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By Maxine Dovere

Is it possible for a mother who has been under great stress to pass that “trauma experience” to her fetus through a biological mechanism that alters the genes of her unborn child?

An emerging body of research suggests that survivors of the Holocaust and other traumatic situations—9/11, a devastating storm—can transmit trauma to the next generation physically and psychologically.

“The children of survivors—a surprising number of them, anyway—may be born less able to metabolize stress,” journalist Judith Shulevitz wrote in The New Republic in 2014. “They may be born more susceptible to PTSD [post-traumatic stress disorder], a vulnerability expressed in their molecules, neurons, cells and genes.”

Dr. Rachel Yehuda is director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, which includes the James J. Peters Veterans Affairs Medical Center. She is a recognized expert in the area of transgenerational transmittance of PTSD. Her research on cortisol and brain function has been termed revolutionary.

In 1993, Yehuda opened the first clinic devoted to the psychological treatment of Holocaust victims. Her clinic discovered that children of Holocaust victims were affected in “a very coherent and cohesive pattern.” Children of survivors have been documented to be three times more likely to develop PTSD if exposed to traumatic events than other Jews of a similar age, and exhibited the “same neuro, endocrine or hormonal abnormalities” seen in Holocaust survivors.

“Epigenetic mechanisms,” said Yehuda, “offer an additional explanation for the impact of personal and family history on vulnerability.”

Her study, published in August 2015 in Biological Psychiatry, describes growing evidence that concentration-camp survivors and their children—the “2Gs”—might show changes in the epigenetic regulation of genes.

Elisabeth Binder, director of the Max Planck Institute of Psychiatry in Munich and Yehuda’s colleague, defines “epigenetic” as “pertaining to changes in the machinery that controls gene expression, rather than changes in the genes themselves.” Their study concludes that “descendants of survivors of the Holocaust have different stress hormone profiles than their peers of the same age whose parents were not in Europe during the Holocaust,” perhaps predisposing them to anxiety disorder. Production of cortisol, a hormone that helps the body return to normal after trauma, is affected.

The adaptation, according to the study, is believed to have happened in utero. If pregnant survivors had low levels of the enzyme in the placenta, a greater amount of cortisol could make its way to the fetus, which would then develop high levels of the enzyme to protect itself—biologically preparing for an environment similar to that of the parents.

“If you are looking for it all to be logical and fall into place perfectly, it isn’t going to yet,” Yehuda said. “We are just at the beginning of understanding this.”

Epigenetic modifications may alter biological responses to stress without changes to the actual genetic code. Such changes alter genetic accessibility, determining how effectively the organism can react to stress hormones. This, in turn, regulates the entire stress-hormone system. Yehuda’s study indicates that the affected gene, FKBP5, is “associated with intergenerational effects”—what Yehuda termed “an epigenetic inheritance.”

She further noted that parents’ Holocaust experiences can affect the genes of their children, resulting in “gene changes…[that] could only be attributed to wartime exposure in the parents. The children of traumatized people have long been known to be at increased risk for post-traumatic stress disorder, mood and anxiety disorders.”

Early detection of epigenetic markers may advance the development of preventive strategies to address the intergenerational effects of exposure to trauma.

In an exclusive interview with NYJL, Dr. Eva Fogelman, a psychologist specializing in the study of the “second generation,” said, “Genetics are not destiny. We are at a preliminary stage of understanding how trauma affects the ability to deal with stress….Traumatized parents’ cortisol levels have been shown to be deficient….When cortisol levels are defective, coping with a stressful situation becomes more difficult.”

Fogelman is the writer and producer of Breaking the Silence: The Generation After the Holocaust, a documentary film about how children of survivors of the Holocaust learn to improve their self-images and relationships with their parents. She is the author of many Holocaust-focused books, some for general audiences and several for professional and academic audiences, including her latest volume, Children in the Holocaust and Its Aftermath. The doctor has led seminars concerned with the emotional and factual issues relating to the Holocaust, and noted that “there was no training program for people working with people who suffered this trauma” prior to her work. She calculated the number of children of Holocaust survivors in the United States at about 200,000. She, too, is a child of survivors.

