We ended up talking to many people like Joseph: adult children of Holocaust survivors who suffered from anxiety, grief, guilt, dysfunctional relationships and intrusions of Holocaust-related imagery. “You have an obligation to me and to history.” “I didn't survive Auschwitz so that my own child would end the family line,” she'd say. She was determined that her son succeed, and his decision to remain unattached and childless infuriated her. His mother spoke endlessly about the war, telling vivid bedtime stories about how relatives had been murdered before her eyes. But almost every night he woke the family with shrieks of terror from his nightmares. His father worked 14 hours a day and said very little, never mentioning the war. Joseph's parents had met in a displaced-persons camp after surviving several years at Auschwitz, then arrived penniless in the U.S. Lately he was tormented by panic attacks and nightmares of persecution, possibly triggered by reports of ethnic cleansing in Bosnia. He'd been preparing for the worst since his early 20s, keeping cash and jewelry at hand and becoming proficient in boxing and martial arts. But Joseph lived each day with a vague sense that something terrible was going to happen and that he might need to flee or fight for his life. A handsome and wealthy investment banker in an Armani suit, he could've stepped off the pages of a magazine. When he came in for an interview, Joseph didn't look like a casualty of anything. “I'm a casualty of the Holocaust,” he claimed. One particularly persistent caller-I'll call him Joseph-insisted that I study people like him. The callers weren't all Holocaust survivors, though most were the adult children of Holocaust survivors. The first study of its kind, it garnered a lot of publicity within weeks I found myself heading a newly created Holocaust research center at Mount Sinai staffed largely by professional volunteers. My first encounter with intergenerational transmission of trauma was in the 1990s, soon after my team documented high rates of PTSD among Holocaust survivors in my childhood community in Cleveland. Or could both outcomes be possible? In the Aftermath But there is some evidence that the epigenetic response may serve as an adaptation that might help the children of traumatized parents cope with similar adversities. The implications of these findings may seem dire, suggesting that parental trauma predisposes offspring to be vulnerable to mental health conditions. Epigenetics potentially explains why effects of trauma may endure long after the immediate threat is gone, and it is also implicated in the diverse pathways by which trauma is transmitted to future generations. And all these channels seem to involve epigenetics: alterations in the way that genes function. The most apparent route runs through parental behavior, but influences during gestation and even changes in eggs and sperm may also play a role. In the decades since, research by my group and others has confirmed that adverse experiences may influence the next generation through multiple pathways. Now it looked like trauma could leave a trace in offspring even before they are born. Just a year earlier a team I led had reported low cortisol levels in adult children of Holocaust survivors, but we'd assumed that it had something to do with being raised by parents who were suffering from the long-term emotional consequences of severe trauma. The effect was most prominent in babies whose mothers had been in their third trimester on that fateful day. Surprisingly and disturbingly, the saliva of the nine-month-old babies of the women with PTSD also showed low cortisol. And those with PTSD had unusually low levels of the stress-related hormone cortisol, a feature that researchers were coming to associate with the disorder. Psychological evaluations revealed that many of the mothers had developed PTSD. Nine months later we examined 38 women and their infants when they came in for a wellness visit. When the babies were born, they were smaller than usual-the first sign that the trauma of the World Trade Center attack had reached the womb. We monitored them through their pregnancies and beyond. My trauma research team quickly trained health professionals to evaluate and, if needed, treat the women. They were at risk of developing post-traumatic stress disorder, or PTSD-experiencing flashbacks, nightmares, emotional numbness or other psychiatric symptoms for years afterward. Many were in shock, and a colleague asked if I could help diagnose and monitor them. Among those who came in for evaluation were 187 pregnant women. After the twin towers of the World Trade Center collapsed on September 11, 2001, in a haze of horror and smoke, clinicians at the Icahn School of Medicine at Mount Sinai in Manhattan offered to check anyone who'd been in the area for exposure to toxins.
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