study by Stessman et al. (2008), the researchers hypothesized that Holocaust

exposure during young adulthood negatively affects physical aging, faster deterioration in health

parameters, and shorter survival (p. 470). This studys primarily goal was to focus on survivors

deterioration and ineffective coping skills in aging after exposure to trauma.

In addition, the study used a sample of people from the European decent including those

who had left Europe before the outbreak of Word War II in 1939, so their trauma was only

associated through family, friends and their community. Since some of subjects from the study

were not closely associated with direct trauma from the Nazis regime, it is difficult to speculate
18


about the exposure of their trauma. However, researchers of the study evidenced that survivors

who have reached their eighth decade are the most fit, adaptable, and most resilient of Holocaust

survivors. Also, the study found no evidence to support its hypothesis that delayed effects of the

trauma of the Holocaust negatively influence physical health and mortality (Stessman et al.,

2008). This study attributed positive findings to the field; however, it failed to look into what are

Holocausts survivors adaptive skills in aging.

In the Shmotkin, Blumstein, and Modan (2003) study, researchers focused on tracing

long-term effects of early trauma in Holocaust survivors in a sample of the Israeli Jewish

population. Survivors were compared with European descent groups that had immigrated either

before World War II or after (these subjects had Holocaust-related life histories but did not

consider themselves survivors). The researchers hypotheses were that Holocaust survivors

would fare worse than comparative participants Shmotkin et al. (2003). Once again, this study

explores the relationship associated with Holocaust survivors and their distress as well as their

inability to effectively cope with their pain, a decade after the war, and psychological and

cognitive limitations. This study does not explore any positive adaptive skills among aging

Holocaust survivors.

Van der Hal-Van Raalte et al. (2007) investigated how trauma during childhood affects

the wellbeing of older Holocaust survivors. The authors hypothesized that older child survivors

who were born before the war would show more physical health complaints and psychosocial

issues. The authors also looked into the present functioning between survivors who lost either

one parent or both during the war verse who have survived the war. And lastly, the authors

looked at postwar circumstances, how the child survivors were able to care for themselves

after going through Holocaust trauma. Their results indicated young child survivors of Nazi
19


persecution who experienced unsatisfactory quality of care immediately after the Holocaust

show a lack of wellbeing in their sixties and seventies. Loss of parents as a result of

persecution, age of the survivors (being born before or during the war), and having

autobiographic memories of the war period did not significantly affect survivors present sense

of wellbeing Van der Hal-Van Raalte et al. (2007, pp. 517518). The researchers implied that

inadequate care given to children who survived during the Holocaust, regardless of absence of

parents, led to emotional distress and psychosocial problems. The authors focused solely on

childcare arrangements after Holocaust liberation and its impact on survivors later stages of

life. This study gave attention to the immediate need of after trauma care to decrease early

childhood trauma. However, the researchers did not examine survivors adaptive life strategies

and coping mechanisms in old age after going through childhood trauma. Once again the

literature focused on the negative implications of the Holocaust survivor, including their

hardships.

Other studies, including Barel et al. (2010), implied that Holocaust survivors who have

reached old age have more psychosocial and physical distress when compared to the same age

groups who have not undergone any trauma associated with World War II. The authors noted

that the Holocaust literature provides evidence that many survivors did demonstrate resilience

and even manifestations of growth. Still, we found that Holocaust survivors displayed lower

levels of general adaptation than did their counterparts (Barel et al., 2010, p. 691).

Lis-Turlejska, Plichta, Luszczynska, and Benight (2008) explored the effects of World

War II on the psychological and social functioning of Jewish Holocaust survivors and non-

Jewish survivors (Polish) 60 years after the war was over. The authors found that posttraumatic

stress disorder was higher for Jewish survivors than for non-Jewish survivors. Interestingly, the
20


authors found no differences between the two counterparts for depression and social isolation.

There was a significant finding about parental loss during the war for Holocaust survivors as it

attributed to global decrement of wellbeing (Lis-Turlejska et al., 2008). The authors went on to

say that a traumatic loss at the time of war could be related to higher risks of failure during future

recovery processes and that those survivors who has lost a parent or parents had elevated PTSD

severity regardless of being Jewish or non- Jewish. A limitation of study is that the authors only

looked at two categories including parental loss and nationality. Although this study may provide

insight into some important long term psychological and social functioning factors after

survivors experienced war related hardships, it still fails to address positive attributing coping

strategies among aging Holocaust survivors.

Other studies in the Holocaust literature as mentioned by Cohen (1991) have argued that

aging for a Holocaust survivor is a traumatic crisis. Cohen argued that reaching old age for

Holocaust survivors could be traumatic since it conjures up feelings of displacement, uncertainty,

and burdens. The author states these circumstances remind survivors of what they went through

during the Holocaust. The author implied that when survivors reach old age and experience

physical deterioration, illness, job loss, and hospitalization they re-experience the humiliation,

degradation, and feelings of helplessness suffered under the Nazis (Cohen, 1991, p. 227). The

author also went on to say that Holocaust survivors never attribute to successful grieving

processes because of their inability to experience their own emotions. In addition, the author

stated that there is unresolved grief, mourning, and strained relations among survivors and their

families and children in the current day. Although this study focused on the negative aspects of

Holocaust survivors hardships in the old age, the author did agree with the current study that the

21


literature has tended to focus on the trauma-related aspects of survivors and not on their coping

strategies and contribution to others (Cohen, 1991, p. 231).

Landau and Litwin (2000) compared an analysis of Holocaust survivors age 75 and over

with those who did not experience the Holocaust. The authors found that fifty years after the

Holocaust, the women survivors are seen to have greater health-related difficulties and poorer

self-rated health, and men survivors are seen to report much higher rates of posttraumatic stress

disorder (Landau & Litwin, 2000, p. 482). Although the findings of this study attributed

positive findings to the field about Holocaust trauma and survivors psychological wellbeing in

aging, it did have its limitations. The authors study population was limited only to elderly

Israelis from European sociocultural background. Also, the gender population is biased, having

had a decreased participation of elder women. And lastly, the study was taken from a clinical

sample in the community.

As mentioned before, most of the work done on Holocaust survivors has been done on

clinical populations or those with problems who have sought professional help. Most survivors

have not sought professional help and research among this population has been limited. The

current study will examine Holocaust survivors who were in hiding or incarcerated during Nazis

occupation during their early childhood, but who did not undergo any professional and

therapeutic treatment following their traumatic experiences. The next section will be exploring

coping strategies among victims of trauma in further detail.

22


Research on Coping Strategies

The following section will examine coping strategies associated with physical and

psychological abuse or trauma. It is important to review studies on victims of trauma and how

they have coped with their experiences because they can provide insight of the survivors

experiences. Littleton, Horsley, Siji, and Nelson (2007) identified two primary adaptive and

maladaptive strategies when dealing with trauma. According to the researchers, coping strategies

are either problem-focused or emotion-focused and approach-focused or avoidance-focused.

Problem-focused coping strategies directly address the problem causing distress and include

seeking information about the stressor, making a plan of action, and concentrating on the next

step to manage or resolve the stressoremotion-focused strategies focus on managing the

emotional distress associated with the stressor and includes disengaging from emotions related to

the stressor, seeking emotional support, and venting emotions (Littleton et al., 2007, p. 977).

Strategies that are regarded as the more adaptive mechanisms are approach strategies

since the focus is on the stressor itself or ones reaction to it and some examples include planning

to resolve the stressor and seeking emotional support and information about the stressor

(Littleton et al. 2007). Littleton et al. (2007) describe avoidance strategies as focused on avoiding

the stressor or ones reaction to it and examples include denying that the stressor exists,

withdrawing from others, and disengaging from ones thoughts and feelings regarding the

stressor. This study assessed through meta-analysis the association between strategies used to

cope with traumatic events and psychological distress. Furthermore, the study assessed the

relationship between approach and avoidance coping strategies and distress following two

commonly studied classes of traumatic events: interpersonal violence and severe injury, and

23


among three types of distress: depression, posttraumatic stress symptoms (PTS), and general

distress (Littleton et al., 2007, p. 978).

