explores a topic virtually untouched in popular culture and scienfic literature: The delayed effects of childhood trauma. Through the story of Sonia Reich, the film shows how a woman who leads a seemingly normal life suddenly can succumb to the terrors of the past.

On the frigid evening of Feb. 15, 2001, a 69‐year‐old who stood less than 5 feet tall packed her clothes into two shopping bags, put on her coat, locked the door to her ‐area home and fled. Someone was trying to kill her, she told the police officers who found her and the doctors who evaluated her in a hospital. But it would take a year unl Sonia’s son, Chicago Tribune jazz cric Howard Reich, received the correct diagnosis: late‐onset Post Traumac Stress Disorder.

PRISONER OF HER PAST traces Howard’s journey to understand his mother’s lile‐known condion and his Herculean efforts to find out what happened to her in the terrible childhood she never discussed. During his invesgaon, Howard locates relaves he did not know existed. He learns that 12,000 Jews from his mother’s hometown in easternmost Poland were executed, his mother among less than 100 who escaped. And he understands, for the first me, his mother’s heroism as a child facing terrible events and as a widow reliving her tormented past.

But Howard also finds psychiatrists in New Orleans helping traumazed children who survived Hurricane Katrina, so they will not re‐experience their childhood terrors as his mother now does.

Running Time 57 min. New Orleans

Sonia Reich in Northbrook, New Orleans students aer Hurricane Katrina

Howard Reich, Olga Chernobaj, and Peter Slominski at Shibennaya Hill Leon Slominski at his sister’s grave

Howard Reich, Leon & Peter Slominski with Sonia Reich in Northbrook, Illinois

Chicago‐based Kartemquin gave the world , one of the most crically acclaimed and highest grossing documentaries of all me, as well as , which recently played for several nights naonally on PBS and won the Internaonal Documentary Associaon “Limited Series Award.” Sonia Reich (Photo: Zbigniew Bzdak, Chicago Tribune)

In effect, Sonia was re‐enacng the traumac events of her childhood.

But the documentary pushes beyond Sonia’s story to show how childhood trauma sufferers today ‐ in Katrina‐ravaged New Orleans ‐ are being helped. Psychiatrists are shown working with teenagers, so that they will not eventually retrace the steps that undid Sonia’s life. New Orleans students aer Hurricane Katrina (Zbigniew Bzdak) Connued‐ As had an enormous impact in print, and Howard Reich believe it is sll more powerful on screen, where most viewers will witness for the first me the lile‐known but remarkably debilitang illness that Sonia (and uncounted others) now suffers: late‐onset Post Traumac Stress Disorder.

Though many people are aware of PTSD from reading about flashbacks that Vietnam veterans have endured, few realize that PTSD can strike decades aer the inial trauma, which is what has happened in Sonia’s case.

Indeed, even many psychiatrists don't understand that someone who has led a normal life might abruptly be overwhelmed by long‐past traumas. Certainly that was the case with Sonia, who was misdiagnosed by psychiatrists for a year, unl a doctor who is an expert in PTSD explained that she did not have Alzheimer's, demena or any of the other ailments that physicians rounely ascribe to senior cizens.

On the contrary, Sonia was ‐ and is ‐ alert and aware of the world around her, except that she insists that everyone is trying to kill her, that yellow Stars of David have been sewn onto her clothes, that the food she is served is rancid and raw.

In essence, Sonia unwingly has merged past and present, the tragedies of her childhood superimposed on her everyday reality.

Psychiatrists explain that many traumazed children, like Sonia, survived the horrors of the Holocaust by trying to forget the terrors they experienced. Only by ignoring their pain could these children connue with their lives aer the war.

"To protect ourselves," wrote Dori Laub and Nanee C. Auerhahn in "Knowing and Not Knowing Massive Psychic Trauma" in The Internaonal Journal of Psycho‐Analysis, "we must, at mes, avoid knowledge. We defend against intense feelings of rage, cynicism, shame and fear by not knowing them consciously.”

Because so few survivors received psychiatric aenon aer the war, and because it's doubul that even the best psychotherapy could have assuaged their traumas, the terrible memories never went away. How could they? They simply were suppressed.

The children became adults, got married, raised children, proceeded with the hurly burly of everyday life. Yet, all the while, they carried with them "unresolved and unresolvable grief," as Dr. Joel Sadavoy wrote in "A Review of the Late‐Life Effects of Prior Psychological Trauma" in The American Journal of Geriatric Psychiatry.

Connued‐ Late in life, when the survivors no longer were distracted by the demands of raising a family, visions of the past returned, with greater force than ever. In many cases, such as Sonia’s, awful memories re‐emerged as delusions. Sonia, and others like her, believes that the events of the past are being replayed, that the killers want to kill again.

