War is difficult and painful. How are Ukrainians managing the heavy psychological stress?

Photo: Master1305 / Shutterstock

This past summer, the wife of the Ukrainian president, Olena Zelenska, said that, according to the Ministry of Health, at least 60 per cent of Ukrainians need psychological support due to the Russian aggression, noting that the consequences of Russian aggression were discussed at a meeting of the working group of the National Program of Mental Health and Psychosocial Support. According to the first lady, due to the Russian aggression, millions of people became internally displaced and were forced to go abroad: 44 per cent of Ukrainian citizens are separated from their families, and 50 per cent of Ukrainians rate their psychological state as very tense.

Situation on the front

“The situation has developed in such a way that all of us who have stayed, and even our fellow citizens who have left, are participants in the war. Some shoot, others get shot at, others suffer because they shoot at someone, and someone has lost property or faith in humanity. Everyone can have their own trauma, and it is definitely a very stressful situation”, says Volodymyr Mamalyga, a psychologist who served in the Armed Forces of Ukraine and recently retired.

According to Mamalyga, many people have post-traumatic stress disorder, which manifests itself gradually, even a year later. A separate issue is the shocking situation the fighters who return from the frontline find themselves in.

“I myself more than once had to, let’s put it this way, bring the fighters who came from the frontline back down to earth. I had to apply the simplest techniques to explain to a person that he is no longer there, in battle, but here, on peaceful ground. This is necessary because for the most part full-time psychologists are located somewhere in the headquarters, not at the place of permanent deployment in the units … Who is on the front lines, besides the soldiers? These are doctors, cooks, logisticians, signalmen, and chaplains. But I haven’t seen psychologists,” he adds.

Mamalyga recently underwent treatment himself. And this is not his first war. He has combat experience from even before 2014. Now, speaking with another psychologist, Volodymyr Mamalyga has heard that it is necessary to communicate with the soldiers while here, in the areas outside the attack zone.

But Mamalyga disagrees: “A soldier can apply for therapy a month after injury. But I can say from my own experience that in a month I will not need that psychologist. I will either need a psychiatrist to prescribe medication or I will have dealt with it on my own. So, a person needs a psychologist exactly when there is a need. Each war is not like others, and it is necessary to rebuild. Many see death, some see the destruction of their homes. So, we need new methods and approaches to help people.”

Chaplain Mykhailo Shevchuk says that in the war it is most difficult for him to talk to the defenders, who are going through psychological breakdowns due to the loss of their comrades.

“In the 57th brigade we passed trenches, platoon strongpoints. We discussed various topics. We drank coffee and talked with the soldiers. I went from platoon to platoon like that, from company to company.” Shevchuk adds: “And there was enough work. I brought some religious attributes; some people needed them. Some just wanted to talk. There was a case when his brother-in-arms died in front of a man’s eyes, he took it hard, rebelled against everything around him … It was difficult, but it was necessary to somehow improve his emotional state.”

By February 24th, the priest says, some people were partially used to the war already. Although it did not end on a single day and Father Mykhailo did not lose contact with the front. But after the start of the full-scale invasion, many people were shocked anew. Sirens do not let you become indifferent; they are a constant reminder that the war is near.

“When the war started, I felt shocked, confused”

The secret to Ukraine’s indomitability has been the coming together of its people. Volunteering is very common. The team of the humanitarian center from Cherkasy travels through Cherkasy as part of the SpivDiya project. SpivDiya was created to help displaced people and vulnerable groups. You can call hotlines of your village council or city council and ask them to fill out an application for you or try it yourself if you have internet. SpivDiya is immediately found in a search engine, for example, in Google. And there you write your needs in the form. Then it is forwarded to Cherkasy, where volunteers pack everything and deliver it.

The logistic direction of the project was taken over by the artist Volodymyr Sinusik. He has already delivered hundreds of parcels from hand to hand. On February 24th, when the invasion began, Sinusik was preparing to go abroad. He was supposed to go to Europe, it was one of his dreams. He had prepared everything necessary, including his drawing materials; he had his plane tickets. Last year he was in Athens where he created a series of paintings. The artist’s collections are located throughout the world, in the United States, Australia, Canada, France, Germany, Switzerland, the United Kingdom and elsewhere.

“When the war started, I was shocked and confused. But the next day I came to the humanitarian aid center and started working for my country. I recorded videos encouraging other artists to join. Sometimes you have to buy everything very suddenly – from scotch tape and scissors to expensive medicines, etc. We help immigrants. We deliver products, clothes. I cannot draw now. I am not in that same state of mind,” Sinusik tells me.

One can only imagine the experience of the people who fled from the Russian troops in those cities where hostilities were ongoing. I spoke with the Yulia Berezhko-Kaminska, a writer and journalist. She told of the horrors of the war she had experienced in Bucha. She was hiding in a house with her daughter, son and husband. Yulia had been in Bucha since the beginning of the war. She spent two weeks in the basement with her family.

“It was very scary when a Smerch shell fell nearby, but fortunately, it did not explode when the neighboring house caught fire. We were cut off from communication. There was no electricity. There were days when there were explosions for hours and the house shook. There was Grad rockets shelling, too. When a mortar hit nearby it was so loud that it seemed as if a plane was falling on the house. None of us believed that this war could be so cruel and destructive,” she recalls.

