Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 15 Bereavement and Grief 309
medications, for example, exceeds that of a control group (Stessman, et al.,
2008), and they have a higher number of suicide attempts (Barak, 2007).
When approaching an older patient of European immigrant background,
it is useful first to ask a caregiver where the patient was during
the war . If the reply indicates a Holocaust experience, the question then
becomes how the patient feels about talking about it. Responses typically
range from acceptance to more dramatic reactions, such as weeping that
continues until the patient breaks down.
Some Holocaust survivors’ children are now moving into the geriatric
age group. Anecdotal accounts and clinical experience suggest that these
offspring may be psychologically affected by what their parents went
through, although objective studies have not been able to confirm any
lasting damage (Sagi-Schwartz, et al., 2003).
Diagnostic Issues
All Holocaust survivors I have known were bereaved as well as victims.
Those seeking treatment now have lost siblings or parents. It is possible
they experienced some of the symptoms of the deprivation of maternal
care described by Bowlby (Bretherton, 1992). Those who lose parents
between the ages of 5 and 18 continue to have less well-being than those
who do not (Lis-Turlejka, Luszczynski, Plichta, & Benight, 2008).
Several distinct syndromes among survivors were noted after World
War II and are now tracking into geriatric psychiatry. Some investigators
( Yehuda, et al., 2008) classify Holocaust survivors as suffering from PTSD.
As with other forms of bereavement, there is a concern from an existential
point of view that these syndromes do not belong to psychiatry
because “the process of diagnosis is dehumanizing and the evil nature
of the perpetrator is neglected” (Kellerman, 1999, p. 55). Such considerations
could lead to the denial of needed treatment. Over the last
50 years, I have treated several survivors who became clinically depressed
and responded well to organic treatments, such as electroconvulsive
therapy (ECT).
Holocaust survivors with dementia and agitation may exhibit geriatric
delusional patterns, such as “phantom boarder delusions” (Birkett,
2001, p. 115). These may be interpreted as due to the revival of memories.
A demented 90-year-old woman was distressed because she believed
starving children were coming into her apartment looking for food and
she had none to give them. Her family felt this was a recrudescence of
her wartime sufferings in the Warsaw Ghetto.