To show exactly what Sonia ‐ and survivors like her ‐ have been running from, Gordon Quinn's film crew and Reich traveled to Sonia’s hometown, Dubno, which was located in Eastern Poland before WWII but now belongs to Ukraine. There we found Olga Chernobaj, a Ukrainian Ukrainianwoman who, as a lile girl, witnessed the machine‐gun execuon of thousands of Dubno Jews at Shibennaya Hill. Chernobaj took us there and described the horrors she saw at a place where Reich’s mother was supposed to be executed and most of her family probably was.

Though Chernobaj was observer rather than vicm, she was understandably traumazed by these events, her intense reacon on camera showing the indelible nature of these emoonal scars. showing Reich, Chernobaj, and Slominski at Shibennaya Hill (Photo: Zbigniew Bzdak, Chicago Tribune) By interviewing witnesses such as Chernobaj, digging up historical arfacts and otherwise documenng the events in eastern Poland and and Ukraine, we were able to show the traumas of Sonia Reich’s childhood.

Why tell this difficult tale on film? Why unearth this dark chapter of a long‐gone war?

Because its impact is playing out today. Tragically, most people ‐ even most health professionals ‐ don't understand late‐onset PTSD. In hospital emergency rooms, in assisted living centers and nursing homes across the country (and beyond), individuals are succumbing to past traumas, but doctors and nurses do not recognize it. Instead, the elderly are presumed to be vicms of demena and, therefore, are treated inappropriately or not at all.

Ignorance of this condion is so profound, even within the medical community, that nobody knows how many people have late‐onset PTSD, how many have been misdiagnosed or how many have been helped. Not a single book has been wrien on the subject, apart from “The First and Final Nightmare of Sonia Reich,” by Howard Reich. And only a few dozen arcane medical papers – many unpublished – have aempted to grapple with this phenomenon.

Sonia Reich’s story gives a face to late‐onset PTSD, just as her past shows the impact that extreme childhood trauma can have on an individual – more than half a century later. Director and founding member of Kartemquin Films, Gordon Quinn has been making documentaries for over 40 years. , of the Chicago Sun Times, called his first film (1966) "an extraordinarily moving documentary." With Home for Life Gordon established the direcon he would take for the next four decades, making cinéma vérité films that invesgate and crique society by documenng the unfolding lives of real people.

At Kartemquin, Gordon created a legacy that is an inspiraon for young filmmakers and a home where they make social‐issue documentaries. Kartemquin’s best‐known film, Hoop Dreams (1994), execuve produced by Gordon, was released theatrically to unprecedented crical acclaim. The film follows two inner‐city high school basketball players for five years as they pursue their NBA dreams. Its many honors include: the Audience Award at the Sundance Film Fesval, The Robert F. Kennedy Journalism Award, Chicago Film Crics Award ‐ Best Picture, Los Angeles Film Crics Associaon ‐ Best Documentary and an Academy Award Nominaon.

Some of Gordon’s other film include Vietnam, Long Time Coming, Golub, , and the Chicago Maternity Center. He execuve produced or produced , , and Stevie. Mapping Stem Cell Research: Terra Incognita and The New Americans (he also directed the Palesnian segment of this award winning, inmate, seven‐hour PBS series). Recently he produced a film that deals with the human consequences genec medicine, In The Family, and execuve produced two films, one about community‐ based conservaon in Africa: , and on a wrongful execuon in Texas. He’s currently direcng A Good Man about dancer Bill T. Jones for American Masters, just completed Prisoner of Her Past as Director, and No Crossover, the Trial of Allen Iverson as Execuve Producer.

Gordon is a supporter of public and community media and has served on the boards of several organizaons including The Illinois Humanies Council, The Chicago Public Access Corporaon, and The Public Square Advisory Commiee, The Illinois Advisory Commiee to the U.S. Commission on Civil Rights. Gordon was a leader in creang the Documentary Filmmakers Statement of Best Pracces in Fair Use, and frequently speaks to the media, legal, and educaonal communies about this fundamental right.

Connued‐ Joanna has been a producer with Kartemquin since 2003. In late 2008, she le the posion of Director of Development for the company to pursue filmmaking full me. She is currently developing a new film with Kartemquin on photographer Rick Guido, who le the world of fashion photography to use his lens to challenge the way we see beauty by photographing individuals with genec condions.

Joanna is also producing A Good Man, a feature‐length co‐producon with Kartemquin, the Ravinia Fesval, Media Process Group and American Masters, following the creaon of a major dance piece by the choreographer Bill T. Jones on Abraham Lincoln to premiere at Ravinia in September of 2009.

