Working with Victims of Persecution: Lessons from Holocaust Survivors Joanne Levine Itis estimated that 25 to 30 million people are forced to leave their homes because of human rights violations or threats to their lives, Such massive dislocations at the international level result in significant numbers of diverse, persecuted populations seeking asylum in the United States. It is estimated that as many as 400,000 victims of torture now reside in the United States, with many survivors suffering in silence. The challenge for social workers is to discover this often hidden, vulnerable population and to serve them. ‘Among all the populations experiencing the trauma and stress of persecution, most is know about Holocaust survivors. Through examining the long-term effects of massive psychic trauma gleaned from research on Holocaust survivors and their children, this article addresses the skills, techniques, and insights about current refugee populations that can be incorporated into social work practice and training. Key words: Holocaust; persecution; psychological trauma; refugees ueled partly by geopolitical manipulation, the | creations of the 20th century—science and technol- Frente: of people experiencing severe politi--_| ogy (Milchman & Rosenberg, 1996; Rosenbloom, cal, religious, ethnic, and social persecution are rising. These displaced populations are created | by civil wars, ethnic conflict, economic depres- Sco igrati . z and Importance of Immigration sions, and wars between countries (Amnesty Ln- ied on a ternational, 1997; Drachman, 1995; U.S. Commit- | Data Considerations: Practical Problems in tee for Refugees, 1998). Counting Refugees Social workers have a long 1995). istory of advocat- Statistics on refugees and other displaced popula ing for and promoting the psychosocial adjust- tions are often inexact and controversial because ment of displaced and traumatized populations, of the following. First, because definitions vary as was the case in the aftermath of the Holocaust. from country to country—one country’s refugee Similarities exist between problems observed in is another country’s illegal alien. Today's inter: Holocaust survivors and those seen in current vie~ nally displaced person may be tomorrow's refu- tims of persecution in regard to behaviors exhib-_gee. Therefore, government tallies cannot always ited under extreme stress and transmission of the be trusted to give fall and unbiased accounts of trauma to subsequent generations (Danieli, 1988, refugee movements (U.S. Committee for Refu- 1994; Rosenbloom, 1995; Solkoff, 1992). Other ‘gees, 1998). Second, in emergency situations it is lessons that may be extrapolated from the Holo- not always possible to provide a reliable estimate caust include the consequences of unquestioning _ because of the ongoing nature of the influx. conformity, abdication of individual responsibil- Third, significant forced displacements may be ity, and the ruthless application of the pro over- or underreported. Fourth, in large-scale 350refugee situations, camp populations are often fluid—moving in and out often without notifying relevant organizations or authorities. Finally, sta- tistics can become quickly outdated as a result of sudden new arrivals or departures (U.N. High Commissioner for Refugees, 1998). Overview of Displaced People at the International Level Currently available statistics underscore the over- whelming magnitude of these dislocations. Itis estimated that 25 to 30 million people are forced to leave their homes because of human rights vio- lations or threats to their lives. Many of these people are displaced within their own borders. It is estimated further that in their search for safety, an additional 13 million people have been dis- placed. Almost 90 percent of these people come from the poorest countries in the world, including Afghanistan, Azerbaijan, Bangladesh, Ethiopia, Liberia, and Somalia (Table 1). Such massive dis- locations at the international level result in signifi- cant numbers of diverse, persecuted populations seeking asylum in the United States, including Cambodians, Caribbean Islanders, Central Ameti- cans, Eastern and Central Europeans, Iranians, sub-Saharan Africans, and Vietnamese (Aninesty International, 1997; Castex, 1994; Fong & Mokuau, 1994; Padilla, 1997; Partida, 1996; U.S. Committee for Refugees, 1998; U.S. Immigration and Naturalization Service, 1998), Table} = Refugee and Asylum Seekers Worldwide, by Region, 1997 Region Number Middle East 5,708,000 Africa 2,944,000 Europe 2,020,000 South and Central Asia 1,743,000 Americas and the Caribbean 616,000 East Asia and the Pacific 535,000 World total 13,566,000 Note: This table includes statistics from the World Refugee Survey (U.S. Committee on Refugees, 1998) for two categories of uprooted people: (1) refugees who are unwilling or unable to return to their home countries, because they fear persecution or armed conflict and lack a durable solution and (2) asylum seekers who are awaiting a refugee status determination. It is critical to note that women and children. constitute the vast majority of those who are dis- placed; women are particularly at risk before, dur- ing, and afier they flee. Rape increasingly has been used to torture and terrorize women into flight, especially in Afghanistan, Rwanda, and the former Yugoslavia, Women also are forced to leave their homelands because of gender-related oppression in addition to reasons of war or civil strife. In some countries, women suffer severe persecution. solely because of their gender and government authorities that tolerate