Air Date: August 27, 1996 Program 9635

HEALING WAR'S TRAUMA

Guest:
Dr. Yael Danieli, Director, Group Project for Holocaust Survivors and Their Children;
Past President, International Society for Traumatic Stress Studies

MARY GRAY DAVIDSON: This is Common Ground.

YAEL DANIELI: Brenda Bettelheim said, "What cannot be talked about, cannot be put to rest. And if it is not, the wounds will fester from generation to generation."

DAVIDSON: Healing the traumas of war and other abuses is the topic on this edition of Common Ground.

Common Ground is a program on world affairs and the people who shape events. It's produced by the Stanley Foundation. I'm Mary Gray Davidson.

Shell shock and battle fatigue are older names for what has more recently come to be known as post-traumatic stress disorder, or PTSD. My guest today is Yael Danieli, an expert in the fairly new field of traumatology. She's a clinical psychologist with a private practice in New York City and is director of the Group Project for Holocaust Survivors and Their Children. Danieli is also past president and the representative to the United Nations for the International Society for Traumatic Stress Studies. Danieli's work as a psychologist often begins when the overt war ends.

DANIELI: The end of war does not mean that the internal war ended or liberation from the concentration camps does not mean internal liberation or psychological liberation as well.

DAVIDSON: So, even though you might have physical security your emotional state could still be in an upheaval?

DANIELI: Yes. You may, in fact, in some cases, have lost the feeling or the sense of security. You may have lost a sense of trust in others. You may have lost the ability to feel, therefore, close to other people. You may have lost your ability to be in control of your anger. You may have lost your ability to sleep full nights. You may have bought yourself a life of repeated nightmares and of repeated startled reactions that you may not understand, like flashbacks and reliving of situations that in places you see reminders or you hear or you interpret as reminders.

DAVIDSON: Is it your opinion that everyone in a society that has been at war is affected psychologically...

DANIELI: Yes. And I don't mean by that to say that everybody is pathologically affected.

DAVIDSON: ...or having nightmares?

DANIELI: That's correct. We are fairly sure now that it is between 15 and 35 percent of people are affected seriously. At one point or another they could be chronically affected for the rest of their lives. They may be seemingly nonaffected for a long time, but then some reminder will happen or a change of life such as aging can become very traumatic for survivors of trauma from the past. Children leaving home, occasions in life that are reminders of the trauma may bring symptoms of trauma for the first time.

DAVIDSON: In the work that you have done, do you find that the trauma occurs across the board in society—meaning not just soldiers but also civilians, men and women, young and old? Or are there certain segments of society more affected than others?

DANIELI: I'm afraid that I have very bad news for you about that. For example, up to World War I only five percent of civilians were directly victimized by wars.

DAVIDSON: Right. Because wars were done out in a field and not within the civilian population.

DANIELI: That's correct. They may have become victims by losing their sons or husbands or fathers, but they were not directly involved. By World War II about 50 percent of the population was affected, and today [it is] about 90 percent. We are talking about women and children. Yes. So you can no longer talk just about soldiers.

DAVIDSON: Are we finding more civilians struck by war because there are now more and more intrastate conflicts; that is, wars within a country instead of wars between two different countries?

DANIELI: Yes. That is correct. Absolutely.

DAVIDSON: I would imagine...

DANIELI: When I classify wars, in my thinking, I differentiate from declared wars, which is what you are talking about when you say war.

DAVIDSON: ...a civil war, maybe.

DANIELI: Not only that, any declared war either between states or within, between ethnic groups within the same country. But I also include undeclared wars, such as living in low-income housing in this country, where children live under the gun. Children live with guns in those areas, but also in gangs around the country. These are not declared wars.

DAVIDSON: Going back to soldiers who used to be the primary victims of war, and then I want to talk more, obviously, about the effects on the civilian population. Do soldiers who have been in war fair better when they are welcomed home as heroes by the rest of society?

DANIELI: Absolutely.

DAVIDSON: Because there has been a lot of study done about the welcome, or lack of welcome, that Vietnam veterans received in the United States.

DANIELI: That's correct. And the Afghanis, the soldiers who came back from Afghanistan to Russia (or at that time the Soviet Union). Yes. For example, World War II victors. I don't think it only had to do with the victory but with having participated in what the country as a whole approved of as a good war, as a war that raised the self-esteem of America as a beautiful country with great ideals that men went to fight for.