The researchers results supported their hypothesis that there is a clear and consistent

association between reliance on avoidance strategies to cope with trauma and psychological

distress (Littleton et al., 2007, p. 985). The study predicted that the reliance on avoidance

coping strategies is a maladaptive coping method. As a result, the researchers speculated that

some individuals are incapable of learning effective coping strategies and experience increasing

vulnerability to distress following stressful events (Littleton et al., 2007). In addition, according

to the researchers, this could occur because these individuals remain to use unsuccessful coping

strategies while at the same time experience a decline in the amount of energy they have to

devote to coping because they have multiple unresolved stressors as a result of the physical and

cognitive changes associated with the aging process (Littleton et al., 2007, p.985). Lastly, the

researchers found that as the duration of the trauma increased, as did the association between

reliance on approach coping and experiencing less distress. Littleton et al. assessed this by

attributing to the notion that an individual may have to cycle through using approach

strategies multiples times before these strategies result in the individual either resolving the

stressor or reducing its effects to a manageable level (2007, p. 985). Although the limitations to

this study are that the pattern of results may not be generalized to other forms of trauma, this

study has examined theories that are relevant to the current studys orientation and has suggested

valuable information regarding how a survivor may have coped in the past and current day with

their traumatic events.

Kahana, Kahana, Harel, and Rosner (1988) stated that coping as a response to the

disequilibrium of a stressful state, has been viewed as the successful reduction of stress
24


(reestablishment of homeostasis) thereby identifying coping behavior as only those actions that

produced the desired results (p. 57). The authors, basing their research on Holocaust survivors

from concentration camps, identified five aspects of extreme stress that involve manmade

disasters: 1) Life is disrupted 2) New environment is threatening, dangerous and hostile 3)

There are limiting opportunities to remove or act upon the stressor environment 4) No

predictable end to the experience 5) There appears to be meaningless and without a rational

explanation for the pain and suffering associated with the experience (Kahana et al., 1988, p. 59).

The authors argued that during the Holocaust, survivors adapted to escaping harm as a coping

mechanism during their traumatic period. The authors further stated that usually in a lesser

traumatic situation, coping by escape or avoidance is perceived as a maladaptive method,

therefore the victims of the Holocaust or extreme trauma had altered coping strategies.

As noticed in the literature from other studies, the authors pointed out that the majority of

research has focused on the negative psychosocial sequelae of trauma and medical and

psychiatric literature has been on populations with extreme trauma in only the clinical setting

(Kanaha et al., 1988). The authors also stated that not all victims of extreme stress have

developed posttraumatic stress disorder and to the same degree or intensity of the trauma.

Furthermore, Kanaha et al. (1988) found from their research, which investigated 300 Holocaust

survivors and compared them to controls, the survivors indicated remarkable intactness despite

the trauma they suffered. The authors also pointed that Holocaust survivors who are now facing

old age may have problems associated with illness, bereavement, disability and retirement. In

addition, they may begin to reminisce about earlier points in their lives including their trauma

because older age can be argued as a time of life meaning and life review (Kahana et al., 1988).

25


However, the authors concluded that for some survivors who were able to cope and

implement adaptive coping strategies during their traumatic experiences might use those

adaptive coping mechanisms during the aging process. This study pointed out useful and

necessary framework that benefits the current studys researcher. The study also had its

limitations regarding the fact that the authors only studied coping strategies among Holocaust

survivors that were in concentration camps and not generalized to other survivors who may have

been in hiding during the Nazi occupation.

Nagata, Yuzuru, and Takeshita (1998) explored coping and resilience across generations

among Japanese Americans and the World War II Internment. The authors found that despite

numerous traumas and hardships, most former internees have gone on to lead productive lives.

Resilience has been defined as the capacity for successful adaptation, positive functioning, or

competence despite high-risk status, chronic stress, or following prolonged or severe trauma

(Nagata et al., 1998). The authors explored what cultural and societal factors helped to instill

positive coping and resilience among second-generation Japanese Americans (Nisei) who lived

in the camps, and third-generation Japanese Americans (Sansei) born after the war. Some of

studys research questions included: How did internees cope with stressors during the war? How

have they remained resilient? In what ways have their coping strategies and perspectives on the

internment changed after the war?

The authors pointed out that internees underwent many traumatic experiences including

anti-Japanese sentiment, war hysteria, inadequate medical care, freezing climate, physical and

psychological stressors, familial disintegration, and feelings of humiliation and self blame

(Nagata et al., 1998). As provided in their research, the authors implied that most of the Japanese

internees held strongly onto their Japanese values including gaman (perseverance), a sense of
26


obligation, and self-restraint/reserve, obedience, honesty, and diligence. Furthermore, this

gaman, the ability to endure or persevere under adverse conditions, had strongly influenced

their response to their internment (Nagata et al., 1998). In addition, the authors found that the

attitude of shikata ga-nai (it cannot be helped) helped to maintain a cultural framework from

which the internees were able to cope with the physical hardships and trauma they endured.

Another resourceful coping method among the internees was strong familial commitment and

this was a critical force that helped Japanese Americans to cope with their hardships and

wartime events. In terms of the effects of resilience over after the war, the authors found that

most of the children internees (Nisei) had intact coping abilities, learning to endure hardships,

resourcefulness, strong family support, and an emphasis on education encouraged the Nisei to

actively reestablish their lives and not dwell on the past (Nagata et al., 1998, Retrieved February

16, 2011 EBSCOhost). The authors concluded that resilience may act as an evolving force that

happens over decades and be affected by socio-historical and structural forces. In addition,

as noted by the authors, Resilience is also renegotiated across the lifespan. For some Nisei,

renegotiation occurred as they moved from a stance of silence and emotional internalization

characteristic of traditional Japanese values, to a more vocal stance, characteristic of the

American value of speaking out for justice (Nagata et al., 1998, Retrieved February 16, 2011

EBSCOhost). This study sheds light on the topic of resiliency, adaptive coping mechanisms, and

cultural values that promoted resourceful tools for victims of trauma. All of the studies

mentioned in this section presented various ineffective and effective coping strategies used to

cope with trauma.

27


Theoretical Perspective

The following section will explore the current topic through the perspective of an

existential approach. Testimonies and the life experiences of existentialist Victor Frankl will be

discussed. It is important to note that not only was Frankl a Holocaust survivor, he also wrote

about his life experience in the concentration camp through the lens of a psychologist (Frankl

1984; Lee, 1985). His testimonies and theories can give meaningful insight to how a survivor

internalized and conceptualized his own survival experience (Lee, 1985; Pytell, 2007). In

addition, this section will explore looking at trauma through an existential approach.

Pytell (2007) noted that Frankls vision of psychotherapy had moved from Freudians

view of psychology to a focus on issues of will, responsibility, and the spiritual dimension of

man. A spiritualized existentialism is what Frankl called his new theory to come to terms with

his own camp experience, (Pytell, 2007). Frankl relied on his understanding of psychology to

objectify his experience and, as the author pointed out, he was able to distance himself from the

absurdity and chaos of the moment and analyze his situations. Its important to note that many

victims of the Holocaust were not professional psychologists, and many endured much worse

than Frankl. In comparison, there are many who have survived worse and lived successful lives

(Pytell, 2007).

Pytell (2007) noted that Frankl was able to work through his personal trauma by

minimizing the horrors of the camp. Frankls theory was to connect the prisoners first

psychological state of shock and then detachment to the second phase of apathy. This transition

was caused by current reality that was seen as intolerable and there was no future to look forward

to (Pytell, 2007). To overcome this issue of apathy and loss of hope, Frankl turned to his

spiritualized height psychology as a solution to apathy and despair and relied on a strategy of
28


attitude adjustment (Pytell, 2007). Pytell claimed that Frankl believed that in these extreme

circumstances, one could place meaning in suffering to overcome apathy.

Pytel (2007) illustrated this by quoting Frankl, Fundamentally any man can, even under

such circumstances, decide what will become of himmentally and spiritually. He may retain

dignity even in a concentration camp. [Also] If there is meaning in life at all, then there must be

meaning in suffering. Here lie the opportunities of attaining the moral values that a difficult

situation may afford him. And this decides whether he is worthy of his sufferings or not (Frankl,

1984, p. 7576). According to Pytell, Frankls existentialist attitude was derived from his height

psychology apparently, which helped him find meaning in the oppressive and dehumanized

situation of the concentration camp (2007). Also, Pytell noted that Frankl turned to a spiritual

dimension of heroic suffering to establish a sense of mastery when confronted by tragic

moments, (2007). For example, Frankls spiritualized version helped him resolve the psychic

turmoil caused by, among other things, the knowledge of how his mother died (Pytell, 2007).

Lee (1985) described Frankl as having the ability to look back to more favorable times

and hold onto the peaceful memory of something soothing from the past. The author described

Frankls abilities as survival techniques to adjust to the camp life during the Holocaust. Lee

suggested that according to Frankl, people who refused to believe that they could survive and

fantasize about happier times were more likely to die during camp (1985). Lee also implied

that based on Frankls testimony, The only possible freedom prisoners could possibly

experience was the freedom to choose his or her attitude toward the circumstances that were to

somehow be endured (1985, p. 93).