or condone the local populations’ harsh or inhuman treatment of women (Amnesty International, 1990, 1997; U.S. Committee for Refugees, 1998). ‘Traumas Suffered by Displaced Populations Although the exact numbers of refugees and asy- lum seekers who have been exposed to situations producing massive psychic trauma are unknown, organizations such as Amnesty International, the U.N. High Commissioner on Refugees, and the U.S. Committee for Refugees have made great strides in obtaining international demographic data and information on the type and magnitude of human rights abuses. Many current refugees and asylum seekers have endured the traumatic exposure to genocide. In the 1994 Rwandan genocide, up to a million people were murdered, In the period that imme- diately followed, 1994-96, the combination of genocide and civil war left more than 40 percent of the country's estimated 7 million people dead or uprooted. In the Sudan, where there is a long-standing conflict between North and South Sudan because of racial, cultural, religious, and political differ- ences, civilian populations have been targeted and exploited by all sides in the civil war. A study con- ducted by the U.S. Committee on Refugees con- cluded that since 1993, 1.3 million southern Sudanese had died otherwise avoidable deaths be- cause of war, war-related famine, disease, and Sudanese government policies. Countless others survived these horrors, only to live with constant bombings of civilian targets by the Sudanese gov- ernment; targets that include displaced-persons camps and hospitals (U.S. Committee on Refu- gees, 1998). ‘Torture—including beatings, psychological abuse, sexual abuse, witnessing the torture of loved ones, deprivation, and burns—is another Levine / Working with Victims of Persecution: Lessons from Holocaust Survivors — 351traumatic experience endured by many of today’s refugees and asylum seekers. Itis estimated that as many as 400,000 victims of torture now reside in the United States, with many survivors suffering in silence. They endure the ongoing physical and emotional anguish that their torturers intended, ranging from chronic pain in muscles and joints to severe depression, constant anxiety, and fre- quent thoughts of suicide, Many are talented, educated, productive people—including doctors, business people, lawyers, and legislators—who were purposefully disabled by their governments (Center for Victims of Torture, 1998). Thus, the challenge for social workers is twofold: to discover this often hidden, vulnerable population and to serve them, Patterns of Immigration ‘The number of immigrants continues to increase annually and consists of two parts: legal and illegal. In 1996 there were 915,000 legal immigrants ad- mitted to the United States and an estimated 300,000 to 400,000 It is estimated that as many as 400,000 victims of torture now reside in the United States, with many survivors suffering in 1990 (P.L. 101-649) that revised the numerical limits and preferential categories used to regulate immigration. Specifically, the act increased the level of employment-based immigration and al- lotted a higher proportion of visas to highly skilled immigrants. This preference resulted in a rise in immigration from most European coun- tries (Karger & Levine, 2000; U.S. Immigration and Naturalization Service, 1998) Refugee and Asylum Seeker Resettlement During 1997 the United States hosted about 451,000 refugees and asylum seekers in need of protection, This included nearly 398,000 pending asylum applications, about 22,300 people granted asylum during the year, and more than 70,000 newly settled refugees. The largest number of asylum seekers were from Mexico (18,684); however, they had among the lowest approval rating for asylum status (0.3 percent) of any nationality The next largest nationality group applying for asylum entering illegally (Federation , was Guatemalans, with 9,886 for American Immigration Re- SueneeS applicants, and an approval form [FAIR], 1997; U.S. Immi- ee rate of 6.9 percent. Salvador- gration and Naturalization Ser vice, 1998). This is four times the number of immigrants that the United States was receiving only 40 years ago. In the next 50 years, the U.S. population is projected to rise from 260 to 400 million people; 70 percent of that growth will result from post-1995 immigration (FAIR). The overall view of immigration to the United States reflects many changes from the 1950s to the 1990s. Among the most notable has been the shift of immigration from Europe and Canada (almost 52 percent of all immigrants to the United States in 1964) to Asia (364 percent of all immigrants in 1994). By 1995 Asian immigration was at its high- est (37 percent), followed by North American (32 percent) and European immigration (17.8 per- cent). This reversed a trend of nearly two centu- ries (U.S. Immigration and Naturalization Ser- vice, 1998). Finally, in 1994 total immigration from Europe more than doubled, from 63,042 in 1985 to 160,916 in 1994. This change has been largely at- tributed to the effect of the Immigration Act of ans represented the third larg- est group, with 7,894 applying during the year, and an approval rate of 3.3 per- cent, The next largest groups were Chinese (5,771; approval rate of 5.5 percent), Haitians (5,230; ap- proval rate of 15 percent), and Asian Indians (4,926; approval rate of 26 percent). Among the nationalities with the highest approval rates for asylum status were Iragis (94.7 percent), Afghans (72.8 percent), and Burmese (61.2 percent) (U.S. Committee for Refugees, 1998) Current political trends