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Addressing the Needs of Jewish Clients and Students through a Trauma-Informed Approach
It has been over 20 years since the publication of Danieli’s (1998) International Handbook of Multigenerational Legacies of Trauma, a seminal cross-cultural compilation examining the generational effects of mass trauma and intergenerational trauma (IGT). In the years since this book appeared, research on IGT has continued to be applied to many cultural groups, including those who have survived the Indian Residential Schools, the Khmer Rouge regime, or the Rwandan genocide. Previous reviews of IGT research have focused mainly on survivors of the Holocaust, which limits the cross-cultural application of this field of study. The purpose of this article is to provide a scoping review of scholarship published between 1999 and 2019 that aims to understand how IGT has been studied in cross-cultural applications. Overall, 29 articles were identified and reviewed. In light of the fact that cross-cultural perspectives on IGT are still emerging (Sirikantraporn & Green, 2016), the methodology and the cultural considerations described in this review can inform future cross-cultural IGT research.
Objective: Countless communities worldwide are exposed directly and subsequently to the effects of massive-scale collective stressors, from natural disasters to human-caused. In contexts of collective adversity, health care providers who are also members of these communities share and interdependently affect the range of responses their patients have. We aim to conceptualize this spectrum, termed shared trauma, shared resilience, and shared growth. Method: In this metasynthesis, we review the literature on these underacknowledged dynamics globally. We include prior conceptualizations of direct and indirect trauma, collective trauma, cultural context, and the COVID-19 pandemic toward clearer conceptualization of shared mental health in global collective stressor contexts. Results: Most trauma and resilience research focuses on prevailing concepts and measures with questionable cross-cultural applicability. These works usually center on acute, highly distressing threats to physical safety at the individual level. The scarce literature on shared trauma describes it as a rare phenomenon, entailing conflicting messages of narrative accounts within contexts of few cultures with medium to high degrees of individualism. There has been little consideration of other non-Western and indigenous communities with more collectivist values and collective trauma histories. There is limited understanding of these concepts as they pertain to the vast majority of cultures. As a result, shared trauma, resilience, and growth have been poorly conceptualized, differentiated, or empirically researched. Conclusions: We propose uniquely inclusive models of shared trauma, resilience, and growth. These models reflect the cumulative effects and interplay of direct to indirect, acute to chronic, individual to collective, and historic to transgenerational factors influenced by cultural context. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Offspring of trauma survivors are more likely to develop PTSD, mood, and anxiety disorders and demonstrate endocrine and molecular alterations compared to controls. This study reports the association between parental Holocaust exposure and genome-wide gene expression in peripheral blood mononuclear cells (PBMC) from 77 Holocaust survivor offspring and 15 comparison subjects. Forty-two differentially expressed genes (DEGs) were identified in association with parental Holocaust exposure (FDR-adjusted p < 0.05); most of these genes were downregulated and co-expressed in a gene network related to immune cell functions. When both parental Holocaust exposure and maternal age at Holocaust exposure shared DEGs, fold changes were in the opposite direction. Similarly, fold changes of shared DEGs associated with maternal PTSD and paternal PTSD were in opposite directions, while fold changes of shared DEGs associated with both maternal and paternal Holocaust exposure or associated with both maternal and paternal age at Holocaust exposure were in the same direction. Moreover, the DEGs associated with parental Holocaust exposure were enriched for glucocorticoid-regulated genes and immune pathways with some of these genes mediating the effects of parental Holocaust exposure on C-reactive protein. The top gene across all analyses was MMP8, encoding the matrix metalloproteinase 8, which is a regulator of innate immunity. To conclude, this study identified a set of glucocorticoid and immune-related genes in association with parental Holocaust exposure with differential effects based on parental exposure-related factors.
There is a vast psychiatric literature on each of the three sections of this chapter – anti-Semitism, the Holocaust, and the intergenerational transmission of trauma. Psychiatry has always been interested in the topic of in-groups and out-groups, in the link between violence and psychopathology, and in the consequences that stem from trauma. The psychiatric field, from its inception, has been preoccupied with weighing nature against nurture, with assessing the risks and results of human action. This chapter focuses on one community’s experience with anti-Semitism and the Holocaust because particularities are often easier to understand than larger sweeps of history. The community I describe was my community, which makes it special to me. Learning about the events that took place there over the last 200 years has opened my eyes to aspects of anti-Semitism of which I was not previously aware. I have learned that discrimination and stereotyping, no matter how irrational, rise to the surface in times of tension and adversity. I have learned that anyone can become an anti-Semite, discriminating not only against Jews but against people of all Semitic backgrounds, often at the instigation of third parties. I have also learned how trauma is transmitted from generation to generation so that the harms human beings inflict on each other live long after the traumatic events themselves are forgotten.
Aim and objective
To synthesise and critically interpret literature of relevance to intervening in intergenerational transmission of relational trauma within parent–infant relationships.
Background
Intergenerational trauma is a discrete process and form of psychological trauma transmitted within families and communities. Intergenerational trauma can be transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma.
Design
Critical interpretive synthesis (CIS) was used. CIS is an inductive qualitative process that generates new theory grounded within reviewed literature.
Methods
The review commenced by systematically searching for literature on interventions for intergenerational trauma. As the core theoretical construct emerged, elements that may contribute to preventing intergenerational trauma were identified iteratively and influenced further searching. In the final synthesis, 77 articles were included from the fields of intergenerational trauma, trauma interventions and attachment interventions. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist.
