War and Psychological Trauma
The conflict triggered by Russia has forced the Ukrainian people out of their homes, who are now fleeing fighting and extortion. These are two causes of psycho-trauma, a phenomenon with symptoms documented since the First World War.
Philippe Fossati, head of the adult psychiatry department at the Pitié-Salpêtrière Hospital and professor at the Sorbonne University Faculty of Medicine, discusses psycho-trauma.
What is a psycho-trauma (PT)?
Philippe Fossati: In the medical sense of the term, a trauma is a serious, unpredictable and potentially life-threatening event, of which one is either a victim or a witness, which one has difficulty coping with and which causes psychological symptoms. It triggers an acute stress reaction that can result in fear, insomnia, pain, and a psychological state that causes people to continue their activities automatically during the event - this is called a dissociative state.
Historically, the study of PT developed with the Poilus1 of the First World War, particularly among those who had escaped the continuous firing of German artillery, and then among veterans of the Vietnam War.
France was the forerunner in the clinical description of psycho-trauma, but the subject has developed especially in recent years with the establishment of precise diagnostic criteria as well as the recognition and management of psychological injuries that can cause post-traumatic stress disorder (PTSD).
Among the events that generate PTSD, the most violent are terrorist attacks and war scenes, followed by more individual events such as rape, physical assaults, car accidents. These are major sources of PTSD for survivors, and even illness can provoke PTSD, as observed during the first wave of the COVID-19 pandemic.2
But not everyone reports PT symptoms after an event. I would say it affects between 10 percent and 15 percent of victims, even 20 percent for the most severe events.
How is PTSD manifested?
P.F.: Through nightmares, avoidance behaviors, withdrawal and memories centered on traumatic events. By definition, PTSD occurs at least two months after the traumatic event. It is a process that is supposed to disappear over time but does not. There is a lack of resilience, of the ability to digest a trauma.
A certain number of symptoms then appear: memory disorders resulting in nightmares centered on the trauma or flashbacks; avoidance of anything that might remind one of the traumatic event such as approaching a subway line, hearing the word "bombing"; emotional hyperactivity or, conversely, a loss of interest and pleasure in usual activities, because they are invaded by traumatic ideas, and depressive symptoms sometimes complicated by depression.
The occurrence of a trauma, a delay before the appearance of typical symptoms and a repercussion on the professional activity of the victims are the criteria for the diagnosis of PTSD. The medical literature is beginning to investigate whether the nature of the trauma also has an impact on the symptoms, distinguishing between single events (war, an attack...) and repeated events (such as rape). There is also work on the effects of distance from a traumatic event. Ukrainians who witnessed the bombing of their country or who migrated to avoid it are more affected than people who see these scenes on television. There is a distancing.
With the little hindsight we now have on the Ukrainian conflict, where life in certain cities seems to have resumed its course, can we speak of the resilience of the Ukrainian people?
P.F.: The term resilience is sometimes applied too quickly. It is always complicated to use because, from a medical point of view, it implies taking advantage of an experience to reorganize one's existence or to come out stronger. It is a personal cognitive process.
The Ukrainian people are all focused on the same goal of fighting and maintaining the country, and they are really impressive from that point of view. Beyond individual capacities, there is this collective goal that facilitates the capacity for resilience and a pride in returning to normal life. This collective dimension was also present after the 2015 attacks in Paris, facilitating this process of resilience that also happens on an individual level. In my department, we have not had Ukrainians who have been driven to migrate, but refugees in general are known to live in traumatic conditions.
Traumatic events are a pathology of the memory, like a memory cyst.
In France, we have observed a resurgence of psychic disorders in the population, in particular in the young people, because of the effects of the COVID-19 and the lockdowns. In addition, the economic worries related to the indirect effects of the war, which initially caused concern in the older population who have known war.
For the time being, Ukrainians are treating their war wounded. Perhaps we will see an increase in PT in the Ukrainian population in the years to come. Traumatic events are a pathology of memory, like a memory cyst.