In Mans Search for Meaning Frankl writes, Everything can be taken from a man but

one thing: the last of the human freedomsto choose ones attitude in any given set of
29


circumstances, to choose ones own way (1963, p. 104). Lee also illustrated how important it

was for Frankl to hold onto meaningfulness and have the capacity to retreat into his inner world.

By doing this, Lee suggested that Frankl was able to have inspirited and was able to produce a

will to live.

Jacobsen (2006) explores looking at trauma and crisis through an existential perspective.

The author described that, existentially, crises are part of being alive. Jacobsen noted that

existential theorists view crisis as an opening of possibilities and from an existential

perspective if one can only cope with the smooth and the well controlled, then there is no room

left for the human being (2006, p. 42). Jacobsen identified with Bollnows theory that crises

are events that due to their critical and dangerous nature stand out from the continuous flow of

life in generalcrisis need not necessarily lead to disaster. The experience of living through the

crisis may involve the overcoming of danger, experiences of relief and, on a deeper level,

cleansing, the elimination of old issues of conflict and the attainment of a new and higher level

of stabilization (2006, p. 42). Bollnow saw crisis as a potential cleansing of the individual and

this type of crisis is a crucial aspect to ones continued direction of development (Jacobsen,

2006).

Jacobsen identified crisis as having three dimensions: loss, adversity, and opening-of-

existence. During a crisis there can be a loss in which something or someone is missed. The

reaction to this loss is grief and through grieving, according to Jacobsen, one either regains what

was lost or comes to terms with the loss. Ultimately, Jacobsen described that in this process the

joy of life is gradually restored (2006). Jacobsen stated that when one person loses another

person or a cherished object, he or she also loses the relationship to that other person or thing. In

connection with the death of a spouse or a close friend, Jacobsen implied that the death of a
30


loved one is loss of existence and the death of a loved one is a piece of ones own death, (2006).

According to Jacobsen, Human beings are able to accommodate these constant losses yet still

grow and be vital and active, precisely because of their basic openness to the world (2006, p.

45).

In crisis as adversity, Jacobsen described that people cannot change given conditions, but

individuals can decide how they wish to tackle their handicap, illnesses, shortcomings or

adversity in general (2006, p. 45). Jacobsen believes that individuals cannot change certain facts

about how they look, what they have lost etc., but need to accept them as their basis, or his or

her existential ground (2006). The author also implied that if an individual does not accept

them, he or she will live on false premises. In addition, Jacobsen pointed out that people are

thrown into existence, and that each individual is thrown into his or her own existential situation.

To exist is in effect to immerse oneself fully in ones real situation. The answer to the adversity

of life is thus to accept ones facticity and to act on that basis Jacobsen (2006 p. 46).

In crisis as opening of existence, Jacobsen saw crisis as becoming existential and as a

personal turning point by offering a new life possibility. Jacobsen speculated that during crisis

and disruption, the individual could find an opportunity to look at what life is really about.

Jacobsen illustrated this concept by Yaloms four basic existential concerns: (1) death (we live

now, but one day we are going to die); (2) freedom (we structure our lives ourselves, but out of

emptiness); (3) isolation (we are born and die alone, but we need other people and a sense of

community); and (4) meaninglessness (we seek and construct life meaning, but in a universe

without meaning). According to Yalom, To be struck by a crisis is a disruptive but also fertile

opportunity to find ones position in relation to these four and other basic existential dilemmas

(Jacobsen, 2006, p. 47).

31


Jacobsen concluded that survivors of an accident related crisis activate their four

existential concerns as mentioned by Yalom. Jacobsen also pointed out that crisis serves as an

important path to development because during a crisis life is lived with particular intensity and

in this process a person should have a chance to take your existence upon yourself (2006).

Jacobsen concluded that even though crisis is and can be painful it is also a chance to

feel the world. In addition, This is a chance to find oneself, clarify ones position on this earth,

to take over ones own life Jacobsen (2006, p. 52). Jacobsens theories help explore, through an

existential approach, how a suffering individual who has undergone crisis can see their crisis as a

turning point, and an opening opportunity for new life development. Looking at these theories

can assist the current researcher in the possibility of understanding the primary adaptive coping

strategies among aging Holocaust survivors. In addition, the current researcher is interested in

assessing and interpreting the Holocaust survivors testimonies through an existential

perspective.

Evaluation of Research Literature and Summary

In the Review of Literature section, studies on Holocaust survivors have been cited and

found that most of the work that has been done on this population has been on the negative

effects of trauma in regards to the victims of the Holocaust. Whats missing in the literature is

not the need to understand the potential benefits that come from coping strategies among aging

Holocaust survivors, but actual nonclinical, positive and primary coping strategies derived from

aging survivors testimonies. The Holocaust experience is a unique experience that is different

from other types of trauma, and therefore can provide valuable information about trauma and

resilience. As cited in the literature review, most of the research on the Holocaust has been from
32


a psychiatric, pathological, and clinical viewpoint. In addition, most of the work on the

Holocaust experience has been guided by psychoanalytic and psychodynamic theories; therefore,

it would be beneficial to explore the current study through an existential perspective.

Holocaust survivors are entering old age, which is causing new questions to emerge about

how best they can be cared for. Studying Holocaust adaptive experiences can provide unique and

relevant information about trauma, resilience, and adaption that can provide further guide with

working with survivors of other genocides. There is an important need to understand and

document the Holocausts survival efforts now that they have entered their final stages of life.

The review of literature is intended to institute a foundation for the current study which will

focus on aging Holocaust survivors who endured childhood and adolescent trauma, and how

have their primary adaptive coping strategies in the current day been able to help them in their

placement in society as they face old age. The next chapter, Methodology, will explore how the

current study was conducted.

33


Chapter 3: Research Design and Method

The following methodology chapter will include Objectives and their Rationales,

Research Plan, Participants, Instrumentation, Data Processing, Ethical Assurances and a Chapter

Summary.

Problem Statement

Holocaust survivors have survived unthinkable and unimaginable hardships. There is no

question that they have dealt with horrific trauma and suffering. Little is known about their

positive coping mechanisms dealing with trauma in old age. What are their primary positive

coping mechanisms? There is a lack of research done on aging Holocaust survivors and their

coping strategies. More insight needs to be gained on this topic.

Objectives and Rationales

What are the lived subjective experiences of Holocaust Survivors now in older age?

This project seeks to understand what are the positive coping strategies among Holocaust

survivors who are now facing old age; to explore what coping strategies have survivors have

used in the last two decades to cope with their trauma; and to explore how the previous

experience (surviving the Holocaust) relates to the current life transitioning among older adults

in the community.

Rationale. All objectives of the current study are contributing factors to explore and

understand the subjective lived experiences of aging Holocaust survivors to help therapists treat

Holocaust survivors. Studying Holocaust survivors adaptive experiences can provide unique and
34


relevant information about trauma, resilience, and adaptation that can provide further guidance

with working with survivors of genocides.

Research Plan

The researcher will establish contact with the San Fernando Community Senior Day

Centers and the program director to request permission to speak with the participants. Once

permission is granted, the researcher will recruit participants who meet the criteria of the study

and who would like to volunteer for interviews. Once the participants have been identified, an

informed consent will be provided before the interviews stating the length of the interview and

the researchers contact information. The initial interview will be held at the participants Day

Center.

Participants

The subjects will consist of eight Jewish female and male survivors who lived during

(19391945) World War II Holocaust. At the time of World War II, the subjects age ranged

from 1318 years. All subjects will be from the origin of country under the former U.S.S.R.,

which would now be anywhere from Eastern Europe (Poland, Belarus, Ukraine, Eastern Russia

Lithuania, Latvia, Estonia, Hungary, Romania, Moldova, Croatia, Czech Republic, and Serbia).

The subjects will be selected from a convenient sample from the San Fernando Valley

Community Senior Day Center.

35


Instrumentation

Data will be collected in face-to-face direct interviews. The data-gathering instrument

will consist of an hour and a half interview administered by a 10-item questionnaire.

Questionnaire items will be open-ended to promote unrestricted response, flexibility depth and

clarification to derive the participants phenomenological experience. All subjects will be given

standard instructions to describe their experiences during World War II, long-term effects of the

Holocaust and their current lives. The interview will explore concepts regarding positive coping

strategies among aging Holocaust survivors. An example question will be: How does it feel to

be a survivor? For all interview questions, refer to Appendix A.

The initial interview will be audio taped, translated from Russian, and immediately

transcribed. For transcription of the responses to interview questions refer to Appendix B. All

subjects will be informed and assured of their right to refuse to respond to any particular

questions during the interview.

