TamarWitztum, Medical student

Published in JHH14.2 – Women’s Health

I am a fourth year medical student at the university of Bristol.When I’m not studying, I have been engaged both in medical research and community work such as volunteering with the NSPCC as well as swing dancing and pottery.Alice Herz-Sommer was a close friend of my parents and was, effectively, a grandmother to me. She was already 91 years old when I was born but for me, she was as young as many other people around me. She has always been inquisitive, alert, and played wonderful music for me. It is only in later years that I have come to realise the extent of her humanity. Not only was she utmost forgiving (for her experience in the second world war) but also, she had her eyes fixated on the future until her last days. But future for her, was not a matter of time. For her, connecting to the future meant becoming one with the flow of what she saw as eternal: music and knowledge. Music, in particular, for her, meant a bridge between the past and the future as it encapsulated the human spirit. I felt that this way of pouring meaning into one’s life in a way that perpetually propelled one into the future is a lesson everyone should learn.

This is also an example of another property of resilience – purposiveness Click To Tweet

It is a social convention to seek medical attention when we are feeling unwell to restore good health. In part, this is due to the more general belief in the role of specialisation in modern society; almost all aspect of human lives have become the subject of specialised experts and medicine is no exception. Following the successes of medicine in prolonging life in the past few decades, it is only natural to seek a specialist response. Nevertheless, I fear that having the advantage of an easily accessible, effective healthcare has led to an increased dependency on others. But such an attitude can be detrimental, undermining the role of an important aspect of the human condition – resilience.

Resilience is ‘the quality or fact of being able to recover quickly or easily from, or resist being affected by, a misfortune, shock, illness, etc’ (www.oed.com). I probably would not be such a firm believer of the hugely positive effects that resilience alone can yield, had I not met Alice Herz-Sommer. In spite of being subjected to horrendous physical difficulties and ailments, surviving a concentration camp, breast cancer, strokes and the passing of her son, she lived till the age of 110, keeping her faculties about and living alone with only the most basic community care. Some see it as a miracle she lived on her own until she passed and that she was extremely lucky to avoid diseases that are very prevalent amongst the elderly such as dementia from which a third of people over the age of 95 suffer (Alzheimers Society, 2015). However, it was clear to anyone who’d spent even 10 minutes in her company that luck played no part in her wellbeing and that it was purely her resilient nature and love of music and life that attributed to her reaching such an old age. I endeavour to explore these two subjects and delve deeper into how we can learn from Alice: the world’s oldest holocaust survivor.

The most important factor, in my opinion, that favours resilience is awareness (Thompson, 2011). If one is not aware of the reality of a problem, it would be very difficult to overcome. Alice was very close with

her mother and so, when her mother was deported to a concentration camp as part of Hitler’s extermination campaign of the Jews, Alice (who was left behind) was devastated. Obviously this is an extreme example but one which demonstrates how her awareness eventually saved her. Alice’s coping mechanism follows DiClemente’s and Proschaska’s stages of change model (Prochaska and DiClemente, 1983). At first, she remained in the contemplation phase for a while, depressed, not eating, not sleeping nor was she playing the piano (which was a significant part of her life). Even specialist doctors were at a loss for how to help and her condition seemed helpless until she entered the model’s loop and began preparing for action. Alice took it upon herself to learn Chopin’s 24 Études on the piano which is an arduous task in itself let alone under such emotional strain. After a year of constant practise, she could play them to concert-performance level. Though this couldn’t bring her mother back, Alice had managed to avoid serious mental illness and returned to being a functional, healthy member of society without need for medical intervention ( Muller and Piechocki, 2008).

This is also an example of another property of resilience – purposiveness. Not only did Alice identify that there was a problem, she gave herself a sense of purpose. Some could argue that this merely distracts oneself from the problem at hand but, without a sense of purpose, would there be a point of being resilient? An existentialist and holocaust survivor called Viktor Frankl wrote a book in which he says that ‘when we are no longer able to change a situation, we are challenged to change ourselves’ (Frankl, 2008). This holds true in Alice’s case, but begs the question – if we do not find ourselves in such trying circumstances, can we develop such resilience? Has living under the shelter of constant and rapid medical access stifled resilience? Given the tribulations that Alice had suffered, it is not surprising that she became so resilient; she didn’t have a choice.

