Bipolar 2 From Inside and Out

We already know that in war, disenfranchised people suffer the most – dependent women and children, disabled persons, and the mentally ill included. The war in Ukraine is no different.

During World War II, mental patients and disabled persons were among the “subhumans” that Hitler sought to annihilate. He felt they were a drain on society. (In fact, there are still people who feel this way.) Nowadays, the impact on the mentally ill is somewhat less direct. Reuters has reported that “Russian forces have taken control of a psychiatric hospital in the town of Borodyanka in Ukraine’s Kyiv region, with 670 people inside.” They quote a Ukrainian official as saying, “Today we do not understand how to evacuate these people, how to help them….These are people with certain special needs, they need constant help. They are running out of water and medicines.”

Not that mental health care in Ukraine was all that great to begin with. General healthcare in Ukraine developed from the old Soviet system, which emphasized preventive care rather than treatment of existing disease. Psychiatric Times also notes that “In comparison to other countries, Ukraine carries a high burden of mental illness and a particularly high prevalence of depression, alcohol use disorder, and suicide….Major barriers to mental health care in Ukraine include lack of trust in the psychiatry system, stigma, and lack of awareness and understanding.”

In the Soviet era, psychiatry was used “as a tool of repression” and “those who opposed the Soviet regime being deemed ‘mentally ill’ and imprisoned in psychiatric hospitals. As a result, Ukrainian older generations are more reluctant to seek mental health care than their youth, remembering the dark history of psychiatry,” reports Not Even Past.

Challenges in the Ukrainian system have included “a large institutionalized psychiatric system associated with human rights violations, alongside public stigma and low awareness of mental health,” says the World Health Organization. They add, “Social services for people with mental disorders are limited or absent in the community. The health information system has mental health data but lacks organization and is not always useful for decision making.”

The COVID pandemic had already taken a toll on mental health in Ukraine, but increasing conflict in the eastern regions caused still more suffering, long before the Russians invaded. In October, 2021, Relief Web reported on the toll-free emotional support hotline that helped more than 3,400 Ukrainians during its first year of operation. The four operators, seven psychologists, and one psychiatrist offered support primarily to women, who made 70% of the calls to the hotline.

Even before the pandemic and the conflict, Ukrainian citizens suffered from a variety of mental health problems. Estimates are that one in three Ukrainians face a mental health challenge at least once during their lives. This is notable, particularly in comparison to countries in Western Europe. Much stigma was also reported, involving problems of “knowledge (ignorance), problems of attitude (prejudice), and problems of behaviour (discrimination).”

Then there are the mental health difficulties directly related to the Russian invasion. Naturally, anxiety and depression are problems in both adults and children. As Relief Web noted, “People fleeing conflict often experience highly distressing situations, loss and trauma, which may impact their mental health and ability to cope. Psychosocial support will be needed in the days, weeks, and months to come.”

ABC News reported on the mental health problems that are arising in Ukrainian children especially. As of March 19, 114 children had reportedly been killed in airstrikes and other acts of war. Children as well as adults no longer have a sense of stability in their lives. Experts recommend supplying structure for the affected children, but this is difficult to impossible in a war zone.

ABC quoted Dr. Jack Shonkoff, director for the Center on the Developing Child at Harvard University, who noted, “Some children in these circumstances tend to be more withdrawn, they’re not crying as much, they’re not demanding much attention.”

He continued, “Sometimes people might look at that and say, ‘This child is managing pretty well.’ Sometimes that’s a sign of the things to worry about the most because these children are withdrawing, they’re internalizing a lot of what’s going on.”

Shonkoff also said that “a good outcome for children in a war zone is … making sure the adults are being taken care of too.” As he put it, “The most important factor that determines how children are going to basically survive and go forward after a war experience is the nature of the adults who are caring for them,” he said. “If the parents and the caregivers are significantly traumatized, they can’t provide that sense of support. The adults’ needs become critically important to protect the children.”

Shonkoff likened it to when adults are advised to put on their own oxygen masks first in case of an airline emergency, before assisting children with theirs. “That’s not a way of saying you’re more important than your child. It’s a way of saying if you pass out, your child won’t be OK,” he said.

What’s the point of all this information? It’s crucial to realize that, in war, not all wounds are physical. We know this from the vast number of veterans who suffer from PTSD. That will no doubt be true of soldiers in Ukraine too. Psychological distress is real – and increasing – and will affect people in Ukraine in both the present and the future. When we talk about sending relief to Ukraine, let’s not forget those with mental health challenges.

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