How are you? — opinion

23 April, 04:30 PM
Bucha (Photo:Олексій Куліба / Telegram)

Bucha (Photo:Олексій Куліба / Telegram)

It was a conversation-starting question before — a formality. But for over a year, we've been asking it more sincerely, when we need to hear an answer. This is the starting point

 First published in the April 2023 edition of NV Magazine

"How do Ukrainians withstand all of it?" foreign journalists always ask me in every interview. And every time, I try to explain what it means to start each day as if it is the last one. When you don't know whether the missiles will come, whether there will be light, what news from the front will come from loved ones. Will there be work and housing for those driven out of their homes because of the war?

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I am talking about the bombed-out houses in Kyiv and Dnipro, where only the contused dogs stayed behind in the ruins. About entire families — mom, dad, kid — who didn't wake up after another Russian attack. About children who are learning to walk with prostheses. About volunteers who convince old women to leave Bakhmut, who hear: "Leave us to die at home" in response. Trying to explain what it's like to live in a war. However, I’m not sure that it can be explained. You can only feel it.

In Ukraine, we ask and answer differently. It is much more concise.

"How are you?" It used to be just a question to start a conversation — a question that did not necessarily need an answer.

A formality.

For more than a year, this question has recovered its original meaning. We ask it to each other to care. And we want and need to hear the answer.

Sometimes you want to ask, "How are you?" to the person you see in the mirror. Sometimes you don't want to look. Sometimes I want to hug them.

This is a kind of "closet from Borodyanka" effect. Keeping up means I’m alright

"How are you?"  This is the central question of the All-Ukrainian mental health program. Everything starts with it. The answers will follow -good and bad, complex and simple, scary and inspiring.  "How are you?" is the starting point.

It was difficult for me to answer myself. Ok, it wasn't difficult to answer — it was difficult to answer honestly.

"How are you?"

"I'm ok" — if everyone is alive and well. This is a kind of "closet from Borodyanka" effect. Keeping up means I’m alright. Going too far into it feels wrong because everyone is in the same situation. It is a sin to complain. It is better to hold on.

 “Trouble with sleep?”  “You’ll sleep after the war!”

“No strength to work?” “Pull yourself together, lazybones. Think about those on the front. They don't whine!"

“Hands shaking, palms sweating, can't concentrate on simple tasks” “Take a sedative from the pharmacy. We’ll get through it somehow!”

We tell ourselves these things every day, right?

Human recovery

Endurance is our armor. But it is unreliable. Psychologists have more to say about this. Behind our courageous "I'm ok," many things are far from ok.  According to survey results, over 90% of Ukrainians report feeling at least one symptom of an anxiety disorder during the Russian invasion. Just imagine: these are 9 out of 10 people on the metro, in the office, at the store, in the trenches.

Externally they are mature, balanced, brave people. But, inside, they are wounded and need help.

At the same time, a third of Ukrainians tend to downplay their mental problems: saying, it’s not a priority during the war. This is "the sin of complaining." 66% would probably go somewhere for help, but don't know where to start. It is clear where to go with conventional medicine. However, in our country, psychological treatment (especially psychiatry) is still often associated with Soviet psychiatric dispensaries and the forced and often inhumane treatment of violent patients rather than with convenient medical services.

It is imperative to realize: Yes, Ukraine is today a symbol of courage and determination.  But, at the same time, Ukrainian heroism is the heroism of people who feel everything keenly, taking everything to heart. So, they are morally exhausted.

Therefore, whenever we talk about the country's recovery, we should start not only with the economy and the buildings but, first and foremost, with the recovery of the people. There will be no economic breakthroughs without people or with extremely exhausted people. It is the same cliché, but a thousand times correct — “A country is its people." It is also necessary to start this recovery immediately. Mental health and the strength to live cannot be postponed until after victory. It is actually a part of the victory.

The mission of the All-Ukrainian Mental Health Program is to make psychological care as accessible and available as general medical care. In fact, the goal is for everyone who works face-to-face with others — no matter who they work for — should learn psychosocial care skills. This knowledge is being acquired not only by doctors, police officers, or first responders, but also employees of call centers, banks, supermarkets, and railways.