in the United reveal ambivalence about accepting all categories of immigrant groups, even refugees and asylum seekers, because of concerns about the burdens they may place on health, education, and social welfare systems. Although an underlying xeno- phobia has been suggested to play a strong role in covertly driving recent immigration legislation, cost containment efforts are overtly presented as the driving force for limiting the number of im- migrants this country can accept and limiting ser- vices available to them. Yet, when immigrants make a successful transition into the mainstream tates Social Work / Volume 46, Number 4 / October 200 — 352of U.S. society, research strongly suggests that ev- eryone can benefit because the arrival of immi- grants frequently increases economic activity and creates jobs for local residents (Taylor, 1997). Clearly, world conditions and events continue to create large populations of displaced people. Consequently, the United States continues to re- ceive significant numbers of refugees and asylum seekers. This influx clearly necessitates the atten- tion of human services professionals to the com- plex systems of services needed to assist them all (PAIR, 1997; Karger & Levine, 2000; Le-Doux & Stephens, 1992; Padilla, 1997; Taylor, 1997) Lessons from Holocaust Survivors Among all the populations experiencing the trauma and stress associated with persecution, the most is known about Holocaust survivors. This is attributable to several factors. First, Holocaust survivors began immigrating to the United States in the middle 1940s. Therefore, social workers and other mental health providers have over 50 years of experience with survivors and their families. Second, survivors and their families have been willing to talk about their experiences and to par- ticipate in designated research to facilitate further understanding of the psychosocial effects of their traumas. Third, self-help groups of survivors’ children have publicized the problems experi- enced by their parents and themselves. Fourth, a large number of research studies have shed light on the coping mechanisms used by survivors. Fifth, willingness of the media to publicize the Holocaust has encouraged survivors and their families to feel freer in speaking out. Finally, Jew- ish organizations have helped focus public atten- tion on the Holocaust, thereby encouraging dia~ logue by survivors. Methodological Concerns Over the past 50 years, mental health professionals have conducted numerous studies on Holocaust survivors and their families. Generally these stud- ies have attempted to understand the effects of massive psychic trauma on survivors and to ex- amine the transmission of trauma from the survi- vors to their children. Whereas these studies have yielded much useful information, there also are critiques about their methodologies. Such criti- ccisms have acknowledged that studying Holocaust survivors and their families is difficult because of, the number and complexity of variables involved. | Regarding studies that have focused on Holo- caust survivors, questions have been raised about the usefulness of the concept of survivor guilt and the dearth of information about the pretrauma personalities of survivors; the loss of family mem- bers; their age at exposure to the trauma; their tive strategies; and the countries in which they grew up. Regarding studies that examine the intergenerational transmission of trauma, major concerns about methodology also have emerged and include absence of data about the personality of the parent who is not a Holocaust survivor; lack of information about competent parenting by Holocaust survivors; over generalizations from the sample to the entire second generation; ab- sence of relevant and properly constituted control groups; and definitions of pathology applied to children of survivors (Rosenbloom, 1995; Solkoff, 1992; Zilberfein, 1996). Recent research, which has tended to focus on the second generation, has become more method- ologically sound. However, deficiencies still noted include failure to analyze potential gender differ- ‘ences in children’s responses to parent's Holo- caust experiences: problems with sampling proce- dures; and use of psychometric instruments specifically developed for studying this population that have not been demonstrated to be valid and reliable (Solkoff, 1992). Despite these method- ological critiques, there are several recurring themes that emerge in studies of Holocaust survi- vorsand their children. Major Effects of the Holocaust on Survivors First, clusters of similar reactions to massive psy- chic trauma have been observed for Holocaust survivors regardless of other factors such as pretrauma ethnicity, socioeconomic status, or glo- bal level of functioning \Stenitz, 1983). These clusters were initially dubbed the “Survivor Syn- drome” and were the forerunner to what became known as posttraumatic stress syndrome (PTSD). Major universal reactions to the long-term effects of massive psychic trauma observed in Holocaust survivors include chronic and severe depression; disturbances in memory and cognition; feelings of guilt (about their survival while others died) marked by anxiety, fear, hallucinations, and sleep disturbances; syndromes of pain, muscle tension, psychosomatic diseases, and occasional personal- ity changes (Nederland, 1961). Levine / Working with Victims of Persecution: Lessons from Holacaust Survivors — 353Second, the life cycle of aging may be experi- enced as highly traumatic by survivors. Old age may elicit a recapitulation of Holocaust experi