Yulia learned about green corridors (negotiated escape routes for civilians – editor’s note) from her neighbours. Her daughter tried to escape first, but she came under fire and stayed with other people in a house damaged by explosions. Later, Yulia and her son got out. Her husband stayed at home. Now Yulia and her children are in Kraków, housed by strangers. Her husband survived, has been in touch and now they are waiting to return to Ukraine.

Olesya Lavrenko’s story is different. She is not a refugee, but an internally displaced person. A young woman who has experience working with children activity groups in Luhansk Oblast, she now joins the SpivDiya for Children volunteer project in Cherkasy. They organise games, creative and educational tasks, psycho-emotional support, and friendly communication with peers – this is how children of internally displaced and local families get help to adapt to the current realities of life. The activity is both work and consolation for her. She worked with children in Popasna (in Luhansk oblast) before February 24th. She does not hold back tears during the conversation. It is difficult to talk about the experience. She regrets not only her own lost home in Popasna, but also the entire town. She says it was very calm. Now it is a ghost town.

“We had a two-storey house with beautiful panoramic windows. I had a place to come home from work, I had my own home. It is as if my soul stayed there. And now we huddle in other people’s backrooms,” Olesya sighs. “Initially, we fled along with my daughter and mother. First, we went to Donetsk Oblast, to Bakhmut, and then to Myrnohrad (we lived with my brother there). But the evacuation also began in Myrnohrad, then we went to Cherkasy. My father said that there is an acquaintance here who invited us. True, at first he offered us his dacha, but it turned out to be unsuitable for living. We then lived in a dormitory, where we renovated the room ourselves, and then moved to a rented accommodation in a village near Cherkasy.” Olesya’s husband unfortunately died long before the full-scale invasion. Now the family is adapting to a new life. Her daughter studies online, Olesya works.

Olesya with children. Photo: Nazariy Vivcharik

“We have two states: fatigue and exhaustion, and then adjustment and adaptation”

Every fifth person who has experienced traumatic events suffers from mental health problems, according to data from the World Health Organisation. Another 10 per cent cannot live a full life. The most common conditions are depression, anxiety, insomnia and back or stomach pain. PTSD can appear within a year of the event and last for several years, according to the US National Institute of Mental Health.

Inna Kukulenko-Lukyanets, a psychologist, says that during the full-scale invasion, Ukrainians first experienced fatigue and exhaustion, and then there was adjustment and adaptation. “I see, on social networks, they write that you can’t get used to war. If people did not have the ability to adapt, then humanity would not have survived. If we are alive today, it means our grandparents were able to survive in their historical periods. So, there is an adaptation to the conditions of war. At the same time, we must admit that there is also fatigue. There is exhaustion. Even though there are relatively calm regions in Ukraine, there is still exhaustion from the stress of war. This stress cannot be compared with anything. This has never happened in our personal experience.”

She lists the negative consequences of stress: exhausted psyche, reduced immunity, and chronic diseases may get worse. “If at the beginning of the war it was a kind of shock, a release of adrenaline, now the adrenaline is decreasing. And now people are getting weaker. I know how volunteers burn out. They sometimes give themselves completely to their work.” She notes that more and more people are turning to her for consultations. She has also seen that relationships are failing due to the stress.

Kostyantyn Harkavyi, head of the Cherkasy Oblast Psycho-Neurological Dispensary of the Cherkasy Oblast Council, says that they had expected a larger number of people after the start of the full-scale invasion than actually came to them. “In the first week, there were significantly fewer people, because many people moved to the countryside or abroad, and some simply could not come from out of town because the buses did not always run. Some people were just hiding, some were packing things up for evacuation. Later, people calmed down a little and started to contact us. But most contacted us about obtaining prescriptions because citizens were afraid that there might be interruptions, so they wanted to stock up on medications. And then came the period of calls from displaced people who evacuated from the war zones and wanted either to recover documents lost in the occupation zone or to receive medicine. We helped as much as possible staying within the framework of the law.”

Over time, Harkavyi says, outpatient appointments began to resume. They began to come as before, although they expected a bigger influx of people with anxiety or depression. But this did not happen.

“We explain this by the fact that if the displaced people had anxiety or depression, they did not dwell on it, they had other goals. They had to go to the border or to western Ukraine. So, if someone needed help, they didn’t always ask, because they were only thinking about moving on. By the way, now there are IDPs who have settled in Cherkasy Oblast, they have found housing and food. Now they are starting to take care of themselves, and turn to us,” the doctor says. He notes that the national programme for mental health and psychosocial support for Ukrainians is currently being developed under the patronage of the president’s wife.

“The goal of Zelenska’s project is to build a system in which every Ukrainian is aware of the importance of mental health, knows where to turn for help, and serious disorders are prevented, not treated,” he concludes.

It is also no secret that military personnel who have returned from the battlefield with injuries turn to specialised doctors. Harkavyi says that if you look at previous experience from other countries, a certain part of the military needs help after wars. Such was the case after the war in Vietnam and after the war in Afghanistan. “We have enough doctors ready to help everyone,” he adds. “Out of several dozen doctors, only two went abroad. One doctor left with her children, and the other left for an educational programme. The rest all work here. Moreover, we have an IDP doctor who works alongside us.”

This article was first published in Ukrainian via the portal Procherk. The full original version is available here 

Nazariy Vivcharik is a Ukrainian journalist and editor-in-chief of the Cherkasy-based online publication Procherk.

mental health, psychology, PTSD, Russian invasion of Ukraine, Ukraine, Ukraine at war