Daniel Schechter

Daniel Schechter

Daniel S. Schechter (born in Miami, Florida in 1962) is an American psychiatrist currently living in Geneva, Switzerland. He is known for his clinical work and research on intergenerational transmission or "communication" of violent trauma and related psychopathology involving parents and very young children.[1][2][3] His published work in this area following the terrorist attacks on the World Trade Center in New York of September 11, 2001 led to a co-edited book entitled "September 11: Trauma and Human Bonds" (2003) [4] and additional original articles with clinical psychologist Susan Coates that were translated into multiple languages and remain among the very first accounts of 9/11 related loss and trauma described by mental health professionals who also experienced the attacks and their aftermath[5][6][7][8] Schechter observed that separation anxiety among infants and young children who had either lost or feared loss of their caregivers triggered posttraumatic stress symptoms in the surviving caregivers. These observations validated his prior work on the adverse impact of family violence on the early parent-child relationship, formative social-emotional development and related attachment disturbances involving mutual dysregulation of emotion and arousal.[9][10][11] This body of work on trauma and attachment has been cited by prominent authors in the attachment theory, psychological trauma, and developmental psychobiology literatures [12][13][14][15][16]

Contents

Career

Following studies in music and French literature (Oberlin Conservatory of Music, Columbia College (B.A.), and Columbia University Graduate School of Arts and Sciences (M.A.)), Schechter then completed his medical training at the Columbia University College of Physicians & Surgeons. His earliest research examined the nature of mother-daughter relationships in the context of male-perpetrated child sexual abuse [17] as well as trauma-related culture-bound syndromes in an inner-city Caribbean Hispanic community[18]

Funding through the American Academy of Child and Adolescent Psychiatry in the form of Presidential Scholar and Pilot Research Awards, allowed Schechter to travel to Tulane University in New Orleans, beginning in 1998, to study with infant mental health specialist Charles H. Zeanah. They have since collaborated on multiple projects and articles related to the effects of psychological trauma and posttraumatic stress disorder (PTSD) on the relationship of infants, young children, and their parents as well as related attachment disorder.[19][20] This collaboration along with involvement as a Zero to Three: National Center for Infants, Toddlers, and Families Solnit Fellow (1999–2001), encouraged Schechter to pursue further research training in developmental neuroscience through a NIH-funded research fellowship in developmental psychobiology with Myron Hofer and Michael Myers at the New York State Psychiatric Institute. In 2003, Schechter received an NIMH Research Career Award to fund the project "Maternal Posttraumatic Stress Disorder and Interactive Behavior with Very Young Children" which was completed in 2008. Part of this project has involved functional neuroimaging studies, in collaboration with Bradley Peterson, of mothers with versus without interpersonal violence-related PTSD in response to own and unfamiliar child stimuli.[21]

In 2008, Schechter was appointed Director of Pediatric Consult-Liaison and Parent-Child Research in the Department of Child and Adolescent Psychiatry at the University of Geneva Hospitals.[22] He is currently also Associate Professor (Privat-Docent) of Psychiatry in the Faculty of Medicine, University of Geneva.[23]

In Geneva, his clinical research efforts together with colleagues François Ansermet, Sandra Rusconi-Serpa and others, continue to focus on the effects of parental violence-related traumatic stress on the parent-child relationship and on child developmental outcomes in the domains of emotion and arousal regulation that might contribute to intergenerational cycles of violence and victimization. Schechter's and team's research has most recently been included in a large Swiss National Science Foundation (SNSF) sponsored National Centre of Competence in Research (NCCR) grant that focuses on the Synaptic Basis of Psychiatric Disorders and that will foster application of clinical and translational research models. [24] His clinical efforts at the University of Geneva Hospitals have also maintained a focus on the needs of high-risk families with infants and young children in which parents suffer from a range of psychiatric disorders that can interfere with engagement in mutual regulation of emotion, arousal, and aggression.[25]

Schechter was Assistant Professor of Clinical Psychiatry (in Pediatrics) from 2002 to 2008 and, since moving to Geneva, has remained as Adjunct Assistant Professor of Psychiatry at Columbia University in the Division of Developmental Neuroscience and Behavior. Trained as a Psychoanalyst at Columbia, he is also Director of Child Research at the Columbia University Center for Psychoanalytic Training and Research. Schechter has been a member of the International Psychoanalytic Association since 2003 and its College of Research Fellows since 1998.

