Posted by Marsha Frankel

I had the good fortune to attend a conference in December called "Addressing Aging and Mental Health in a Multi-Cultural Society," sponsored by the Massachusetts Association of Older Americans and the Massachusetts Department of Mental Health. I say "good fortune" because it turned out to be a very informative, well-presented, and, at times, moving day centered on issues that have great relevance for those of us who work with seniors at JF&CS. All of us work with immigrants—Russian immigrants, Holocaust survivors who are originally from a range of countries, and many others as well.

When Antonio Bullon, MD, talked about the acculturation process in older age immigrants, I knew he "got it," and I began to focus on some things that I had never thought of before. His talk was sprinkled with examples from his own immigration to the United States from Peru. For example, when he first saw snow in Chicago, he thought it was fantastic. After a few days, "not so much." It's so easy to become blasé and think that we know what our clients are dealing with…and so helpful to have the issues described in a fresh, relevant way.

Likewise, my colleague, Ellen Fishman, director of Schechter Holocaust Services, gave a workshop presentation, entitled "Respecting the Presence of History in the Lives of Older Clients." She emphasized that, although for us history may be what we read in textbooks growing up, our immigrant clients often lived in the midst of historical traumas, such as the Cambodian tragedy, the Vietnam War, or the Holocaust, among many other cataclysmic historical events. Our clients lost family members or whole families, were forced to flee their countries of origin, had their dreams shattered, and have lived with Post Traumatic Stress Disorder since then. For them, there is no separation between "history" and their personal angst.

Ellen appealed to clinicians to learn about their clients' histories. She explained that clients don't come to see us to give us history lessons and may not even talk about that painful, traumatizing part of their life stories, yet understanding that history can be incredibly helpful to us in understanding a client and making effective interventions.

She described a framework for looking at historical trauma and how it impacts a person throughout his or her life. Further, she showed with vignettes how understanding a person's history enhances our ability to make helpful interventions today. For example, a Holocaust survivor may hoard food in her bed table at a nursing home and can easily be viewed as a difficult patient when that food begins to spoil. If staff can understand that she is hoarding food because she nearly died of starvation during the Holocaust, the client might be assured that she can always obtain her food but must keep it in a refrigerator down the hall.

These presentations, and the others as well, illuminated the worlds of our clients in ways we might not have thought of before.

Marsha Frankel, LICSW, is the Clinical Director of JF&CS Senior Services. She has many years of direct and consultative experience working with older adults in a variety of settings.