Data Processing

Qualitative data processing will be analyzed and interpreted by the interviewer. The

questionnaire will be evaluated by means of data analysis consisting of methodological and

descriptive triangulation. The methodological triangulation will consist of constant comparison,

classical content analysis and keywords-in-context qualitative data analysis tools. Constant

comparison involves developing themes in the research data. In classical content analysis, the

researcher will count the number of times each theme is used to understand the frequency of each

theme. In keywords-in context data analysis, the researcher will identify keywords that are

frequently or in an unusual manner used.

36


Ethical Assurances

Due to the sensitive nature of the current study, the researcher will adhere to all

guidelines to ensure ethical considerations and privacy rights of all subjects. The subjects will be

assured and informed that they have the right to refuse to answer any questions and can terminate

the interview if they feel uncomfortable or unwilling to continue. Every caution will be taken to

uphold the ethical and privacy of the subjects.

According to the American Psychological Association, by the ethical principles of

psychologists and code of conduct, the researcher will inform participants about (1) the purpose

of the research, expected duration, and procedures; (2) their right to decline to participate and to

withdraw from the research once participation has begun; (3) the foreseeable consequences of

declining or withdrawing; (4) reasonably foreseeable factors that may be expected to influence

their willingness to participate such as potential risks, discomfort, or adverse effects; (5) any

prospective research benefits; (6) limits of confidentiality; (7) incentives for participation; and

(8) whom to contact for questions about the research and research participants' rights (American

Psychological Association, 8.02, 2010). In addition, an opportunity for the prospective

participants to ask questions and receive answers will be provided.

Because the nature of the study may elicit strong emotions and feelings, a referral for a

licensed psychologist will be available to consult with any participant who feels that he or she

may need the support. Dr. Dmitry Tuller will be available for one free consultation and any

additional services can be provided by the psychologist if necessary.

In this chapter the researcher described the Research Plan, Participants, Instrumentation,

Data processing and Ethical Assurances. The next chapter will be Analysis and Results.

37


Chapter 4: Analysis and Results

The aim of the research was to understand the positive coping strategies among

Holocaust Survivors who are now facing old age. By interviewing older adults aged 86 and

older, the researcher wanted to gain a better understanding of how surviving the Holocaust and

the atrocities of WWII relate to the current life transitioning among older adults in the

community.

The interviewer gathered information about participants gender, age, country of origin,

and relationship status. The participants were asked to complete face-to-face interviews with the

interviewer surrounding their experience during WWII. All face-to-face interviews were

conducted at the approved Adult Day Center in a confidential private room. Each interview

lasted approximately 1.5 hours. The researcher reminded the participants that the interview

process may elicit strong emotions but is a safe and comfortable environment. Since the

participants are from a specific culture and background, the researcher conducted interviews in a

respectful, sensitive, and carefully paced manner. In addition, prior to the interviews, the

researcher reminded the participants that they have the right to refuse to answer any questions

and can terminate the interview at any time if they feel uncomfortable or unwilling to continue.

Analysis

During transcription of each audio recording, researcher assigned numbers to participants

to maintain anonymity, confidentiality, and a method to refer to the participant throughout the

discussion of findings. Researcher reread transcripts and evaluated documentation and notes

taken during participants interviews to identify any patterns of themes within the context of

responses.
38


Using qualitative processing, researcher counted the number of times each theme is used

to understand the frequency of each theme. Next, researcher identified keywords that are

frequently used as commonalities among each theme. Through interpretation and qualitative

processing, researcher was able to identify emerging themes and patterns that developed within

the face-to-face interviews.

Participants

Five of the eight of the participants were female and three were male; all participants

were between the ages of 8797. All eight of the participants identified themselves as Jewish

Caucasians from the former U.S.S.R. Participants were three couples and two female widows

residing independently. Demographic information on the participants is presented in Table 1.

Table 1: Participant Demographics

Participant # Gender Age Country of Relationship
Origin Status

1 Male 97 Ukraine Married

2 Female 89 Ukraine Married
3 Male 89 Ukraine Married
4 Female 87 Ukraine Married
5 Male 88 Belarus- Married
(former
U.S.S.R)
6 Female 87 Belarus- Married
(former
U.S.S.R)
7 Female 89 Poland Widowed
8 Female 91 Latvia-(former Widowed
U.S.S.R)

39


Findings

This researcher used 10 open-ended, semi-structured questions to gather information

about the participants phenomenological experiences. As previously indicated, the semi-

structured interviews attempted to answer and explore the following objectives and rationale: (1)

To understand what are the positive coping strategies among Holocaust survivors who are now

facing old age; (2) To explore what coping strategies have survivors used in the last two decades

to cope with their trauma; and (3) To explore how the previous experience (surviving the

Holocaust) relates to the current life transitioning in older adults in the community.

As outlined in Appendix A the research questions that the interviews attempted to answer

were: (Q1) Tell me about your experience during World War II? (Q2) How have you learned to

cope or deal with your WWII experience (e.g., Holocaust)? (Q3) How does it feel to be a

survivor? (Q4) What do you think are some of your strengths, which have gotten you to where

you are now? (Q5) How have you handled the experience of living past the Holocaust now in

older age? (Q6) Now that you are facing older age, how has surviving the Holocaust aided you?

(Q7) Can you name some of your specific coping strategies? (Q8) When you feel overwhelmed,

what do you do to make yourself feel better? (Q9) Have you at any time since your Holocaust

experience received any professional psychiatric/psychological help? (Q10) How did you feel

talking about the Holocaust with me? Bonus question (Q11) Anything additional about yourself

or experience that you would like to share with me?

Because the interview questionnaire elicited many responses, themes that emerged from

the questionnaire related to the researchers objectives were considered in five themes. The five

themes and descriptions of themes are presented below. Theme results from participants are

presented in Table 2.
40


Table 2: Theme Results

Themes PT1 PT2 PT3 PT4 PT5 PT6 PT7 PT8

Resilience X X X X X X X X

Strong maternal influence X X X X X X

Freedom from oppression X X X X X X

Interpersonal/family relationships X X X X X X X

Success to healthy aging X X X X X X X X

Theme Presentations

Resilience. One theme that emerged from most participants had to do with their ability to

be able to recover from their misfortunes (e.g., atrocities of WWII, famine, loss, pain, etc.) and

adjust into the world. This form of resilience can be illustrated by the following quotes from the

participants:

Participant 1: The heart lived on, Im not the same but still strong. Ive survived
the unthinkable because I was able to bounce back and keep going. Many of my
comrades died along the way, but my spirit was strong.

Participant 2: What was I supposed to do? There was nothing to do but keep
going. Nobody had the time to stop and think about what had really happened. My
God gave me the will to adjust, wed, bear my children, make it to America and
live.

Participant 3: The Holocaust was one of the worst times in my life. But its very
simple: life went on. Older age did plague me and weigh me down, diseases only

41


occurred naturally and worry increased. But I have survived. You learn to go on
because you have to.

Participant 4: You build resiliency and learn to forget the bad. If you dont fight
the will to live then you die (or died back then). Everything is here (points around
her) thats the point. Nothing will be like the Holocaust. Thus, everything is all
ready better in life. My family, my life, my home, is all here and THAT is life.

Participant 5: You yourself can choose what happens to you. I chose to move on
and adjust. I chose to live.

Participant 6: Whether its Gods plan or my destiny. I had an adaptation to

tolerate pain. A will and determination to get through the misfortunes brought
upon me. I have struggled through all my life. But all my struggling has helped
me overcome my obstacles to this day. It has shaped me into who I am today. Its
an inner resiliency that words cannot explain.

Participant 7: Maybe it was Gods plan or my inner will that helped through such
trauma and pain. Or maybe I was destined to survive so I can born my family and
contribute to this world. Regardless I credit my survival to some form of
resiliency.

Participant 8: Its always been a coping method of mine, to turn negative things
into positive. I am alive today because I take care of myself, worry little and I am
a determined person.

Strong maternal influence. A second theme that arose throughout the interviews was

the discussion of how a maternal figure influenced participants strengths and resiliency during

WWII. Many participants reported that most men over the age of seventeen had to fight in the

Russian army against the Nazi regime, which left many of the women behind. Participants recall

how their mothers strengths kept them alive. This form of a strong maternal influence was

demonstrated by the following quotes of the participants:

Participant 2: My father was killed in the war. My mother was my only family in
the four years that we hid from the Nazis. Every day I thought I would die but my
mother stayed by my side and became my shield. She somehow believed in
freedom and even though my young mind couldnt understand it, her strength
saved me. I owe everything to her and the kind people who hid us all those years.

42


Participant 3: After the war, it was extremely difficult. We barely survived

through the famine. Just because the war was over doesnt mean the city wasnt
destroyed. Since the older men in the family were gone, to live without my father
was hard. My mother had to go find work and feed the children (me and my
younger brother). I had to work and help her as well. Women as a whole had to
work and care of their family. I am grateful of her and her will to survive the
family.