He is most recently co-editor of the 2010 book entitled Formative Experiences: The Interaction of Caregiving, Culture, and Developmental Psychobiology [26] This book is currently in its second printing.

Schechter's work has received multiple awards including: a Pierre Janet Scientific Paper Prize from the International Society for Trauma and Dissociation (2007), two Significant Contribution to Research Awards from the International Psychoanalytical Association (2005,2009), a Gertrude von Meissner Research Prize from the University of Geneva Faculty of Medicine (2008), a John J. Weber Prize for Excellence in Psychoanalytic Research from the Columbia University Center for Psychoanalytic Training & Research (2009), and the Norbert and Charlotte Rieger Psychodynamic Psychotherapy Award from the American Academy of Child and Adolescent Psychiatry (2010).[27]

Helping traumatized parents "change their minds about their young children"

During his work as director of infant mental health services at the Columbia University Medical Center (1998–2008), Schechter found that the large majority of inner-city mothers who were requesting consultation for their infants and young children for reasons of behavioral difficulties had histories of childhood maltreatment and/or family violence victimization and exposure, often with related psychiatric sequelae (i.e. PTSD, major depression, dissociation, and personality disorder). He further observed that many of these traumatized mothers, despite their best intentions, not only had great difficulty in "reading" and tolerating their infants' distress, but that they also had a tendency to misattribute their children's intentions and personality characteristics.[28][29] As a result, the child, in an effort to maintain an attachment with the traumatized parent, would conform to these misattributions and/or attempt to join the parent's hypervigilant mental state, leading to a traumatically-skewed intersubjectivity[30]

Schechter developed an experimental paradigm informed by attachment theory called the Clinician Assisted Videofeedback Exposure Sessions (CAVES to test whether mothers could "change their mind" about their young children if helped to watch video-excerpts of play, separation and similarly stressful moments in the presence of a clinician who asks the mother to think about what she (and her child) might be thinking and feeling at the time of the excerpt and at the moment of videofeedback. Thus this technique applies principles of mentalization as an aide to emotional regulation with traumatized parents[31][32] This technique also involves elements of prolonged exposure treatment—in other words confronting avoidance of trauma-related negative emotions,[33] the video-based treatment Interaction Guidance,[34] and psychodynamically-oriented child-parent psychotherapy [35] Schechter and colleagues showed a significant change in the way mothers perceived their own child and their relationship together.[36]

Intergenerational communication of violent trauma

Schechter has studied how the distressed toddler can trigger a mother's posttraumatic stress marked by a) emotional unavailability or frank avoidance and b) how mothers communicate— often unintentionally, memories of their own violent traumatic experiences. In relation to emotional unavailability, Schechter and colleagues' found that mothers with interpersonal-violence related PTSD, while not showing differences in their capacity to jointly attend to play with their toddlers before a stressor when compared to control-subjects, show significant limitation in their responsiveness to their toddlers upon reunion following separation stress. This is despite that children of PTSD mothers show no greater distress during separation than those of controls.[37] And in relation to communication of traumatic experience,following from the work of Scheeringa and Zeanah, Schechter explored the implicit and explicit non-verbal and verbal ways parents communicate their traumatic experiences to their children who may or may not have been present during these violent events.[38] In particular, Schechter has shown how a parent can vicariously and unintentionally transmit her prior experiences of interpersonal violence to her child through her behavior and narrative associations by doing or saying something— or drawing connections between actions and/or language, that the child cannot place in any familiar context, but that is by its nature, frightening or even traumatizing. His work has demonstrated this both in routine daily interactions, laboratory observations, and, most recently, in violent-media viewing practices by mothers and their toddlers in the home.[39][40][41][42] He has hypothesized that this inadvertent intergenerational transmission is often an effect of traumatized mothers' efforts to control their own psychophysiologic dysregulation that is linked to their posttraumatic psychopathology.

