Traumas of War – Psychotherapist on Warning Signs and Self-Help Techniques

War can be frightening, difficult and traumatic, not only physically but mentally. For the past eight months, Ukrainians have experienced the most difficult of times and been confronted with a complex set of emotions, such as grief, loss, fear and even guilt.

Kyiv Post’s Alisa Orlova explored these topics in an interview with psychotherapist Oksana Purzhash who specializes in Gestalt therapy. This type of therapy focuses on a person’s experiences during the present time and how individuals respond and adjust in relation to their situation.

Could you describe what was likely happening to the psyche of Ukrainians during the first few weeks of the war?

In the first weeks of the war, we all had an acute stress reaction, where we each would have responded in accordance with our in-built stress mechanisms. Some will have frozen, some will have run away, while others will have gone to the military commissariats to fight and defend the country.

These are well known “fight or flight” reactions, along with a desire to try end help and calm those around us. For instance, I know of a girl who left the country because her mother desperately begged her, but the girl herself really wanted to volunteer and help. Those who acted according to what their psyche told them found it easier than those who succumbed to the persuasion of others. That said, it is likely that everyone at some point will have doubted their own choice.

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As time has moved on, how would you describe our emotional state? Has it changed?

Exhaustion has now come to the fore. We have experienced conditions of chronic stress combined with – for the most part – relative safety for around eight months now. I’m talking here about those who are in Ukraine.

For Ukrainians abroad, the situation is somewhat different. The sense of safety may be greater or smaller depending on the person and their situation. But a sense of basic safety is, perhaps surprisingly, what we all need for a decent life.

Regardless of whether or not someone reacts to an air alert (in the sense that you go to a shelter or move at least two walls away), a person still reacts psychologically. You hear the alert, you see the notification on your phone, and – even if you choose to continue what you were doing (I’m not encouraging anyone to do that, just stating it as common practice) your body still reacts.

In the event of an air alert, our sense of relative safety becomes smaller. On top of that, the alert can affect our plans, for example where transport stops running, establishments close, etc. There is also now the added complication of power outages which makes it even more difficult to plan something.

These factors place incredible stress upon us and can be very difficult. The fact that many people, despite everything, continue to live and work, donate and support others, helps them to cope. It also inspires great respect, because it takes much more energy now just to live. People often forget about this and place high demands upon themselves in the same way as at a pre-war level.

Many people also begin to devalue themselves, including their work and how they live their daily lives. It can often seem that they have no right to fatigue, disappointment or even their life, because someone else is closer to the front or under occupation, while another person might have died.

It is as though someone, somewhere, being worse off, somehow negates or devalues what we are experiencing ourselves. This is also one of the signs of fatigue – the inability to resist such thoughts, and to protect, support and validate yourself and your own feelings and needs.

By maintaining our daily routines, are we becoming more accustomed to grief and death or is this how our inner protective mechanisms work? If these are indeed defense mechanisms, what might be the result of suppressing our emotions be once the war is over?

Should it be otherwise? Yes, the war is continuing, but so too is life. It comes down to focus. Sometimes we focus on the news and it can be difficult because it triggers a lot of different reactions: rage, anger, disgust, pain, and – the hardest thing, in my opinion – powerlessness.

It is neither possible nor necessary to experience these difficult responses all the time.

The current situation is absolutely unprecedented: on the one hand a war “live on air”, with a constant “sensitive content” warning, juxtaposed alongside daily life where we talk with friends, go to work, joke, eat, drink coffee etc.

It is not necessarily about suppressing emotions. This is our life now.

If these are indeed defense mechanisms, what might be the result of suppressing our emotions be once the war is over?

It’s difficult to talk about it now, because everything will strongly depend on how long the war will last. We will only be able to comprehend, understand and feel it more clearly once the war is over. Only then, will we begin to fully process the traumatic experience (and this is exactly what it is) in safety.

Please can you tell me more about post-traumatic stress disorder (PTSD)? Can a civilian who did not fight at the front or did not see the atrocities of war with his own eyes develop PTSD?

 PTSD is the inability of the psyche to process a traumatic experience, and when the brain seems to be “stuck” in that event and does not perceive it to be over.

PTSD can greatly affect a person’s life, behaviors and relationships with others, and can manifest in a number of ways These can include physical responses (breathing problems, high blood pressure, headaches, nausea, dizziness, heart palpitations, etc. ); emotional (fear, anxiety, guilt, restlessness, irritability, loss of control, etc.); and behavioral (alcohol or drug abuse, difficulties in communication and handling relationships, reduction or loss of interest in activities and things that used to matter, possible antisocial behavior or avoidant behavior that serves to steer you away from reminders of the trauma).

Changes take place in the brain itself, including those structures responsible for self-control, response to stressors, memory, empathy and planning. This is especially useful to note for those who advise you to just “pull yourself together.”

