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A Wholistic Approach in Working with Holocaust Suvivors


Myra Giberovitch, M.S.W., P.S.W.
Coordinator, Services for Holocaust Survivors
Cummings Jewish Centre for Seniors
Montreal, Quebec, Canada
April 26th, 2000

It was in the early nineties that I was first exposed to wholistic interventions in working with Holocaust survivors. At that time, I was coordinator of Services for Holocaust Survivors at a community-based agency. Funding for this program had been provided from the Conference on Jewish Material Claims against Germany. In January 1991, during the time of the Persian Gulf war wherein survivors' beloved State of Israel was threatened by Scud missile attacks, vulnerable survivors were referred to our agency. Many were re-experiencing their own traumatic experiences and wanted to meet others who shared similar reactions. It was at that time that we implemented time-limited support groups for Holocaust survivors. It was my good-fortune to co-facilitate the group with Dr. Alan Bonsteel, a family practice medical resident who had previous experience with Vietnam veterans. He introduced me to wholistic interventions. The techniques he used included progressive muscular relaxation exercises, breathing exercises, calming recorded music, affirmations and the use of a calm scene to reinforce the relaxed state. Although some members had difficulty relaxing, others were able to find some relief and their body language demonstrated a letting go. As the group continued, we noticed that the wounds that had been opened during the sessions closed and members left the group in a more relaxed state. All subsequent groups that I have coordinated and facilitated have included relaxation exercises.

In 1995 I registered for courses in natural health at a leading institute in Montreal. I had come to the conclusion that my traditional training needed to be augmented. At times, I had felt limited in the interventions I had to offer trauma survivors who were experiencing chronic symptoms of post-traumatic stress. The school I attended introduced me to a host of mind/body approaches to well-being which I have integrated into my practice. From the concepts of health as wholeness and balance, wholistic health recognizes that we cannot separate our physical health from our emotional, mental and spiritual states of being. All levels are interconnected. In the words of Frank Ochberg (1993): "Holistic health recognizes that the healing process is more than chemical reequilibrium. Attention to exercise, nutrition, humor, and spirituality are important elements of the holistic approach" (p.778).

In 1997, the Jewish Community Foundation of Montreal, a constituent agency of Combined CJA provided funding to implement a Drop-in Centre for Holocaust Survivors at the Cummings Jewish Centre for Seniors (previously known as Golden Age Association). I was hired as a consultant to implement, coordinate and facilitate the program. An important tenet of the program is the utilization of empowerment strategies such as the teaching of coping skills and wellness strategies. The majority of our members (about 75 of whom 50 attend on a weekly basis) are open to the learning of new skills. Wellness strategies focus on members' physical, mental, emotional and spiritual well being. I will now discuss some of the ways in which these wellness strategies have been incorporated into my practice.

At the physical level, members participate in a weekly half-hour aerobic exercise class taught by an instructor. Educational programs have included nutritional information about whole foods, vitamins and herbs, and cutting down on processed foods, caffeine, salt and sugar. In fact, we model healthy eating habits by serving snacks such as whole wheat crackers and tea instead of coffee. In the beginning we had complaints about the crackers and tea but the members have accepted it and some have even asked where they can buy the crackers to eat at home.

I have found that some survivors have benefited from a referral to a reflexologist. Reflexology is the therapeutic art of applying pressure to the reflexes of the feet. These reflexes correspond to the organs and glands of the body and when pressed, release stiffness and tension and bring the body into a state of balance. A recent lecture given by a reflexologist at our center was very well received. A clinical psychologist at a large geriatric hospital told me about the benefits of reflexology in calming an aggressive Alzheimer's patient. Some of our members have benefited from referrals to massage therapists for insomnia and pain management.

The programs directed at the mental level have helped survivors with their post-traumatic stress reactions. My work with survivors includes an educational approach that consists of passing on information about their post-traumatic stress reactions and the teaching of coping skills and wellness strategies. In the Drop-in Centre, I educate members about the effects of war trauma on a regular basis. Such an approach helps normalize survivors' experiences and breaks down their self-perceived notion of being "crazy" because they are experiencing certain reactions. I find that survivors often feel ashamed to discuss their reactions with family members or friends and suffer in silence. We can encourage mastery in their lives through the teaching of new skills. Educational programs have included; managing stress, building healthy self-esteem, assertiveness techniques, communication skills, managing anger, conflict resolution and dealing with depression.

They have also learned to nourish their mental body by exercising control over their thoughts and attitudes. Programs utilizing cognitive-behavior techniques such as cognitive restructuring, thought-stopping techniques and refuting irrational thoughts have been utilized. They have also learned to release tension at the mental level through relaxation exercises. For example, breath-counting meditation has helped some people to deal with their ruminative thoughts and to allow their body to enter a state of relaxation. The method consists of beginning with deep diaphragmatic breathing and then breathing in and saying the number "one" and then breathing out and saying the number "one." They continue to do this until a count of four and then start over again. They have also been exposed to guided visualizations such as visiting a special calming place for relaxation and inducing a calm state by listening to music with no emotional baggage. I have also introduced them to aromatherapy, the ancient art of using concentrated oils of aromatic plants and flower essences, liquid extracts derived from flowers. Some survivors have found relief from anxiety and insomnia by using essential oils such as lavender. Others have benefited from rescue remedy flower essence and herbs to deal with their states of anxiety.