ences, most prominently separation from children and the deaths of family and friends (Davidson, 1980). These recollections of loss may supersede any positive cultural or personal associations with old age, such as a time for sharing knowledge and wisdom or assuming the mantle of family matri arch or patriarch, Third, normative events that typically occur during old age—such as illness and loss of functioning—may elicit exaggerated feelings of anxiety, panic, and depression. Memories of the Holocaust, a prior period of catastrophic loss, are once again triggered. Survivors remember that not being able-bodied in concentration camps signified certain death (Danieli, 1994). Should the survivor need hospitalization or institutional placement (for example, nursing home), ex- treme reactions may occur because these transi- tions are an admission of sickness and deteriora- tion. The associated feelings of helplessness may cause psychotic-like delusions of being in a con- centration camp. The caregiver's uniforms, over- head sound systems, and the background noise of ambulance sirens or life fight helicopters all serve to trigger further flashbacks of the concen- tration camp experiences. Invasive medical proce- dures can further invoke a loss of control and trigger feelings of revictimization (Danieli, 1994; Karger & Levine, 2000; Zilberfein & Eskin, 1992). Fourth, the strength and vitality of Holocaust survivors emerges throughout the literature. There are many who went on to create successful careers, start families, and make contributions to society. Those survivors who coped most success fully appear to make conscious efforts to interpret their survival as a special obligation to give mean- ing to their lives—neither denying the trauma of their ordeal or succumbing to it (Danieli, 1994; Davidson, 1980; Katz & Keleman, 198]; Rosenbloom, 1995; Solkoff, 1992). Finally, research clearly underscores that survi- vors and their families are not a homogenous group of vulnerable, dysfunctional individuals (Solkoff, 1992). Instead, they have displayed a wide range of adaptive coping strategies. In fact, there are many who exceed the level of function ing displayed by peers who have not endured ex posure to such massive trauma Long-Term Effects of the Holocaust on the Second Generation As a sequel to their massive personal losses, many | Holocaust survivors started families, albeit often small. Adult children therefore are called on to enact multiple roles that would normally be as- sumed by extended family members. This may place additional burdens on adult children who also struggle to maintain their own families as well as careers. In addition, adult children may be unrealistic about or underestimate the care needs of elderly, medically ill Holocaust survivors. This ‘may arise from beliefs about their parents as he- roic, almost superhuman figures for having sur- vived the vicissitudes of the Holocaust. Adult chil- dren of survivors also may perceive that having survived the Holocaust their parents can survive anything—especially without the help of formal or informal caregivers (Danieli, 1994; Karger & Levine, 2000). Children of survivors also may feel a great bur- den to spare their parents any more pain and suf- fering. Their rationale is that survivors have al- ready endured enough misfortune. Although a caring and noble sentiment that is highly under- standable given the circumstances, this perspee- tive may sometimes result in confliets with formal caregivers. These caregivers may be misperceived as not attending to survivors’ best interests or causing them needless pain. Because of a desire to protect the Holocaust survivor, children may not always be receptive to explanations about the cur- rent realities of limited institutional and commu- nity resources or the unavoidable discomfort caused by numerous medical procedures (Danieli, 1994; Davidson, 1980; Karger & Levine, 20005 Zilberfein & Eskin, 1992). Finally, researchers consistently have reported a high degree of separation anxiety by both Holo- caust survivors and their children. For some sur- vivors, this may be manifested by discouraging their children’s attempts to develop autonomous activities, peer friendships, or romantic relation- ships. Bereavement-related issues have been sug- gested to play a role, with some survivors not be- ing able to fully grieve the loss of dead relatives. Many survivors may even have attempted to re- place lost loved ones with their current offspring. Asa result, even in their adult years, some chil- dren of Holocaust survivors may experience a significantly greater threat of separation from their parents than peers who are not children of Social Work / Volume 46, Number 4 / October 2001 — 354survivors (Katz & Keleman, 1981; Stenitz, 1983; Yeheskel, 1995; Zilberfein, 1996). Thus, difficulties in helping Holocaust survivors also may extend to their families. As discussed earlier, some children of Holocaust survivors may be overprotective of their parents, and both may feel revictimized when institutional needs super- sede client needs. This is especially true in medical settings where hospitals stays are shortened and. the need for strict compliance with health care providers’ treatment plans and recommendations are required (Danieli, 1994; Zilberfein & Eskin, 1992). Taken together, these factors can result in exaggerated difficulties in developing a therapeu- tic alliance with survivors and their families. Lack of Public Resources Allocated for Mental Health Services to Holocaust Survivors The age-old use of torture has continued to