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Recognizing delayed PTSD in Holocaust survivors

Decades after WWII, many show signs of delayed post-traumatic stress disorder

Prisoners at Dachau cheer US troops who liberated the concentration camp in May 1945.
Horace Abrahams/Keystone/Getty Images
Prisoners at Dachau cheer US troops who liberated the concentration camp in May 1945.

The first time Sonia Reich was hunted by the Nazis, she was an 11-year-old orphan, seeking refuge in the Polish countryside.

The second time was almost 60 years later, on a quiet street in the Chicago suburb of Skokie, Ill. That time, however, the pursuit was happening solely in her head.

“I received a call at midnight saying that my mother had run out of her house and been picked up by the Skokie police,” said her son, Howard, a Chicago arts critic. Sonia had been screaming that someone was trying to kill her. “I couldn’t even comprehend that,” he recalled. “I thought it was a dream.”


Like many Holocaust survivors, Sonia Reich was not offered therapy after the war, and she never talked about her experiences. She spent five decades as an active suburban mother and wife. But as Sonia entered her 60s, after her husband died, her children began to notice some odd survivalist behavior, such as sleeping with an ax under her pillow and bringing her own water to restaurants. “But we did not connect those behaviors with what she went through as a child in the Holocaust,” Howard Reich said.

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No one did. After the midnight incident, Sonia Reich was moved into a nursing home, where her delusions continued. She accused the staff of throwing bugs at her, calling her a prostitute, and stealing her food.

Eventually, Howard Reich consulted a specialist in geriatric mental health, and got a diagnosis for his mother: late-onset post-traumatic stress disorder (PTSD). While the label came as a surprise to her family, who thought she had risen above her past, researchers are increasingly focusing on the boomerang effect of psychological trauma. They are finding that the passage of time does not always diminish traumatic symptoms, and in fact, the physical, mental, and social changes that come with age can aggravate them.

In the DSM IV — the standard manual of psychiatric diseases — late-onset or delayed PTSD is described as a collection of debilitating symptoms, from flashbacks to nightmares, that start at least six months after the traumatic event. In the case of Holocaust survivors, the incubation period can be decades longer — although researchers debate whether the symptoms are entirely new or, rather, intensified versions of what survivors have been secretly coping with throughout their lives.

“For some people, it may have been behaviors that have just been building,” said Elihu Kover, director of Nazi Victim Services for Selfhelp Community Services Inc. The New York agency oversees the care of 5,000 survivors, some of whom hoard rotting food, refuse to take showers, or accuse social workers of stealing their possessions. Kover thinks many survivors had learned to cover those behaviors during their busy, productive years. “When you’re older and your mind is slipping, then you’re not covering it anymore,” he said.


Many Holocaust experts say the problem is surfacing now, in part, because few survivors got psychiatric help early on. Certainly some suffered immediately from what would later be called PTSD, including severe anxiety and depression. But many appeared highly resilient as they focused on work, school, and family — and lodged their worst memories deep in their subconscious.

Brookline-based Auschwitz survivor Michael Kraus was among those. He lost both his parents in the concentration camps. After liberation, he stayed with American cousins while he went back to school. “Their attitude was, you are in a new environment, and you should start from scratch and forget everything else,” he said.

Psychologists say that strategy can work for years, and then just stop. In some cases, long-dormant memories are triggered by the trappings of old age itself. Loss of independence, the death of a spouse, chronic illness, social isolation, or physical decline — all have grim associations to a Holocaust survivor.

“Being in poor condition (at Auschwitz) meant that you will not live. Survival depended purely on your condition,” said Kraus, who, at 81, still goes in every day to the Boston architecture firm where he has worked for 40 years, in part to keep active and avoid being overtaken by his past.

Kraus is still mentally sharp, but for some survivors, cognitive decline adds to the confusion between past and present. Vancouver-based psychiatrist Robert Krell, who lectures on aging survivors, says dementia can eat away at the protective walls erected by the mind years earlier. His own father, a concentration camp survivor, was in a nursing home with early dementia when he pointed to a caretaker and confided to his son, “Rob, be careful of her, she’s Gestapo.”


With the average survivor now around 80, their population is dwindling, but the thousands still living in the United States will need considerable geriatric and psychiatric care over the next two decades. Their advocates wonder if the medical community is prepared.

In the past few decades, prominent scholars and psychiatrists, from Elie Wiesel to Haim Dasberg, have written about reemerging trauma in elderly Holocaust survivors, and the topic has been studied by the Veterans Administration. One support organization in Israel, Amcha, estimates that 40 to 65 percent of survivors are experiencing the late effects of trauma.

Yet many nursing homes and geriatric caregivers are unaware of the phenomenon. Kathy Bowen, a social worker in Springfield, saw it happen to one of her elderly Jewish clients. For 40 years, he had never spoken of his time in concentration camps. Then one day he broke his hip and entered a rehab facility.

“He was combative, he was screaming, he was having auditory hallucinations,” Bowen said. “When people in white coats were coming toward him, he was terrorized.”

Bowen said the nursing home staff had no idea what was causing this behavior in someone who previously showed no signs of delusions. She learned from online research that entering a locked facility is a common trigger for late-onset PTSD, so she urged the staff to approach him more gently, scale back his sedatives, and coax him back to the present.

Sonia Reich’s caregivers initially attributed her behavior to Alzheimer’s disease, but her son pointed out that she was alert, recognized all her family members, and could still absorb new information.

It took Howard Reich a year before he found a psychiatrist who linked his mother’s symptoms to her past trauma. “The [first] doctors missed it. Even though the hospital records that I obtained said, ‘69-year-old Holocaust survivor, who believes her life’s in danger and the dogs are chasing her,’ they never made that connection,” he said. His efforts to understand the diagnosis, and educate other survivor families, became the subject of his book and documentary, “Prisoner of Her Past.”

Kover, of Selfhelp, says most caregivers and nursing homes aren’t used to seeing Holocaust survivors, so they don’t recognize a pattern in their odd behaviors. Agencies such as his that specialize in aging survivors train social workers to avoid obvious trauma triggers. They learn not to throw out a client’s food or belongings without permission and not to hold buffet dinners, because standing in line can remind survivors of the camps.

“We’re not going to cure their history. We probably aren’t going to cure their psychological issues,” said Kover, “but we can understand them, and understanding it helps us find a way to deal with them.”

As for full-blown cases of late-onset PTSD, psychiatrists recommend anti-anxiety or anti-depressant medications, as well as cognitive behavior therapy, a type of counseling meant to uncouple traumatic memories from the fears associated with them. Some therapists help elderly survivors record their Holocaust narrative, as a way to gain control over memory fragments. But specialists say the longer the symptoms have festered, the harder they are to treat.

For Sonia Reich, nothing has worked. Howard Reich says her case is so severe that she doesn’t trust any doctors and believes she is in immediate danger. She even sees a yellow Star of David on her clothes, like the ones the Nazis forced Jews to wear.

Nevertheless, despite the pain of seeing her now, Reich thinks his mother’s previous ability to submerge her Holocaust memories is the reason she was able to live well for 50 years. “People say to me, ‘If only she’d talked about it, it would be much better.’ Well, that is not necessarily true,” he said. “Some people’s way of dealing with memory is to put it aside. That is their defense mechanism. And that enabled people like my mother to have a beautiful life in America with a husband and house and a family and all those great things.”

An audio version of this story is on Vox Tablet, the podcast of Karen D. Brown can be reached at karen@karen