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Large corporations are also joining in the effort. About 200 Business Without Barriers community recruits have completed their training and are now sharing their knowledge with 30,000 colleagues. The value of a word is very high, even in a surface-level business conversation. Depending on how those words are used, they can either provide support or worsen trauma.

Another challenge is helping children. In the pilot camp Gen.Camp, psychologists try to treat children who have witnessed what nobody their age should have — the death of their loved ones. There are already promising results — the participants of the first two cohorts have already started to smile. One member of this group is quite well known, Vlad from Bucha, who brought food to his mother's grave in the yard. Clinicians are taking what they are learning from this program and hope to scale it upwards so that the whole country can benefit.

Another example is the Masha Foundation and the Unbreakable Mother project, which help to stabilize the emotional state of women and children affected by war using a special program developed by specialists in psychotherapy and post-traumatic syndromes.

In total, there are about 300 international and public organizations and charitable foundations working in Ukraine which provide services in the field of mental health through various means: hotlines, offline and online platforms, individual and group consulting, training for workers in areas with particular psychological stresses, etc.

It is difficult to overestimate the role of international experts. Even one of the joint projects — with the IsraAID mission team — is a significant boost to Ukraine’s supply of crisis psychologists. And they are already providing help: during the terrible rocket attack on an apartment building in Dnipro on January 14, the specialists of this project were already working with the victims.

In the future, Ukrainian mental health specialists may have the world's most extensive knowledge base — how to react in war and emergencies.  No one in the world has experienced quite what we are experiencing in this century.

When you're not ok

All Ukrainians must develop self-help skills and make mental health care a daily habit. A separate information campaign dedicated to this topic is also beginning to promote these skills.

To understand what this means, we can start with the definition of mental health from the WHO. We can walk through it right now. Are you able to overcome everyday stresses? To realize your potential? To work productively? Do you still have the mental energy to take part in your community? If the answer is yes to all of the points, that's great. If there are no, then you most likely need support.

It's okay not to be ok. Saying that it is difficult for you is not a weakness but a responsibility to yourself and your community. The government is gradually taking a leadership role in this topic by making psychosocial support services available and universal. If you feel mental discomfort, if it worsens the quality of your life, contact your family doctor first. Because they are also currently being taught to identify and manage the most common disorders: acute stress response, depression, anxiety, sleep or eating disorders, etc.

The focus is on psychological support and psychological assistance to Ukraine’s defenders. Among other things, rehabilitation at medical institutions increasingly involves multidisciplinary teams. Emotional support for soldiers is essential because after returning from the front, they often feel like strangers, even among their own. Comprehensive psychological rehabilitation is provided at the Center for Mental Health and Rehabilitation of Lisova Polyana of the Ministry of Health of Ukraine. The solemn "invisible wounds" of war are healed, and the soul is treated along with the body. Experts from all over the world will go to Lisova Polyana to study a unique experience.

A few more examples: The Ministry of Social Policy will create a network of Sustainability Centres in local communities, and the Ministry of Education will focus on developing resilience (stability) at all levels of education, rethinking the functions of school psychologists. There are many practical examples in the regions. The Kharkiv Regional Psychological Service, created by a team of psychologists from Bucha, began its work in March. Mobile brigades go to the communities of the region — to the places where people need the so-called post-isolation recovery most. They are developing a training program for specialists and a pilot program for treating the populace better. This model will be scaled to other de-occupied territories.

The Lviv region is home to an example of the successful integration of medico-psychosocial services. It focuses on unifying and coordinating all resources: community, partners, volunteers, experts, and businesses. At one location, someone can get help with documents, medical support, social adaptation, advice on work, or placement of a child in a school or kindergarten.

Yes, there is still a lot of work ahead. But I am sure: We, Ukrainians, are capable of being stable and purposeful not only in resisting the aggressor, but also in helping each other. And we will walk this path with dignity, as only we can.

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