be a part of modern life since World War II. The use of torture by the Gestapo was revealed to the world in the Nuremberg trials of war criminals and led to the clear statement in the Universal Declaration of Human Rights that no one shall be subjected to torture or to cruel, inhuman, or degrading treat- ment or punishment (International Rehabilitation Council for Victims of Torture, 1998). Yet, even though Holocaust survivors have en- dured massive traumas, initial plans for their re- adjustment entirely overlooked their need for psy- chological assistance. Despite the cry from some mental health professionals (as early as 1948) and the vast literature documenting the destructive emotional effect of the Holocaust, there were never any government programs developed in the United States to address their psychological needs (Danieli, 1988). Mental health services were pro- vided through the auspices of self-help groups, private religious organizations, or individual men- tal health providers (Danieli, 1988; Neipris, 1992). Resulting from this lack of public attention to the psychological aftermath of the Holocaust was a conspiracy of silence, a glossing over or ignoring of the survivor's traumatic experiences, Denial of the Holocaust survivor's psychic pain occurred not just from society at large but also from many ‘mental health providers. Consequently, many sur- vivors were left alone to struggle with their pro- found sense of isolation, loneliness, and alienation (Danieli, 1988; Neipris). Thus, another lesson emerges from the experi- ence of Holocaust survivors: that silence about atrocities perpetuates victims’ mistrust and alien- ation, thereby impeding their tasks of mourning, emotional healing, and social reintegration. Implications for Social Work Practice: Framework for Assisting Current Victims of Persecution As discussed earlier, ofall the populations who have experienced the traumas associated with per- secution, the most is known about Holocaust sur- vivors. Therefore, examining the effects of trauma on survivors and their families has become a case study for other victims of persecution (Stenitz, 1983). Based on extrapolations from research on Holocaust survivors and their families, the follow- ing framework suggests guidelines for social work intervention with current victims of persecution. Assess and Intervene from a ‘Systems Perspective Research on Holocaust survivors and their chil- dren has shown that the effects of massive trau ‘mas are systemic and multigenerational (Danii 1994; Davidson, 1980; Karger & Levine, 2000; Katz & Keleman, 1981; Rosenbloom, 1995; Solkoff, 1992; Stenitz, 1983; Yeheskel, 1995; Zilberfein, 1996; Zilberfein & Eskin, 1992). There- fore, it is imperative that social workers assess and intervene with current victims of persecution from a systems perspective. This framework is critical even when the refugee or asylum seeker needs assistance as an individual because family members are deceased, missing, in their country of origin, or in displaced persons camps. Al- though data obviously cannot always be obtained from other family members, a systems perspective is essential for developing a holistic understanding of individuals in their social, psychological, cul- tural, and economic contexts. Because each family is unique, social workers must use a systems framework that enables them to analyze and understand the behavior of the in- dividuals in relation to the ongoing operations of the family group. It is also critical when assisting this population to devote special attention to the family context component of the assessment. This includes the family's access to basic resources such as food, health care, housing, or job training. Clearly, providing assistance to meet basic sur- vival needs must take precedence over interven- tions to change family dynamics (Hepworth, Rooney, & Larsen, 1997 Levine / Working with Victims of Persecution: Lessons from Holocaust Survivors 355Undertake Culturally Competent Assessments and Interventions Despite universal responses to massive psychic trauma (for example, PTSD, Survivors Syndrome), it is crucial not to view current refugee and asy- lum groups as homogenous. Holocaust survivors came from every continent, and their diverse cul- tural and ethnic perspectives influenced both their reactions and adaptations to extreme stress (Danieli, 1994; Davidson, 1980; Milchman & Rosenberg, 1996; Rosenbloom, 1995). The current populations of refugees are also highly diverse in both their demographic and socioeconomic pro- files. Consider, for example, that Hispanic refu- gees come from 26 nations in North and Central ‘America, the Caribbean, and South America. Asians and Pacific Islanders include Chinese, Fili- pinos, Koreans, Vietnamese, Laotians, Cambodi- | ans, and many others. ! There are significant differences among these | nationalities, including languages, customs, edu- cational systems, and status structures. The his- toric experiences of each country with the United States also vary considerably. This too may affect refugee attitudes toward this country and receiv- ing assistance through its auspices (Castex, 1994; Fong & Mokuau, 1994), Assess and Intervene from a Strengths Perspective Despite their traumatic experiences, the strength and vitality of Holocaust survivors and their fami- lies underscore the fact that assessment and inter- vention with current persecuted groups should emphasize strengths (Katz & Keleman, 1981; Rosenbloom, 1995). Strengths shown to sustain the viability of immigrant families include reli- ance on cultural