Results
The key construct is that prevention of intergenerational trauma transmission is the key intervention. The two contributing constructs were identified as “resolving parental trauma” and “actively supporting parent–infant attachment.”
Conclusions
Prevention is the most effective intervention approach for intergenerational transmission of trauma. Prevention requires trauma‐specific interventions with adults and attachment‐focused interventions within families. Preventative strategies need to target individual, relationship, familial, community and societal levels, as addressing and preventing trauma requires a multipronged, multisystemic approach.
Relevance to clinical practice
Systematic trauma‐informed attachment‐focused interventions in health and social service settings are recommended. There are opportunities to provide multifocal individual and relational interventions within existing services that work with parents to help prevent the likelihood and impact of transmission of intergenerational relational trauma within families. Nurses are well placed to provide preventative interventions in mental health, early childhood and primary health settings.
The question of whether and how the effects of cultural trauma can be transmitted intergenerationally from parents to offspring, or even to later generations, has evoked interest and controversy in academic and popular forums. Recent methodological advances have spurred investigations of potential epigenetic mechanisms for this inheritance, representing an exciting area of emergent research. Epigenetics has been described as the means through which environmental influences “get under the skin,” directing transcriptional activity and influencing the expression or suppression of genes. Over the past decade, this complex environment–biology interface has shown increasing promise as a potential pathway for the intergenerational transmission of the effects of trauma. This article reviews challenges facing research on cultural trauma, biological findings in trauma and posttraumatic stress disorder, and putative epigenetic mechanisms for transmission of trauma effects, including through social, intrauterine, and gametic pathways. Implications for transmission of cultural trauma effects are discussed, focused on the relevance of cultural narratives and the possibilities of resilience and adaptivity.
This paper reviews the research evidence concerning the intergenerational transmission of trauma effects and the possible role of epigenetic mechanisms in this transmission. Two broad categories of epigenetically mediated effects are highlighted. The first involves developmentally programmed effects. These can result from the influence of the offspring's early environmental exposures, including postnatal maternal care as well as in utero exposure reflecting maternal stress during pregnancy. The second includes epigenetic changes associated with a preconception trauma in parents that may affect the germline, and impact fetoplacental interactions. Several factors, such as sex‐specific epigenetic effects following trauma exposure and parental developmental stage at the time of exposure, explain different effects of maternal and paternal trauma. The most compelling work to date has been done in animal models, where the opportunity for controlled designs enables clear interpretations of transmissible effects. Given the paucity of human studies and the methodological challenges in conducting such studies, it is not possible to attribute intergenerational effects in humans to a single set of biological or other determinants at this time. Elucidating the role of epigenetic mechanisms in intergenerational effects through prospective, multi‐generational studies may ultimately yield a cogent understanding of how individual, cultural and societal experiences permeate our biology.
There has been great interest in the possibility that effects of trauma might be passed from parent to offspring through epigenetic mechanisms. This topic has stimulated discussion and controversy in the scientific literature, the popular press, and culture at large. This article describes the initial observations that have led to recent examinations of epigenetic mechanisms in association with effects of parental trauma exposure on offspring. Epigenetic research in animals has provided models for how such effects might be transmitted. However, the attribution of any specific epigenetic mechanisms in human studies of offspring of trauma survivors is premature at this time. The article describes some of the ways in which initial epigenetic findings in the offspring of trauma survivors have been represented in the popular media. Reports have ranged from overly simplistic and sensationalistic claims to global dismissals. The authors discuss the importance of clarity in language when describing epigenetic findings for lay audiences, the need to emphasize the limitations as well as the promise of research on intergenerational transmission of trauma effects, and the importance of countering popular interpretations that imply a reductionist biological determinism. Scientists have an obligation to assist in translating important research findings and nascent avenues of research to the public. It is important to recognize the ways in which this research may unintentionally be received as supporting a narrative of permanent and significant damage in offspring, rather than contributing to discussions of potential resilience, adaptability, and mutability in biological systems affected by stress.
Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupational performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment-behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation.
The evolving theory of occupational justice links the concept to social justice and to concerns for a justice of difference: a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences. The purpose of this descriptive paper is to inspire and empower health professionals to build a theoretical bridge to practice with an occupational justice lens. Using illustrations from a study of leisure and the use of everyday technology in the lives of very old people in Northern Sweden, the authors argue that an occupational justice lens may inspire and empower health professionals to engage in critical dialogue on occupational justice; use global thinking about occupation, health, justice, and the environment; and combine population and individualized approaches. The authors propose that taking these initiatives to bridge theory and practice will energize health professionals to enable inclusive participation in everyday occupations in diverse contexts.
Postmemory, as Hirsch (1997) has defined it, describes the relationship of the second generation to powerful, often traumatic experiences that preceded their births, but that were nevertheless transmitted as to seem to constitute memories of their own. Although subsequent research has created a more complete picture of the interactions between parents and children, Hirsch’s definition has clear bearing on how descendants have attempted to commemorate the prior generation’s ordeals through various means, some narrative, some visual, while still qualifying those modes as acts of transfer or the resonant after-effects of trauma. Focusing on the Holocaust, this article examines certain lines of communication between survivors and their children as mediums of transgenerational transmission of trauma through both theoretical and experiential models of identification. It also attempts to signify how parenting styles contribute to children’s maladaptive behaviors if no intervention is staged. Additionally, I conclude that while second generation Jews may suffer negatively from intrapsychic and interpersonal problems observable by clinicians, they can also learn to integrate and understand their heritage through personal and therapeutic expression linked to the larger cultural context.
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Ancient Judaism: New visions and views
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