Is the transmission of trauma multi-generational? Do children of survivors of mass atrocities have a higher risk of developing psychological disorders? To understand the process of multi-generational legacies of trauma, Maria Armoudian speaks with Andrei Novac and Yael Danieli about the impact of survivors’ post-trauma adaptational style in their children’s eyes.
Andrei Novac is a Clinical Professor of Psychiatry at the University of California, Irvine, School of Medicine, and Founding Director of the Traumatic Stress Program.
Yael Danieli is Director of the Group Project for Holocaust Survivors and their Children. She is the Founding Co-President of the International Network of Holocaust and Genocide Survivors and their Friends, and a Founding Director of The International Society for Traumatic Stress Studies.
This interview has been edited for clarity and length
Maria Armoudian: What is inter-generational trauma exactly, Yael Danieli?
Yael Danieli: Actually, we speak about inter-generational legacies of trauma. What we mean by that [is] the legacies, good and bad – it’s not only bad – but the legacies children grow up with…
MA: So what you are saying is they have adopted a particular way of coping with life and life’s traumas based on something their parents did when they were dealing with a very severe trauma?
YD: Parents have adapted to their trauma the best they could. They coped in different ways. As I have described in our research, they have coped for example by adapting a style of remaining a victim, or a style of always fighting, or a style of being numb to the world. And the children grew up within homes that contained what I call the parents’ ‘adaptational styles’, and they for themselves had to adapt to their own environments, their parents’ history, and their own. This is what I call ‘reparative adaptational impacts’ where the children simply adapt to what they are brought into when they are brought into this world. By reparative, I want to emphasise that the children’s main mission in life, conscious or not, is to repair the parents and themselves from the trauma – that is what I mean when I say reparative. So in the children’s adaptation to their own lives after trauma, after their parents’ trauma they develop reparative adaptational impacts of themselves. Now impacts are high intensity if they take over their lives. The children suffer a great deal if the reparative adaptations are more direct, although they might not experience a life full of suffering and they may experience a life as being far less difficult than those whose impacts are high.
MA: Could you give us an example?
YD: A child, for example, for whom every task you propose says ‘I can’t, I just can’t’. That means the child feels not up to meeting the world and very often defeats themselves even if they have all of the capacities but they don’t have the feeling that they can. They may lack confidence, they may experience the world as a very threatening place because perhaps the parents taught them that the world is a dangerous place and to watch out all the time.
MA: And this is something a parent would not necessarily say. So where is it coming from?
YD: First of all, the parents say it by telling stories. The parents also may behave like it if every knock at the door becomes scary, and the child might have experienced the parent’s behaviour, not just their words. The world is a scary place and people actually say that in the United States, this is a scary place to live. But even when it is in silence, the behaviour might convey that kind of fear or it would be difficult for the parents to let the children separate from them. These are some examples.
MA: Andrei Novac, how would you see this?
Andrei Novac: Just to understand where I am coming from, in my earlier years that was the time when I was working more with Yael and I was very interested in the biological aspects of inter-generational transmission. That paper refers to some specific vulnerability to children of survivors, I was not the first one to report it. But what we know, just to summarise a little bit: there are many aspects, there is a whole spectrum of what we would call inter-generational transmission, like Yael said, the multi-generational legacy of transmission. I will focus briefly on what we know about the biology of transmission and then focus a little bit about my current research on implicit memory or what is called non-declarative memory.
So the early work, and it continues now to be done in different brains, they are studying inter-generational transmission in different families of sexually molested children and many other groups. Basically there is a transplacental transmission in the placenta in mothers of a variety of chemicals including cortisol. The cortisol level has been shown to be abnormal in mothers who were traumatised or come from a traumatised background or have PTSD. Children down the line tend to be during the first two years overreactive, so there seems to be a biological component to that. In addition, another biological component has been the behavioural epigenetics. So if you grow up with parents who continuously re-traumatise you because there is inconsistency, lack of support, there is fear, there seems to be something happening in the body of the children which now has been demonstrated that it shifts some of the effector genes. This is not a genetic change but it is just the effector genes and some of the proteins in the body tend to be synthesised in different ways and the person develops a prior response, abnormal or varied, to stress. And so somebody who grows up with parents who were survivors of some kind of major catastrophe or Holocaust or trauma or war may in time develop over-reactivity, not only by acquiring their parents’ behaviour directly by observation, but also by developing some epigenetic changes. The adrenaline system tends to react. This tends to be a survival mechanism and it probably also exists in animals.
