Ukraine: From Invasion to PTSD (Newsweek, Part 1)

Uploaded 8/23/2022, approx. 13 minute read

We are in Bucharest, Romania, and I am honored to meet you here.

Please tell us about your work. What are you doing? What's your career? What are your main accomplishments? And of course, what are you doing in Romania?

Well, my name is Sam Vaknin, I am a professor of psychology in the outreach program of SIAS consortium of universities, it's known as CIAPS, Centre for International Professional Studies, and I am a professor of psychology and professor of finance at several universities in several countries. Until recently, actually, in Russia as well, I resigned my position in view of the invasion of Ukraine. But I used to teach there. I taught there for six years. I got to know people, I got to know the environment, I met oligarchs, I met political leaders, and so on and so forth.

And while I deeply liked the people, I grew very alarmed with what was happening among the elites.

The elites were being radicalized, nationalized, they lost touch with reality, they became delusional, they became more and more religious in the bad sense of the word, and so I really grew very alarmed.

In the past two years, I taught only online, only distance learning, because I really was very worried about what's happening here.

And in Romania?

In Romania, I came to work with private clients, I provide counseling and therapy, and my own brand of therapy, it's a new treatment modality, Cold Therapy, so I'm working with several clients.

I was very surprised by the demand, one far exceeded my expectations, so I'll be visiting often. I hope to establish a permanent connection with this country. I like it a lot. I like the people a lot.

You mentioned Ukraine and this war. What do you think about this war, and what kind of consequences from the psychology point of view would be in Ukraine because of this war?

One very important fact that is often neglected in the analysis of this war, and I will not go into geo-strategic or geo-political, it's not my forte. My forte is psychology.

So one fact that is often overlooked is that the Russians, considering the Ukrainians, their brothers. They actually called them small brothers.

The Ukrainians, over centuries, starting with the Kiev Principality, had an affiliation, not to say affinity, with Russia and with Russians.

There are many mixed marriages, there are many hybrid populations, there are many people who speak Russian and yet identify as Ukrainians, and there are many people who speak only Ukrainian and actually identify with Russia and aspire for Russian.

It's not a clear-cut situation, so it's like an internecine fight between brothers. It's like one brother killing the other. It's like Cain and Abel in the Bible.

This background enhances the trauma involved in any war. It's like an inter-family feud which results in bloodshed and so on.

The trauma in this case is much more enhanced because the brutality and barbarity of the war had been unexpected.

While I think many people in the last stages before the war started, many people anticipated an attack on infrastructure, an attack on the air force, so very few people had believed that the Russians would level cities, kill civilians, deliberately target shopping malls and schools and hospitals, very few people believed that because of the common history and so on.

Even people who were adversaries of Russia or regarded Russia as a malevolent, malignant force couldn't bring themselves to believe that Russia will target Ukrainians because they are Ukrainians.

That has been a massive shock in my view, and this places the template on which trauma evolves.

Now we have two types of trauma. We have PTSD, post-traumatic stress disorder, and we have what we call complex trauma or CPTSD.

PTSD is a reaction to an event. You see someone killed, you get injured, your child dies, a bomb drops on the school. Something, you witness an event or you're involved in an event or you're the victim of an event, that creates PTSD, post-traumatic stress disorder.

By the way, not in everyone, luckily, but in a minority, usually 10-20% of the witnesses.

But still it's a huge number because if a bomb falls and 1,000 people witness the event, 200 of them will develop PTSD.

We can therefore safely say that PTSD we will have in Ukraine at the very least, 3 million people with PTSD, at the very least.

Complex trauma is even more common. Complex trauma is when you are repeatedly exposed to a series of minor traumas.

For example, having to leave your home, or having to watch your dog die, or having to see your school destroyed, or enduring hunger and thirst on the way to Germany.

All these things are mini traumas. When they accumulate, we have a phenomenon called CPTSD, a complex trauma, which was first identified in 1992.

So our understanding of this phenomenon is not complete, to use another statement.

Complex trauma is much more common than PTSD. And that means that there's a very high likelihood that 25% of the population of Ukraine will display post-traumatic effects.

Post-traumatic effects are defined in the fifth edition of the Diagnostic and Statistical Manual.

And trauma is a systemic affliction. Everything is affected. Your ability to think, your ability to verbalize, your ability to trust others, your ability to consider yourself positively, your ability to believe in a better future, your ability to sleep. Everything is affected.