attachments, values, and social support from family, kin, and community (Padilla, 1997). Social workers are encouraged to facilitate partnerships with these clients through sharing power and de-emphasizing the stigmatizing diag- nostic categories that often reinforce passivity. Working from a strengths perspective has been shown to diminish the feelings of victimization, ow self-esteem, and loss of control that arise in those who struggle to cope with the emotional sequela of persecution, victimization, and cata- strophic losses (Hepworth et al., 1997). Finally, using a strengths perspective with this population helps to ameliorate the effects of resettlement—a life crisis caused by the loss of all that is familiar (Hulewat, 1996) Use Empowerment and Political Advocacy Skills Empowerment is defined as a process through which people become strong enough to partici- pate in, share in control of, and influence events and institutions affecting their lives and those they care about (Gutierrez, 1994; Parsons, 1991). Self- help groups such as the American Jewish Joint Distribution Committee (JDC), a humanitarian organization represented and supported by the various segments of the U.S. Jewish community, demonstrate how one persecuted group empow. ered itself in the face of catastrophic losses. After World War Il, as the representative of organized U.S. Jewry, the IDC carried responsibility for the Jewish residents of displaced persons camps, pro- vided assistance for physical reconstruction of communal buildings and synagogues, provided personal physical rehabilitation through medical and health services, and provided economic reha- bilitation of communities and individuals. The latter was carried out through the support of edu cational and vocational programs and the devel- opment of indigenous services for aid to individu- als in need of social and psychological services (Neipris, 1992). Current self-help efforts for Holocaust survi- vors and their second generation include noi profit Israeli organizations such as AMCHA. Named after the code word (amcha) that helped identify fellow Jews in war-ravaged Europe AMCHA provides a range of psychosocial support services, including psychotherapy, support groups, clubs for aging survivors, and volunteer services to homebound survivors. Their clientele includes the three population groups most af- fected by the Holocaust: older survivors who ex- perienced the Holocaust as adults, “child survi vors” who were in concentration camps during their youth (often not remembering their families ‘or where they came from), and children of survi- vors (AMCHA, 1998), These examples of one persecuted group's self- help efforts can be useful in developing empower- ment-based interventions with current groups. Plans for psychosocial intervention must include access to mental health services to help trauma- tized individuals cope with psychological sequela such as depression and anxiety (Center for Vie~ tims of Torture, 1998). Micro-level interventions Social Work / Volume 46, Number 4 / October 2001 356focus on promoting participatory behavior, skill acquisition, and differing forms of self-efficacy attributions (for example, self-esteem), leading to an increased sense of personal control. At the mezzo level, the use of group modalities can result in the development of collective problem-solving, skills, affiliate behavior, normalization of emo- tional responses, and joint feelings of efficacy and control. At the macro level, research should be conducted to document the adverse effects of unmet needs (for example, mental health services) on the social, educational, and economic out- comes of refugees and asylum seekers, the possible gender-related responses to massive psychic trauma, and the identification of torture survivors within the general clinical and social services populations (Center for Victims of Torture, 1998; Gutierrez, 1994; Padilla, 1997; Parsons, 1991). Finally, social workers also can facilitate commu- nity organizing efforts so that victims and poten tial victims of human rights abuses can empower themselves toward achieving the goals of social justice and participatory decision making. Victims who become empowered may be able to focus public attention on the crimes of their oppressors and accomplish remarkable acts of res- titution, For example, Jewish groups, on behalf of remaining Holocaust survivors and their heirs, are currently engaged in efforts to expose past gov- ernment collaborations with the Nazis—especially by the Swiss. Through the World Jewish Restitu- tion Organization, a class action suit was filed against Swiss banks that failed to return the claim- ants’ undisclosed assets. Brokered by the U.S. State Department, this has resulted in a $1.25 bil- lion settlement against the banks, which must now compensate Holocaust survivors and heirs of victims who deposited money prior to or during World War II. This agreement came as the U.S, Senate Banking Commission on Switzerland pre pared to apply pressure against the Swiss banks if they did not comply. This success empowered Holocaust vietims to seek further compensation. In another class action suit, these vietims are su- ing seven European insurance companies for a $1 billion settlement, These companies convinced victims who feared Nazi persecution to buy poli- cies to protect their families and then used some of the funds to enrich Nazi leaders. Finally, an- other class action lawsuit brought by Holocaust survivors is against German companies—includ- ing Volkswagen, BMW, Audi, and Daimler Benz—that forced inmates in Nazi