Older adults are the group most vulnerable to isolation and loneliness even prior to the COVID-19 pandemic, and early data suggest that COVID-19 exacerbated these feelings and might be associated with both an increase in psychological distress among individuals who did not suffer from such symptoms before, as well as an intensification of distress in older adults who suffered from mental health problems before the pandemic (Serafini et al., 2020; for observations from across the globe, see: Psychological Trauma: Theory, Research, Practice, Policy, July and September issues, 2020). It is therefore important to recognize potentially vulnerable older adults, such as those sensitized to existential threats and to isolation and loneliness by the impact of intergenerational trauma.
Prior research about offspring of Holocaust survivors (OHS) identified particular vulnerabilities associated with intergenerational transmission of effects related to parental trauma, and highlighted the critical role of parental PTSD in determining the burden of transmission in offspring (Danieli, Norris & Engdhal,2016; Letzter-Pouw, Shrira, Ben-Ezra and Palgi, 2014; Yehuda, Schmeidler, Wainberg, Binder-Brynes, & Duvdevani, 1998). While OHS generally function adaptively, specific vulnerabilities which do not necessarily interfere with their daily functioning have been shown become activated in the face of life-threatening events, such as war, serious illness, or the threat of nuclear annihilation (Baider, Goldzweig, Ever‐Hadani, & Peretz, 2006; Solomon, Kotler, & Mikulincer, 1988; Shrira, 2015). A recent study has shown that OHS with parental PTSD experience more distress and more loneliness during COVID-19 despite the fact that there are no differences in the perceptions of available social support between them and comparison groups (Shrira & Felsen, 2020, in preparation). These vulnerabilities suggest that OHS, who are now almost all over 60 years old, might be especially sensitive to feelings of loneliness and isolation and to negative effects related to the COVID-19 pandemic and to the confluence of crises that followed in its wake.
Since the middle of March 2020, I have been invited by various organizations to present online webinars to groups of adult children of survivors. The sheer numbers of participants who attended such web-based forums reflected a current intensified need among OHS to come together and to process their experiences with others who share the same unique background of historical trauma. In response, over the past months I have offered multiple web-based, free, interactive group ‘stand-alone’ meetings, which have been attended so far by over 2000 participants. Qualitative observations from these meetings confirm that intergenerational transmission of trauma sensitizes aging OHS to current events, especially to actual and perceived reminders associated with the Holocaust. Subjective trauma-related associations can amplify negative reactions to current adversities. For example, the fact that their age places OHS in at an elevated risk was even more ominous for some participants as it echoed the fact that people over 50 were not likely to have survived the Holocaust (Tammes, 2017). Intergenerational transmission, especially in families with a parent who suffered from PTSD, was also associated in previous studies with more medical conditions in OHS as they reached middle age, reflecting both biopsychological processes and epigenetic changes related to parental trauma (Flory, Bierer, & Yehuda, 2011; Keinan-Boker, 2014). These pre-conditions can expose aging OHS to medical problems when social distancing limits access to non-emergent medical care. Concerns about access to care and in particular, scarcity of food and supplies have been triggers for Holocaust associations. Some children of survivors, averse to memories of their parents’ tendencies to hoard food and be always preparing for a disaster, resisted such behaviors. E., a mental health professional herself, said: “I consciously avoided allowing myself to get overly anxious. Perhaps to a fault, numbing myself to what was going on around me. I did not go to the shops, and I refused to hoard food or toilet paper. But then…when there was shortage…I started having thoughts about what might happen and what people might do if there is not enough food in the stores…” OHS have been deeply troubled by the sharp increase in gun sales in the USA. As one woman sharply stated, “we know how neighbors can become murderers”.
An overarching sense of hypervigilance and anxiety associated with Holocaust-related associations was experienced alongside a recognition of the hardiness and an inherent preparedness for disaster that was conferred by the legacy of trauma: “The feeling of doom? I kind of feel this is the feeling I have been expecting my whole life…It is not at all a surprise…”and also: “We are interestingly appreciative while comparing with what our parents went through. This is setting me apart from others [not 2G] who are struggling more. I have the acceptance that things can change within seconds, and I have extreme resources to adapt to new situations…” Commenting on the cost and adaptive value of this hypervigilance, a woman who left her job in Brooklyn when she realized the danger of continued unprotected exposure, while others, including her boss, were still underestimating the risk of COVID-19 and avoiding protective measures, said: “I am like the canary in the mine. I sense things before other people do, I tried to warn them, but I was viewed as an alarmist…” However, participants also expressed that to be always scanning for danger interferes with their sense of well-being and with the family atmosphere: “It’s my experience and observation that many of us 2G’s are faring better emotionally than others – we are accustomed to extreme situations of threat and danger. The challenge is: how do we live in more ‘normal’ times?”
The social upheaval that followed the police killing of George Floyd evoked a flood of Holocaust-related associations. Systemic discrimination, audio-recordings and televised instances of police brutality, and images of shattered glass from broken storefront windows called forth “Kristalnacht”, the “night of broken glass” between November 9-10, 1938, in which Nazis torched synagogues, vandalized Jewish homes, and killed close to 100 Jews.