Joanna produced and directed In the Family, her personal story of tesng posive for the hereditary "breast cancer" gene and an exploraon into the psychological, social, legal and ethical challenges surrounding predicve genec tesng. The film premiered at Silverdocs in 2008, was broadcast naonally on PBS' P.O.V. the same year and was a finalist for the NIHCM Foundaon’s Health Care Radio and Television Journalism Award.

Before coming to Kartemquin, Joanna co‐produced a film on war photographer Robert Capa for the American Masters series at WNET in New York. Robert Capa in Love and War was broadcast on PBS and the BBC, premiered at the 2003 Sundance Film Fesval and was the presenng film for the 2003 Emmy award for Outstanding Nonficon Series.

Prior to the Capa project, Joanna worked for American Masters for three years contribung to numerous films including Juilliard, Ella Fitzgerald: Something to Live For and Joe Papp: In Six Acts. Joanna also worked to help research and develop a 6‐part series on the American novel, funded in part by the Naonal Endowment for the Humanies.

Joanna received a Master’s degree in Science and Environmental Journalism from New York University and a Bachelor’s degree in English from Northwestern University. She is currently an adjunct professor at Northwestern University’s Medill School of Journalism.

Connued‐ Howard Reich has been a Chicago Tribune arts cric and writer since 1983. In addion to covering jazz, blues and gospel music for the Tribune, he has authored several invesgave reports, including arcles on the systemac the of royales from the jazz composer Jelly Roll Morton, the illicit trade in looted musical instruments and the hidden story of his mother's Holocaust past. His invesgaons have been featured on ABC‐TV's "Nightline" and various Naonal Public Radio programs. He is the author of three books: "The First and Final Nightmare of Sonia Reich: A Son's Memoir" (2006); "Jelly's Blues: The Life, Music and Redempon of Jelly Roll Morton" (2003), wrien with William Gaines; and "Van Cliburn" (1993).

Howard has been wring on culture since 1976 and has won two Deems Taylor Awards from ASCAP; the Alumni Merit Award from Northwestern University's Alumni Associaon; six Peter Lisagor Awards from the Society of Professional Journalists; two William Jones Awards and the Outstanding Professional Performance Award from the Chicago Tribune; the Excellence in Journalism Award from the Chicago Associaon of Black Journalists; and the Sarah Brown Boyden Award from the Chicago Press Veterans Associaon, among other honors. His assignments have taken him to many of the world's cultural capitals, including Havana, Moscow, London, Paris, Vienna, Munich, Warsaw, Prague, Montreal and Panama City.

He is a longme correspondent for DownBeat magazine and lives in a Chicago suburb with his wife, Pam Becker, an editor at the Chicago Tribune.

Connued‐ A founding partner of Kartemquin Films, Jerry Blumenthal has been a director, producer, editor and sound recordist with Kartemquin since 1967. Blumenthal's film, Golub: Late Works are the Catastrophes (2004) ‐ co‐produced with Gordon Quinn ‐ revisits the great American thirteen years aer the award‐winning Golub (1988) and was an official selecon of the 2004 Internaonal Documentary Fesval Amsterdam (IDFA).

Vietnam, Long Time Coming (with Quinn and Peter Gilbert) aired on NBC and earned a naonal Emmy and the Directors Guild of America Award for Best Documentary of 1999. Among his many other films, Blumenthal lists The Last Pullman Car, the two Taylor Chain films, The Chicago Maternity Center Story, and the Palesnian story in Kartemquin's seven‐ hour PBS series, The New Americans (2004).

Zak is Kartemquin Films' Director of Producon and has been on staff since 2002. Most recently he served as Co‐Producer on At the Death House Door. That film premiered at the 2008 SXSW Film Fesval and won awards at the Atlanta Film Fesval, the Full Frame Documentary Fesval, DOC NZ, and Doc Aviv. It was a finalist for the Human Rights award at IDFA in 2008 and was officially short‐listed in the Best Documentary category for the 81st Annual Academy Awards.

Currently, Zak is co‐producing with Steve James and Alex Kotlowitz, an ITVS‐ funded project that will air as part of the Frontline series in 2011. He has served as Locaon Sound Recordist for At The Death House Door, In the Family, and Typeface. Previously, he has recorded sound on a variety of documentaries for the CBC, Channel 4, and PBS.

Zak began at Kartemquin by serving as Post Producon Manager and Audio Mixer on the acclaimed PBS documentary mini‐series, The New Americans. He received his Bachelor’s Degree from Columbia College Chicago in 2001 in Film and Video. Connued‐ Jim Trompeter is an award‐winning composer, performer, and instructor in Chicago. His richly varied composional styles can be heard on the Oprah Winfrey Show, HBO’s “The Sopranos” and ABC News.

