– Refugees from Ukraine have limited access to information on the situation in their country. Loved ones who remained “on the other side” can protect them from traumatic images. Like a doctor who tries to make an unsuccessful diagnosis as gentle as possible. Those who remained at the front live under severe stress, not knowing what the future holds. Col. Radosław Tworus, MD, PhD, talks about the psychological trauma of Ukrainians in an interview with Medonet.
- Our Country’s aggression against Ukraine began on February 24. Bombs are falling on cities, alarm sirens sound, civilians are joining the Ukrainian army. Over 2 million refugees have already arrived in Poland
- The trauma faced by the Ukrainian nation at the moment may affect the psyche of both combatants and civilians. In extreme cases, they may also develop post-traumatic stress disorder (PTSD)
- It’s hard to talk about what is happening in Ukraine. For me, this information is very rudimentary. And biased in a way. It must be so, because war requires it – these include, among others messages that raise the spirits of the fighters, but also misinform the opponent – emphasizes in an interview with Medonet the psychotraumatologist Colonel Radosław Tworus, MD, PhD
- What’s going on in Ukraine? Follow the broadcast live
- More information can be found on the Onet homepage
Psychiatrist, head of the Department of Psychiatry, Combat Stress and Psychotraumatology of the Military Medical Institute
Monika Mikołajska, Medonet: Every day we watch images of war that until recently seemed unreal or were a voice from the past. We see the despair of people whose world has suddenly ceased to exist, who have lost everything they worked for. Those who stayed are hiding from bombs, firing fire, still endangering their lives. Those who escaped often went into the unknown. These are situations that are hard for us to imagine. Can science and medicine bring us closer to what is happening in the minds of people in such an extreme position?
Let’s start with the fact that we really know very little about the realities of the war, so we do not know the situation in which these people found themselves. Since the end of World War II, we have been a country living in peace. The old saying that “the hungry one will not understand” fits well here. We do not know much about the -Ukrainian conflict itself, as the information is distorted for the purposes of military operations. The fact that things are going wrong is evidenced by the huge number of refugees, e.g. to Poland.
Wherever war goes, fear arises in the minds of civilians who are not directly involved in combat (and therefore have no direct influence on reality). It goes back to the basics of human functioning. It is fear for the safety of life, health of your own and your loved ones. This is what happens for sure.
If the warfare is as extensive as we can see in the accounts, then surely there is also a fear-induced need for action at the moment. Some join the army or auxiliary forces and fight the invader with arms in hand. Those who do not fight try to survive and save lives, also through emigration. It is fear that allows these people to find strength and, in conditions of war, take their family to a safe place. What not so long ago seemed impossible to them, turns out to be possible (e.g. women with small children and in advanced pregnancy, crossing the border). This is the positive phase when stress activates us to act, saves our lives.
The rest of the article is available under the video.
Does high, and during war extreme, stress change our perception of reality?
You could say. Thanks to it, we have a better assessment of the situation, and our eyesight and hearing function better. Thought processes are also more intense. We are looking for various types of solutions. We become a kind of computer working at very high speed, we process a lot of data and quickly choose the solution that seems to be the best at the moment. Everyone has this mechanism. It is activated in various life situations, from family events, such as your own wedding, the death of a parent and the related mourning, through a traffic accident, a child’s illness.
And those who fled the war? Their lives are no longer in danger, but they are actually going into the unknown. Often, in a hurry, they packed into one suitcase, some into a plastic bag, leaving everything that was dear to them. It is also an extreme situation.
Of course. Let us remember, however, that people have always migrated. They do it and they will do it. People have always escaped from difficult situations. I think the most difficult thing for the refugees themselves is that they have very limited contact with those who remained in Ukraine. They also have a very limited information message about what is happening in their country. I deliberately said at the beginning that it’s hard to talk about what is happening in Ukraine. For me, this information is very rudimentary. And biased in a way. It must be so, because war requires it – these include, among others messages that lift the spirits of the fighters, but also misinform the opponent.
The most aggravating stress factor, therefore, is the lack of knowledge about what is happening to loved ones. Are they alive because if they don’t speak up, it can be different. Are they telling the truth, claiming that they feel good, or are they not speaking because they don’t want to burden us with their suffering? In medicine, which is also supposed to be based on truth, we also try to convey unfavorable news to the patient and his family gently, not to throw them straight in the eye. It may be harmful, not help.
What psychological effects can life in the extreme circumstances of an ongoing war have? Can you say something about it?