While Holocaust associations were prominent in the reactions of OHS, individual responses to direct comparisons with the Holocaust were varied. Acknowledging the tragedies of those personally impacted by COVID-19 and the heroism of first responders, many OHS felt that “this is not the Holocaust!” emphasizing that the current crisis is not the result of malignant intent towards any particular group. Many found the comparison to Anne Frank and the Holocaust particularly trivializing and offensive, stating “we have zoom classes and zoom parties! How can one compare?!”
Social distancing has prevented physical contact with one’s family, especially with elderly survivor parents, for many weeks. The reverberations of traumatic separations in the lives of the survivor parents have colored all previous actual and perceived separations in the lives of the second generation, and the responsibility for the parents’ wellbeing has been a central theme in the psychological world of the children raised by survivor parents (Bar-On et al., 1998; Felsen, 1998; Prince, 2015; Quadrio, 2016; Scharf & Mayseless, 2011; Shmotkin, Shrira, Goldberg, & Palgi, 2011; Shrira, Palgi, Ben-Ezra, & Shmotkin, 2011; Wiseman & Barber, 2008). The inability to protect aging trauma survivor parents, especially those living in residential facilities, has been excruciatingly painful for OHS.
Of note was the observation that many participants felt they could not be understood by family and friends who are not children of survivors. This theme, expressed by many participants, is particularly relevant as it can exacerbate subjective experiences of loneliness and isolation which are a particular concern regarding the mental health burden of the pandemic (Moreno et al., 2020). Social distancing disrupted many relationships and activities, and a subjective inability to utilize the social support available to them can put OHS at a heightened risk in the face of vulnerabilities that current adversities have activated. Some OHS feared their reactions would be judged as extreme because of their sensitivity to reminders of the Holocaust. Others felt that the difficulties expressed by friends are exaggerated, and people would be offended if they shared that as children of survivors, their perspective is less extreme, based on what survivor parents endured during the Holocaust. Regardless of individual differences, there was an overwhelming sense of comfort expressed by participants about being able to share their feelings with others who are also children of Holocaust survivors, because of the prominence of the Holocaust to their personal experiences and the meanings conferred by it, which others cannot comprehend.
While it will be important to research the effectiveness of such interventions using adequate empirical studies, it is suggested here that web-based groups that emerged as a spontaneous intervention during COVID-19 showed that aging OHS are older adults who are sensitized to trauma-related triggers in the current circumstances and to subjective feelings of isolation due to the experience of not being able to share with, nor to be truly understood, by non-Holocaust-related others. Studies in other trauma-exposed populations have found many similarities in the mechanism of intergenerational transmission and in the outcomes in offspring of survivors (Leen-Feldner et al., 2013; Lambert et al., 2014). Older adults with various legacies of intergenerational of trauma are potentially experiencing sensitivities during these times of uncertainty, turbulence and social distancing. Our observations show evidence for resilience and hardiness and also for amplified anxieties and vulnerabilities related to the intergenerational transmission of trauma. Social support during times of adversity is critical to buffer negative effects and can, in fact, allow re-working of negative internalized mental content that has been activated by current adversities. Psychosocial interventions can buffer the negative effects and also promote resilience and post-traumatic growth in older adults (Feeney and Collins, 2015). Moreno et al. (2020) state: “The COVID-19 pandemic could provide an opportunity to improve the scale and cost-effectiveness of different mental health interventions,” and in order to meet this challenge, sustainable adaptations of delivery systems of mental health care and public health prevention and intervention programs should be developed. The formats of web-based psychosocial meetings of groups who share unique vulnerabilities and interests can offer a “web-based, second-best” sense of community and provide a holding space that offers non-pathologizing social support and psychoeducation, representing a form of effective intervention and prevention for vulnerable groups of older adults when social distancing precludes more direct contact and increases potential distress and loneliness. Equitable access to such interventions needs to be a focus in the preparations for prolonged periods and for future circumstances requiring older adults to maintain social distancing.
Danieli, Y., Norris, F. H., & Engdahl, B. (2016). A question of who, not if: Psychological disorders in Holocaust survivors’ children. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 98-106.
Feeney, B. C., & Collins, N. L. (2015). A New Look at Social Support: A Theoretical Perspective on Thriving Through Relationships. Personality and Social Psychology Review, 19(2), 113–147.
Felsen, I. (1998). Transgenerational Transmission of Effects of the Holocaust: The North American Research Perspective. In: Danieli, Y. (Ed.) Handbook of Multigenerational Legacies of Trauma, pp. 43-68.
Felsen, I. (2017). Adult-onset trauma and intergenerational transmission: Integrating empirical data and psychoanalytic theory. Psychoanalysis, Self and Context, 12(1), 60-77.
Felsen, I. (2018). Parental trauma and adult sibling relationships in Holocaust-survivor families. Psychoanalytic Psychology, 35(4): 433-445.
Felsen, I. (2020). Patient and Therapist Meeting in Shared Intergenerational Transmission of Genocidal Trauma. Psychoanalysis, self and context, 15(2) 170-186.