To test this hypothesis, Schechter and colleagues measured maternal salivary cortisol within a clinical sample of 32 mothers before and after a mother-child interaction protocol involving separations and reunions; the study led to the first publication in the literature examining maternal Hypothalamic-Pituitary-Adrenal Axis (HPA-axis) functioning.[43] The study showed modest, but significant associations between pre-separation cortisol as well as cortisol reactivity with the severity of maternal PTSD, dissociative symptoms, and atypical caregiving behavior. Since that 2004 paper, other more rigorously controlled studies have been published that further support Schechter and colleagues' hypothesis. A recent review of these studies suggests that intergenerational effects related to PTSD and HPA-axis stress reactivity are likely via epigenetic mechanisms requiring further study[44] An additional active area of study with Alexandre Dayer and Alain Malafosse in Geneva related to this association, is that of gene-environment (GXE) interactions involving the role of the serotonin-transporter gene and its polymorphisms as markers of vulnerability (i.e., increased brain plasticity). Schechter and colleagues had observed clinically and hypothesized for empirical study in the 2003 September 11 book (see also related video) that the parent-child relationship (i.e., attachment security, specific organization, and characteristics) can be a buffer against and an exacerbating factor for the adverse consequences of violent trauma. Recent advances in the study of GXE interactions in the presence of environmental stressors such as interpersonal violence, and the regulatory effects of the serotonin transporter gene and other genes with which it is known to interact on the HPA axis in the context of child development have raised questions requiring further study.[45]

One consequence of mother's at once defensive, at once frightening behavior is that the mother and child often end up having to co-construct a new moment together that resembles in feeling tone and arousal mother's original traumatic experience(s) but is by definition, new to both. The therapist, as an observing third mind, can receive the communication within and by the mother-child dyad, "connect seemingly disparate dots" and offer an alternative perspective that helps to make sense of, and thereby contain the traumatic overexcitement.

An important motivation for traumatized parents, Schechter and colleagues have found is the conscious aim of the traumatized parent to interrupt intergenerational cycles of violence and trauma so that her child does not have to suffer the emotional and often physical pain that she had experienced as a child. As Schechter and Willheim describe in a recent case-study, this can be a long and difficult process for families—and one that requires that the therapist be prepared to intervene thoughtfully (i.e. modelling and stimulating parental mentalization) as much in-the-moment in response to real-life events reported by the parents and professionals (i.e. pediatricians, daycare and preschool staff, child protective agencies, the courts) as during parent-child sessions.[46] The work with parents and their relationship with their child often needs to continue, when possible and feasible.[47] As infants and young children and their needs are so rapidly developing, and as their parents find themselves in a parallel phase of adult development during which they are more open to change, the therapist can be surprised by quick, positive shifts in relational patterns within the context of both brief consultations and long-term treatments such as for caregivers with complex PTSD and their young children.[48][49]

Infant and early childhood mental health advocacy

Schechter served as a key member of the New York City Early Childhood Mental Health Strategic Work Group, an advisory group to the New York City Department of Health and Mental Hygiene under the direction of Evelyn Blanck from 2004-2008. In 2005, the Workgroup published a White Paper,“Promoting the Mental Health and Healthy Development of New York’s Infants, Toddlers and Preschoolers, A Call to Action,” that has been used to effectively advocate for mental health services for children from birth to age 5 across all child-serving systems in New York City and New York State.[50] This paper was instrumental in the inclusion of infants and toddlers in the Child and Families Clinic Plus Initiative implemented by the New York State Office of Mental Health, thus officially recognized for the first time as under the responsibility for care by state licensed child and adolescent mental health clinical programs.[51]