concentration, camps to work as slave laborers (“Holocaust sur- vivors file suit,” 1998; Simon Wiesenthal Center, 1998). These examples illustrate the power of using empowerment and political advocacy skills, thereby facilitating progress by persecuted groups toward achieving social and economic justice Therefore, I encourage social workers not only to enact their historic role as advocates for vulner- able and oppressed groups but also to facilitate ownership of the skills needed to advocate by the persecuted themselves. Advocate and Intervene to Prevent a Conspiracy of Silence For refugees and asylum seekers who have in vary- ing degrees experienced violence and deprivation, mental health problems are critical issues that of- ten go unaddressed, despite extensive research that shows this group to have significantly higher rates of mental health problems than the general population (Danieli, 1988; Karger & Levine, 2000). This has been partially attributed to the crisis of resettlement and exposure to war, vio- lence, and deprivation. if left unaddressed, torture and other war-related traumas can lead to depres- sion and anxiety, inability to concentrate, memory problems, disruptive behavior, learning difficulties, and acts of fighting and other violence (Center for Victims of Torture, 1998) Thus, a critical aspect of being able to success- fully resettle and join the mainstream of society is the availability of mental health services (Dani 1988; Karger & Levine, 2000; Padilla, 1997). Yet, after the initial resettlement period when most emotional problems begin to manifest themselves, there are only limited public funds for mental health services. Even if mental health problems were to be present during the reception period, only 15 percent of funds for refugee and asylum services are available for nonemployment-related services; mental health counseling being only one of several finding categories (Le-Doux & Stephens, 19925 Padilla). The lack of public resources designated to help people cope with the psychological aspects of forced immigration, especially crucial for victims of persecution, can contribute to a conspiracy of silence—as was the case for Holocaust survivors after World War II. Social workers must advocate for mental health services to meet the needs of Levine / Working with Victims of Persecution: Lessons from Holocaust Survivors 387this traumatized and underserved group. Refugees and asylum seekers also should be encouraged to. | talk openly about their traumatic experiences with the goal of becoming their own advocates. They can be the most persuasive voice for bringing at- tention to human rights abuses and for getting help in resettlement. They can also take the lead- ership role in helping to prevent a conspiracy of silence. Develop Strategies to Cope with Effects of Vicarious Trauma Vicarious trauma occurs when helping profession- als cannot help but absorb some of the emotional pain from bearing witness to their clients’ traumas and victimization (Nelson, 1998). Research on the emotional responses of mental health profession- als who counseled Holocaust survivors supports this idea and reveals important themes, including bystander’s guilt (for example, “I feel an immense sense of guilt because I led a happy and protected childhood while these people have suffered so ”); overwhelming feelings of rage; shame about the potential boundlessness of human evil; dread and horror; griefand mourning; and the tendency to dwell excessively on the Holocaust, thereby neglecting the survivor as a whole person. (Danieli, 1988). These themes are relevant to helping profes sionals who are exposed to disturbing content through listening to contemporary victims of per- mucl secution recount their experiences in civil wars, genocides, and “ethnic cleansings.” Social workers must recognize their vulnerability and know the warning signs, such as when a specific case is con- suming their thoughts and entering into their per- sonal life. The symptoms of PTSD can affect the helpers as well as the primary victims of the trauma, Those who help victims of persecution are not immune to nightmares, hypervigilance, avoidance, or a preoccupation with the trauma (Nelson, 1998). To help stave off the deleterious effects of vi- carious trauma, it is essential for helping profes- | sionals to develop anticipatory coping strategies. | First, the helper should be made aware that having | intensive emotional reactions to the disturbing material is normative. Second, effort should be placed on developing social supports to amelio- rate the toll of these reactions. Earlier research on job stress and coping has examined factors in the work setting and in individuals’ lives outside of work that may influence their reactions to work- related stress. Evidence about the relationships among work stressors, social support, and stress strongly support the buffering role of social sup- port (Levine, 1997). Peer supervision, friends, and personal therapy all can be helpful toward in- creasing social supports for the helpers of those who have been traumatized. Conclusion The Holocaust serves as a reminder of how hate- based policies and political movements can affect the destiny of millions of people. In Nazi Ger- many respected judges par cial laws, physicians conducted gruesome medical experiments, and engineers built the chambers for extermination (Milchman & Rosenberg, 1996; Rosenbloom, 1995). Around the world there con- tinue to be destructive policies and political ‘movements resulting in human rights abuses and genocides. As was the case after the