He has played with an impressive array of musicians over the years and as a member of Gloria Estefan’s “Miami Sound Machine”, he performed in over 350 live and televised concerts worldwide. He performed on the band’s double planum recording, "Let it Loose," and composed and arranged for its live tours. Jim also toured with Jazz Trumpeter Arturo Sandoval, Jon Secada, Boy George, Amy Grant, Tony Randall, David Lee Roth, Joe Mantegna, Whitney Houston, Sammy Davis Jr., Oprah Winfrey, Shecky Green, Art Garfunkel, Dennis Miller, Sinbad, Paul Rodriguez, Freddie Hubbard, Joe Lovano, Arturo Sandoval, Kurt Elling, Bob James, Dave Liebman, Randy Brecker, Crisan Mcbride, Tim Hagans, Rick Margitza, Steve Rodby, Paul Werco, Paquito D'Rivera, Bobby Mintzer, Eddie Daniels, Fareed Haque, Conte Condoli, Lou Marini, Andy Narell, Richie Cole, Sco Wendholt, George Garzone, Louis Bellson, Bill Watrous, and Carl Fontana, Claudio Rodi, among others.

Jim won the Down Beat Magazine award for “Best Instrumental Jazz Performer”; Montreaux Jazz Fesval’s “Stan Kenton Memorial Scholarship” award for Best Performer, finalist in the “Hennessey” Naonal Jazz Fesval and five Down Beat awards in the Large Ensemble category.

As a Producer Jim’s produced and arranged BillBoard Magazine's Pop Song of the Year, “It Doesn't Really Maer Now.” Jim was Musical Director of the 1993 Clio Awards held in New York City.

Photo by Joanna Kozek

Prisoner of Her Past, a searing hour‐long documentary inspired by The First and Final Nightmare of Sonia Reich by Chicago Tribune jazz cric Howard Reich, is one of the most emoonally wrenching yet rewarding films I have recently seen.

Howard's mother, Sonia, a Holocaust survivor, is living in a nursing home in Illinois and is having unusual trouble dealing with her life. She can't escape her past, yet it's impossible for her to confront it. She lives in a state of almost constant paranoia. It turns out that she is suffering from what is termed "late onset post traumac stress disorder" stemming from her horrible experiences as a child, running and hiding from the Nazis and their collaborators. She sll fears that "they're going to give me a bullet in the head." It is heartbreaking to see Sonia, who otherwise appears to be a healthy and intelligent woman, so completely immersed in her delusions.

Since Sonia, like many other survivors, has always been reluctant to talk about the terrible mes she has lived through, some of her past behavior witnessed by Howard and his sister when they were growing up is only now beginning to make sense. They relate many instances that, at the me, did not strike them as parcularly abnormal. For instance, Howard recalls waking up in the middle of the night and seeing his mother sing on the floor in their living room, alert, staring out the front window at the street.

A psychiatrist, whom Howard consults about this, tells him that his mother was "on guard duty," protecng her family. The bad people were sll out there aer them. One me, Sonia was discovered walking down the street late at night in their hometown of Skokie, a predominantly Jewish suburb of Chicago. She was carrying her clothes in two brown shopping bags, escaping from the evil men who sll wanted to put a bullet in her head. The psychiatrist says that Sonia is reliving her past: "The Holocaust has begun again." But perhaps in her mind it never stopped.

Howard decides that he must find out more about his mother's past, to try to beer understand her mental pain. So he takes a trip to Eastern Europe, to visit the places where his mother and other members of his family struggled to survive. He and a few others ‐‐ including Sonia's Polish cousin Leon, also a survivor ‐‐ visit the small town of Dubno in the Ukraine where, at ten years old, Sonia's parents sent her out of her home into the world outside because it was the best chance she had to stay alive. She hid and fled from the evil ones for years. It is hard to imagine how traumac that must have been.

Howard notes a striking difference between Sonia and Leon. Unlike Sonia, Leon is able to confront his past and even retain a few posive memories from his experiences. Howard says, "Leon is not afraid to look at his past. My mother can't go there. She is fighng that past, and he is accepng it." The reason for this is that Leon was helped in his plight by a Czech family. "Leon actually had a childhood. My mother had years of flight and terror. She never had an opportunity to learn how to trust, and Leon did." Later, Leon very movingly pays tribute to the father of that family who saved his life and also, he knows now, kept him from falling into a spiritual well of hopeless paranoia.

Connued‐ Connued from previous page Howard and Leon talk to many of the local Ukrainians. One elderly woman takes them out to a field where she witnessed as a lile girl the slaughter of hundreds of Jews ‐‐ not by the Nazis, but by other Ukrainians. She shudders at the memory of it. Howard asks her, "How do you know they were Ukrainians?" She looks stunned for a moment and then says, "Because they were speaking Ukrainian.”