References

  1. ^ Mayer, KM. (December 10, 2001). Der Terror bleibt in den Menschen (The terror lingers...). Focus, Germany
  2. ^ http://www.aerzteblatt.de/v4/archiv/artikel.asp?id=41844
  3. ^ Davaris, S. (March 18, 2011). Mon enfant peut-il me rendre fou (Can my child drive me crazy?). Tribune de Genève, Switzerland. [1]
  4. ^ Coates SW, Rosenthal J, Schechter DS — Eds. (2003). September 11: Trauma and Human Bonds. New York: Taylor and Francis, Inc.
  5. ^ Schechter DS, Coates SW, First E (2002). Observations of acute reactions of young children and their families to the World Trade Center attacks. Journal of ZERO-TO-THREE: National Center for Infants, Toddlers, and Families, 22(3), 9-13.
  6. ^ Schechter DS, Coates SW, First F (2003). Beobachtungen von akuten Reaktionen kleiner Kinder und ihrer Familien auf die Anschläge auf das World Trade Center. In T. Auchter, C. Buettner, U. Schultz-Venrath, H.-J. Wirth (Eds.): Der 11. September. Psychoanalytische, psychosoziale und psychohistorische Analysen von Terror und Trauma. Giessen, Germany: Psychosozial-Verlag. pp. 268-280
  7. ^ http://www.cairn.info/revue-psychotherapies-2002-3-p-142.htm
  8. ^ http://www.stamfordadvocate.com/news/article/Messages-from-those-lost-on-Sept-11-656435.php#page-2
  9. ^ Schechter DS, Zygmunt A, Coates SW, Davies M, Trabka KA, McCaw J, Kolodji A., Robinson JL (2007). Caregiver traumatization adversely impacts young children’s mental representations of self and others. Attachment & Human Development, 9(3), 187-20.
  10. ^ Schechter DS, Coates, SW, Kaminer T, Coots T, Zeanah CH, Davies M, Schonfield IS, Marshall RD, Liebowitz MR Trabka KA, McCaw J, Myers MM (2008). Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers. Journal of Trauma and Dissociation , 9(2), 123-149.
  11. ^ Schechter DS, Willheim E (2009). Disturbances of attachment and parental psychopathology in early childhood. Infant and Early Childhood Mental Health Issue. Child and Adolescent Psychiatry Clinics of North America, 18(3), 665-687.
  12. ^ Fonagy P, Gergely G, Target M (2007). The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology, 3, 288-328.
  13. ^ van IJzendoorn M, Bakermans MJ (2008). DRD4 7-repeat polymorphism moderates the association between maternal unresolved loss or trauma and infant disorganization. Attachment and Human Development, 8(4), 291-307.
  14. ^ Charuvastra A, Cloitre M (2008). Social bonds and posttraumatic stress disorder. Annual Review of Psychology, 59, 301-328.
  15. ^ Mills-Koonce WR, Propper C, Gariepy JL, Barnett M, Moore GA, Calkins S, Cox MJ (2009). Psychophysiological correlates of parenting behavior in mothers of young children. Developmental Psychobiology, 51(8),650-61.
  16. ^ Hibel LC, Granger DA, Blair C, Cox MJ (2009). Intimate partner violence moderates the association between mother–infant adrenocortical activity across an emotional challenge. Journal of Family Psychology, 23(5), 615-625.
  17. ^ Schechter DS, Brunelli SA, Cunningham N, Brown J, Baca P (2002). Mother-daughter relationships and child sexual abuse: A pilot study of 35 mothers and daughters (ages 1-9 years). Bulletin of the Menninger Clinic, 66(1), 39-60.
  18. ^ Schechter DS, Marshall RD, Salman E, Goetz D, Davies SO, Liebowitz MR (2000). Ataque de nervios and childhood trauma history: An association? Journal of Traumatic Stress, 13:3, 529-534.