Trauma is a systemic event which destroys all modes of functioning. You become less empathic. You are unable to sustain relationships. You have intrusive thoughts. You have flashbacks.

Flashback is not just a memory. Flashback is when you mistake reality. You think you are back in the traumatic event. It's not just that you remember the traumatic event, but you are suddenly reliving the event. So there will be flashbacks. Nightmares are very common, debilitating nightmares, and so on and so forth.

These are conditions that last at least one month, but that's a joke. That's the DSM's joke on us. Most PTSD conditions last for years. And CPTSD lasts a lifetime.

So we are talking about one quarter of an enormous country which will live for a very long time in a state of trauma and will be unable to perform or to function both with themselves and with others, which will hamper any attempts at recovery and healing after the war.

And there are a series of mistakes when we come to PTSD. A series of misunderstandings.

The first one is that you could either have PTSD or CPTSD. You could either have the acute reaction. It's also called acute stress reaction. You could either have an acute reaction or a prolonged chronic reaction, like a chronic condition and acute condition. That's wrong. You could have both. And many people will have both.

The second thing is the belief that traumatic reaction is immediate. You see a bomb falling next to you. You are immediately traumatized. That is not true. A traumatic reaction can develop months after the event.

Now this is a seriously worrying thing, what I just said, because it means that we're going to look in Ukraine after the war is over and the war will be over at one point. We're going to look at people and they're going to seem to us totally normal. And we are not going to treat them because they don't present any symptoms and any signs.

And then suddenly a few months later they will go berserk. They will disintegrate. They will fall apart. And they may even harm other people.

So it's like an insidious slow acting poison which can erupt months later in people where we have no indication that it's at work.

This is the second mistake.

The third mistake is that we think that trauma is universal.

Like as I said, if a thousand people are exposed to a traumatic event like a bomb falling or someone killed or whatever, then all thousand will have some kind of trauma. Small trauma, big trauma. That's not true. Luckily.

In this group of people there will be traumatized people. Some of them will have PTSD. Some of them will have lesser traumatic reactions.

But there's a big group of people who will remain untouched. These are resilience leaders.

What we need to do is to use or leverage these people who are untouched to help sustain, support, recover and heal those who are touched.

Now what I've just said is a bit unorthodox because it's a different approach to healing trauma. Instead of sending people with trauma to a clinician, to a therapist, to a psychiatrist, to a psychologist, we are actually sending people with trauma to other people who share the same event, the same experience but were not affected by trauma.

We believe it's a much more effective strategy. Also much more doable in Ukraine because how many therapists and psychiatrists can you have in a country? There's a limit.

So we need to use the people who share the same experience to help each other. That leads me to the last point.

The last point is that it is wrong to consider trauma as an individual event.

Trauma is a communal event. It's a community event.

When your village disintegrates, you don't lose only your home or your school or your dog or even your father and mother. You lose the fabric, the fabric in which you were embedded.

You lose social connections. You lose your place in the hierarchy, relative positioning because all of us position ourselves relative to other people. Suddenly the frame of reference disappears, the context. People are plucked out of context and they feel adrift. They feel floating.

So we need, in massive crisis like this, we need to work with communities, not with individuals, which ties into what I said earlier.

We need to work with people who share the same experience, are resilient and belong to the same community. We need to rebuild communities. As we rebuild communities, the level of trauma will abate.

There are guidelines by the World Health Organization. Guidelines that were created after the crisis in South Sudan, in Rwanda, to some extent Kosovo and so on. And these are the guidelines today that dominate the treatment of trauma.

The First Lady of Ukraine has already announced that Ukraine as a country is going to deploy the WHO guidelines for the treatment of trauma.

But we need to augment these guidelines. We need to augment these guidelines with a community approach. You need to augment it with a community approach.

Because if you heal the individual's trauma, but you don't provide the individual with refurbished and renewed context, the individual will relapse. There will be remission, remission and then relapse.

And so this is the challenge that faces Ukraine.

Now there's a question of budgets.

There's a question of allocation of resources.

How you and other experts can help Ukraine to recover at least?

I personally made myself available, of course, free of charge. I made myself available fully as long as it takes to help to train local mental health practitioners in Ukraine to treat people.

But this is less than a drop in two oceans.

We need to establish a Peace Corps, the equivalent of a Peace Corps, of mental health experts from all over the world. Israeli mental health experts are very good at trauma. Some American mental health experts. Mental health experts from Asia and from Africa where such disasters are very common and so forth.