In one scene, Howard, who looks to be in his fores, and Leon's thirty‐something son Peter take me out to compare notes about their experiences as children hearing adults constantly talking about polics, the Holocaust, and the war. Howard says that the older folks were always angry, always shoung about one thing and another, always worrying that someone was sll aer the Jews. It got to the point where Howard immersed himself in music, playing his piano louder and louder to drown out the disturbing talk. Peter says his father never stopped talking about the past, and that aer a while, it all just went in one ear and out the other.

While Howard and Leon are vising a Jewish cemetery in Warsaw, Leon decides that he wants to visit Sonia in America because he thinks that seeing him might help her. In a scene that is almost otherworldly, Sonia refuses to recognize Leon when he walks into her room at the nursing home. Howard shows her an old picture of her and Leon sing with her grandfather, but she refuses to look. She doesn't want to speak to Leon, refers to him as a stranger bung in on her private conversaon with her son. She won't even look at Leon, but pays excessively close aenon to her can of Diet Coke. Later, outside in the corridor of the nursing home, Leon says, "I am crushed." He can't help feeling so, even though he and Howard had earlier discussed Sonia's possible negave reacon to his visit.

In a change of pace at the end of the film, Howard tells of his visit to New Orleans in the wake of Hurricane Katrina, where he listens to other vicms of post traumac stress: children whose homes were destroyed and who were displaced, separated from their friends and family. One girl reveals a chilling fact: No maer where she is, she always keeps a suitcase packed with clothing and other necessies close at hand in case she needs to evacuate. Howard remarks that his mother sll has those two brown shopping bags packed and ready to go in her room at the nursing home.

At least nowadays, Howard says, many of these kids are geng help, the kind of help that was not available to his mother and other Holocaust survivors back in the fores and fiies when they sorely could have used it.

What helps the children most is telling their stories, sharing their experiences, learning that others have gone through similar passages of pain. This is something that Sonia never had the chance to do and was never even encouraged to explore. She has always felt deeply alone living with her past, truly a perpetual prisoner of that past who, tragically, can never be set free.

Joseph Smigelski Posted: April 20, 2010 12:26 PM PsycCRITIQUES - Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story Page 1 of 7

Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story

A review of

The First and Final Nightmare of Sonia Reich: A Son's Memoir by Howard Reich

New York: PublicAffairs, 2006. 200 pp. ISBN 1-58648-362-5. $22.95

Reviewed by H. Russell Searight

At age 69, Sonia Reich, a widowed Eastern European immigrant and mother of two, was picked up by the police after she ran from her house insisting that people were trying to kill her. She seemed terrified of something only she could see. Ms. Reich soon became worried about imaginary Stars of David on the refrigerator and the walls of her house. Later, after she had moved into a nursing home, Ms. Reich insisted that the other residents were calling her “a dirty Jew” and a “Kike.”

Ms. Reich's symptoms came on fairly suddenly, without any history of formal mental health treatment. When evaluated in the emergency department and psychiatric hospital, Ms. Reich's apparent confusion was accompanied by intact orientation, attention, concentration, and short- and long-term memory, thus making dementia highly unlikely. Her son, Howard, a jazz critic for the Chicago Tribune, was bewildered and a bit frightened by his mother's dramatic changes. He felt responsible for his mother but was also made aware that Ms. Reich, not an imminent danger to herself or others and capable of self-care, could not be held in a facility against her wishes for an extended time.

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Howard Reich's memoir is primarily an account of how his mother, a Holocaust survivor, developed late-life posttraumatic stress disorder (PTSD). The book is written for the general reader and does not focus solely on mental health issues. Reich describes growing up in Chicago during a period in which his parents gradually readopted their Jewish identity and heritage. He also visits the Eastern European village that was his mother's childhood home.

Howard Reich's Family and the Holocaust

Reich's early childhood was spent in Chicago's Little Deutschland neighborhood, where his parents ran a German bakery. As a young child, Reich was told that his Jewish background was to be kept secret. After moving to a new neighborhood and leaving the bakery, his parents became more open about their heritage and sent Reich to Hebrew school. Eventually, Reich's family moved to Skokie, a Chicago suburb with a large concentration of Holocaust survivors. By this time, Reich had heard brief fragments of his father's experiences in a Nazi labor camp as well as on a forced march to Buchenwald. His mother said even less; she had been on the run and, as a child, slept in the snow.

