Kate Pokrovskaya, a 39-year-old psychotherapist, was asleep at her home in Kyiv, Ukraine, on Feb. 24 when she and her husband were awakened by the sound of explosions. Russia had launched its invasion. “At that moment, our life stopped,” she said.
Pokrovskaya tried to help her patients cope with the stress and trauma of war. But she was living through it herself.
“We began to sleep badly; my body was tense,” she said. “The sirens became more and more frequent, especially at night. All this was very oppressive, and mentally and physically exhausting.”
In early March, Pokrovskaya saw on Telegram that Israeli psychotherapists were offering free support to their Ukrainian colleagues, drawing on their country’s experience of war. She reached out for help and found something transformative. “It is very valuable for us that we can discuss our issues 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 quickly overwhelmed with requests for help. Along with colleagues, she organized hundreds of Israeli mental-health professionals who volunteered their services, first as crisis support to people seeking help, and then as longer-term guidance for therapists in Ukraine.
They are now engaged in a dauntingly ambitious project: helping Ukrainians to address the mental-health consequences of war, even as the war is ongoing.
Most people who go through a traumatic event — defined clinically as an episode of actual or threatened death, serious injury or sexual violence — have some period of symptoms like nightmares, anxiety or headaches, experts say, but then recover.
A smaller subset develops debilitating long-term distress, or post-traumatic stress disorder. George Bonanno, a clinical psychology professor at Columbia University who studies trauma and resilience, estimated the total as less than 10 percent. In a country where millions have experienced traumatic events, that adds up to a lot of people. And in some circumstances, the percentage of people who develop PTSD can be higher.
One factor in whether people develop long-term problems is whether their community shares the trauma, said Patricia Resick, a professor of psychiatry at Duke University who developed cognitive-processing therapy, a specialized form of trauma treatment. “We see lower rates of things like PTSD after natural disasters than we see after individual events because of community involvement,” she said. “They’re supporting each other, and sometimes that’s a crucial difference.”
War can be that kind of shared experience, particularly when the nation unifies against a common enemy, as Ukraine has against Russia.
But some kinds of trauma are more isolating. “When you’re raped, you’re raped alone,” Resick said, referring to both the typical circumstance of the crime and the stigma that follows.
Soldiers experience trauma but often feel isolated and ashamed of it as well, said Valery Hazanov, a psychologist in Jerusalem who helps lead Pokrovskaya’s supervision group. In the “macho” Israeli Army, he said, the view used to be that “if you came back with PTSD, then something is wrong with you.”
That mind-set has begun to shift, particularly since the 2006 war with Hezbollah in Lebanon. “Nowadays, it’s much more in the discourse,” Hazanov said. “There’s more of an understanding that trauma is part and parcel of what’s happening here.”
He hopes the Israeli project will help Ukrainian therapists foster a similar adjustment in consciousness. “We’ve been directly talking with them about this, and kind of anticipating and thinking together about this shift,” he told me.
Pokrovskaya wants to make a priority of correcting public perceptions of trauma and destigmatizing the notion of going to therapy. She wants Ukrainians, she said, “to develop a culture of seeking help from specialists, rather than cope on their own.”
Treatment and survival
For now, the war is ongoing, for therapists in Ukraine as well as their clients.
Pokrovskaya was temporarily displaced to a nearby town but still felt she couldn’t 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 shifting needs of her clients. “At first, it was crisis assistance,” she said. “There were many requests to cope with panic attacks.”
Later, people sought help with the problems of displacement: conflict with new neighbors, or between family members hosting once-distant relatives. Relationships cracked under the stress of mothers taking children out of the country while fathers stayed behind to fight.
Now, Pokrovskaya said, many patients are struggling with longer-term trauma and grief as they grapple with the magnitude of their losses. “It is difficult for them to cope with their emotions,” she said. “The realization of the scale of 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 time. “We always have a plan in our heads,” she said. “We have everything ready, emergency suitcases.”
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