Holocaust, present day consequences include vast numbers of traumatized, displaced people—including chil- dren—who desperately seek asylum (Amnesty International, 1997; U.S. Committee for Refugees, 1998). Given social work’s historic tradition of advocating for social justice, itis essential for members of the profession to engage in interna- tional efforts toward changing these present-day human rights abuses. Lessons from the Holocaust also serve to act as a catalyst for future research and reflection in this country about the history and continuing effects of genocide. Questions for exploration include: How can social workers deal with the experiences of people who have been tortured and oppressed by our own government through international military operations or by its support of unjust governments that commit genocide? How do so- cial workers cope with assisting vi cution, genocide, and torture who have suffered at the hands of the same group to whom the social worker belongs? Social workers can learn from and help Holo- caust survivors and contemporary victims of per- secution. Survivors can teach social workers how to rebuild a life torn by unimaginable horrors and how to adjust to a foreign society that has little understanding of genocide, torture, and disap- pearances. Although unique, many coping mecha- nisms used by Holocaust survivors translate into other vulnerable populations. cipated in writing ra- ims of perse~ Social Work / Volume 46, Number 4 / October 2001 358Human services professionals also need to take responsibility for obtaining the skills and know!- edge that can best facilitate their efforts—on indi- vidual, group, organizational, and community levels—to best assist current victims of persecu- tion. Human history is replete with many shame- ful chapters; however, these periods can provide useful information on how to best ameliorate the deleterious effects of such horrors. This article has reflected on some lessons from the Holocaust available for those who want to make a differ- ence—for those who strive to fulfil their moral, ethical, and professional mandates to pursue so- cial justice in a world that continues to undermine this pursuit. I References AMCHA. (1998). What is AMCHA? [Online]. Avail- able: www,virtual.co.il/orgs/orgs/amcha/ whatsit.htm, Amnesty International, (1990). Reasonable fear: Human rights and United States refugee policy. New York: Author. Amnesty International. (1997). Refiegees: Human rights hhave no borders. New York: Author. Castex, G. (1994), Providing services to Hispanic! Latino populations: Profiles in diversity. Social Work, 39, 285-296. Center for Victims of Torture. (1998). Who we are [Online]. Available: www.cvt.org. Danieli, Y. 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(1983), Psychosocial effects of the Holo- caust on aging survivors and their families, Journal of Jewish Communal Service, 60, 331-336. Levine / Working with Victims of Persecution: Lessons from Holocaust Survivors 359Taylor, |. (1997). An interactive model of immigration, employment, poverty and welfare |Online]. Available: www. migration ucdavis.edu/mm21/Taylor10- 6.htmil. U.N. High Commissioner for Refugees. (1998) REFWORLD [Online]. Available: www.unher.ch/ refworld/refbibyrefstat/1998/98intro.htm. U.S. Committee for Refugees. (1998). World refugee survey. Washington, DC: Immigration and Refugee Services of America. USS. Immigration and Naturalization Service. (1998). INS statistics |Online}. Available: www.ins.usdoj.gov/stats/200htm! Yeheskel, A. (1995). The intimate environment and the sense of coherence among Holocaust survivors. So- cial Work in Health Care, 20, 25~: Zilberfein, F, (1996), Children of Holocaust survivors: Separation obstacles, attachments, and anxiety. So. cial Work in Health Care, 23, 35-55. Zilberfein, F., & Eskin, V. (1992). Helping Holocaust survivors with the impact of illness and hospitaliza~ tion: Social work role. Social Work in Health Care, 18, 59-70 —a Joanne Levine, DSW, MPH, is assistant professor, Graduate School of Social Work, University of Houston, Houston, TX 77204-4492; e-mail: jlevine2@uh.edu. An earlier version of this article was presented at the Joint World Congress of the International Federation of Social Workers and the International Association of Schools of Social Work, July 8, 1998, Jerusalem, Israel. Original manuscript received November 17, 1998 Final revision received February 17, 1999 Accepted May 24, 1999 Graduate School of Social Work “Research in Action” Ph.D. in Social Work & Social Research Integration of Practice, Policy, and Research, a Emphasizes Individualized Study of a Social Problem, including Theories, Policy Analysis, and Practical Solutions For information contact: Ph.D. Program Director Graduate School of Social Work Portland State University PO Box 751 Portland, OR 97207-0751 © Preparation for Program Develop = Applied Learning Through Teaching and Research Practica |, Administration, Teaching, and Research A research institute, including one of the eight social work research and development centers in the country, and a unique partnership with child welfare, offer multiple 503-725-4712 Toll-free 1-800-547-8887, ext. 4712 heepsffwwwsswopdx.edur opportur ies for research experience and financial assistance. The 25 faculty have research and practice interests in mental health, services to the aging, health care, criminal justice, services to children and families, and vulnerable populations. Application deadline: January 15 PSU ma afoman st al emplronen penny sian Social Work / Volume 46, Number 4 / October 2001