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This chapter sets the stage for a description of the lives and memories of older adults who experienced extreme trauma as survivors of the Nazi Holocaust. It also provides a systematic review of prior work on the effects of the Holocaust on survivors and their adaptation to challenges in the postwar years. In setting the stage for presenting our empirical findings, we provide an overview of the conceptual frameworks we relied on for understanding adaptation of Holocaust survivors and immigrants. We delineate concepts we found useful within the gerontological, general stress, and traumatic stress traditions.

Before presenting data on our quantitative study of the functioning and well-being of Holocaust survivors in the aftermath of the trauma they endured, it is useful to provide a glimpse into the phenomenology of survivors as they recount their traumatic experiences. We also need to outline the historical reality that defined the man-made disaster known as the Holocaust. This chapter provides information from responses to qualitative questions by Jewish survivors of the Holocaust. They experienced the war in diverse countries of Europe including Germany, Austria, France, Holland, Belgium, Poland, Ukraine, Czechoslovakia, Hungary and Romania. The interviews provide glimpses of the stresses and coping responses of persons who were prisoners in concentration camps, part of the resistance movement or were refugees in hiding. The chapter is organized into sections: first we offer a general background detailing critical dates of anti-Semitic policies as these were implemented in the various countries. Then the focus shifts to a review of first-hand accounts of the stresses endured in the different countries where the respondents weathered the Holocaust.

This chapter reviews the experiences of survivors in their quest to establish new lives, following their liberation from the horrendous experiences during the Holocaust years. As indicated in the previous chapter, over six million Jews perished at the hands of the Nazis. The Allied Forces liberated fewer than 200,000 survivors at various concentration camps in Germany and Austria (Harel, Biegel, & Guttman, 1994). There are extensive historical accounts of the Holocaust period, which most certainly constituted a unique period in the annals of human history (Bauer, 1982; Lookstein, 1985; Wyman, 1984).

Our study on the impact of the Holocaust on survivors' lives has been anchored in the broader stress paradigm (Pearlin, 1989; Dohrenwend, 1998; Wheaton, 1994). Researchers in this burgeoning field have increasingly recognized the importance of aggregating life long stressors, which may involve phenomena ranging from daily hassles to severe trauma. Even as we focus on the aftermath of one of the most extreme forms of adversity known to man, we are interested in taking a more detailed look at life long stress experiences of survivors and members of the comparison group. Additionally, we consider the role of recent life events (Krause, 1991) in contributing to cumulative stress endured by our respondents.

This chapter reviews conceptual perspectives and empirical findings on physical health of Holocaust survivors and immigrants in the United States and Israel. Initially, we review findings of prior studies on physical health sequelae of the Holocaust. Our second focus is on defining elements of physical health vulnerability and the measures we employed in this research to ascertain health status. Third, the focus shifts to examination of the empirical evidence on the health status of survivors and immigrants in the United States and Israel. Finally, the implications of the findings for the health vulnerability of elderly Holocaust survivors and their health care needs are discussed.

The primary focus of this chapter is the mental health of Holocaust survivors and immigrants in the United States and Israel. First, the evolution of concern for the mental health of Holocaust survivors will be reviewed, followed by the review and discussion of the empirical findings from our cross-national research project. In our investigation of mental health of Holocaust survivors, we attempted to determine the prevalence, nature, and severity of psychiatric symptoms and psychological characteristics, which may distinguish survivors from a closely matched comparison group of immigrants of similar socio-cultural background.

There has been considerable interest in the gerontological literature concerning the social resources and mental health of the aged. This interest has been stimulated by attempts in gerontological research to identify salient elements of “successful aging” and predictors of well-being, and by efforts to delineate dimensions of frailty and vulnerability among the aged (Harel, Noelker, & Blake, 1985; Kahana & Kahana, 1996; 2003). Cross-sectional studies on the well-being of the aged have shown that mental health is best predicted by health and functional status, socioeconomic status, and by social resources and/or social integration. There are consistent indications in the literature that higher levels of mental health and psychological wellbeing are associated with better health and functional status, higher socioeconomic status and higher economic resources (Bengtson, & Roberts, 1991; Hobfoll & Vaux, 1993). Psychological well-being has also been found to be associated with social interaction, social activity and social support (Harel & Deimling, 1984; Kahn, 1994).

This chapter reviews predictors of psychological well-being among survivors of the Holocaust and immigrants of similar socio-cultural background living in the U.S. and Israel. Six independent variable groups that included socio demographic characteristics, socio economic status, health, stress, personal coping, and communication with significant social resources were employed in these analyses. The analyses included a comparison of survivors and immigrant groups on the independent variables, an examination of the bi-variate association between the independent variables and psychological well being (morale), and the identification of the best predictors of psychological well-being in multivariate regression analyses.

In prior chapters of our book we sought to delineate physical and mental health, social supports and coping resources among Holocaust survivors and a comparison group of immigrants. We also sought to understand how personal and social resources and quality of life outcomes are interrelated among aging survivors participating in our research. We noted typologies of adaptation to the aging process among the highly traumatized Holocaust survivors and the less traumatized immigrants who nevertheless experienced the stressors of being refugees, fleeing countries where threats of the Holocaust provided the impetus for escaping. Furthermore, we considered differential adaptations and long-term outcomes among those survivors and those immigrants living in the U.S. as compared to those who had migrated to Israel. In addition to employing social science methodologies of survey research, we also sought to give voice to our respondents regarding their experiences, anchored in the historical periods and social milieus in which they occurred.