DAVIDSON: That translated itself into self-esteem for the individual.

DANIELI: And rights and study...

DAVIDSON: ...but you got paid to...

DANIELI: Yes. It got translated to a great many good things. But it doesn't mean that they had less of an incidence, for example, of PTSD.

DAVIDSON: Oh really? Post-traumatic stress disorder?

DANIELI: Yes, right. But it was not diagnosed that way at the time. So there was less of an awareness.

DAVIDSON: Shell shock.

DANIELI: Shell shock or battle fatigue, as I mentioned. But it was experienced differently because of the homecoming. Because you felt loved, you felt welcomed, you felt wanted, and you felt esteemed. So at least the humiliation and the shame that Vietnam veterans came back with was not there.

World War II veterans also were very much welcomed to talk about their experiences. Again, history is quite different. In those days to be a hero meant not to talk much. So I don't think much talking was done, and [it was as if] the films served the function of talking for some of the men. But they were heroes.

DAVIDSON: That's interesting. I never regarded films that way.

DANIELI: Yes. It's American. It's part of the American way of conveying important experiences. But the Vietnam veterans, basically, were not allowed to talk. They really suffered so unjustly.

DAVIDSON: You're listening to Common Ground. My guest is clinical psychologist Yael Danieli, who directs the Group Project for Holocaust Survivors and Their Children. She recently coedited a book for the United Nations titled International Responses to Traumatic Stress, a survey of how the world community is responding to grave and widespread traumatizing events. In early 1997, Danieli has a new handbook coming out dealing with the multigenerational legacies of trauma.

Common Ground is a service of the Stanley Foundation, a nonprofit, nonpartisan organization that conducts a wide range of programs meant to provoke thought and encourage dialogue on world affairs. Printed transcripts and audiocassettes of this program are available. Listen at the end of the broadcast for details on how to order.

In a report to the United Nations, Yael Danieli addressed the right and the need for restitution after someone has suffered grotesque human rights violations.

DANIELI: It has to be accomplished by compensation both real and symbolic; that is, financial or in other ways. By restitution, that is returning to the person things that were taken. By rehabilitation, that means healing. Help that is given that should be given. Very importantly and often forgotten by commemoration, you could see, for example, talking about the Vietnam War here that the building of the wall in Washington.

DAVIDSON: That was a very important gesture...

DANIELI: That was the beginning of the healing process.

DAVIDSON: ...just to have that symbolic recognition.

DANIELI: Right. Because it involved recognition, it involved commonality, it involved saying, "Yes, this is our war not only your war."

DAVIDSON: The response to that wall has been tremendous.

DANIELI: Yes. It taught us a great deal about the importance of commemoration, not only erecting a monument for heroes but simply a place to remember and to mourn. I then also elaborated about issues of relieving the victim stigmatization and separation from society. How do you do that? How do you accomplish that? Commemoration does that, as I mentioned. Memorials to heroism do that. Empowerment, that is giving the person a place that makes a difference in society rather than keeping them apart. By education, so that the whole society knows. And by education, not only in school but through the media.

Of course, there is the issue of repairing the nation's ability, the whole society's ability, to provide and maintain equal value on the law and provisions of justice. This is accomplished by prosecution, which is a great challenge today for the international community in particular. By an apology, a formal apology.

DAVIDSON: Oh, prosecution. At first, I thought you said "persecution."

DANIELI: Did I? If I did, I meant "prosecution." By apology, for example, the United States apologizing to the Japanese in World War II. Formally the government apologized. Formally the government of Japan apologized to the Korean women, 50 years later.

DAVIDSON: Even 50 years later that apology is important.

DANIELI: Of course, it's an acknowledgment of the wrong that was done. It's an acceptance of the responsibility for it. So the victim doesn't walk around with a demoralized sense that people can do whatever they wish and don't even have to acknowledge it to them.

DAVIDSON: Does it create doubts in the victim's mind if it's never acknowledged?

DANIELI: Absolutely.

DAVIDSON: About their own reality?

DANIELI: Yes. I will talk about that in a second. I just want to complete my thought, simply because I want people to see that it's a rather complex issue. Then, of course, securing public records, so the knowledge would not be questioned. So there will be evidence forever for the generations to come.

