'Holocaust journeys' can cause mental health problems

A new study led by Tel Aviv University researchers finds that the Holocaust education trips Israeli high school students take to Poland every year can trigger mental health problems.

About a third of the psychiatric professionals surveyed in this pilot study said they had treated teenagers for psychological problems arising from the Holocaust education trips. While most of the teenagers were treated for less severe symptoms such as anxiety, adjustment, and mood disorders, reports also cited hospitalization, post-traumatic-stress disorder, and psychosis.

In the majority of cases, the affected teenagers exhibited risk factors—like psychiatric or family crises or social difficulties—prior to the Holocaust education trips. Others had stressful experiences during the trips, such as being bullied, that were unrelated to Holocaust education.

"The trips to Poland appear to pose a risk primarily to adolescents with histories of psychological difficulties," says Dr. Yuval Bloch of Tel Aviv University's Sackler Faculty of Medicine and head of the Child and Adolescent Outpatient Clinic at Shalvata Mental Health Center. Dr. Bloch was prompted to conduct the study with his wife Dr. Aviva Mimouni-Bloch, also a lecturer in the Sackler Faculty of Medicine and head of the Neuropediatric Unit at Loewenstein Hospital Rehabilitation Hospital, after she and their son went on one of the trips.

A rite of passage

Every year, about 20 percent of Israeli high school students take Holocaust memorial journeys designed to teach them about the Nazi atrocities committed against European Jewry on Polish soil. Over eight days, the students tour concentration camp sites with Holocaust survivors, share Holocaust stories of family members, and learn about the horrors Jews experienced during World War II. Since the trips were made an optional part of the Education Ministry's curriculum in 1988, more than 30,000 students have participated.

The Holocaust education trips have occasionally generated controversy in Israel, with some people questioning if they are psychologically damaging the country's youth. An unpublished study presented to the Knesset of 1,996 teenagers who participated in the trips found that 1 percent felt they lacked the "mental strength" to handle their experiences.

The new study, coauthored by Prof. Gary Walter of the University of Sydney and published in the journal Australian Psychiatry in May 2013, is the first to look at the Holocaust education trips from a mental health perspective. As a pilot study, with a small amount of retrospective data, it draws limited conclusions and calls for further research. The study notes that evidence is accumulating that "indirect exposure" to traumatic events, like learning of a friend's drowning or watching people falling or jumping from the World Trade Center on September 11, 2001, may precipitate PTSD.

Support and screening

The study was based on questionnaires filled out by 50 Israeli psychiatrists and residents specializing in children and adolescents. The Holocaust trips accounted for as many reported psychiatric referrals as high school "sleep-out" trips – multi-day hiking excursions to various parts of Israel – which are much more frequent and widely attended. Even so, the researchers say, severe psychological fallout from the Holocaust-education trips appears to be rare. Only four diagnoses of psychosis, one diagnosis of PTSD, and one hospitalization were reported.

"Ninety-nine percent of the adolescents that went on the journey were not traumatized," says Bloch. "It was a stressor for them: a harder stressor than other things in their lives. But we were not able to say that we are traumatizing our children."

The study recommends that "high-risk" students be psychologically evaluated before participating in the Holocaust-education trips – and that support be provided before, during and after the trips. "The parent who is hesitating about sending his child on the journey, thinking it may throw the child off a good path, can now probably be less worried," says Bloch. "On the other hand, the parent whose child has an eating disorder or anxiety issues should probably try to get the child more support on the trip, or, in the last resort, not send him." But this decision itself, he adds, could have its own set of psychological consequences.

In the future, the study suggests investigating the role identity plays in teenagers' reactions to preplanned stressors. For instance, do Holocaust-education trips affect Israeli teenagers differently than their peers from other countries? Or is having a Holocaust-survivor grandparent a risk factor?

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