There were day-to-day events in the Reich household that hinted at a deeper, darker past. As a child, Reich noted that his mother always seemed to be awake throughout the night—often checking the door locks multiple times, then staring out the window for long periods as if watching for something. Reich's father was always in angry, drawn-out conflicts with various members of his extended family:

Our house often shook with battles typically waged on the telephone, my father arguing with one relative or another, loudly smashing down the receiver or jumping as it was slammed down on him from the other end. It was hard to tell what all the yelling was about, but it often seemed to involve invitations that should have been forth-coming, gifts that should have been made, thank you notes that should have been written and a thousand other perceived slights. These people simply did not trust each other, or anyone else. (pp. 36-37)

Occasionally, family members mentioned http://psycinfo.apa.org/psyccritiques/display/?artid=2006339812 1/11/2007 PsycCRITIQUES - Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story Page 3 of 7

Holocaust experiences, but it was hard for the young Reich to know exactly what to make of these disclosures:

“I was in camp with Anne Frank—she was right next to me,” bragged one of my aunts. “I was saved by Oskar Schindler,” retorted another. “I saw my grandfather's head cut off,” said a third apparently hoping to make up in gruesomeness what she lacked in celebrity cachet. These discussions provided a gateway to other areas of dispute, the brothers and sisters and in-laws shouting at each other over what one person had said or done five minutes or five years ago. (p. 37)

It was only after his mother's late-life illness that the true horror of her childhood came to light. Reich, through conversations with relatives, travels to Ukraine and Poland, and a few fragments shared by his mother over the years, pieced together her terrifying, primitive, lonely struggle for existence. As a preadolescent child, his mother spent years running and hiding from the German army—often without any adult support. While hiding in a field, she saw a woman beheaded just a few feet away from her. At one point, she was found on a farm by a friend of her aunt's. “Lice crawled on my mother's scalp, her clothes were dirty and torn, her fingers and feet had turned red with frostbite” (p. 70).

Research on PTSD and the Holocaust

Available research suggests that close to half of Holocaust survivors may have developed PTSD in later life, with up to 80 percent having some residual symptoms (Kuch & Cox, 1992; Sadavoy, 1997). Although sparse, available research suggests that the majority of Holocaust survivors with psychiatric symptoms have never received formal mental health treatment (Kuch & Cox, 1992). In some instances, PTSD may have persisted for years unabated, whereas in others like Sonia Reich there may be a lifelong pattern of subclinical distress (in her case, pronounced insomnia was a chronic symptom). Throughout most of her adult life, Ms. Reich remained awake, like a sentry on watch, throughout the night, only later erupting into full-blown, late-life PTSD. Although heterogeneity among Holocaust survivors makes generalizations difficult, PTSD in

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this population has been associated with alexithymia (Yehuda et al., 1997) and greater explicit memory impairment on paired associate tasks (Golier et al., 2002). Of note, adult children of Holocaust survivors with PTSD may themselves be at elevated risk for developing PTSD in response to a stressor (Yehuda, Schmeidler, Giller, Siever, & Binder-Byrnes, 1998).

When Should Denial Be Respected?

Although Reich continues to marvel at his mother's ability to remember the names of physicians, nurses, and other health care professionals whom she has just met, emotional numbing and efforts to avoid remembering had been her long-term coping style. In 1978, when her husband was alive, a Nazi organization obtained considerable media coverage when they attempted to organize a march through the heavily Jewish community of Skokie. Whereas Reich's father was openly angry (“I'll get a bat and break his head if he marches”; p. 59), his mother withdrew: “My mother didn't say a word—at least none that I can remember. She exiled herself to the kitchen working, scrubbing, forgetting herself—or trying to— in a never-ending circuit of duties” (p. 59).

Years later, when she was convinced that the other residents of her nursing home were trying to kill her, Ms. Reich continued to avoid direct confrontation with her past, even while it was creating daily terror. After visiting his mother's childhood home and the village of Dubno, Reich returns with photos. Although Ms. Reich carefully looks at the pictures, these images are more than enough for her and are clearly distressing:

By the time my mother reached the end of the photos, she had become agitated, a stiff expression coming over her face. Though she did not deny that these images came from Dubno… she abruptly ended my little exhibition. “You can pack up the pictures and put them back in the envelope,” she said to me sternly. “I do not want to remember this.” (pp. 179-180)

Many therapists may viscerally respond to Ms. Reich's “avoidance” as a defense needing to be challenged so that her symptoms will remit. Reich, by the end of the book, reaches a respectful http://psycinfo.apa.org/psyccritiques/display/?artid=2006339812 1/11/2007 PsycCRITIQUES - Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story Page 5 of 7

acceptance of his mother's efforts to cope through avoidance. I am not sure how many of us would reach the same conclusion. However, I am impressed with Reich's humanity, and I hope that I would be able to show that same respectful concern to aging trauma survivors.