MA: I remember they actually tested some of this in mice, where they intentionally traumatised a mouse and even though its offspring was not traumatised, I seem to remember that the offspring of the offspring also demonstrated PTSD and depression.
AN: Exactly. A lot of work in mice or rats, for instance, [there is] implicit trauma where the rat was shocked only at birth and then left alone to be nurtured by the mother, and then later in life with the same rat you can evoke the shock, just a very mild shock, [and] the traumatised-at-birth-rats will overreact and will have a reaction that is abnormal compared to rats that were not shocked at birth. And then there are other studies done on monkeys. So we know there is a biological component. But what Yael mentioned – the family component – is extremely important because it is not only being exposed during your early life, in other words three, four, five, pre-school and later…
YD: Actually, our study has shown that the most influential parental behaviour is at an early stage. So that could not necessarily be with words but with behaviour.
AN: Exactly, non-verbal…Besides the placental transmissions there seems to be a learning mechanism at the body level of the foetus that is independent of the placenta, no hormones, and that has been demonstrated by sending some weak stimulations through the mother’s abdomen and after a while the foetus tends to recognise the stimulant. So that is very important because what it tells us is that in certain mothers who are over-reactive or are involved in more conflict at work or at home there is an additional component, a learned component of reactivity which is independent of the placenta. And then there is one more element, and that is what is uploaded immediately after birth and during the first three years prior to the introduction of language, that means during the so-called ‘childhood amnesia’. During the first three years most people do not remember a lot of the first three years of their life, but it seems that that is a very important period when non-verbal patterns of reactivity are being uploaded. And that is a universal mechanism, there is a lot of work being done that shows really the visual interaction, eye to eye, looking away, preoccupied mothers have a faulty ability to nurture the infants, which we knew from before, pediatricians have always known that but now there is some research for that.
MA: So one of the questions that came up with your work is that there seems to be variation between siblings. So same parents, same experiences, variation among siblings, how do we account for this?
YD: Every child actually grows up in a different family constellation. If you think about it, the first child is one plus two parents, so the issue is not just a matter of the birth order, but that every child is in a different milieu and every child is born at different times of the parents life, be it very soon after the trauma or later on. We used to think that the eldest one would be the one most affected. Our studies however have shown that actually it is the youngest ones. So first of all, every child has a different family constellation and therefore a different bio-psycho-social milieu where they adapt to life and learn how to live. And in different times in life parents behave differently. For example, survivor mothers who during the camps stopped menstruating – which was most often – were not even sure they could give birth. Rape, stress, and hunger might create that, not just in Holocaust survivors but also in other catastrophic event survivors. So the mere fact of giving birth or getting pregnant might have felt like a miracle. Later on it might feel differently.
Now, I do want to elaborate on the different adaptational styles in the parents. So in the victim style, that would be characterised by a feeling the child has about the parent, as if the parent is stuck in the trauma rupture, that the parent is over-protective and that the parent’s emotions are volatile. So you see both emotional volatility and control. I use the word ‘parent’ here advisedly, because until now most of the implications were about mothers…We tested the children’s perception of both the mothers and the fathers and found independent contributions to the child’s upbringing and adjustment.
