Presentation at William Allen White Institute in NYC on January 23, 2018

On January 23, 2018 , I will be giving a presentation, entitled “Trauma, Psychosis and Functionality” at the William Allen White Institute in NYC. More details, as well as the registration procedure, can be found from this link.

The presentation will describe personal experiences from encounters with Jewish survivors of the Holocaust who have been chronically hospitalized in psychiatric institutions in Israel for many decades. The Holocaust survivors were interviewed in the context of a study I conducted as a member of the Yale University Trauma Study Group, together with our Israeli colleagues. The findings of the study were published in the paper available from this link, as well as in contributions I published in this paper in Kavod (the online magazine of the Claims Conference, dedicated to issues related to Holocaust survivors), and in a recently published book entitled Psychoanalysis and Holocaust Testimony: Unwanted Memories of Social Trauma (2017, Laub and Hamburger, eds., Routledge). The presentation will describe the unusual and surprising experience of taking the testimonies of the chronically hospitalized patients, most of whom had been diagnosed as schizophrenic and spent decades in psychiatric institutions.

Despite the torrent of research on PTSD since the introduction of the diagnosis into the DSM-III, studies continue to show that the disorder is grossly under-diagnosed, that many individuals suffer from sub-clinical levels of symptoms which are sufficient to create nearly as much distress and impairment as the formal disorder, and that other post-traumatic reactions, primarily depression and anxiety, often follow exposure to extreme trauma. The life trajectories described in this paper highlight the importance of diagnosis of PTSD and other post-traumatic reactions, which in turn determines the availability of appropriate treatment, and in particular, the critical role of social support in maintaining functionality despite symptoms of post-traumatic stress.

                 Irit Felsen

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Workshop at the LiveOn Conference in NYC, January 25, 2018

I will be giving, with Adeena Horowitz, Administrative Director of Selfhelp Community Services, a workshop entitled

When the Past is Present: What Holocaust Survivors Can Teach Us About Working With Elders Who Experienced Trauma

at the LiveOn Conference in NYC on January 25, 2018.

LiveOn is an organization consisting of 100 agencies from small, single-site centers to large multi-service organizations, representing the 3.2 million older New Yorkers and their caregivers. The organization is dedicated to improve aging in NY city through targeted advocacy, data-driven policy, direct assistance & innovative programs.

The workshop, open to all those who register to the conference, will address special issues in the care of elderly who had experienced traumatic events in prior times in life. A brief description of the workshop is as follows:

Rejecting life-sustaining services. Hoarding food. Neglecting personal hygiene. Accusing others of stealing trivial items. How do we help clients whose behaviors have the effect of pushing us away? Holocaust survivors have taught us that perplexing symptoms in older adults sometimes have their origins in early trauma. Yet trauma is not unique to Holocaust survivors – traumatic experiences have shaped the lives of many older adults we serve. Lessons learned from Holocaust survivors give us keys to connecting with aging trauma survivors, opening the door to helping. This workshop will empower participants with strategies for providing Person Centered Trauma Informed (PCTI) care that can be used by staff in a variety of settings.

The workshop will take place between 10:30 am  and 12:00 noon on Thursday January 25, 2018  at the New York Academy of Medicine at 1216 Fifth Avenue – 103rd Street, New York, NY 10028.

To learn more, and to register for the conference go to this link.

Irit Felsen

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Presentations to the Speakers’ Bureau at the Museum of Jewish Heritage – A Living Memorial to the Holocaust

Over the recent years I have had the privilege of developing a very special connection with the Speakers Bureau and the docents at the Museum of Jewish Heritage in NYC. The Speakers Bureau and the docents are part of the Educators program at the museum, which is run by Elizabeth Edelstein, Vice President for Education at the Museum. The docents meet with the public and guide tours in the galleries of the museum, and the speakers are invited to schools and other settings in the community where they give presentations to students, telling them their own story of survival and the history of the Holocaust as they had lived through it.

The Speakers Bureau consists of Holocaust survivors and some children of survivors are now also joining the core group. It has been my great honor and pleasure to have been invited to return every year to the annual meeting of this unique group of people, who remind me so much of my own parents, and with whom I feel a very warm and special bond. Over the years, I have given several different lectures about topics that I thought might interest the participants.

