An interview with Ukrainian psychologist Anna Katruk
TEXT AND PHOTOS BY JEREMY BIGWOOD
To get deeper insight on the psychological impacts of the war, MindSite News correspondent Jeremy Bigwood interviewed Anna Katruk, a member of the Association of Psychotherapists and Psychoanalysts of Ukraine.
Katruk is from Vinnytsia in west central Ukraine, but presently resides in Prague, Czechia, where she works with the refugee community. She frequently appears on Ukrainian and Czech television and radio shows to speak about the problems of adjusting to life during a war. She is no stranger to the war’s tragic impacts. Her brother was killed fighting against Russian forces earlier this year and she is now a refugee.
How are people in cities away from the front lines handling the stress?
People are living in a so-called napiv stabilizovanyy – “semi-stabilized” – environment: That’s the term I use to describe the situation of people living inside Ukraine but away from the front lines – people must withstand high levels of tension, uncertainty and exhaustion. First, there is a need to get rid of this tension, so among the first consequences that we see are irritability, dissatisfaction, increased aggressiveness, as well as apathy and depressed states, alcoholism, drug addiction, domestic violence and an increase in crime.
But it is also important to understand that society is not homogenous, so not everyone reacts to the situation in a destructive way. We are also seeing a powerful wave of solidarity and mobilization of efforts around assisting the army, people donating and volunteering, preparing dinners and trench candles and weaving camouflage nets, etc. This helps to transform negative feelings into constructive actions, working together towards the upcoming victory. When people are actively involved, they cope better with the challenges of the day.
Usually, trauma leads to isolation, so uniting around a constructive idea or assisting others helps to stabilize people.
However, it is very important to consider the long-term risks. Since the war has been going on for quite some time and we don’t know when it will end, the tension has to be withstood for a very long time. It’s a kind of a torture – like being put on the rack. And the nervous system reacts with exhaustion, imbalance, and exacerbation of underlying conditions. Many people develop post-traumatic stress disorder and have uncontrolled outbursts of aggression or anxiety, flashbacks in which images of traumatic events pop up in the mind, and impulsive reactions of attack or defense.
The human brain is designed so that its first task is survival and maintaining vital activity. Only after that come pleasure, relationships, development. Therefore, during periods of high-intensity long-term stress, some hormones and neurotransmitters that normally produce pleasant feelings are not released in sufficient quantities. Instead, the stress hormone cortisol accumulates. Hence the increase in depression and other mental disorders. And since the psyche affects the body, chronic diseases can be stimulated and actualized, and new ones can appear.
It’s not only people who remained in the country that suffer, but also those who sought refuge in other countries. Now the life of every Ukrainian is divided into “before” and “after” the invasion. And every Ukrainian embodies the pain of the whole country. But everyone has their own challenges and tasks depending on the location, quantity and intensity of their losses – such as relatives and housing.
Living under wartime conditions tests the strength of the psyche and body. Therefore, it is extremely necessary for people to take care of themselves as much as possible, as well as have access to the help of mental health specialists.
What are mental health professionals doing to support people in Ukraine?
Requests for psychologists, psychotherapists and psychiatrists have become more frequent. Unfortunately, very often people wait until their condition is already critical before asking for help. All medical or educational institutions in Ukraine have mental health personnel. Many initiatives are being implemented in Ukraine and in countries where Ukrainians sought refuge. International donors are also implementing many such projects – online and face-to-face mutual support groups plus consultations with psychologists, doctors, lawyers, etc. have been created. A lot of information on self-help techniques for acute stress is now available in open sources: articles, videos, webinars.
What kinds of strategies can people use to try to manage their stress levels and mental health in this kind of environment?
A healthy nervous system involves the alternation of the processes of excitation and inhibition, something like a sine wave. It is important that the amplitude of this sine wave is moderate. Otherwise, it can mimic bipolar disorder when there are episodes of depression and episodes of a manic state. I urge people to use techniques that ground them and draw their attention to objects around themselves, to be in the here and now, to practice conscious breathing, self-embracing and to concentrate on those activities that a person can control through his or her own efforts.
It is also important not to get stuck. If the processes of excitement become overwhelming – and a person becomes irritable, impulsive, fussy they need to find a way to relieve tension by playing sports, taking quick walks in the fresh air, breathing and gradually slowing down and calming down.