Participant 5: If the Germans captured you, you were dead. If you were a man
over the age of 17 you went to fight in the Russian army against the German
Nazis. It didnt matter if you were Jewish or Christian or whatever. You had to go
fight. Many people were being murdered in the front (Russian army) or by the
Germans. My father left to fight and never returned.

My mother was the only thing that saved me. I recall how hard she worked to
make sure I was alive. I remember her looking so old. As if the war had aged her
beyond her years. I remember wanting to help her. I think I got my strength and
will from her.

Participant 6: My father and my mother were separated during the war. As we

ran we lost many people along the way. My grandfather was killed by bombings
right in front of my mother. So as you can see, it was my mother who made sure I
was alive, since she was the only one with me.

Since I was in the hierarchy of being the oldest, I was used to taking care of
people. Being the CEO of cooking, cleaning, everyone was dependent on me.
Thats how I go forward in life. Expectations set on myself. This is what I think
my mother has instilled in me.

Participant 7: Unfortunately, the Nazis murdered my immediate family. I didnt

have a mother or father or siblings after that. My husband was in the same place,
with all his family murdered as well. So when we wed I became a mother for my
children. (Becomes sad and tearful) Realizing how important my duty was to be
in my childrens lives probably had to do with losing my mother so young under
such painful conditions.

Participant 8: My mother was an angel. She taught me to run a household, take

care of myself and be a lady. Mothers are one of the most important people in our
lives.

Freedom from oppression. A third theme that emerged was in regards to the freedom

of life, liberty, and the pursuit of happiness. The following quote reflects participants

43


perception of what freedom in the United States has meant to them. Many participants reported

being religiously oppressed, prosecuted, denied access to healthcare, and limited jobs due to their

religious affiliation and the anti-Semitism that plagued them in the many regions of the former

U.S.S.R. Participants described that their immigration to the United States was for a better

quality of living, medical advancements, and unlimited opportunities for everyone in their

family. The following quotes illustrate this theme.

Participant 3: I have had heart surgery, few bypasses and a pacemaker. America
literally has saved me. Russia didnt have these medical advancements or
procedures. I am alive today because I have had these advancements in medicine.
In Russia, rarely people lived longer than 60-65. And I cant believe I even lived
passed 80.

Participant 4: Its a different life here in America. We were able to get a

pension/SSI. To have a life surrounded by the things that are important to you is
everything. I have my ailments and physical problems but thats what you have a
doctor and specialist for. For instance, my husband is alive because (here) he
could have the surgery he needed. So I am forever indebted to this country
(smiles).

Participant 5: I have been discriminated my entire life in Belarus due to being

Jewish. Schools, education, jobs were denied. Most people tried to cover who
they were. You dont feel alive. You are not human. Can you imagine not feeling
human? I have always wanted to feel part of something. My country of origin
didnt make me feel part of it. But when I came to America, everyone here is an
immigrant. So you all are the same. You feel part of this country. And when you
feel alive you are living.

Leaving an oppressed country is what has given me life. To be free from

oppression is the freedom needed to live and find happiness. To have a future
makes you see beyond obstacles. To have a future for your family, to see your
children grow. (smiles at researcher).

Participant 6: Many people think after the Holocaust it became easier for us
(Jews) but on the contrary anti-Semitism was at it highest. Besides sparse food
and limited opportunities, you had people who hated you for no other reason but
your last name. So many hid who they really were. It was the Nazis all over again.
You couldnt read the great literatures or listen to the music you wanted to.
Communism took over everything whole. My family and I did everything in our
power to try to get out of Russia and it would take 11 years to find our freedom.
44


We are destined from the day we were born to the day we die. We all have a
destiny. My destiny was to have been married, to meet my husband, for my
grandchildren to be alive and to be living right here in United States. And for this
freedom I am so grateful. Its the reason I stand beside you today.

Participant 7: It was unbearable to leave Israel, my home for so many years. But
my adult children persisted for a long time for me to come to my senses. I needed
the medical technology that only United States had so I did what many had to do I
suppose. I came here and because of that I bought many years to my life. But I
dont think I will ever get over how hard it was to leave my country, and I left
many countries to be here.

Participant 8: America gave my family the freedom that it needed to make

something of themselves. Happiness is where you can be yourself, make
something of yourself and be proud of yourself.

Importance of interpersonal/family relationships. Participants discussed the

importance of interpersonal and familial relationships. Participants reflected about their views on

marriage, family, and social relationships as an aid to their resiliency and adaptive coping

strengths. The direct quotes below represent this theme.

Participant 1: Since all my family members were killed by the Nazi regime, my
marriage and children from this marriage are the only family I know of.
Socialization with peers and other relatable people like me have been important to
me. I used to socialize much more but I am still a cheerful and happy
person.(Recites poem and sings song to the researcher.)

Participant 2: As a mother my only goal was to help my child grow and be happy
despite the world in which he was created. I love my son and grandchildren and
them having a good life has been my motivation to live.

Participant 3: Support of my family brings me hope and motivation to fight and

live longer. Ive survived many of my friends but in the past when I was healthier
I used to love to socialize with my peers. Talking to people your age and
background made you feel part of the community.
Participant 4: Ive survived a stroke and have had many psychological battles to
deal with. But having family around me gives me happiness and strength. Family
is the most important thing to me and always will be.

45


Participant 5: My motto has been since I came to this country to work honestly
and respectfully. Be part of the community, respect thy neighbor, always be
positivethings will be better. Make good connections with people. My family
will be happy and free people. My familys future and happiness is what kept me
going strong.

In Russia I always feared a war, always looking over my back. But now in
America, I didnt feel so afraid so I was ready to make a better living for myself
by making friends and providing for my family. Family is the number one most
important thing in the world.

Participant 6: The most important thing that has helped me is familial support.
Seeing my daughters and granddaughters to succeed means everything to me.

Participant 8: People are beautiful angels. To have relationships is the most

precious thing. Having good people in my life helped me to be who I am today. I
love people and being surrounded by them on a daily basis. Socialization is key.

Success in healthy aging. Lastly many participants described specific elements that have

contributed to their success in aging and coping with past and present traumatic experiences.

Participants recalled the importance of leisure activities, socialization, family support, positive

mottos, patience, determination, cultural/religious beliefs, past adaptive coping strategies, and

present positive coping styles. The following quotes below support this theme.

Participant 1: I attribute physical strength as the reason for my long life. Like my
father and fathers before him, I too possess a strong spirit (points to his chest).
Comparing to some of my counterparts, many of my peers have dementia and are
losing their (minds).

You cannot get depressed or feel bad. I am not afraid to die. I am not afraid of
tomorrow. Never been afraid of death. You have to stay strong, do what you love
and live. Those that were afraid and complained all the time, all perished a long
long time agoWhat doesnt kill you makes you stronger.

46


Participant 2: I know God saved me. I have always believed in God.

Since people saved my life during hiding from the Nazis, I always loved to help
people and be around people.

I used to socialize more before my physical pains, however now I just see
caregivers, family and my husband.

Participant 3: Witnessing trauma younger helped me to cope and tolerate the

pain because the younger mind couldnt conceptualize such atrocities during the
war. Not understanding the way of the war saved me from the mental turmoil that
would probably have weighed me down. Had I been an adult or my current age I
would probably be dead right now.

I believe having good nutrition, medications I need, and support of familyis all
contributing factors to my success in aging and surpassing many of my peers.

Participant 4: My motto was always to see the good in things. I believe I have a
strong will. Determination and being patient was something I learned to possess
quickly in time of trauma and pain.

When I feel overwhelmed, I cook, clean, do anything that is distracting. To get

involved with things to clear the mind, to stay busy is an important quality to
have.
When I was physically more able, I used to love to go to the beach, to socialize
with peers outside in nature. Get out of the house and keep mind on other things
was helpful in dealing with stressors.

Participant 5: I think because I was used to living poor, I was adapted to living
poor during the war with everything sparse around. So that adaptation definitely
saved me.

When young, when youre not as old, youre not as predisposed to the emotional
trauma because your mind cant imagine what really is going on. Only until later
you begin to intellectualize what happened to so many people. Life and death
wasnt a concept when youre a young mind so you just get through things
easier.

I have always prided myself in being mentally and physically strong. I had
endurance. I learned patience and stayed positive and healthy. I was determined
about everything. Quit smoking? Yes, I did. I learned that if I put my mind to
something I could do it. Thats my biggest strength and coping mechanism. Mind
over matter is a motto of mine as well.

