Since Russia invaded Ukraine on February 24, Ukrainians have been living in conditions of long-term and unpredictable threat to their lives. The body and the psyche are overloaded with stress. Every day, the media informs the public of horrific new details of torture, rape and murder. As the coordinator of a training program for Ukrainian mental health professionals, working with frontline providers, I heard stories beyond those in the mainstream media. I understand the depth of the lingering psychological pain and anguish.
At the start of the full-scale war, the main psychological threat was post-traumatic stress disorder (PTSD). But this is not the only consequence that the war will leave behind. Consider what other conditions and diseases may arise during or after the war.
Psychological impact of war
For the Ukrainian population, the modern conditions of Russian military aggression contribute to the simultaneous formation of individual and collective trauma. Trauma negatively affects personal, psychosomatic and social conditions. War with the enemy, in the wake of the COVID-19 quarantine, has become the perfect incubator for growing mental health issues.
Average estimates suggest that around a third of refugees in other countries suffer from post-traumatic stress disorder (PTSD), depression and anxiety. Research suggests a similar prevalence among Ukrainian refugees in the current conflict, as well as a similar prevalence among the population remaining in the conflict zone. PTSD usually coexists with other forms of psychopathology. Among PTSD survivors, 90% have at least one comorbid mental illness in their lifetime. The most common concurrent disorders are anxiety disorders, depression, alcohol abuse or dependence, and psychosomatic disorders. Since women and children are the most vulnerable, long-term family, medical and psychological support and rehabilitation of affected families is needed.
Burden of Trauma
Among the Ukrainian population, the main factors of collective trauma include:
- Significant prevalence: It covers the entire population (directly and via online sources), regardless of direct relationship to traumatic events.
- Significant public irritability: Because the interaction between people is much more important than natural and technical factors.
- A collective and global feeling of having been wronged: Painful awareness of the innocence of the victims (eg handicap of children) and inability of aggressors to resist (eg rape of babies). Where the objects of trauma are social groups, not just individuals. The whole community feels traumatized. Especially those who managed to leave in time and were not personally affected by the tragedy (Bucha, Gostomel, Irpin, Moschun, Mariupol, Izyum, etc.). Where children’s limbs, parts of genitals and pierced skulls were found in mass graves.
- The impossibility of a quick reaction: The waiting period is prolonged, people are forced to wait in lasting tension (current events are superimposed on the 8 years of war and are further reinforced by the traumatic memory of past generations).
- The long-term nature of the trauma: The war continues, there is no trauma treatment period. Untreated trauma has many unseen psychosomatic effects.
The Current State of War through a Psychological Lens
The four phases of war reflect:
- Heroism Stage: We want to succeed. This is why there is an influx of energy, and during this phase many people become volunteers. But we also do reckless things.
- Stage of the “honeymoon”: The goal of independence unites everyone, leading volunteers to achieve great feats and military to achieve extraordinary results.
- Disappointment phase: People get tired and feel depressed; they look for the culprits and where to express their anger. People are starting to get physically sick. They think about reality and are disappointed.
- Recovery stage: Understanding that basic needs must be met, this step helps people make decisions more responsibly and take care of each other. Everyone fights according to their abilities: a soldier fights on the battlefield, a teacher fights for his country and teaches children, a doctor treats patients, a cook feeds. Together, we form a united front that becomes an extraordinary force.
These steps often go in circles. New difficulties appear, the first stage begins, the Ukrainians will fight heroically and support each other. Then they are disappointed when they lack strength and opportunities. And again, they get up and learn new behaviors, listen to their needs, try new strategies, because war brings new challenges all the time.
Dealing with the psychological consequences after the war
According to forecasts of the Ukrainian Ministry of Health, about 15 million Ukrainians will need psychological support in the future, of which about 3-4 million will need to be prescribed medication. The colossal number of cases of PTSD and/or depression among war survivors has negative consequences, including significant distress for individuals and families, the potential for increased individual or domestic violence and health problems chronic mental.
In response, the provision of medical, psychological and social assistance is essential. With two organizations, I work to train mental health professionals to support Ukrainian survivors. For those seeking primary medical and psychological help, trained professionals must assess the presence of signs of PTSD for all those who have experienced a traumatic situation (refugees, participants in hostilities, displaced persons, tortured, raped, released from captivity, etc. .). Diagnostic and treatment interventions can reduce the prevalence and severity of PTSD in trauma survivors. Modern prevention of PTSD is a short-term psychological intervention in the first hours after a traumatic event; it is a “cognitive block” of traumatic images and the cognitive and emotional processing of a traumatic event.
Beyond immediate response, a comprehensive psychological first aid and crisis response system should be applied in Ukraine. We expand the galaxy of medical and psychological methods of trauma-focused diagnosis, treatment, prevention and rehabilitation of victims.
Psychological techniques help refugees overcome the distress of war. These include problem management and a multifaceted approach to stress management. The problem of training doctors and psychologists to identify and work effectively with refugees and victims of war, and above all effective rehabilitation, has become extremely important. For example, a crisis intervention program in the Acceptance and Responsibility Therapy method has been widely used. Thanks to the simplicity and effectiveness of this program, it was possible to train a large number of specialists throughout Ukraine in a short time.
Positive results of war for the human psyche
In an effort to look at the positive, we must ask ourselves if anything good can come out of this excruciating crisis. From 4 to 6 months after the start of the war, an awareness of new life priorities for personal development will appear. There will be questioning of acquired experience, and awareness of desires and values.
This can be seen in the development of organizations and the expansion of care methods. But more importantly, it will show up in the quality of a person’s daily life. For example, after a soldier lost his leg during the war, thanks to new friends, love and a great job that brought him a fair wage, he was able to take his mother to the theater for the first time. of his life. This side of war inspires and sustains our hearts.
It has also been extremely heartening to learn that so many people around the world – including so many doctors, first responders and mental health counselors – are willing to help, even at the expense of their health and time spent with their family. A low bow to you for that.
Oksana Martsyniak-Dorosh, PhD, is an associate professor at the Department of Theoretical and Practical Psychology at Lviv Polytechnic State University and Director of the Academy of TCC in Ukraine.