Psychologist Discusses Impact of War, Post-war Challenges

Ukrainian society is currently focused on one common goal — survival and ultimate victory in conditions of blackouts and deadly rocket attacks. However, there is a misconception that everything will be fine immediately once Ukraine has won. Yet, the post-war period is usually even more difficult than the wartime period. After all, we will have to solve many problems in all sectors. Therefore, some things need to be taken care of right now to speed up rebuilding and prevent negative consequences. 

One of the most important issues is the psychological rehabilitation of military personnel and their recovery. Work with their relatives will also be necessary. 

Kyiv Post spoke to Tatyana Filkina, a freelance psychologist at the Odesa clinical center of the State Border Guard Service, head of psychological support at the Ukrainian Union of Border Guards NGO and psychologist at the Rehabilitation Center of St. Paul NGO.

The conversation covered the challenges and obstacles facing Ukrainian society after the war and the psychological stages Ukrainians are currently going through. 

In general terms, what difficulties will Ukrainians face, first and foremost, once the war has ended?  

Right now people are focused on the fact that everything will be fine after victory, and survival is their priority.

But you must realize that it will be different and not easy. Because many people now do not have a home and have nowhere to go back, because nothing will be rebuilt quickly. As a result, there will be problems with finding new jobs. 

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The first thing that can already be observed in 70-80 percent of the population are signs of a depressive state, which are expressed by unwillingness to do anything, a constant feeling of heaviness and loss of meaning and values — when you don’t know the reason for getting up in the morning, and then you cannot get up at all. 

What is happening to society right now?  

Now there is a reevaluation of values and a loss of meaning, which has become noticeable since the fall.

If we take the psychological stages of living grief, then this process lasts about a year. It is divided into five stages: denial (up to about three months), anger (usually verbal aggression), bargaining, depression, and acceptance.

At the same time, the stages of aggression, bargaining and depression can alternate for about six months. And only in the interval, from nine to 12 months, does acceptance take place. Which is caused by a reevaluation of values, loss of meaning and a search for new things.

And now the whole country is gradually beginning to accept that nothing will be the same as before. It is quite symbolic, since carrying a child also lasts nine months. And it was just after nine months that noticeable deterioration in the infrastructure began. 

So, people began to fall into a depressive mood. 

Many people have questions like "What should I do in future? Where should I go?".

Many families have also felt changes in their relationships. Mostly due to the fact that women are now abroad with their children, while the men are here. And if a man is left without a job, then he feels that he is of little benefit. In fact, not everyone can volunteer, because volunteering is a certain state of mind.  

Despite the fact that the war is not over yet, many military personnel are already experiencing psychological and emotional stress due to overly stressful long-term conditions. What can be done to prevent their mental state from getting worse?  

The problem is that Ukraine has a low level of mental education. Therefore, my first task is to introduce the fighter to who a psychologist is and how he or she can be useful, so that the person understands that a psychologist is a specialist, just like any other.

Furthermore, the main thing is to make it clear to the person that the sooner he or she comes to a psychologist, the less likely he or she is to suffer from post traumatic stress disorder.  After all, about 80 percent of people can cope independently with trauma, turning it into traumatic growth. But to do this, you need to hear from someone that you can get a positive experience from a negative situation, even in wartime. 

In addition, many warriors subconsciously take care of their families and cannot tell them many things. But if you carry pain for a long time, it will manifest itself on a somatic level.

For example, in our society, there is a stereotype that men do not cry, so they end up in hospital with heart attacks. A psychosomatic disorder can appear, like when unshed tears in men lead to a heart attack. This is due to the strong force raised pressure inside the body. 

Therefore, we need clear terms for the stay of military staff on the front.

For example, in 2014-2015, mobilization lasted six months, with three months consisting of rotation, and three were on the third line or in the rear.

Now, unfortunately, there is no such thing. There are people who left for the front on Feb. 24, 2022 and who are still there. 

But there are only a few of them left, as most are either in hospital or dead.

Therefore, special centers are needed so that a person can relax and reconfigure their psyche to a peaceful life.

What problems do serving military personnel encounter the most today? 

If we compare the active military operations in back 2014-2015, that was a war of infantry, and now it is a war of artillery. And concussion is prevalent in the military. Concussion is sometimes more difficult to cope with than a wound or a traumatic brain injury, because it is not visible.

Concussion occurs after an exploding wave takes place inside the head as a result of which the brain hits the skull and gets injured.

This causes loss of hearing, loss of vision and sometimes loss of speech. 

Unfortunately, we have very few specialists who can work with this with adult speech restoration. In addition, work in rehabilitation centers should be multidisciplinary. First of all, an examination, and then a psychotherapist, audiologist, speech therapist, and rehabilitation specialist should all work. But we don’t have such teams and do not have sufficient numbers of such specialists, because all recovery processes are long-term. 

Have you had any experience of working with military personnel who have lost the ability to speak?

Yes, in my practice I have experience with military personnel who have lost the ability to talk due to injuries.

My first case was in mid-April with a border guard who suffered 80 percent burns as a result of a house fire. He could nod "yes" or "no", but the main thing is that he had a desire to communicate. Many military staff have their primary desire — which is to close themselves off from strangers.