47


I have worked very long hours and exhausted my body; therefore, I am plagued
with many ailments. But I am content and grateful for what I have here and my
family is happy and healthy.

I currently enjoy games on computer, chess, Sudoko, seeing my children, and

reading books.

Participant 6: I have learned to curb my anxiety by cleaning, it helps me be clear

and distracts my mind (laughs). I have always been into reading and self-
educating. As Ive aged, Ive become more positive and I like to intellectualize
things. I find myself wanting to learn more, being more caring, empathetic and
understanding. I have more time for these things see? I dont like negative people,
so I try to stay away from negative things.

Gardening, sewing, cooking, spending time with my grandchildren and reading a

good book are my leisure activities in life.

Participant 7: Moving forward one step at a time is what helps me in time of

despair and stressful life events. If its too overwhelming and encompassing it can
swallow you whole so you have to take baby steps to get where you are going and
hope for the best.

I have lived a long life because I have always been eager to learn. I am fluent in
five languages, have lived around the world thus been exposed to many cultures,
beliefs and various ways of living.

Participant 8: I have learned that there are negative forces (e.g., people, nature
disasters, wars etc.) that may strike you down but you have to carry on no matter
what. Find positive people, surround them around you. Find a job you love, I
loved helping people. Do your prayers and commit to God. Draw, paint, eat
healthy, exercise, socializelike I do. All these things make you a better person
and part of the community.

Summary
In this qualitative study, participants shared their overall subjective experiences during

and post WWII. Through the semi-structured interviews with eight older adults, the researcher

was able to obtain themes related to these experiences. The research themes that emerged

pertaining to these experiences are described in the following chapter, Discussion of Results.

48


Chapter 5: Discussion of Results

This study examined the positive coping strategies of World War II (WWII) Holocaust

survivors. A phenomenological qualitative study was conducted to explore and uncover themes

from the testimonies of Holocaust survivors who are now facing old age. The importance of

studying adaptive coping experiences can provide unique and relevant information about trauma,

resilience, and adaptation that can provide further guidance with working with survivors of

genocides and related traumatic experiences. The following research questions guided the study:

1. What are the lived subjective experiences of Holocaust survivors in older age?

a. To understand what are the positive coping strategies among Holocaust

survivors who are now facing old age.

b. To explore what coping strategies survivors have used in the last two decades

to cope with their trauma.

c. To explore how the previous experience (surviving the Holocaust) relates to

the current life transitioning in older adults in the community.

The results of the research study demonstrated that there are specific styles of adaptation,

resilience and lifelong adaptive coping strategies within the older population of trauma survivors.

The participants were able to report lifelong coping mechanisms that have aided them in times of

trauma related to loss, bereavement, chronic illnesses, medical/physical conditions, acculturation,

and psychosocial stressors. The following are five themes derived from the findings.

Resilience

The first research theme explored resilience as a coping mechanism among the older

adult population. The majority of the older adults described having a strong inner mechanism or
49


organism that guided them throughout their traumatic and distressing experiences. The

participants reported that this inner strength and type of attitude was an adaptive method of their

choice to keep on living despite the many horrors surrounding them. This attitude can be

supported by Frankls own survival techniques, as illustrated by his observation that the only

possible freedom prisoners could possibly experience was the freedom to choose his or her

attitude toward the circumstances that were to somehow be endured (Lee, 1985, p. 93). Many

participants described that in a time of horror and despair, they had a will to live and the

alternative method would have been death. As Frankl stated, Everything can be taken from a

man but one thing: the last of the human freedomsto choose ones attitude in any given set of

circumstances, to choose ones own way. This was found to be an adaptive attitude related to

the participants own coping styles (1963, p. 104). An example of resilience was demonstrated in

participants comments:

You learn to go on because you have to.

You build resiliency and learn to forget the bad. If you dont fight the will to live
then you die (or died back then). Everything is here (points around her), thats the
point. Nothing will be like the Holocaust.

You yourself can choose what happens to you. I chose to move on and adjust. I
chose to live.

Strong Maternal Influence

Results pertaining to the second research theme revealed that a majority of participants

had a strong maternal influence that aided them during their traumatic experiences. Many

participants described having a characteristically strong mother who contributed to their ability

to adapt and cope with their distressing experiences during and after WWII. Participants

testimonies demonstrated that there is a strong correlation of healthy attachment styles from a
50


mother to a childs adaptive psychosocial and developmental upbringing. Subsequently, research

findings demonstrated that participants with healthy and adaptive maternal influences during

childhood and adolescence contributed to participants long-term resiliency and capacity to cope

with traumatic conditions.

Consequently, children with an absent or unavailable parenting figure hinder a childs

psychosocial functioning. Similar findings in the literature supports the current researchers

findings as illustrated in the work of Huopainen (2002), Krystal (1978), and Freud (1893-1895)

that indicate that, without the maternal figure acting as protective shield, the child can become

distressed and unable to bear the effects of the traumatic event, thus giving evidence to show the

impact of the distress on the Holocaust child survivor who may not have had any parental and

nurturing contact during WWII. Examples of strong maternal influence can be illustrated by

participants comments:

Everyday I thought I would die but my mother stayed by my side and became
my shield. I owe everything to her and the kind people who hid us all those
years.

My mother was the only thing that saved me. I recall how hard she worked to
make sure I was alive. I think I got my strength and will from her.

Freedom from Oppression

The third research theme surrounded the influence of older adults experiences of

freedom from oppression. The majority of participants reported being religiously persecuted and

frequently exposed to prolonged anti-Semitism in their former country of origin. Older adults

reported that they no longer had respect nor received equal rights as a person during their life in

former Russia. The results demonstrated that participants felt that they were not part of the

51


community and in some cases felt not human as they described their psychological and

emotional disturbances living in the former U.S.S.R. post-WWII.

Most of the adults who immigrated to the United States experienced freedom of religious

persecution, medical advancements, increased job opportunities, healthier surrounding

environment, and part of a specific group and community. Older adults who reported belonging

to a community or group free from religious oppression indicated that this belonging contributed

to their adaptive coping strategies. Research demonstrating the importance of being able to

identify the self with a group of people or community for the aging Holocaust survivor has been

limited in the current literature. The results demonstrated that older adults who were able to

belong to a group of people and community without discrimination and religious persecution

were able to transition and adapt healthier long-term coping strategies despite earlier childhood

traumatic conditions. Examples of freedom of oppression can be demonstrated by participants

comments:

Leaving an oppressed country is what has given me life. To be free from

oppression is the freedom needed to live and find happiness. To have a future
makes you see beyond obstacles. To have a future for your family, to see your
children grow.

Many people think after the Holocaust it became easier for us (Jews) but on the
contrary anti-Semitism was at it highest. Besides sparse food and limited
opportunities, you had people who hated you for no other reason but your last
name. So many hid who they really were. It was the Nazis all over again. My
family and I did everything in our power to try to get out of Russia and it would
take 11 years to find our freedom.

I needed the medical technology that only United States had so I did what many
had to do I suppose. I came here and because of that I bought many years to my
life.

52


Importance of Interpersonal/Family Relationships

The fourth research theme discussed the importance and benefits of interpersonal and

familial relationships. Participants reflected on the significance of marriage, family, and social

relationships as an aid to their resiliency and adaptive coping strengths. Older adults described

the importance of interpersonal relationships in regards to their overall happiness. Participants

identified how social and interpersonal support brought purpose and meaning to their quality of

life. In addition, many participants reported their inner psychological strength and motivation to

succeed in life was for the well being of their children and family. These results can be supported

in various findings in the literature including Sigal (1998) and Suedfelds (2003) studies

identifying adaptive coping strategies of Holocaust survivors and the positive influence of

external factors of help from others, social support, and familial environmental factors. An

example of the importance of interpersonal relationships was demonstrated in the following

participants comments:

Since all my family members were killed by the Nazi regime, my marriage and
children from this marriage are the only family I know of.

Ive survived a stroke and have had many psychological battles to deal with. But
having family around me gives me happiness and strength. Family is the most
important thing to me and always will be.

But now in America, I didnt feel so afraid so I was ready to make a better living
for myself by making friends and providing for my family. Family is the number
one most important thing in the world.

Success in Healthy Aging

Lastly, the fifth research theme explored what are the overall adaptive strengths that

enabled participants to cope with the varying traumatic conditions from their past to the present

53


as they have faced older age. Most participants reported that witnessing horror, emotional

disturbances and malnourishment did not significantly impact their psychosocial and emotional

development, but in fact, contributed to their strength and resiliency. This type of strength can be

witnessed throughout participants lives as they now adapt to their own aging illnesses and

potential traumatic conditions including physical deterioration, sadness related to bereavement,

and decreased mobility.