Then we have the numb style that I mentioned. In those families you find emotional isolation and detachment, intolerance for weakness and anything threatening, both happiness and catastrophe. These are families where there was a conspiracy of silence in the family. The child didn’t know the history…and if there was no talking, the wounds would continue to fester from generation to generation, and the numb style shows that very clearly. Then we saw different types of families which we called the fighter-style, where there is a great deal of valuing justice, of valuing Jewish identity among Jews, or valuing their own group identity. Now when you prefer to pathological reactions in the children, when the children do develop emotional and psychological maladjustments, you actually see the influence primarily of the victim style and of the numb style. It seems like the fighter-style has no influence one way or the other, interestingly enough. So stereotypically people used to think that when I described these styles, the fighter-style will contribute to health or wellbeing. But we found out that the fighter-style doesn’t contribute one way or the other interestingly enough. But it is those who grow up in homes that are of the victim style and the numb style that seem to develop the higher reparative adaptational impact.
I want to give some more details about the reparative adaptational impact. First, we found in the children what we call reparative protectiveness: the children protect the parents and protect each other, and that is the highest factor. We also found what I would describe as insecurity about their competence of meeting the world and performing in the world. You also find among the children – again it is a matter of intensity, so not every child is the same, different intensities – defensive psycho-social constrictions in the children, they develop watchfulness about others. They also share with their parents the need for power and control, both of themselves and of others. These are the children who would be obsessed with the Holocaust, similar to the victim style in the parents. And we also see amongst those who develop high-intensity reparative adaptational impacts immature dependency. They would let the parents do for them what they can actually do for themselves, for no reason that reality dictates.
We found many differences as well. We found differences among children of survivors who live in Israel and those living in North America. Those who live in Israel, even if they were less wealthy, let’s say, their counterparts here live with a more fulfilling sense of meaning and connectedness. After all, trauma is a rupture, so what helps resurrect the sense of connectivity and continuity would be healing, and you find the existence of homeland, a land that you experience as home from before and forever gives this sense of security and healing, a sense of place and a sense of meaning. So for example, today in the world where we have over 68 million refugees you want to always do your studies both in the homeland and outside in the diaspora because they might very well be different. We cannot just generalise.
MA: These manifestations, whether psychological or physical, particularly the negative ones, the maladaptive ones that you mentioned, the PTSD, the deep depression, if these are more or less static, particularly if they are biological…is there a pathway of healing?
AN: There are two questions there. The first question I sensed was ‘Is there anything static about inter-generational transmission?’ and the answer is no, it is not static, it is a moving target. And that is why it is sometimes difficult for many people to understand that there are great variabilities between people in terms of outcome, manifestations, and also life in general. Remember that outcome has to do with an interaction in the family with children and their parents, and this varies from child to child of course. Different kids means different times in parents’ lives which may be totally different even though they have the underlying trauma, but they cope with that differently. And then there are the children. Each child at birth may be a different temperament, it is a different person, and while they may be immature when they are born, we know from studies of infants that different kids, different children have different temperaments. So you have different interactions: some children that are more demanding will challenge their parents more and very often will make their parents regress their point where they become actually more symptomatic and more needy themselves, so that may become a problem, and that may vary from child to child. So I think that is one component.
The other part that you mentioned was the physical. The physical is something that first of all we should not draw a distinction between, because there is a continuity between the physical and the psychological and the mental. They all happen basically at the same time. We know now from a lot of work with the vagal system, the autonomic nervous system, that the cortex and different cortical functions including exposure to parents’ behaviour…are manifested in the autonomic reactions and then are learned or acquired in patterns. So certainly it becomes written in and that is very important. So there is no surprise that some of the kids that come from traumatised parents later have some somatic symptoms. But in others it doesn’t happen because they just don’t have the intensity of the exposure to affect their entire neuroendocrine and physical body. As you can see, there is large variability and that with very high levels of exposure, you can certainly have the body be affected and in the long run have physical immunological problems. The immune system is very sensitive in terms of early interactions and it becomes programmed early in life. So the body is being rewritten according to trauma in many of the inter-generational families. So the short answer to your question is yes, there is a lot of physical participation. Is it always the case? No. Sometimes it is and sometimes as we have seen, the physical reactions can be actually an impetus for success in life. We have seen a lot of times individuals have come from traumatised families that are anxious by nature, but somehow that served as an imputes to become successful in a sort of neurotic way. So the outcome, the variability of outcome is tremendous in this case.