Flory, J. D., Bierer, L. M., & Yehuda, R. (2011). Maternal eposure to the Holocaust and health complaints in offspring.Disease Markers, 30, 133-139.
Keinan-Boker, L. (2014). The mothers have eaten unripe grapes and the children’s teeth are set on edge”: The potential inter-generational effects of the Holocaust on chronic morbidity in Holocaust survivors’ offspring. Israel Journal of Health Policy Research, 3(11).
Lambert, J. E., Gikzerm, H., & Hasbun, A. (2014). Association between parents’ PTSD severity and childrens’ psychological distress: A meta-analysis. Journal of Traumatic Stress, 27(1), 9-17. https://doi.org/10.1002/jts.21891
Leen-Feldner, E. W., Feldner, M. T., Knapp, A., Bunaciu, L., Blumenthal, H., Amstadter, A. B. (2013). Offspring psychological and biological correlates of parental posttraumatic stress: Review of the literature and research agenda. Clinical Psychology Review, 33, 1106–1133.
Letzter-Pouw, Shrira, Ben-Ezra and Palgi, (2014). Trauma Transmission Through Perceived Parental Burden Among Holocaust Survivors’ Offspring and Grandchildren. Psychological Trauma: Theory, Research, Practice, and Policy 6(4):420-429.
Moreno, C. Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N.,Jones, N., Cannon, M., Correll, C.U., Byrne, L., Carr, S., Chen, E. Y. H., Gorwood, P., Johnson, S., Kärkkäinen, H., Krystal, J. H., Lee, J., Lieberman, J., López-Jaramillo, C., Männikkö, M., Phillips, R., Uchida, H., Vieta, E., Vita, A., Arango. C. (2020). How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020, 7, 813-24. doi.org/10.1016/ S2215-0366(20)30307-2
Prince, R. M. (2015). The Holocaust after 70 years: Holocaust survivors in the United States. American Journal of Psychoanalysis, 75(3), 267-286.
Scharf, M. and Mayselss, O. (2011). Disorganizing experiences in second- and third-generation Holocaust survivors. Qualitative Health Research, 21(11), 1539-1553.
Serafini, G., Bondi, E., Locatelli, C., Amore, M. (2020). Aged patients with mental disorders in the COVID-19 era: The experience of northern Italy. The American Journal of Geriatric Psychiatry, 28(7), 794-795.
Shmotkin, D., Shrira, A., Goldberg, S., & Palgi, Y. (2011). Resilience and vulnerability among aging Holocaust survivors and their families: An intergenerational overview. Journal of Intergenerational Relationships, 9(1): 7-21. https://doi.org/10.1080/15350770.2011.544202
Shrira, A., Palgi, Y., Ben-Ezra, M. and Shmotkin, D. (2011). Transgenerational effects of trauma
in midlife: Evidence for resilience and vulnerability in offspring of Holocaust survivors. Psychological Trauma: Theory, Research, Practice, Policy, 3(4), 394-402.
Shrira, A. (2015). Transmitting the sum of all fears: Iranian nuclear threat salience among offspring of Holocaust survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 364-371. https://doi.org/10.1037/tra0000029
Solomon, Z., Kotler, M., & Mikulincer, M. (1988). Combat-related posttraumatic stress disorder among second-generation Holocaust survivors: Preliminary findings. The American Journal of Psychiatry, 145, 865-868. http://dx.doi.org/10.1176/ajp.145.7.865
Tammes, P. (2017). Surviving the Holocaust: Socio-demographic differences among Amsterdam Jews. European Jounral of Population, 33(3): 293-318. DOI:10.1007/s10680-016-9403-3
Yehuda, R.,Schmeidler, J.,Wainberg, M.,Binder-Brynes, K.,Duvdevani, T. (1998). Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors. American Journal of Psychiatry, 155, 1163-1171.
Quadrio, C. (2016). Family therapy with families of Holocaust survivors. Journal of Aggression, Maltreatment & Trauma, 25(6), 618-634.
Wiseman, H. (2008). On failed intersubjectivity: Recollections of loneliness experiences in offspring of Holocaust survivors. American Journal of Orthopsychiatry, 78(3), 350-358. Wiseman, H. and Barber, J.P. (2008). Echoes of the trauma: Relational themes and emotions in children of Holocaust survivors, Cambridge University Press.
Irit Felsen, PhD is a clinical psychologist specializing in trauma and traumatic loss. Dr. Felsen has a private practice, and she is an Adjunct Professor at Columbia University and at Yeshiva University, Ferkauf Graduate School of Psychology. Dr. Felsen’s clinical experience includes having worked in inpatient and outpatient settings, as well as in emergency psychiatric care, and as a specialist on a national emergency response team. Dr. Felsen is the chair of the working group on Older Adults and Caregivers of the APA COVID-19 Interdisciplinary Task Force and a co-chair of the trauma group of the NGO on Mental Health in Consultative Relationship with the United Nations. Dr. Felsen is a researcher with the Yale University Trauma Study Group, and her published work focuses on the trauma of the Holocaust and intergenerational transmission of trauma.