Many participants reported that surviving past traumatic conditions gave them the

capacity to deal with existing distressing and painful experiences. Nietzsches popular phrase

whatever doesnt kill you, makes you stronger, supports the existential belief that was found in

the participants describing an inner psychological model that influenced their adaptive

functioning through their adversity. Similar references to participants resiliency and coping

strengths can be noted in Yaloms (1989) existential theories and Jacobsens existential working

model of dealing with trauma. Jacobsens (2006) theories influenced by Yalom support

participants existential positions of how the suffering individual through adversity and crisis

emerges stronger and that even though crisis is and can be painful it is also a chance to feel the

world. In addition, Jacobsen stated that this is a chance to find oneself, clarify ones position on

this earth, to take over ones own life (2006, p. 52). Jacobsens theories give further guidance,

through an existential approach, as to how suffering individuals (like many of the participants in

the study) who have undergone crisis can see their crisis as a turning point, and an opening

opportunity for new life development. This is evidenced in participants testimonies that

expressed the importance of moving forward through hardship by restoring and rebuilding their

lives. All participants after WWII finished their education, married, and started a family. The

54


results of the study gave evidence that all participants wanted a better future for themselves and

their family members.

Kahana et al. (1988) further support current findings, stating that not all victims of

extreme stress have developed posttraumatic stress disorder and some survivors who were able

to cope and implement adaptive coping strategies during their traumatic experiences might use

those adaptive coping mechanisms during the aging process. Similarly, findings from Nagata et

al. (1998) support resilient coping strategies among Japanese child trauma survivors. The authors

concluded that these child survivors had intact coping abilities, resourcefulness, strong family

support, did not dwell on the past, and exhibited resilience across the lifespan.

In addition to psychological strengths, older adults reported that leisure activities such as

cooking, gardening, board games, socializing with peers, drawing and other related recreational

activities have contributed to their positive attitude and adaptive coping strategies. Some older

adults described coping in aging as finding a meaning to life including spirituality and

exploring a sense of purpose, education, and creative outlets. It was clear in the results that the

quality of their life is a result of various factors associated with inner psychological strengths,

adaptation, and familial and healthy environmental factors. Examples of success to healthy aging

can be demonstrated by participants comments:

You cannot get depressed or feel bad. You have to stay strong, do what you love
and live. Those that were afraid and complained all the time, all perished a long
long time agowhat doesnt kill you makes you stronger.

I believe having good nutrition, medications I need, and support of familyis all
contributing factors to my success in aging and surpassing many of my peers.

I have always prided myself in being mentally and physically strong. I had
endurance. I learned patience and stayed positive and healthy. I was determined
about everything. I learned that if I put my mind to something I could do it. Thats

55


my biggest strength and coping mechanism. Mind over matter is a motto of mine
as well.

I had an adaptation to tolerate pain. I have struggled through all my life. But all
my struggling has helped me overcome my obstacles to this day. It has shaped me
into who I am today. Its an inner resiliency that words cannot explain.

Contributions of the Study

This study provides a qualitative and phenomenological approach to understanding

adaptive coping strategies among aged survivors of various traumas suffered during WWII

holocaust. There is limited research in the importance of adaptive coping strategies in the older

adult population. Most research findings, as the literature suggests, have focused on the

psychological and physical distress of childhood trauma post WWII Holocaust. Past research

studies have focused on the negative effects of trauma in regards to the victims of the Holocaust.

Research has been from a psychiatric, pathological, clinical viewpoint and mostly been guided

by psychoanalytic theories.

This study explored the psychological aspects, through nonclinical testimonies derived

from aging survivors experiences of resiliency, adaption and positive coping strategies among

aged Holocaust survivors.

As mentioned previously, survivors of WWII are now entering older age, which is

causing new questions to emerge about how best they can be cared for. Studying Holocaust

survivors adaptive coping experiences can provide unique and relevant information about

trauma, resilience and adaptation that can provide further guidance with working with WWII

veterans, Holocaust survivors, and survivors of genocides. As baby boomers reach older age, and

the population of older adults outnumber other age groups, it is important for mental health

56


professionals to practice effective therapeutic interventions related to working with older adults

with trauma.

Identifying and implementing therapeutic interventions that help maximize the capacity

for better living and functioning for older adults may prolong their lives. Further, this

researchers results can assist the older adults family, friends, and caregivers regarding how to

preserve areas of functioning for the aged adult. In addition, studying lifelong coping strategies

among older adults can assist the mental health professional, social worker, and counselor in

identifying early warning signs of children with trauma and provide necessary tools to manage

symptoms of distress (e.g., anxiety, depression, PTSD, fear, guilt, shame, environmental

stressors, loss/separation, anger, worry and feelings of helplessness) to improve daily functioning

and implement lifelong adaptive coping mechanisms.

In summary, these research results have demonstrated psychological inner strengths,

external factors including social and peer support, healthy environment and surroundings,

belonging to a specific community or group, strong maternal influence, proactive positive

attitude, religious freedom, impact of medicinal/medical contributions, as all contributing factors

to adaptive coping strategies among aged Holocaust survivors.

Cultural Influence

The current researcher was emotionally affected by participants testimonies of their

lived subjective experiences, as she is of the same cultural and religious background of

participants from the former U.S.S.R. Further, researchers own family has a history related to

WWII Holocaust trauma, religious persecution, and loss/separation. Listening to participants

experiences during WWII and the devastating aftermath of the war was an exceptionally difficult
57


and moving process that further contributed to the researchers own passion and interest in the

proposed topic.

Sharing a similar cultural and historical background aided the researcher in

demonstrating empathy and understanding of the sensitive material presented by the participants

testimonies. Furthermore, researcher was more attuned and motivated to explore, interpret and

evaluate participants experiences due to their personal and meaningful implications.

Limitations

This qualitative study was limited to eight participants and all the participants are from an

Eastern European background, residing in Los Angeles. Out of these eight participants, three

were male. As a result, the generalizability of the results to other older adults is limited. Some

transference was exhibited throughout the interview processes as participants mentioned that the

researcher reminded them of their daughter and/or granddaughter. Thus, some may have

generated answers that they believed would show them in a more favorable or less favorable

light toward the researcher. Each participant provided self-reported information, which may also

have impacted the results, as they may not have responded in a completely honest manner. Due

to the nature of the study and the personal connection to the topic, it should be noted that the

researcher might have developed countertransferences toward the participants and their lived

subjective experiences. Also, even though researcher is fluent in the participants language, due

to language differences, some dialogue may have been lost in translation when transcribed.

Additionally, the interpretation of the data may pose a limitation, in that the coding and origin of

the themes from the interviews was performed from the perspective of the researcher.

58


Recommendations

This researcher found several implications for future research such as:

1. A study that includes a larger sample size that incorporates more input from the older

adult participants.

2. Psychological and physical evaluation of an older adult to assess for cognitive and

physical functioning as part of the interview and research process.

3. A study that incorporates the experiences of participants adult children to explore the

possible impact of trauma across generations.

4. A comparative study between older adults who were exposed to trauma in childhood

versus older adults who have not been exposed to trauma.

5. A study that includes other religious and cultural populations who have endured

childhood trauma to understand other genocides and culture-specific life experiences.

Furthermore, the results of this study raise implications for psychological and

psychosocial interventions. One recommendation pertains to increased training in mental health

professionals in working with trauma with older adults of various ethnic backgrounds.

Conclusion

According to the United States Census Bureau, there were 40.3 million people in the U.S

who were over the age of 65 and that this was the highest increase in older population in 2010.

Between the years 2000 and 2010, the total population of older adults increased from 281.4

million to 308.7 million, further indicating that this is the fastest growing age group in the

country (The U.S Census Bureau, 2010).

59


In addition, between the years 2000 and 2050, the proportion of the worlds adult population

over the age of 60 will double from about 605 million to 2 billion over the same period (World

Health Organization, 2012). It is becoming increasingly important to understand this older adult

population as well as the implications that population aging has for various families, and social,

economic, and psychological aspects of society.

This research study provided results that can help create new areas of research and

formulate further understanding of the importance of adaptive coping strategies when dealing

with trauma within the older adult population.

This study has shown that there are various significant adaptive coping strategies among

older adults including, but not limited to, psychological inner strengths, external factors

including social and peer support, healthy environmental surroundings, belonging to a specific

community or group, strong maternal influence, importance of interpersonal relationships,

proactive positive attitude, religious freedom, impact of medicinal/medical advancements that

have contributed to their long lasting and more enjoyable lives.

As research has shown, there is a growing need for the aging population that are

often accompanied by various geriatric stressors (e.g., decreased independency due to

limited mobility and other physical or mental health problems). There is also an increase in

care for older adults in home nursing, community and assisted living, residential care and

long stays in hospitals due to psychological and physical deterioration. Programs and

resources involved that can limit the impact of these stressors on older adults and result in a

better quality of life should be considered and implemented.