The success of this wholistic psycho-educational approach is evidenced in several ways. The majority of participants have said that one of the main reasons they attend the drop-in is to learn ways to enhance their well-being. Some members come prepared with pencil and paper and take notes. Others let me know in advance when they will be absent and ask that I keep handouts for them. Still others report on their success or failure to implement strategies learned.

Members have been taught to release tension at the emotional level in the following ways. They have been taught to get in touch with their feelings and label them. They are reminded of the importance of developing an emotional vocabulary. They are also encouraged to express their feelings to a trusted friend, family member or professional counselor. Those individuals unwilling to do so are encouraged to release their feelings through the art of journal writing in their mother tongues. Members are also reminded that their feelings are always changing, very much like the weather.

Spirituality is an important tenet of a wholistic approach. Over the years, I have observed that survivors differ in their spiritual beliefs. After the war, many devout survivors felt abandoned by God. However, in recent years some have returned to their religious roots as they get ready to die. Others continue to maintain strong religious beliefs. Still others replaced religious values with other commitments such as family, involvement in communal organizations, support for the State of Israel, fighting Nazism and involving themselves in Holocaust related activities.

In my interactions with survivors, the issue of spirituality sometimes arises. The spiritual dimension of our work is often left to religious leaders. However, for some survivors this is not a viable option as they refuse a referral to a religious leader. Therefore, when it comes up spirituality needs to be addressed. I remind them of their indomitable spirit that helped them to survive and overcome adversity in the wartime and post-war years. Although some attribute their survival to luck or fate, when probed further, they often recount specific actions they undertook to ensure their survival. I remind them that their survival was not a passive act and that it often required creativity and courage. I encourage them to apply the same creative skills to their present challenges. A spiritual intervention I employ with some success with survivors who express feelings of helplessness, despondency and despair deals with the concept of the soul. I wish to add that I employ this intervention only with those survivors who believe in the concept of the "neshumah" or soul. When they make statements such as "I am feeling depressed. I do not know why I am still here. I don't know how I can go on with my life," I probe for ways that s/he has been able to go on this far. The intent is to help the survivor recognize her/his strengths and coping skills. I then suggest that their soul, the part of them that is all knowing, must feel that their work is not yet complete. I ask them what they feel they must still accomplish before they die. The intent of this intervention is to stimulate feelings of hopefulness and set some goals to counter the despair. I also provide them with inspirational poetry and prose and encourage them to turn to these materials for personal solace and enrichment.

Other ways in which survivors are encouraged to nourish their hearts and souls include:

  • Connecting with and trusting their inner intuitive voices by listening to the wisdom of their own bodies
  • Finding a spiritual connection that makes them feel they are an important part of the tapestry of life
  • Being in awe of something on a regular basis, E.g. appreciating the miraculous creation of their bodies, connecting with the natural environment
  • Getting in touch with their creativity
  • Engaging passionately in activities that give meaning and purpose to their lives
  • Spending time in a natural setting on a regular basis
  • Injecting humor into their lives
  • Connecting with others

I wish to discuss briefly the issue of humor and joy, the simple act of giving oneself the permission to have a good time. Some survivors' unrelenting mourning process prevents them from enjoying themselves and even laughing. Life is serious business for them and they feel that they will dishonor the memory of their family if they listen to music. In the two survivors' social centres that I have coordinated, some have left when an entertainer was present. Others have remained but cried throughout the program. When asked why they are crying, the answer has been, "I miss my family more during happy times." An intervention that I have employed has been the following statement: "If you could talk to your family member would s/he forgive you for having a good time?" The answer has always been, "Yes, I know that s/he would not want me to feel sad for such a long time." My response has been, "Then why can you not forgive yourself?" Sometimes this leads to a discussion of their unresolved mourning process, a description of the last time they saw their family members and feelings of guilt.

My work with survivors over the years has evolved to incorporate wholistic interventions. As previously mentioned, I had come to realize that utilizing solely traditional approaches limited my work with this population. Many survivors are highly motivated to enhance their well-being and to work on their personal growth and development. They welcome new strategies and interventions to help them do so. I have also learned that as practitioners we must remain flexible in our work and have a host of different interventions to present to individuals to help enhance their well-being. For me, this has entailed educating myself about both traditional and non-traditional areas of treatment and applying them in a manner that meets and respects individual needs. Certain wholistic interventions may be appropriate for some individuals but not for others. Survivors must be given the permission to tell us when this is the case. They must be allowed to say, "I do not want to try this or I do not believe in this." Empowering survivors means giving them choices in terms of the service delivery modality to be used and allowing them to participate in the development of an intervention plan and/or programming. Giving survivors decision-making powers allows them to maintain a sense of autonomy and control over their lives. .


REFERENCES
Ochberg, F.M. (1993). Postrraumatic therapy. In J.P. Wilson and B. Raphael (Eds.). International handbook of traumatic stress syndromes (pp.173-183). New York: Plenum Press.