Useful Lessons for Clinicians

Sonia Reich's initial diagnosis was “delusional disorder with auditory hallucinations.” Although not a clinician, the author correctly points out that this label tells us very little about his mother—it is a perfect example of psychiatric diagnosis as a description masquerading as an explanation. This issue is well illustrated in Molière's play Le Malade imaginaire (The Hypochondriac). During a doctoral candidate's oral exam, the learned professors ask him the final question: “Why does opium put people to sleep?” The candidate confidently answers, “Because it has a dormitive principle” (meaning it puts people to sleep). The learned professors cheer; the candidate has answered correctly and passes his exam. However, the candidate has done little more than rename the phenomenon; he has explained nothing.

This superficial understanding of Ms. Reich's symptoms is something of which I am sure that I have been guilty at times. Once a seemingly accurate diagnostic label is applied, there is a reluctance to probe further. However, particularly with depressive or anxiety symptoms that do not seem to make sense, are atypical, do not fit a customary symptom pattern, or fail to respond to reasonable evidence-based interventions, I urge our family practice residents to ask one valuable screening question: “Have you ever been in a situation where you were afraid that you or someone close to you was going to be hurt or killed?” The unusual rituals and atypical fears often become far more comprehensible when the patient describes a history of domestic violence, crime victimization, or child abuse. Apparently, the health care team evaluating and treating Ms. Reich did not pose this potentially illuminating question to the patient or her son.

Reich suggests that mental health professionals' http://psycinfo.apa.org/psyccritiques/display/?artid=2006339812 1/11/2007 PsycCRITIQUES - Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story Page 6 of 7

neglect of trauma history with Holocaust victims may represent a conspiracy of collusion. Many Holocaust victims have coped for many years by relying on a “false self” that may outwardly appear successful through work, friendships, long-term marriages, and commitment to child rearing (Sadavoy, 1997). Underneath this show of successful adaptation lie vulnerability, profound fear, apprehension, and suspicion. With the diminished energy and physical health of the later years, there are fewer internal resources to keep the turmoil of the trauma at bay, and painful memories become relived.

As a psychologist, the accounts of war trauma survivors are the most devastatingly awful narratives I have ever heard. Patients often become tearful, agitated, and frightened discussing these memories. It is not surprising that we unconsciously collude with our patients to avoid these accounts by failing to ask. Although uncomfortable, we do our patients a disservice by failing to understand their symptoms' origin and meaning. However, like Reich's eventual acceptance of his mother's “delusions” as a means of surviving a painful flood of childhood images and fears, there are times when we should respect the struggle not to remember.

References

Golier, J. A., Yehuda, R., Lupien, S. J., Harvey, P. D., Grossman, R. I., & Elkin, A. (2002). Memory performance in Holocaust survivors with posttraumatic stress disorder. American Journal of Psychiatry, 159, 1682-1688. Kuch, K., & Cox, B. J. (1992). Symptoms of PTSD in 124 survivors of the Holocaust. American Journal of Psychiatry, 149, 337-340. Sadavoy, J. (1997). A review of the late-life effects of prior psychological trauma. American Journal of Geriatric Psychiatry, 5, 287-301. Yehuda, R., Schmeidler, J., Giller, E. L., Siever, L. J., & Binder-Byrnes, K. (1998). Relationship between posttraumatic stress disorder characteristics of Holocaust survivors and their adult offspring. American Journal of Psychiatry, 155, 841-843. http://psycinfo.apa.org/psyccritiques/display/?artid=2006339812 1/11/2007 PsycCRITIQUES - Late-Life Posttraumatic Stress Disorder and the Holocaust: A Son's Story Page 7 of 7

Yehuda, R., Steiner, A., Kahana, B., Binder-Byrnes, K., Southwick, S. M., Zemelman, S., & Giller, E. L. (1997). Alexithymia in Holocaust survivors with and without PTSD. Journal of Traumatic Stress, 10, 93-100.

PsycCRITIQUES January 10, 2007 Vol. 52 (2), Article 7 1554-0138 © 2007 by the American Psychological Association

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Capturing Holocaust memories on film a harrowing, 5-year journey

The often-harrowing journey of a documentary crew and a son into a woman's horrific childhood memories that she can never escape

Howard Reich

Arts critic

April 4, 2010

Slowly, we were sinking into the muck.

On that raw November morning in Ukraine, a sharp wind slicing into our faces, we weren't sure we would be able to start filming, let alone finish.

But we had to. For we had brought with us a silver- haired Ukrainian woman, Olga Chernobaj, who witnessed what happened here more than 60 years earlier. She was possibly the last person alive to have observed the machine-gun execution of thousands of Jews, in the summer of 1941.