Education, of course, is very important. The most important, perhaps, is what you're talking about that was acknowledged by some UN resolutions creating mechanisms for monitoring conflict resolution and preventive interventions, so it doesn't happen again.

DAVIDSON: Over and over, sometimes.

DANIELI: Over and over again. And to be able to stop it when you just see the signs for it. Okay. I mean there are various interventions along the way.

DAVIDSON: So war crimes tribunals do serve an important purpose psychologically?

DANIELI: Very. Justice is very important psychologically. You see the failure of it when you don't have justice. People take justice into their own hands, and then it turns into revenge and vindictiveness in the next war.

DAVIDSON: Has that been done? Do you see people taking justice in their own hands, in places like the countries in South America that have had some horrendous regimes (Argentina and Chili) where there weren't any real prosecutions to speak of?

DANIELI: No. There were not only not prosecutions to speak of, but they were given impunity.

DAVIDSON: Right. Amnesty.

DANIELI: Amnesty, which for the victims was a revictimization.

DAVIDSON: There is a fascinating film based on a play by Ariel Dorfman. Did you see it?

DANIELI: Yes. It was quite wonderful. Here you asked when justice is not done, does the victim get confused or start doubting themselves? And, of course, you know we speak of survivors' guilt. You must have heard of the concept.

DAVIDSON: They're the ones who survived. In survivors' guilt are they referring to the fact that you've survived and yet someone you may have loved or befriended didn't survive?

DANIELI: That is correct. Survivors' guilt, objectively, simply means the things that I survived while others did not. In my writings I talk about the existential functions of survivors' guilt, so that when you encounter it you understand what it means. Why do survivors need it actually? After all, they survived.

DAVIDSON: Yes. What purpose does it serve?

DANIELI: Right. The major purpose that I say it serves is to deny or undo the sense of total helplessness and powerlessness. Because when you hit yourself and say I should have done this or I should have done that. When you blame yourself, actually what you are saying is that you could have done it, that you had the choice, that we had the means to do it, but you had the power.

DAVIDSON: You had the power.

DANIELI: That's right, and you had opportunity. You deny all of the conditions of the actual victimization, which is existentially intolerable to live with. Then I come back to what you asked, which is the self doubt. Do I really believe it happened? Part of it is you see in the world that the perpetrators, for the most part, are not punished and say that they are not guilty. At least I feel guilty, so at least I don't feel demoralized. At least the world is a just place. There is justice, even if I sacrifice my own.

DAVIDSON: Everybody needs a sense of justice. You see even young children...

DANIELI: That is correct.

DAVIDSON: ...need justice.

DANIELI: Yes.

DAVIDSON: I am very curious. I was just reminded...

DANIELI: While justice is just one element—because we also need rehabilitation and compensation and education etc.—it is an absolutely crucial one, literally, for peace of mind. If you think what a peace of mind after war or after victimization it contained, justice is a very important balancing act.

DAVIDSON: The whole idea of compensation, rehabilitation, restitution, and prosecution, these are becoming codified within the United Nations?

DANIELI: Yes.

DAVIDSON: That is novel.

DANIELI: Small steps. Governments have to accept responsibility and take them on. (laughter)

DAVIDSON: I can imagine that is difficult.

DANIELI: The genocide convention took years and years and years to ratify. There are some other conventions that are not yet ratified.

DAVIDSON: I'm wondering if somebody who has suffered trauma from conflict, I'm trying to think from a macro level like these interstate wars between two countries. It just seems to me that it might be a little easier for someone to recover psychologically from traumas of that than within your own society? I am taking that down even to a family level. When the people closest to you hurt you, it just seems as a...

DANIELI: It's a brilliant question.

DAVIDSON: ...lay person, that would be the most difficult thing to recover from.

DANIELI: It's a brilliant question. The brilliance of it is that you are acknowledging the importance of trust in the most elemental relationships. The betrayal of a child by a parent who sexually or otherwise abuses the child; that is, that person who is responsible for the child, that the child relies on...

DAVIDSON: ...for everything.

DANIELI: ...for everything. When that basic trust is broken, that is far worse than when your neighbor during the Holocaust betrayed you. That was bad too. It was terrible. It made it very difficult for people to then trust anyone else besides their families later. Your question is absolutely correct.