I have decided to put the slides from my lectures here on my blog, and will do so one at a time, each week over the next few weeks, with great appreciation and love to my friends at the Museum of Jewish Heritage – A Living Memorial to the Holocaust.

The lecture posted on this link is from September 2014, and was entitled “Maintaining Vital Engagement in the Later Years“.

Irit Felsen

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Come Join Me for “Intergenerational Legacies of Trauma in Families”: A Full-Day Workshop In West Palm Beach, FL

On February 5th-6th, 2018, I will have the honor of presenting a professional training about trauma and aging for the Alpert Jewish Family and Children’s Service in West Palm Beach, Florida. The workshop will take place at the Marriot, West Palm Beach and is organized and supported by Herzog Israeli Center for Treatment of Psychotrauma; Next Generations; The Jewish Federations of North America Center for Advancing Holocaust Survivor Care.

The first day of the workshop will consist of professional training sessions for the staff, while the second day is a workshop for second generation and family members of Holocaust survivors. Registration and other information about the public workshop on the second day is presented in the flyer displayed below.

Much of what is known about the intergenerational transmission of effects related to parental trauma is based on the vast body of studies and observations related to the children of Holocaust survivors, which by now span an entire lifetime, manifesting the way the so-called “Second Generation” navigated important life transitions and challenges from adolescence through adulthood. The knowledge that has accumulated about the impact of a legacy of trauma in the family shows that there are significant effects on the relationships between children and survivor parents as well as among siblings, and long-reaching effects on later relationships of the children of survivors with spouses/partners and with their own children. This accumulation of knowledge that led to the recognition of “historical trauma” has implications for many other populations exposed to extreme and prolonged traumatic experiences. This workshop aims at increasing the knowledge understanding of trauma, its immediate and in particular, its long-term effects, and increase familiarity with the symptoms and signs of it in individuals, especially in elderly individuals, as well as in staff.

Finally, the workshop will discuss recent insights from neuroscience about processes involved in dehumanizing perceptions of others, their origin in evolutionary psychology, and the evidence for prevalence of dehumanization in modern medical settings. The presentation aims at education those working with trauma survivors and their families to know about the risk for dehumanization of elderly patients, especially of elderly trauma survivors, in medical settings and at increase ability among well-intentioned healthcare providers to self-regulate non-conscious bias and prevent re-traumatization of those who had already experienced malignant cruelty and aggression.

               Irit Felsen

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Workshop on “Working with Traumatized Clients”, Dec. 14/2017 in NYC

On Thursday December 14, I will present a talk at a one-day event organized by ESCOTA, the Ease Side Council of the Aging, which is a voluntary not-for profit interagency interdisciplinary organization for professionals working in the field of aging. For more information about ESCOTA, see their webpage.

The talk will address unique issues that elderly adults who have suffered trauma at earlier phases in life might experience as they age, and how trauma in the survivor might have impacted others and the family dynamics including survivors’ spouses and adult children. An important focus of the presentation will be the risk for re-traumatization of elderly trauma survivors in healthcare. In addition to the need for health providers and care givers to become able to recognize the signs of trauma in elderly and become aware of particular sensitivities in their clients, I will address particular strategies to reduce the  risk of dehumanization of elderly trauma survivors.

The event will take place at James Lenox House, 49 E 73rd Street (between Madison and Park).  More inf0rmation about the event can be found from this link.

                 Irit Felsen

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Video of Panel Discussion on Lessons from the “Doctors Trial” and Ramifications for Medicine Today Are Now Available on My YouTube Channel

The video-recordings of the panel discussion “70 Years After Nuremberg: What Have We Learned?” are now available online on  my Youtube channel.

The event took place on November 9, the anniversary of Kristallnacht, at the Museum of Jewish Heritage in New York City. There are three segments of the discussion that can be viewed. My personal comments about the lessons to be drawn in healthcare today focused on the issue of palliative and pain relief care at the end of life, and can be viewed in the recording entitled “Part 3”. For my contribution to the discussion I decided to share a painfully personal experience around the death of my mother and the inexcusable and unnecessary suffering she endured due to the lack of appropriate care at the end of life.