However, this guy is 22 years old, so the recovery process went quickly. As a result of talking to him, I found out that he’d also studied to be a psychologist, so I got hooked on it.

I told him how useful he would be as a psychologist for the military, because he would later understand this experience of injuries received serving in the military. After all, the principle of "equal to equal, brother to brother" always works better.  

Another case was a situation in eastern Ukraine. Due to the fact that it took four days to get this soldier to hospital, a lot of time was lost. And when he was taken to Dnipro, he immediately fell into a coma in intensive care and suffered a neurological trauma.

When he came to, he could only cry and say the words "yes" or "no". I have been providing him with psychological support since April. In September, he was sent in a wheelchair to the only nationwide center for recovery from neurological injuries in Ukraine, which is located in the city of Klevan, Rivne Region. He is already learning to walk now with the help of a professional cane. 

And if a soldier is discharged from hospital, and he is unable to return to the front, but he is no longer at home, what happens next?  

It is not unusual for serving military staff to really have nowhere to go back, because their house is located either in occupied territory, or everything there has been bombed.

At the same time, the rest of the family might be abroad and unable to return due to refugee status. There are no places in hospitals, so the serviceman is either transferred from one rehabilitation center to another, or resettled with the help of volunteers.

However, this is still a problem in most cases, especially when a person is unable to live independently due to injuries.

Also, a common problem experienced by the military is documentation that needs to be properly issued in order to at least receive social payments in the future.

The people who do this first and foremost are commanders who are on the front line and hand over documents to the rear.

And, unfortunately, it so often happens that the commander may die serving on the front. So, then we have to look for someone who will handle these documents. 

What can be done for the families of veterans, and what training programs are required for them? 

Learning to live again, with sustained injuries, is a difficult and lengthy process. The support of loved ones is important here, but more often they break down faster than warriors.

Because quite often relatives don’t understand that a person who went through war will never be the same again. Also, many people do not know what to do with an injured person and they get tired after a few months. Unfortunately, work on supporting relatives has not yet been established at state level. 

The Institute of Mental Health NGO currently implements the program of the Akershus Clinic in Norway for those people who have suffered a loss or for those who have faced an indefinite loss (missing or captured relative).

The latter situation is more difficult, because the person is in limbo and needs to recognize the fact that his or her relative is either dead or alive. 

For example, in Israel every unit has a military psychologist who assesses the state of mind of each of the fighters before and after each task. Do we have something similar, and what other countries can we learn from?  

There are psychologists on staff in military units, but not all of them have experience working with military personnel who have been on the front line.

The Norwegians have a strong peacekeeping mission and rehabilitation centers. And after a mission, all the military goes there for three weeks, because this is the time to form a new habit. Once there, entire teams work with them to determine for whom this time will be sufficient and who will need to continue therapy. 

 What should be done to prepare Ukraine for the post-war period?  

We need more centers with a psychologist on staff, we need to enlist foreign specialists and develop a plan for the period when we will be told "the war is over, period".

But the main thing is to prepare for the new reality — to train society, specialists, create various psychological assistance programs, and to accept help from other states. The sooner we do this, the easier it will be for us to adapt.

It is also important to inform the foreign audience what is happening here, because they have no idea. And if we smile and joke here, then this is just one of the ways in which we experience inner anxiety, and not a sign that everything is fine. 

How can military personnel adapt to civilian life, and how will the war affect their psyche?

In Ukraine there is a law on psychological assistance for veterans. A register of organizations providing psychological assistance services has been created, where you can choose the appropriate specialist. We also have employment centers where there are programs for retraining and employing veterans.

All the processes of recovery and habilitation are long, so society needs mental education and patience.

Because, for example, learning to not sleep in a trench is difficult. On one occasion the mother of a serviceman complained that the chap fell asleep in bed, but each time he woke up he was already dressed in a sleeping bag at the doorstep. 

And I explained that everything should be done in stages — he needs to get used to the fact that in the middle of the night you don't have to run and shoot anywhere, you need to change habits. Unfortunately, soldiers on the front line can spend several weeks wearing the same clothes and not taking them off. And the process of a parent getting used to the fact that he is at home and safe can last about three months.  

As a result of military injuries, suicides and addictions (drug addiction, alcoholism) are possible, which is also a form of suicide, but a slow one.

And even painkillers work like drugs, because a person gets used to them. And domestic violence too as a result of harmful addictions. 

In fact, should it be stipulated that every member of the military should have his or her own psychologist? 

I will tell you more. Every person should have a psychologist! But the problem is that often the military does not perceive, for example, me, a female psychologist who has never been in a war and in the trenches. 

But I give the example of a male gynecologist who will never be able to give birth to a child, but takes delivery and examines women. Because he has learned, practiced and does what he has to do every day, he has protocols and tools.

It's the same with a psychologist. And if I were in the trenches, I wouldn't be able to help, because I would also need help. And psychologists who were in a war could not do without psychological and medical help.

In addition, when a person has a toothache, he or she goes to the dentist, and the same applies to a psychologist. If you sustain mental injuries then you need to get in touch with a specialist (psychologist, psychotherapist).