Much research is being done to investigate the effects of art on our healthcare

Mind-body medicine is well-known to have a significant effect on health for it’s the explanation behind the placebo effect –a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment (www.oed.com). An example of this is elite cyclists being able to cycle faster than ever before after ingesting a pill of corn flour (an inert substance) (Horizon, 2014. It is also suggested that increased positive attitudes may protect against CHD via improvements in sleep habits, smoking cessations and lower levels of cholesterol (Davidson, 2010). This demonstrates that our outlook on a particular medicine will have an impact on how effective it will be. Alice was known by the world for being an optimist. Despite the atrocities she faced throughout her life, she would always tell me that ‘every day is a miracle’ and that she is ‘full of joy’. Having such a positive attitude to all aspects of life meant that she faced barely any health problems relative to how long she lived for. While in the concentration camp, she survived despite eating barely any food and barely drinking while being made to play the piano for the other prisoners and she would always think that ‘where there is music, it cannot be so terrible’. This is one of many examples in Alice’s life where her emotional health triumphed against all odds and scientific reason. I am certain that it was her unfathomable optimism that was the main contributor to her long life.

Many people think of medicine as a purely scientific subject but, in fact, much research is being done to investigate the effects of art on our healthcare. Music in particular has been shown to reduce stress levels, reduce blood pressure and improve our immune response (Kushnir, 2012). Alice’s emotional health overlaps greatly with this pivotal concept of whole person care – the art of medicine. She started playing the piano at the age of four and would regularly practice into the early hours of the morning as a teenager. She became a professional pianist and was kept alive in the concentration camp in order to give concerts to the other prisoners. When the war was over and her camp was liberated, Alice and her son left for Israel where she continued her professional career and also started teaching. When I knew Alice, she had already moved to London and was over 90 years old – still playing the piano. Even in her final years, she would still play the piano for hours each day and everything would be played from memory. There is no doubt that playing complex classical compositions from memory requires significant brain activity and this is another reason Alice managed to live so long and avoided mental diminishment. Music was her medicine.

Through Alice’s life, the importance of holistic care is observed. Though the three themes that I have discussed – resilience, art of medicine and mind-body medicine – are all considered to be separate from one another, Alice’s life reveals that each aspect of whole person care is interlinked to complement the other. A huge contributor to her undefeatable resilience was her love of music and it was from her relationship with music that grew her optimism. It is only when we face extreme situations that our bodies are put to the ultimate challenge of survival. Alice was a remarkable woman who had to endure such hardships and by speaking to her throughout my upbringing, speaking with her grandsons, friends and doctors, I can conclude that her longevity was not a result of traditional medicine but of her perpetual love of life and resilience. I hope that I have shown the importance of holistic care upon examining Alice’s life and I hope that the many films and books about her will continue to inspire many generations of doctors for as soon as anyone hears her speak, nobody can deny the importance of resilience and I am confident that she will encourage doctors not to underestimate this life-saving quality.

References

• Alzheimer’s society [online]. Available at: www.alzheimers.org.uk/site/ scripts/documents_info.php?documentID=341 (accessed 5 March 2015).
• Davidson K (2010) Don’t worry, be happy: positive effect and reduced 10-year incident coronary heart disease. European Heart Journal, 31: pp1065-1070.
• Frankl V (2008) Man’s search for meaning. London: Rider and company publishing.
• Horizon (2014) [online]. Can a placebo make you cycle faster? Available at: www.bbc.co.uk/programmes/p01s6f3f/ (accessed 5 March 2015).
• Kushnir J (2012) Coping with preoperative anxiety in caesarean section. Birth, 39(2) pp121–127.
• Muller M, Piechocki R (2008) A garden of Eden in hell. London: Pan Books.
• Prochaska JO and DiClemente CC (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), pp 390–5.
• Thompson T (2011) Resilience – a concept comes of age. Journal of holistic healthcare, 8(2) pp20.