Kate Pokrovskaya, a 39-year-old psychotherapist, was sleeping at her home in Kyiv, Ukraine, on February 24 when she and her husband were awakened by the sound of explosions. Russia had launched its invasion. “At that point, our life stopped,” she said.
Pokrovskaya tried to help her patients cope with the stress and trauma of war. But she lived it herself.
“We started to sleep badly; my body was tense,” she said. “The sirens were becoming more and more frequent, especially at night. It was all very oppressive and exhausting mentally and physically.
In early March, Pokrovskaya saw on Telegram that Israeli psychotherapists were offering free support to their Ukrainian colleagues, drawing on their country’s war experience. She asked for help and found something transformative. “It is very valuable for us to be able to discuss our problems with such great specialists,” she said.
The Israeli group was started by Jenya Pukshansky, a Ukrainian-born psychologist in Israel. Pukshansky initially posted her phone number on social media, offering support to Ukrainians, but was soon overwhelmed with requests for help. Along with her colleagues, she organized hundreds of Israeli mental health professionals who volunteered their services, first as crisis support for people seeking help, then as longer-term referrals for therapists in Ukraine.
They are now engaged in a hugely ambitious project: to help Ukrainians cope with the mental health consequences of war, even as the war continues.
Most people who go through a traumatic event – defined clinically as an episode of real or near death, serious injury or sexual violence – have a period of symptoms like nightmares, anxiety or headaches, say the experts, but then recover.
A smaller subset develop long-term debilitating distress or post-traumatic stress disorder. George Bonanno, a professor of clinical psychology at Columbia University who studies trauma and resilience, put the total at less than 10%. In a country where millions of people have experienced traumatic events, that’s a lot. And in some circumstances, the percentage of people who develop PTSD may be higher.
One factor in whether people develop long-term problems is whether their community shares the trauma, said Patricia Resick, a Duke University psychiatry professor who developed cognitive processing therapy, a specialized form of treatment. traumas. “We see lower rates of things like PTSD after natural disasters than after individual events because of community involvement,” she said. “They support each other, and sometimes that’s a crucial difference.”
War can be that kind of shared experience, especially when the nation unites against a common enemy, as Ukraine did against Russia.
But some types of trauma are more isolating. “When you’re raped, you’re raped alone,” Resick said, referring to both the typical circumstances of the crime and the stigma that ensues.
Soldiers experience trauma but often feel isolated and ashamed as well, said Valery Hazanov, a psychologist in Jerusalem who helps run Pokrovskaya’s supervision group. In the “macho” Israeli army, he said, the opinion was that “if you come back with PTSD, then something is wrong with you”.
This mindset has started to change, especially since the 2006 war with Hezbollah in Lebanon. “Today it’s much more in the talk,” Hazanov said. “There’s more of an understanding that trauma is an integral part of what’s going on here.”
He hopes the Israeli project will help Ukrainian therapists foster a similar mindful adjustment. “We spoke directly with them about it, and we kind of anticipated and thought about this change together,” he told me.
Pokrovskaya wants to make it a priority to correct public perceptions of trauma and destigmatize the notion of going to therapy. She wants Ukrainians, she said, to “develop a culture of seeking help from specialists, rather than fending for themselves.”
Treatment and survival
For now, the war continues, for therapists in Ukraine as well as for their clients.
Pokrovskaya was temporarily moved to a nearby town but still felt she could not escape. “There were days when the explosions did not subside. Emotionally and physically it was very hard,” she said.
Over time, she marked the progression of the invasion through the changing needs of her clients. “At first it was emergency aid,” she says. “There were a lot of requests to deal with panic attacks.”
Later, people sought help with relocation issues: conflict with new neighbors or between family members hosting formerly estranged relatives. Relationships fractured under the stress of mothers taking their children out of the country while fathers stayed behind to fight.
Now, Pokrovskaya said, many patients grapple with longer-term trauma and grief as they grapple with the scale of their losses. “It’s hard for them to deal with their emotions,” she said. “The realization of the magnitude of the losses for their families is coming.”
In April, she and her husband returned home to Kyiv. They hope to stay but are ready to flee at any moment. “We always have a plan in our heads,” she said. “We have everything ready, the emergency suitcases.”
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