It is very difficult to analyze because we do not know what the future will be. Meanwhile, an expert in a given field of science must be based on facts, on a specific material. He cannot play the fairy. I always remind you that the greatest disgrace of many experts was the prophesying of events in the famous “Magda case”. A lot of experts, including psychologists, took the floor on this subject. Professionals have already drawn up what it was like, where the girl was taken, and what organs she was kidnapped for. The truth turned out to be completely different …
But back to the question … We can only guess what could potentially happen. Perhaps the war will end soon. And probably in people who have struggled, it will be possible to talk about disorders related to traumatic stress, such as PTSD, there will be emotions related to returning home and experiencing mourning. It may also turn out that the conflict will last for a very long time or that Ukraine will be permanently occupied (the conflict and fights will continue). Then the emotional situation will be different.
The body’s reaction, and thus the way soldiers and their families experience a difficult situation, depends on what will happen and for how long. If the families of the fighters will know that their husbands, fathers, brothers are fighting for their homeland, that the situation is controlled by them, that they have food, what to fight, they are well provided, they will be more calm about them.
You mentioned PTSD. More and more talk about him. What exactly is it, what sets it free, how does it manifest itself?
Post-traumatic stress disorder, or PTSD, is a complex set of symptoms that occurs after experiencing a traumatic situation, i.e. one in which we risk losing our own life or see another person die or be seriously injured. There must therefore be direct contact with death. It is the most common trigger of PTSD and the reactions associated with it. Importantly, while experiencing these events, our reaction is most often fear, a sense of threat, and terror. Post-traumatic stress disorder occurs later – usually a month after these events.
When it comes to PTSD symptoms, they are concentrated in three groups. The first is the bundle of reliving the trauma. Most often it is recalling this or a similar event, compulsory analysis of traumatic events (then we experience the same fear). The second beam is the avoidance beam, i.e. changing the lifestyle, avoiding places and situations that may be similar to those tragic events. The third bundle concerns over-arousal and is often associated with aggression, outbursts of anger, anger, even the destruction of objects.
Who is at greater risk of PTSD?
Anyone can experience post-traumatic stress, regardless of experience or “inner strength”. The high-risk group are those who have come into direct contact with death, with the sight of the wounded and the dead, with a direct threat to their own health and life (being in a place where rockets fell, bombs, where artillery fire took place). The more such experiences there were, the greater the probability of developing PTSD.
It is certainly not the case that PTSD can develop from just hearing about the war, from watching TV shooting at my home, from listening to the sounds of gunfire or bombs. As I said, this contact has to be direct, it is very important. Even then, we cannot say for sure that PTSD will occur. It may or may not be the case. There is no such relationship. Not everyone who has experienced the nightmare of war or other life-threatening traumatic situation will have PTSD. Let’s not dramatize it, please.
So how often does PTSD occur? What is the scale of this disorder in a society affected by war?
Mental health problems in war situations do not affect the majority but the minority. It is not that as a result of the war, 70 percent. society will have PTSD. This percentage is estimated at a maximum of 30 percent. actively involved in extreme war events (both soldiers and civilians). Of course, there will be more people with problems among actively fighting soldiers, but the estimates do not exceed 50 percent. Therefore, it cannot be assumed that a large part of the society will develop serious disorders of the PTSD type.
So what difficulties may arise here?
The problems that will start after the end of hostilities, i.e. after the mobilization phase and adaptation to the new situation, will have a larger scale. The scale of the destruction will be visible, it will bring economic and economic problems. «We have nothing. We don’t have houses, flats, economy, jobs, money. We have no relatives because they died ». If the conflict ends with a victory for Ukraine, the victory will motivate people, if not – the loss will cool down their enthusiasm. All of this can give rise to depressive reactions and other mental deficits.
Of course, it doesn’t have to be this way. Much will depend on the Ukrainian government’s policy, reconstruction strategy, information messages (simple messages, clearly defined goals, etc.). This will help society recover from the crisis of war.
We should also remember that man is a living organism, our reactions depend on many factors. Man is not a machine that breaks down according to some pattern. Besides, what is extremely important about the matter we are talking about: man has tremendous self-healing abilities. If he is not disturbed and does not do certain things by force, the body is perfectly able to find a way to help itself.
I cannot fail to mention the issue of helping Ukrainian citizens fleeing the war. What can be done to make them feel better mentally?
The most important thing is to be with another person, talk to them, not ask questions, but just talk. And be consistent and authentic in this message. Let’s treat them as normal people trying to find themselves in new conditions, in a new place. We accompany them in this. This is the simplest solution. And we often forget about them.
We encourage you to listen to the latest episode of the RESET podcast. This time we are talking about the war in Ukraine and the drama of our eastern neighbors. We help as much as we can, but we ourselves are full of fears. Is it possible to get rid of them? How to help, but also how to take care of yourself? You will hear about this and many others below.
Also read:
- Ukrainian women give birth in shelters and cellars. “Under these cruel conditions, the fullness of femininity is created”
- We threw ourselves into helping Ukraine. The psychologist explains what drove us
- The doctor is hiding in the basement with a panther and a jaguar. «I’m going to endure»