And we need to mobilize all these thousands and tens of thousands of mental health practitioners and so on. And they need to rotate, to serve in Ukraine, to rotate a month a year, I don't know, a week a month, whatever it is.

It's like, you know, when there was the Spanish Civil War, there was the international legion. We need such a thing, but of mental health practitioners.

The problem with Ukraine is that the devastation of the infrastructure, I mean physical infrastructure, is such that the absorption capacity of the country is extremely limited.

Even if tomorrow we were to mobilize, let's say, 10,000 mental health experts, where do you launch them? How do you transport them? Where can they work? And so on and so forth.

So we need to reconceive of how to administer therapy in case of trauma.

First thing, we need to go to the field. We need to have mobile units, simply mobile units, vans with two or three psychiatrists, to travel to all the villages and all the, and so on.

Second thing, we need to work with the Ministry of Interior to recreate lists of communities. So we need to, for example, take a village and we get lists of all the citizens and denizens before the war. We need to locate them. We need to bring them together.

Now, we don't need to bring them together physically, luckily. So we can create virtual communities, digital communities, put together.

So there's 20 Ukrainians in Germany, 14 in Poland, 13 in Romania, and so on. All of them belong to the same village. We bring all of them together in a global online digital village.

And they have, somehow, to interact with each other and to speak?

That's the idea. The idea that this village is recreated online, because at this stage, it's impractical to think that.

And to share somehow their feelings, their thoughts, their losses.

Some of them will be traumatized, some of them will not. And the ones who are not traumatized will support the ones who are traumatized with the mediation of mental health practitioners, mental health practitioners will be like moderator or supervisor.

So this would leverage each mental health practitioner will be able to cope with 5000 people, 10000 people, because they will have many helpers, these helpers will be members of these digital communities.

You know, we have to use everything, technology, everything.

The restoration of the infrastructure in Ukraine, judging by, for example, what happened to Nazi Germany after the war. It's the same level of devastation, by the way, is, I don't need to tell you. The restoration will take something like 15 years, something like 15.

So we don't have, we can't wait for 15 years. We can't wait, for example, the rate of suicide, the whole people with PTSD is 11%.

Yes, if we are talking about, at the very least, 3 million people, if we don't hurry, half a million of them will commit suicide.

It's an emergency. So it's a health emergency. It's exactly like cholera, cholera, or some infectious disease that breaks out.

You don't say, well, there's infectious disease, we'll treat it in five years. It's an emergency. PTSD is an emergency.

And this kind of trauma is more intense in the case of children?

It's a very good question with a surprising answer. Children are more resilient than adults, more resilient actually than adults, but the trauma distorts their developmental path.

So while they don't react as badly as adults, for example, the suicide rate, when you say children is not teenagers. Teenagers react like adults. It's a same group.

But children, usually when we say children, we mean under the age of six.

So children in this age group, for example, the suicide rate is close to zero. They don't react as badly as adults, but it has a massive and severe impact on their later life development.

They become problematic as adults.

Actually, we trace most personality disorders, like narcissistic personality disorder, borderline personality disorder. We trace these to trauma, early childhood trauma.

The trauma of this type could lead to personality disorders, but even more so to mood disorders, anxiety disorders, which are lifelong, require medication, school counseling, follow-ups and so on.

And many of these children can develop antisocial behaviors. You could definitely anticipate an explosion in the crime rate, that's for sure.

It's a universal reaction, which is essentially post-traumatic reaction.

Many children, maybe millions, left Ukraine.

It's a trauma. It's a trauma in itself. Dislocation is a trauma in itself.

Refugees are defined as prime traumatic population, cohort, it's called, prime population, traumatic population.

Immigration, dislocation, forced, forced, not willing.

Even willing, by the way, even if you migrate willingly, it's a bit traumatic, but definitely forced and sudden.

For many of them, there were no other options. So they were forced to leave because otherwise they had to face bombs and death, daily basis, daily...

No disputes this, of course, but still it's a trauma.

The elements of trauma are the suddenness, you can't prepare for it.

If you prepare for trauma, the level of trauma is much lower.

Never mind how bad the event, if you have time to prepare, it's much lower.

For example, we see different rates of trauma among cancer victims.

If the cancer is slow and you have pre-advice, you know you're going to die in 5 years or 10 years, your level of trauma is much lower than if you get a sudden type of cancer, pancreatic cancer or liver cancer, that kills you in 6 months.

The inability to prepare, so the suddenness, the abruptness and the dislocation are very traumatic in themselves.

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