60


References

American Psychological Association. (2010). Ethical principles of psychologists and code of

conduct. Retrieved from http://apa.org/ethics/code/index.aspx.

Ayalon, L. (2005). Challenges associated with the study of resilience to trauma in holocaust

survivors. Journal of Loss and Trauma, 10, 347358.

Barel, E., Sagi-Schwartz, A., Van IJzendoorn, H. M., & Bakermans-Kranenburg, J. M. (2010).

Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide.

Psychological Bulletin, 136(5), 677698.

Cohen, B. B. (1991). Holocaust survivors and the crises of aging. Journal of Contemporary

Human Services, 72(4), 226232.

Corsini, R. J., & Wedding, D. (2008). Current psychotherapies. Belmont, CA: Thomson.

Eissler, K. R. (1966). A note on trauma, dream, anxiety, and schizophrenia. Psychoanalytic

Study of the Child, 1(21), 1750.

Frankl, V. (1963). Mans search for meaning. Boston. Beacon.

Frankl, V. (1984). Mans search for meaning: An introduction to logotherapy. New York: Simon

& Schuster.

Freud, S., & Breuer, J. (1893). Standard Edition (Freud). The standard edition of the

complete psychological works of Sigmund Freud; Volume II (1893-1895): Studies

on hysteria. The Hogarth Press and the Institute of Psycho-Analysis; London.

Goldenberg, J. (2009). I had no family, but I made family. Immediate post-war coping

strategies of adolescent survivors of the Holocaust. Counseling and Psychotherapy

Research, 9(1), 1826.

61


Huopainen, H. (2002). Freuds view of hysteria in light of modern trauma research.

Scandinavian Psychoanalytic Review, 25(2), 92107.

Jacobsen, B. (2006). The life crisis in an existential perspective. Existential Analysis 17(1).

Kadushin, A. (1976). Adopting older children: Summary and implications. In A. M. Clarke Early

experience: Myth and evidence. New York: Free Press.

Kahana, E., Kahana, B., Harel, Z., & Rosner, T. (1988). Human Adaptation to Extreme Stress:

From the Holocaust to Vietnam (Springer Series on Stress and Coping); Coping with

extreme trauma, 5579.

Krystal, H. (1978). Trauma and affects. Psychoanalytic Study of the Child, 1(33). PEP Archive,

EBSCOhost (accessed January 10, 2011).

Landau, R., & Litwin, H. (2000). The effects of extreme early stress in very old age.

Journal of Traumatic Stress, 13(3), 473-487.

Lee, B. S. (1985). Effects of the Holocaust on Jewish adolescent survivors. Unpublished doctoral

dissertation. California Graduate Institute, Los Angeles.

Lee, B. S. (1988). Holocaust survivors and internal strengths. Journal of Humanistic Psychology,

28, 6796.

Lis-Turlejska, M., Plichta, M. A., Luszczynska, A., & Benight, C. C. (2008). Jewish and non-

Jewish World War II child and adolescent survivors at 60 years after war: Effects of

parental loss and age at exposure on wellbeing. Orthopsychiatry, 78(3), 369377.

Littleton, H., Horsley, S., Siji, J., & Nelson, V. D. (2007). Trauma coping strategies and

psychological distress: A meta-analysis. Journal of Traumatic Stress, 20(6), 977988.

62


Nagata, K. D., Yuzuru, J., & Takeshita, J. Y. (1998). Coping and resilience across generations:

Japanese Americans and the World War II. Psychoanalytic Review, 85(4). EBSCOhost

(accessed February 16, 2011).

Pytell, T. (2007). Extreme experience, psychological insight, and holocaust perception.

Reflections on Bettelheim and Frankl. Psychoanalytic Psychology, 24(4), 641657.

Reisner, S. (2003). Trauma: The seductive hypothesis. Journal of the American Psychoanalytic

Association, 51(2), 381414. doi:10.1177/00030651030510021701. EBSCOhost

(accessed February 3, 2011).

Shelli, S., & Baum, J. (2000). Dissertation Abstracts International Section A. Humanities and

Social Sciences, 61(1-A).

Shmotkin, D., Blumstein, T., & Modan, B. (2003). Tracing long-term effects of early trauma: A

broad-scope view of Holocaust survivors in late life. Journal of Consulting and Clinical

Psychology, 71(2), 223234.

Sigal, J. J. (1998). Long-term effects of the Holocaust: Empirical evidence for resilience in the

first, second, and third generation. Psychoanalytic Review, 85(4).

Stessman, J., Cohen, A., Hammerman-Rozenberg, R., Bursztyn, M., Azoulay, D., Maaravi, Y., et

al. (2008). Holocaust survivors in old age: The Jerusalem longitudinal study. The

American Geriatrics Society, 56(3), 470477.

Suedfeld, P (2003). Specific and general attributional patterns of Holocaust survivors. Canadian

Journal of Behavioural Science, 35(2),133141.

U.S. Census Bureau. (2010). The Older Population: 2010. 2010 Census Brief. Retrieved from

http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf.

63


Van der Hal-Van Raalte, E., Van ljzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2007).

Quality of care after early childhood trauma and wellbeing in later life: Child

Holocaust survivors reaching old age. Orthopsychiatry, 77(4), 514522.

World Health Organization. (2012). World Health Day. Retrieved from

http://www.who.int/world-health-day/2012/toolkit/background/en/index.html.

Yalom, I. D. (1980). Existential Psychotherapy. New York: Basic Books.

Zimberoff, D., & Hartman, D. (2003). The Existential Approach in Heart-Centered Therapies.

Journal of Heart-Centered Therapies, 6(1), 3-46.

64


Appendix A: Interview Questions

Tell me about your experience during World War II?

How have you learned to cope or deal with your WWII experience (e.g., Holocaust)?

How does it feel to be a survivor?

What do you think are some of your strengths, which have gotten you to where you

are now?

How have you handled the experience of living past the Holocaust now in older age?

Now that you are facing older age, how has surviving the Holocaust aided you?

Can you name some of your specific coping strategies?

When you feel overwhelmed, what do you do to make yourself feel better?

Have you at any time since your Holocaust experience received any professional

psychiatric/psychological help?

How did you feel talking about the Holocaust with me?

11th (bonus question) Anything additional about yourself or experience that you

would like to share with me?

65


Appendix B: Consent Form

Title: Exploring Holocaust survivors lifelong coping processes

Investigators: Irina Koll
I am asking you to participate in a research study. Please take your time to read the information
below and feel free to ask any questions you may have before signing this document.
Purpose: Studying Holocaust adaptive experiences can provide unique and relevant information
about trauma, resilience and adaptation that can provide further guide with working with
survivors of other genocides. Your participation in this study can provide a valuable tool for the
desired research.
Procedures: Participation in this study will include an hour and a half long interview consisting
of a 10 item open-ended questionnaire at the centers location. Responses will be audio taped.
Risks to Participations: Potential risks may include painful emotions and feelings associated
with experiences during the Holocaust (e.g. triggers of past traumatic events). You have the right
to refuse to answer any questions and can terminate the interview if you feel uncomfortable or
unwilling to continue. A referral for a licensed psychologist will be available to consult if you
feel that you may need the support.
Benefits to Participants: You will not directly benefit from this study. However, we hope the
information learned from this study may benefit society in our understanding of lifelong coping
processes to aid therapists working with survivors of trauma.
Confidentiality: Participation in this study is voluntary. You may withdraw from study
participation at anytime without any penalty. I will only ask to obtain your name and phone
number on the consent form. Your address, social security, email address and medical
information will not be collected to safeguard confidentiality. Research materials will be kept for
a minimum of five years per APA guidelines.
Questions and Concerns: If you have any questions regarding your participation in this study you
may reach me, Irina Koll, by phone at (818) 632-1024 and my supervisor Donald Schultz, PhD,
at (310) 481-5225.
In addition, if you have questions concerning your rights in this research study you may contact
the Institutional Review Board (IRB), which is concerned with the protection of subjects in
research project. You may reach the IRB office Monday-Friday by calling 312.467.2343 or
writing: Institutional Review Board, The Chicago School of Professional Psychology, 325 N.
Wells, Chicago, Illinois, 60654.

66


Consent
Subject
The research project and the procedures have been explained to me. I agree to participate
in this study. My participation is voluntary and I do not have to sign this form if I do not
want to be part of this research project. I will receive a copy of this consent form for my
records.

Signature of Subject: __________________________ Date: _______ Phone #:

Signature of the Person Obtaining Consent: ________________Date: ______

67