Fogelman was a leading force in making Holocaust survivors and their children “visible.” She identified a “2G complex,” which “affects identity, self-esteem, interpersonal interactions, and worldview.” She developed awareness groups for 2G children and organized the First Conference on Children of Holocaust Survivors. Four years later, in 1981, 2G children and their survivor parents journeyed to Jerusalem for the World Gathering of Holocaust Survivors: The International Network of Children of Jewish Holocaust Survivors.

Fogelman told NYJL, “Preliminary studies show that genes are somewhat transformed by stress, and that such deformed genes can be passed to the next generation.”

When both parents were survivors, there was a significant likelihood this would occur. If one parent was a Holocaust survivor and the other had “normal” experiences, the problem may not manifest.

“It is not universally applicable,” she continued. “Genes are, of course, inherited from both parents. If children of survivors do not experience significant stress or trauma, they may never be affected by the transformed gene, even if they carry the trait. If, however, those with the gene are traumatized or in a stressful situation, they may experience a form of post-traumatic stress disorder. For example, upon hearing a siren, a Holocaust survivor may become anxious or fearful to a far greater degree than would the ‘average’ person. Survivors may associate the siren with their wartime experience.

“Any interaction with an authority figure, especially one in a uniform, evokes associations with Nazis in uniform. Survivors may become fearful, afraid for their very lives. The police were not your friends,” she noted. “They ransacked your home, deported, raped and murdered you. Such experiences leave a ‘hidden trigger.’”

The psychologist said that while PTSD is not apparent on a daily basis, incidents that provoke fear of annihilation can result in symptoms of PTSD.

NYJL asked Fogelman to comment on survivors’ likely response to the Nazi symbolism displayed during the alt-right march in Charlottesville, Virginia, and at similar events.

“The situation is awakening fears,” she responded. “More nightmares and a greater level of anxiety are common….Nazis marching through the streets brings out PTSD that might have been dormant for years. Externally, survivors may look like they have adjusted well; that doesn’t mean there are no consequences of the past.”

Fogelman said that “survivor’s guilt,” probably one of the most blatant symptoms, is a response that goes from generation to generation. She also noted that the nature of the parents’ marriages—sometimes loveless unions directed mainly at rebuilding family—left children without the nurturing needed to develop a positive self-image.

“Children may represent a replacement of what was lost,” she said. “Survivor parents may have been overly sensitive and anxious about their children’s behavior, pushing them to unrealistic goals. They may have been overprotective, distrustful of the external environment.

“The ‘2Gs’—second generation— may have identity issues and experience a continuum from guilt and shame to pride. They may feel they cannot enjoy themselves, but must mourn lost family they never even knew. How the Holocaust is communicated within the family can evoke a tremendous amount of anger and rage. Where there was silence, second-generation children have had a more difficult time. Trust—or the lack of trust—is an issue.

“2G children may psychologically trade places with their parents, experiencing survivor’s guilt and feeling the effects of the Holocaust as if they themselves had actually been there. 2Gs have found it difficult to trust people outside their family. Separation from parents was often difficult, inherently associated with death.”

Fogelman said good psychological health requires that the mourning process be “integrated in a constructive manner” through such mechanisms as involvement in Holocaust-awareness programs and education, Jewish community participation and “perhaps most important, ‘taking revenge’ in a constructive way, making a positive difference in society.

“Establishing the process of identity is much more important than the genetics. We are at the very early stages of understanding the acute impact of any changes in the genetics. Most of the time, these things are dormant. The cortisol levels only matter when in a stressful situation; they are not important in everyday life.”

In her article in The New Republic, Shulevitz wrote, “If the intergenerational transmission of trauma can help scientists understand the mechanics of risk and resilience, they may be able to offer hope not just for individuals but also for entire communities as they struggle to cast off the shadow of the past.”

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