  19. ^ Schechter DS, Zeanah CH, Myers MM, Brunelli SA, Liebowitz MR, Marshall RD, Coates SW, Trabka KT, Baca P, Hofer MA (2004). Psychobiological dysregulation in violence-exposed mothers: Salivary cortisol of mothers with very young children pre- and post-separation stress. Bulletin of the Menninger Clinic,68(4), 319-337.
  20. ^ Schechter DS, Willheim E (2009). The Effects of Violent Experience and Maltreatment on Infants and Young Children. In CH Zeanah (Ed.). Handbook of Infant Mental Health—3rd Edition. New York: Guilford Press, Inc., pp. 197-213.
  21. ^ Schechter DS, Moser D, Wang Z,et al. (in press). An fMRI study of the brain responses of traumatized mothers to viewing their toddlers during separation and play. Journal of Social, Cognitive, and Affective Neuroscience.
  22. ^ http://spea.hug-ge.ch
  23. ^ http://neurocenter.unige.ch/groups/schechter.php
  24. ^ http://www.myscience.ch/wire/eight_new_national_centres_of_competence_for_research_to_be_launched-2010-sbf
  25. ^ Almeida, A., Merminod, G., Schechter, D.S. (2009). Perinatal consultation with psychiatrically ill vulnerable mothers and newborns. Journal of ZERO-TO-THREE: National Center for Infants, Toddlers, and Families, (5), 40-46.
  26. ^ http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=9780521895033
  27. ^ http://www.cumc.columbia.edu/celebrates/issue46/index.html
  28. ^ Schechter DS, Coots T, Zeanah CH, Davies, M, Coates SW, Trabka KA, Marshall RD, Liebowitz MR, Myers MM (2005). Maternal mental representations of the child in an inner-city clinical sample: Violence-related posttraumatic stress and reflective functioning. Attachment and Human Development, 7(3), 313-331
  29. ^ Schechter DS, Kaminer, T, Grienenberger JF, Amat J (2003). Fits and starts: A mother-infant case study involving pseudoseizures across three generations in the context of violent trauma history (with Commentaries by RD Marshall, CH Zeanah, T Gaensbauer). Infant Mental Health Journal. 24(5), 510-28.
  30. ^ Schechter DS, Zygmunt A, Coates SW, Davies M, Trabka KA, McCaw J, Kolodji A., Robinson JL (2007). Caregiver traumatization adversely impacts young children’s mental representations of self and others. Attachment & Human Development, 9(3), 187-20.
  31. ^ Fonagy, P., Gergely, G., Jurist, E.L., Target, M. (2002). Affect Regulation, Mentalization, and the Development of the Self. London: Other Press, Inc.
  32. ^ Slade, A. (2005). Parental reflective functioning: An introduction. Attachment and Human Development 7(3), 269-283.
  33. ^ Foa, E.B., Dancu, C.V., Hembree, E.A., Jaycox, L.H., Meadows, E.A., Street, G.P. (1999). A comparison of exposure therapy, stress inoculation training and their combination for reducing PTSD in female assault victims. Journal of Consulting and Clinical Psychology, 67(2), 194-200.
  34. ^ McDonough,S.C. (1995). Promoting positive early parent-infant relationships through interaction guidance. Child and Adolescent Clinics of North America, 4, 661-672.
  35. ^ Lieberman, A.F., Van Horn, P., Ippen, C.G. (2005). Towards evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1241-1248.
  36. ^ Schechter DS, Myers MM, Brunelli SA, Coates SW, Zeanah CH, Davies M, Grienenberger JF, Marshall RD, McCaw JE, Trabka KA, Liebowitz MR (2006). Traumatized mothers can change their minds about their toddlers: Understanding how a novel use of videofeedback supports positive change of maternal attributions. Infant Mental Health Journal, 27(5), 429-448.