If the processes of inhibition prevail, a person may become apathetic, lethargic and sleepy. It then becomes necessary to gradually increase activity: dancing, yoga, walking with gradual acceleration, more active breathing. Finding an interest in something can also be helpful in this situation.
In any case, it is important to establish a routine and use physiological processes as much as possible: sleep, nutrition, walks in the fresh air, drinking enough water. And also pay attention to breathing by slowing it down and making it deeper or accelerating it to make it more active. Breathing practices are a very effective tool for self-stabilization, since breathing is the basis of our lives. Breathing occurs both unconsciously and consciously, so through it we can balance unconscious processes in the body and psyche. It is also important to pay attention to the sensations in the body, here and now, to train and relax the body.
Are there enough mental health professionals doing this kind of work?
The need for mental health care professionals is growing every day. It is difficult to assess whether there will be enough, since the psychological consequences from the war appear to be growing every day. On the other hand, experts do not stand still; they develop and study new ways to help the population, compare the experiences of other countries and exchange experience with each other.
How can non-mental health professionals provide useful support to other people — and is this kind of mutual support work happening?
Help is needed at different levels. People with deep psychological wounds will need help from specialists with greater training. But the primary level of assistance can be carried out by non-specialists.
Even simple human support can help a lot. When leading adult groups, I notice how participants help each other by sharing their contacts, information that can make life easier, because they have to solve so many issues. Sometimes people in a state of maladjustment need help in simple everyday matters, for example, to be taken somewhere they need to go, help with documents, buy or cook food, stay with children. Some people are especially vulnerable – the elderly, for example, or mothers of young children, people who are lonely and isolated, people with disabilities.
I work with Ukrainian refugees in the Czech Republic, and many have difficulty learning a new language and understanding the rules of this society. Therefore, escorting refugees to institutions and organizations, explaining unclear things, translating, etc. can be very helpful.
Since I visit Ukraine once every month or two, I have observed that even internally displaced persons have similar problems within their own country. They too need support and help.
Fortunately and paradoxically, one of the side effects of the war that we are seeing is a blossoming of a certain kind of humanity (and desire to help others?). Keep the desire to help others here. That is what she means.
What types of mental health support do people displaced to the Czech Republic receive? And what mental health support do people displaced to Poland, Romania and other neighboring countries receive?
Since March 2022, I have been living with my children in Prague, in the Czech Republic. Work with refugees is very active here. At the state level, support comes mainly in the form of social and material assistance. Psychological help, support and adaptation are also provided by organizations financed by international funds. Colleagues from Poland and Germany tell me that psychological work is also carried out by public initiatives (in those countries?)
There is also a language barrier, given that there are few Ukrainian-speaking specialists, and the need is enormous. Therefore, Ukrainian mental health specialists were contacted and recruited from the circle of those who left Ukraine during the early days of the invasion.
Together with my colleagues, I work as a psychologist in a project to help Ukrainian refugees through the Czech psychological center Alivio and the Ukrainian community center Svitlo. Our activities are funded by the RSJ Foundation.
I provide one-on-one counseling for children and adults and six weekly groups. These are groups of play and art therapy for children of different age categories (4-8 years, 7-10 years, 11-13 years), an adolescent group (14-16 years) and a parental educative group and women’s mutual support group.
My colleagues also lead several groups for children and individual consultations for children and adults.
How will another year of war affect the situation?
In fact, it is very difficult to make predictions, because both the situation and the psychological consequences depend on many factors. Our human losses are extremely high. Our family is also experiencing a loss, my own brother died at the front in the Donetsk region in January. Grief touches almost every Ukrainian family. And this exhausts and demotivates on the one hand, and also incites rage on the other. These are very strong tests for the nervous systems of people. Mental disorders are more likely to increase. But restoring the nation’s mental stability can be facilitated in several ways:
- Psychoeducation, raising awareness of what exactly happens to the psyche during these loads, how to help yourself.
- Creating programs to help the mental health of the population.
- Support from Western partners, direct assistance in the fight (weapons, equipment, military training.)
Part Three: Ukraine Uses TV, Internet To Train People to Manage Their Stress and Anxiety
Part One: “This Was Not a Dream”
Introduction
