Aging Holocaust survivors suffering from both schizophrenia and post-traumatic stress disorder can find relief from their PTSD symptoms by relating their life stories while being videotaped, according to a psychiatrist at the Be'er Ya'akov Mental Health Center. The findings are published in the December 1 issue of the American Journal of Psychiatry, which is considered the "flagship" journal of international psychiatry. Dr. Rael Strous, a senior clinician at the psychiatric hospital and staff member at Tel Aviv University's Sackler Faculty of Medicine, has found a surprising therapeutic benefit from this testimony method while working with colleagues at Yale University and in New Jersey. The study was conducted among 24 patients at Be'er Ya'akov and Lev Hasharon Mental Health Centers who had schizophrenia and PTSD symptoms. They were chosen from among about 100 residents housed in the hostel section for Holocaust survivors established at these centers in 2000. The rest of the patients were not included in the study because they did not suffer from PTSD, they had severe psychiatric problems that prevented them from being interviewed, or the researchers did not get their families' and doctors' permission to include them. The Holocaust survivors, with a mean age of 72, had been hospitalized for decades due to schizophrenia. Though they did not get relief from their psychoses through the interviews, there was a significant reduction of functional impairment and of the severity and intensity of symptoms, including intrusion of thoughts, avoidance and hyperarousal. The inpatients were closely monitored and assessed daily for any adverse events or clinical deterioration after giving the video testimony, and a hospital psychiatrist was present throughout. There were none, despite their recollections of many gruesome situations. One example of improvement was "Sara," who recalled how she had hid in a house in Belgium for two years before being reported upon to the Gestapo by a neighbor. "We lived in constant fear," she said. "We never left the house in two years, and in the end they really did come and get us." For three days and nights, she and her family stood in a packed cattle car while it rolled towards Auschwitz. "There, they separated us from Mother. We never saw her again," she said. The hospital staff had not been aware of either her hiding experience or the intensity of her Holocaust experiences. Her PTSD symptoms included nightmares about what happened in the concentration camp; she rarely ventured outside the hospital, and even when taken on infrequent outings she remained tense and hypervigilant. Staff members, the authors wrote, "today more clearly recognize the connection between her traumatic childhood and her current suspicious behavior, lack of trust and self-neglect." But after her videotaped interview she showed significant improvement in rapport with staff and activity involvement. While 38 percent of the patients were shown to have PTSD symptoms in two separate series of extensive tests before the extensive videotaped interview, only 19% of them had the symptoms four months later. Strous noted that the finding was surprising, given the fact that up to 60 years had passed since their suffering during the Nazi era. One possible explanation for the results is that, after "testifying," subjects may finally feel relieved to some extent of the burden of their story, which would remain safe forever on videotape. The findings disproved the theory that recalling and revisiting memories of severe persecution, such as the Holocaust, could be counterproductive to an individual's mental well-being and cause their conditions to worsen. Strous notes that while the sample was relatively small given the difficulty of finding such a patient group, the journal published the findings because it regarded them as so significant. "The paper also shows for the first time that individuals could still be suffering from such PTSD so many years after the event and that individuals with schizophrenia and psychosis also can suffer from PTSD." As a result of Strous's discovery and his presentation of the findings at various international forums, the videotape technique is now being used in the US and Europe with many former "slave laborers" from the World War II era. Further research in larger groups of schizophrenics who suffer from PTSD symptoms should be conducted, he concludes. The authors noted that over the years many Holocaust survivors have not voluntarily disclosed their experiences, and that the Holocaust, taught as history, was ignored by many in the mental health community. "The patient didn't talk, and the psychiatrist didn't know how to ask," said the journal article. "There was a lot of difficulty in dealing with the fear, the loss, the sadness, the loneliness." Routine brief accounts of the patients' pasts as rendered in the context of a conventional psychiatric assessment of hospitalized Holocaust survivors surprisingly do not include extensive personal histories and often omit particular features of the traumatic experiences suffered, the authors added. Most of the patients were diagnosed and hospitalized many years before PTSD became a recognized mental problem, said Strous, and their cases should be re-evaluated. Sharing the story through testimony psychotherapy, even in the context of a single extended interview process many years following the intensely traumatic event, can reduce chronic PTSD symptoms and thus likely improve psychosocial functioning and quality of life, according to the researchers. The autobiographical testimony method, Strous said, was pioneered by a group of Chilean therapists as a form of brief psychotherapy used to treat survivors of state-sponsored violence. The therapists in Chile found it alleviated many chronic symptoms by transforming the painful trauma story into a cathartic experience as well as an historical document that could be useful to others. While the Chilean therapists were the pioneers in this regard, Strous's team believes it is the first to use the testimony method with the aim of comparing PTSD symptoms before and after. The researchers said they had the right to prohibit the sharing of video testimony and to withdraw it at any time from the video archive or the locked collections kept for future medical training and research.