  37. ^ Schechter DS, Willheim E, Hinojosa C, Scholfield-Kleinman K, Turner JB, McCaw J, Zeanah CH, Myers MM. (2010). Subjective and objective measures of parent-child relationship dysfunction, child separation distress, and joint attention. Psychiatry;73(2):130-44.
  38. ^ Scheeringa, M.S., Zeanah, C.H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14(4), 799-815
  39. ^ Schechter DS, Coots T, Zeanah CH, Davies, M, Coates SW, Trabka KA, Marshall RD, Liebowitz MR, Myers MM (2005). Maternal mental representations of the child in an inner-city clinical sample: Violence-related posttraumatic stress and reflective functioning. Attachment and Human Development, 7(3), 313-331.
  40. ^ Schechter DS (2003). Intergenerational communication of maternal violent trauma: Understanding the interplay of reflective functioning and posttraumatic psychopathology. In S.W. Coates, J.L. Rosenthal and D.S. Schechter (eds.) September 11: Trauma and Human Bonds. New York: Taylor & Francis, Inc., pp. 115-142.
  41. ^ Schechter DS, Kaminer, T, Grienenberger JF, Amat J (2003). Fits and starts: A mother-infant case study involving pseudoseizures across three generations in the context of violent trauma history.
  42. ^ Schechter DS, Gross A, Willheim E, McCaw J, Turner JB, Myers MM, Zeanah CH, Gleason MM (2009). Is maternal PTSD associated with greater exposure of very young children to violent media? Journal of Traumatic Stress. 22(6), 658-662.
  43. ^ Schechter DS, Zeanah CH, Myers MM, Brunelli SA, Liebowitz MR, Marshall RD, Coates SW, Trabka KT, Baca P, Hofer MA (2004). Psychobiological dysregulation in violence-exposed mothers: Salivary cortisol of mothers with very young children pre- and post-separation stress. Bulletin of the Menninger Clinic, 68(4), 319-337.
  44. ^ Yehuda R, Bierer LM (2008). Transgenerational transmission of cortisol and PTSD risk. Progress in Brain Research, 167,121-35.
  45. ^ Kochanska G, Philibert RA, Barry RA (2009). Interplay of genes and early mother-child relationship in the development of self-regulation from toddler to preschool age. Journal of Child Psychology and Psychiatry. 50(11), pp.1331-8. Epub 2009 Jan 12.
  46. ^ Schechter DS, Willheim E (2009). When parenting becomes unthinkable: Intervening with traumatized parents and their toddlers. Journal of the American Academy of Child & Adolescent Psychiatry, 48(3), 249-254.
  47. ^ Almeida A, Merminod G, Schechter DS (2009). Mothers with severe psychiatric illness and their newborns: a hospital-based model of perinatal consultation. Journal of ZERO-TO-THREE: National Center for Infants, Toddlers, and Families, 29(5), 40-46.
  48. ^ Schechter DS, Myers MM, Brunelli SA, Coates SW, Zeanah CH, Davies M, Grienenberger JF, Marshall RD, McCaw JE, Trabka KA, Liebowitz MR (2006). Traumatized mothers can change their minds about their toddlers: Understanding how a novel use of videofeedback supports positive change of maternal attributions. Infant Mental Health Journal, 27(5), 429-448.
  49. ^ Coates S, Schechter DS (2004). Preschoolers’ traumatic stress post-9/11: relational and developmental perspectives. Disaster Psychiatry Issue. Psychiatric Clinics of North America, 27(3), 473-489.
  50. ^ http://www.docsfortots.org/documents/NYCMentalHCalltoAction.doc
  51. ^ http://www.omh.state.ny.us/omhweb/clinicplus/

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