DAVIDSON: I'm also wondering about children who are victims of war. Is it much more damaging psychologically to them?

DANIELI: It is almost a rule of thumb that the earlier the worse. Here again, it's not always the case. For example, there is an interesting observational study that was done in one of the refugee camps in Sweden where it was shown that—well it was mostly mothers and children that inhabited those refugee camps—when the mothers held an optimistic view and when they created the community for each other and, therefore, had the support of each other the children fared better.

Trauma is a rupture. Traumas differ in terms of how much of life they rupture, how many dimensions of life they rupture. But because trauma is a rupture, and in terms of the time dimension as well, anything we do that resembles or maintains the sense of continuity—be it human continuity, being with people you love, having schooling in refugee camps—anything that will resemble...

DAVIDSON: ...normalcy...

DANIELI: ...normalcy, if you will.

DAVIDSON: ...or routine.

DANIELI: ...or might go with it. What that means, is very important in buffering the impacts of trauma.

DAVIDSON: I'm wondering how someone who doesn't recover from the effects of war, how that manifests itself down the line? Does helping survivors or victims of war deal with their current trauma, in your opinion, possibly help prevent future conflicts?

DANIELI: Such a complicated question, isn't it? Brenda Bettelheim said, "What cannot be talked about, cannot be put to rest. And if it is not, the wounds will fester from generation to generation." Now this is great wisdom. I mentioned before, right, we spoke about the fact that not everybody gets PTSD, post-traumatic stress disorder. Not every PTSD looks the same throughout their life cycle. But what research has shown over and over again is... and you asked me is everybody affected? Yes. It changes the meaning and the world view of the person, and nothing is ever the same again. What's important to say is that also there remains a vulnerability in the person to further trauma. The reason I quoted Bettleheim is to make the point that what we have been showing now in research is that the vulnerability for further trauma is seen in the children of survivors as well.

DAVIDSON: So it's passed on?

DANIELI: So it's passed on, even in biological terms.

DAVIDSON: Really?

DANIELI: That's correct, which is absolutely terrifying and surprising if you think about it.

DAVIDSON: How is it passed on? Can you give me an example?

DANIELI: I don't want to get too technical for those listeners who don't know what cortizol levels are for example.

DAVIDSON: I'm not thinking about the biological, but an example within a parent-child...

DANIELI: I'm talking about levels of chemistry in the body. Of course, you can see meanings being passed on.

DAVIDSON: What do you see in your practice with Holocaust survivors being passed on?

DANIELI: Again, the knowledge now of this population has become vast, which is wonderful, since the time that we started when there was so little known. For example, because separation during the Holocaust for the most part was forever, survivors find it very difficult to let their children separate. Children of survivors find it very difficult to separate from their parents. Again, it's the meaning of the separation. If you are afraid that a goodbye means forever; of course, you will be very scared of saying goodbye.

Issues of what does it mean to be angry? Does it make me a Nazi? Am I allowed to have angry feeling? Am I going to make my parents suffer if I get angry?

DAVIDSON: So you have to learn how to be angry.

DANIELI: Yes, or how to be angry in a way that doesn't feel like you're going to destroy or be destroyed. The chronic sense of grief and mourning. Because how do you grieve for six million people? How do you grieve for your family? How do you live having not ever met a grandparent or uncle or aunt, etc.? It's hard to trust people, because humanity as well as people betrayed you and your people. There are quite a few effects. The kind of survivors' guilt I described before, it can be found.

There are people who will fight for everything, all the time. Any injustice that they may perceive, any racial injustice that they may see for their own people or others, they will jump to the fight to make sure it will never happen again to anyone. So there are many effects. Again, individuals differ in terms of the effects. I have written a great deal about the originality(??) of responses. Not everybody looks the same. Not everybody behaves the same way, of course. But some of the issues are there.

DAVIDSON: Yael Danieli has been my guest on Common Ground. She's a clinical psychologist with a private practice in New York City. Danieli is director of the Group Project for Holocaust Survivors and Their Children and she served as past president and representative to the United Nations for the International Society for Traumatic Stress Studies. For Common Ground, I'm Mary Gray Davidson.

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