YD: There are different dimensions where the trauma entered the system. Psychotherapy might very well help with the physical manifestations as well as many other manifestations. It is simply not true that what shows itself in the body is more stable or more stuck than in the heart, in the mind, in the soul, and it is really important to understand that. What we are finding are manifestations of different dimensions of the organism.
AN: That is absolutely correct. And there is work now that has shown that for instance the immune system has a very important representation in the meningeal area of the brain, which is extremely sensitive to social and interpersonal interactions. So very often you have modified the immune system with interactions and social interactions are very evolutionary valuable. Psychotherapy is based on very evolutionary valuable process which is interactive. Obviously what we know is that trauma can result in very treatment-resistant or very severe symptoms of PTSD. But in those cases we have the physical and psychological almost in parallel, and when something is resistant it just takes much more work, but when they respond they respond in groups and you see an entire improvement in the entire functionality of the body and the brain.
YD: Also, let me add that we found that independent of the parents’ diagnostic category, in the children the highest manifestation of psychopathology was that of generalised anxiety disorder, the second highest was depression. PTSD was the lowest in the children. It is important to not assume a one-to-one correlation between the parent’s psychopathology and the child’s psychopathology. It sort of makes sense, because generalised anxiety disorder expresses that sense that the world is a dangerous place, you are fearful all around.
AN: Yes. This takes us back many years ago where we knew at that time that PTSD is never transmitted inter-generationally but trauma is, the legacy of trauma. Now it is important about generalised anxiety, because generalised anxiety is an evolutionary adaptive condition – it is survival. And so what is generalised anxiety in terms of the nervous system? It is a lower threshold of response to external stimulation which sometimes results in feelings of anxiety, which is a signal, or sometimes it doesn’t, just feelings of palpitations and de-activity and scrutinising the environment. So it is a lower threshold of response which is adaptational and it makes sense to be present. Now that being said, there is an important issue here from the point of view of psychopathology. What we know from psychiatry is that people who have generalised anxiety are more likely to develop other psychiatric disorders in the long run…
MA: Final concluding thoughts Yael Danieli?
YD: I would like to add that we have now developed for the first time psychological-behavioural objective measures for multi-generational legacies of trauma that are now already translated into over twenty languages and is being studied not only among children of survivors of the Holocaust but grandchildren and also is being studied by many different populations who have experienced massive trauma. This includes the Armenians, the Cambodians, Rwandans, etcetera. And as I said, one of the recommendations we always have because of our cross-cultural findings is that when you study a traumatised population it is good to study it both where they live now, perhaps with the history of being a refugee, but also in the homeland because we found significant differences. We also, after all these years, have finally built [an] international centre for the study, prevention and treatment of multi-generational legacies of trauma that undertakes research, is multi-disciplinary and is multi-dimensional, and it is important that people know it as a major resource.
MA: And final thoughts, Andre Novac?
AN: I’m very preoccupied by current international and national political changes, changes in attitude. What I would just like to reiterate is that the work in intergenerational transmissions of trauma serves something. It teaches us first of all, that in families of traumatised people there is a narrative of trauma that persists. We also learn that this narrative of trauma can sometimes make victims become victimisers, hence a cycle of trauma that has been talked about a lot. But I am very concerned that what we are seeing right now internationally and nationally with millions of refugees around the world being traumatised, families being separated, is something that may create a negative legacy in the future. I am very concerned that all the work we have done in trauma and all the teaching and education very often is ignored by political leaders.
YD: I am one hundred percent with Andre on this. I passionately feel that decision-makers must understand that the results of immediate decisions might carry on not only within one generation but from generation to generation, and they must remember it when they make their decisions. They really need to keep in mind and be mindful of how long the effects of political decisions will remain.
AN: I have been more preoccupied now with looking at the relationship between individual narratives and social narratives and I think that one issue that we might look at at one point is, do democracies have an inbuilt mechanism to think about long term consequences of this kind? I think this is a global failure of democracies and I think there is something that has remained behind and that is looking at the psychological wellbeing of people in the long run.
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