Rabbi Dr. Norman Berlat
Rabbi Ronald Weiss
Toronto

The Holocaust spans 12 years that have no parallel for evil in the history of mankind. Millions of people, 6 million of whom were Jewish, were singled out for extermination because of their religious beliefs, cultural heritage or ethnic origin. Nazi tormentors considered them untermentchen , (subhuman beings) and treated them without any semblance of dignity or appropriate amenities.

The victims were subjected to conflictual messages. The entrance to Auschwitz bore a sign "Arbeit Macht Frei", "Work Makes (for) Freedom". The Holocaust experience demonstrated the intentional incongruity of this reality. Release from horrendous suffering came about through death. It was this planned and purposeful conflictual experience that was a factor in the dehumanization of masses of persons.

Following liberation and subsequent attempts at rebuilding their lives, the survivors continue to grapple with the life long effects of their horrific wartime experiences. These difficulties are often exacerbated, and may pose specific challenges, as Holocaust Survivors reach the end stage of life.

In our clinical experience as pastoral care providers we have ministered to the spiritual needs of great numbers of Holocaust Survivors within our community. As patients and clients they present unique and unusual pastoral care concerns.

Disbelief
Many of those whom we have encountered have manifested great difficulty coming to terms with the reality of their impending death. After having lived through the shadow of death for many years, they are often unwilling to believe that they are now close to death themselves. To cite a case example:

A 70 year old mother arrives from Israel at an American medical facility with her 45 year old son who has been diagnosed with terminal liver cancer. He is totally jaundiced, appears emaciated and is extremely weak. The mother asks a prominent liver specialist to treat and cure her son. She tells the physician that she has expended what little life savings she has to make this trip to North America seeking expert medical care. She further informs the physician that she does not want to hear that her son is dying and there is no hope for his cure. Mother shows the concentration camp numbers on both her and her son's forearms and says "See, we met the angel of Death at Auschwitz. He didn't get us then and won't get us now."

The mother felt that there was yet hope for them. She was unwilling to entertain even the possibility that her son's death was immanent.

Requesting the chaplain's involvement in this situation, the physician felt that medical science had very little to offer this patient. The chaplain and the doctor discussed the function of the art of medicine. In this context both patient and parent could be treated and cared for. The patient was admitted to the hospital, appropriate medical orders were issued and the physician visited daily. He ordered pain medications and fluid to prevent dehydration. But more than this, he offered himself and presented an image of caring to the family constellation. The patient succumbed to his illness two weeks following admission. The mother genuinely felt that her efforts were purposeful in providing all that she could for her son. She was able to return home to Israel with his remains knowing that no stone was left unturned. It was this caring attitude that enabled her to confront the reality of his death with the seeds of comfort already sown.

In our current fiscal climate this hospital admission might be deemed inappropriate. However, the caring, concern and compassion shown to the family cited is always the proper response.

Strained Relations
Survivor parents often have particularly difficult relationships with their children. These children are frequently sheltered, and sometimes smothered, by their zealously cautious parents. It is easy to understand parents, after having lost everything once before, being overprotective to guard against possible future loss. It is equally easy to understand how children, even those who understand their parents' fears, would rebel against such intrusive and controlling behaviour.

Similarly, we have seen cases where the horrific experiences of a Holocaust Survivor may render them unable to communicate effectively, even with those they love most. When an individual in either of the above situations is dying, these issues can become major obstacles to necessary closure. Everyone involved is in desperate need to reconcile, but the strained relationships, entrenched over many years, combined with anxiety of the current illness, often make the principals unable to obtain resolution.

The chaplain can be helpful in the role of a facilitator assisting each family member see the perspective of the other. Often in a traumatic situation people are locked in their own analysis of a situation. They are unable to experience a larger picture of family dynamics and concerns. The chaplain who is a trained counselor is often able to help obtain movement of the parties towards mutual understanding of each other's issues. This understanding is a significant factor in bringing the parties together and opening the possibility of more fruitful and healthy inter-family discussion.

To cite a clinical example:
Upon introduction to a terminally ill Holocaust Survivor, the patient said, "I know I'm dying, but don't tell my wife". Later, when speaking privately to the wife, she confided, "I know my husband is dying, but he doesn't know, and I don't want you to tell him".

Each spouse felt the other had enough pain in their lives and wanted to spare the other additional grief. For years they lived surrounded by death. Now, in order to protect their loved one, they wish to keep death as far away as they can for as long as possible. Yet, by pursuing such a path, not only is resolution and any possibility of closure forestalled, the precious time they still have together was not being used to maximum potential.

The chaplain can speak to each spouse separately and emphasize that they have shared many life issues together. The chaplain can stress that it would be therapeutic for the situation to be faced jointly by the couple. Otherwise, inevitably the loss they will suffer individually and collectively will be magnified. This may lead to a broadening of perspective and an opening of meaningful dialogue.

Theological Issues
"Where was God then?" "Where is God now?" Both are a familiar, and often angry, response of Holocaust Survivors at the end of their lives. How is this to be handled? What is the appropriate response?

The chaplain approached an elderly gentleman and asked if he would join in a minyan (prayer service) for someone who was observing a Yartzeit (anniversary of a loved one's death). He remarked, "NO ! YOUR God died along with people in the concentration camps. There is no one to speak to. Why should I come ?"

It is significant to accept the individual's anger directed at God. The chaplain does not become reactive to defend God. The survivor is yet awakening from the emotional anesthesia that has enabled him to survive. He once again experiences the pain of the ultimate issues directed to the Ultimate One. Only the sufferer can discover an acceptable answer to his loss. Sharing the intensity of his pain with the listening availability of the non-judgmental chaplain can help reconnect the survivor with his faith group.

Language of the Survivors
Survivors often use terminology that has particular meaning unto them. To cite some examples:

One patient, to the great discomfort of staff, would refer to any medical procedure as an "experiment". This patient had undergone cruel experimentation in the camps and, having become psychologically and emotionally wounded, associated all medical care with "experimentation".

It was helpful for the chaplain to orient staff to the possible terminology of Holocaust survivors and to reassure them that this expression was not a value judgment on the quality of their care.

Another patient, an elderly lady, refused a life saving pacemaker because it involved a minor surgical procedure. She had been surgically damaged during the Holocaust and when this procedure was proposed, she said "No cut. God who wanted me to live until now, will let me live if He so wants, but no cut."

The sensitive chaplain may offer this lady an opportunity to share her fears and remain with her while the physician explains the nature of the procedure. It has been useful and supportive to Holocaust Survivors and their families for the chaplain to be present with them during certain medical/surgical procedures. This provides a genuine aura of trust with a co-religionist who represents assurance that nothing will be done that is not within the parameters of mutually agreed care.

Conclusion
Survivors present with dynamics that have been unparalleled in medical practice. The need for sensitive and compassionate care is essential. Medical personnel collaborate with the trained chaplain in effectively treating the whole patient/family unit. Spiritual and psychological needs impact on patient's well-being and affect the quality of life.

Healing does not necessarily result in obtaining a cure. But it does reconcile the spirituous-emotional factors that enable a person to continue living despite the reality they are forced to confront. Healing can be achieved through caring and reconciliation.

It was the hope that lies embedded deep in the hearts of the survivors that enabled them to endure the unendurable and to rebuild their lives.