With the exception of those who suffer from terminal illness, we think of medical care primarily in terms of healing interventions. We don’t usually think about what kind of end of life care we would like to have for our loved ones and for ourselves. However, crisis might arise abruptly, especially with elderly individuals, as it did for my mother after she fell and broke her hip at age 93.  My mother was hospitalized and passed away in a highly reputable hospital in Israel, a country that has good medical care. However, we should not assume that good end of life care is simply an extension of general good medical care. Last October’s Lancet Commission on the topic of palliative and pain relief care addressed the abyss in accessibility to such services in many low-income countries and pointed out, that even in high-income countries where good medical services exist, good palliative and pain relief care at the end of life are not necessarily available to all patients who need them. The report examined 20 health conditions which might require palliative and pain relief care and strongly recommended widening the scope of such services, which are currently offered to terminal cancer patients and patients suffering from a very limited number of other conditions.

The report pointed out that often there are passionate disagreements about the use of palliative care and pain relief at the end of life, which stem from “opiophobia,” misinformation and prejudice about the use of opioid medications to ease serious distress at end of life for fear of causing the patient’s death.  The lack of training about the distinct difference between the management of serious distress at the end of life and euthanasia, or “mercy killing,” leaves physicians ill-prepared to deliver adequate care and worried about their own liability.

As a society, we must come to decisions and reach a transparent consensus about what kind of end of life care we demand. We mustn’t leave the ethical, moral and faith-based issues involved in end of life care to be interpreted by individual physicians according to their own personal perspective. The Lancet commission emphasized the need for creating interdisciplinary forums that will include faith-based leaders, law makers, physicians and other healthcare providers, as well as representatives of the public and of non-profit advocacy groups to have an open discussion and come to clearly stated conclusions about how to allow people to die with dignity and without unnecessary suffering.

The guidelines about palliative and pain relief care must outline clearly physicians’ roles, for example, delineating the responsibility of the pain management specialist vis a vis the other physicians involved in the care of a particular patient. Since not all physicians can be fully trained in palliative end of life care, the responsibility for such treatment must be placed in the hands of the specialists who are properly trained, so that physicians who are not experts in this particular aspect of medicine will not act out of ignorance, or fear for their licenses. The Lancet commission also strongly emphasized the need for creating structures for stewardship and monitoring of end of life care within hospitals as well as between institutions, to assure that the guidelines are being translated into practice.

The personal story I chose to share highlights the importance of the recommendation of the Lancet report, because everything that could have gone wrong did. As a society, we must work to create structures that protect first and foremost the patients, but also their family members, as well as their doctors, when all are brought face-to-face with the suffering that is sometimes part of the encounter with death.

          Irit Felsen

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Presentation at Trauma Institute of Orange County in Goshen NY, Nov. 30/2017

On  Thursday November 30, 2017,  I will be giving a presentation entitled “Trauma, Aging, and the Implications for Treatment at the Trauma Institute of Orange County, in Goshen, NY. The program offers 2 Continuing Education hours for Licensed Social Workers, Licensed Mental Health Counselors, Licensed Marriage and Family Therapists and Psychoanalysts.

The presentation will focus on the impact of various types of traumatic experiences in prior phases of life on the way aging trauma survivors experience the process of aging and the losses that often accompany it. Studies have shown that healthcare providers might perceive elderly trauma survivors as difficult patients, and experience hopelessness, helplessness, anger, and distancing in the relationships with them. However, better knowledge and understanding of the survivors’ historical background and potential triggers has been shown to improve the care they receive. This presentation will focus on articulating the potential sensitivities of elderly individuals previously exposed to interpersonal cruelty, and offer ways to address difficult dynamics with the aging survivors of trauma and their family members.

The program is organized by the Geriatric Mental Wellness Alliance and The Trauma Institute of Orange County. More details can be found from this link, or by downloading the flyer for the event.

                   Irit Felsen

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