A traumatic event is an event that threatens or is experienced as threatening the life of a person or a loved one, their physical health and integrity, their self-image, and is accompanied by intense fear, feelings of helplessness and loss of control. It is an excessive amount of stress that exceeds the ability of the psyche to cope with it.

So, yes, people who have not been at the forefront of the war or experienced occupation can still develop PTSD. Whether a person develops PTSD will be strongly influenced by factors such as their personality; the type of stress involved (natural disasters are easier to cope with than wars, torture and rape); and protective variables (such as how the environment reacts and whether it acknowledges the traumatic event and provides support/instigates blame).

The risk of acquiring PTSD can increase where (for example) a person has a history of trauma or stress, few coping resources, reduced self-regulation and self-support, and/or a lack of social support. According to various sources, PTSD tends to develop among 6-20 percent of people who experience a traumatic event. In Ukraine, a PTSD diagnosis can only be made by a psychiatrist, so if you have suspicions about your own condition or that of someone close to you, you should go to a psychiatrist.

What does a person find more traumatizing: the death of people around, or fear for their own life and the lives of their loved ones?

It is impossible to say in general terms what traumatizes people the most. It very much depends on the circumstances and personal values of each person. For example, is it horrifying to see the bodies of murdered people? Yes, of course it is. Does it cause the same reaction to see the bodies or photos of the bodies of killed occupants? No, absolutely not. And that is quite understandable given the situation.

Similarly, for someone whose home is the most important thing in their life, seeing its destruction or desecration may well become a trigger for trauma. And for someone who has built their identity around their professional life, a trigger may be the loss of work. So, these things can also be traumatic – not only death or the threat of it.

Apart from PTSD, what other mental disorders could Ukrainians develop after the war?

PTSD, depression, anxiety disorders and alcohol addiction are all possible. Somatic diseases caused by prolonged stress might also be a problem. Therefore, it is important to actively monitor this now: do not neglect your health and seek help if possible.

 How should support be provided to a person who has survived a traumatic event, such as a massive rocket attack, loss of their home, loss of a loved one, living under occupation, or experiencing humiliation and torture?

 First, you need to ask if the person needs help. It also depends on when the event took place (five minutes ago, a week ago or a month), and whether the person perceives it as traumatic and needs support at that point.

The main thing is to pay attention to what is happening to the person. Listen to what they are saying and be ready to support them without prejudice and condemnation. Do not put pressure on them and do not ask about the circumstances of what happened, so as not to retraumatize them. Do not make assumptions about what happened to the person either. If they want to share it, they will share it.

Is it normal to go on enjoying life while other people are suffering?

If you look more broadly, someone, somewhere is suffering in the world all the time. It’s been happening from the moment of our birth to the present time.

But if you narrow it down, how can someone who is (let’s say) in a worse condition, be helped by your suffering? The beginning of the full-scale war in Ukraine was the impetus for many people to stop putting things off for later. Like never before, people have felt that life is finite and decided to stop postponing life for later. It is a fact. Is it bad?

I may feel good at the same time someone else feels bad. One does not exclude the other. We live in a complicated world.

What should someone do if they have feelings of hopelessness?

 Well, for many people, it is a crisis. A crisis of relations with the world, with others, and with God. This is the time to look for new meaning and answers. Questions to ask might include: What matters to me in life now? What can I rely on? What supports me?

You can then do something where you see the result, be it cooking, cleaning, painting or something else. Pay attention to your body. Stretching, yoga, sports, jogging or dancing can help. So it’s about working in two directions at once: spiritual and physical. And remember that this is how times are now. It is natural if it feels difficult for you.

While we are still in danger, what can be done to reduce the risk of developing PTSD? Do you have any recommendations that could help us to better adapt to the current normal?

 Firstly, it’s important not to dismiss our feelings but notice and identify them. In his book “Emotional swings of war,” Volodymyr Stanchyshyn recommends keeping a “diary of war” and writing about our experiences every day. Even if we don’t know what to write, or if it seems mundane, uninteresting or difficult, he suggests it’s worth trying.

It’s also important to acknowledge your fatigue and let yourself rest when you have the opportunity. Take part in activities that you want to do and that bring pleasure. Ensure you get enough sleep and eat well. Sleep and appetite are core to what our psyche is built on.

Pay attention to your body, notice what surrounds you and create safe spaces for yourself where there is no war. At least for a while. You could do this by watching a movie, reading a book, meeting with friends etc. These freedoms can help to remind us why we endure what we have to endure.

Communicate with people and with animals. It’s incredibly important. Trauma is formed in solitude. If you share your experiences with someone, and if you can talk about it, cry or grieve, there is a high probability that it will not become a trauma. A difficult episode of life – yes. Something displaced, undigested, unprocessed – no. We need one another.

Another important thing is not to wait for the return of the former life. The world has changed. People have changed. Someone has left and will not return. Someone else has died. And between some people there might now be irreparable differences in views. The past life as it was will never return. It’s important to grieve and mourn, because we cannot change the present without going through that process.