My mother, Sonia Reich, was supposed to have been one of them. But somehow, at age 10, she had escaped, and now we were telling her story on film — or trying to.

As the cameras rolled, and as the old woman tried to describe the unfathomable scene, the mud seemed to be giving way underneath us. Slowly, inch by inch, we were slipping into earth that had devoured so many souls. All the while, the old woman wept, reliving experiences she never has been able to forget.

At this moment — as a frigid Ukrainian winter hovered in 2004 — I understood fully, for the first time, why we were making "Prisoner of Her Past," a documentary that opens Friday at the Siskel Film Center. Why a crew from Chicago-based Kartemquin Films had traveled halfway around the world to capture such sorrow. For we weren't merely revisiting my 2003 Tribune article, which described my mother's stunning, late-in-life belief that her Holocaust experiences were happening all over again.

By making "Prisoner of Her Past," we were putting flesh and blood on the ghosts that haunt my mother — and countless other survivors of childhood trauma. If we could show on film the terrors my mother experienced as a child, then demonstrate how an otherwise alert woman believes (to this day) that she is soon to be executed, we would illuminate a virtually unknown mental illness: late-onset post-traumatic stress disorder.

We could show the doctors who originally misdiagnosed my mother that just because you're old doesn't mean you have Alzheimer's or any other form of dementia. And we would establish, once and for all, that childhood trauma, left untreated, never goes away and, as in my mother's case, can unravel a life.

•••

Filming my mother never was going to be easy. Less than 5 feet tall but ferocious to the core, she routinely threw doctors and orderlies out of her room in a suburban nursing home. If they got too close, she heroically took swings at them.

Believing that her life was in constant danger, she slept every night for years in the nursing home sitting in a chair, fully clothed, her bag always packed in case she suddenly had to flee. This was an echo, no doubt, of the years she spent running and hiding during World War II near the massacred village of Dubno, in easternmost Poland (borders were redrawn after the war, placing Dubno in Ukraine).

So in 2005, when I arrived at the nursing home with a Kartemquin film crew, I feared that the filmmakers' camera equipment might not survive the presumed confrontation with my mother.

Not to worry. As soon as director Gordon Quinn and producer Joanna Rudnick plugged in their gear, my mother launched into her performance.

"Welcome to my palace," she said directly to the camera, dripping with sarcasm, as she surveyed her drab-looking room.

"How do you like my beautiful view?" she asked, gesturing to the dismal parking lot outside her window.

Could this woman, so mentally acute, so lacerating in her comments, also be so profoundly delusional?

I sadly knew the answer, and my mother often confirmed it. Frequently she insisted that someone was "trying to put a bullet in my head," and that yellow Stars of David had been sewn onto her clothes. Two realities were unfolding in my mother's psyche — the past and the present — and they were plain for the camera to observe. •••

There were many times when we wondered if we could complete this film. Director Quinn, who had been diagnosed with lymphatic leukemia and would be undergoing treatment throughout the filmmaking process, collapsed in the lobby of our Ukrainian hotel after filming the scene at the massacre site. The rigors of the trip, the hours working in terrible weather and the toll of the story itself briefly had overcome him.

Editor Jerry Blumenthal, who spent years transforming reels of raw footage into a cinematic narrative, was diagnosed with colon cancer in the midst of his work and had to stop for months on end to endure surgeries and radiation treatments.

Still, after all these struggles, no one was prepared for what happened in New Orleans.

•••

After the arduous shoots in Poland and Ukraine and all the sessions filming my mother at her nursing home, I thought we were done with our location work.

I was wrong.

While covering the cultural devastation in post-Katrina New Orleans, I discovered practically an entire city in the grip of post-traumatic stress disorder. It was as if the story I had been trying to document in Eastern Europe had followed me back home to America, where the children of New Orleans were trying to cope with traumas of their own.

When I told director Quinn about the psychiatrists I encountered who were trying to help these kids — most notably Drs. Joy and Howard Osofsky — Quinn said he was coming to meet me and bringing a crew. In short order, we were filming the girls of Xavier Prep School as they described their post-Katrina horrors: running from the rising floodwaters of the Mississippi River; being attacked in the Superdome; losing touch with their family and friends; learning about those who died before they could say goodbye.

I was shocked — though I shouldn't have been — to discover that some of these girls were starting to act just as my mother was: terrified, paranoid, delusional.

But the kids were receiving the kind of psychiatric interventions that my mother, and most of the rest of her generation, never did. Because these teenagers were brave enough to tell their stories before Quinn's camera — even as their tears flowed — they will educate the world about the consequences of childhood trauma.

They, like my mother, are the heroes of this film. [email protected]