What I Learned by Listening to Ukrainian Refugees - Pt. 2
"Numb and Empty" - Trauma or Depression?
One of the more surprising observations during these interviews with Ukrainian refugees (see Pt.1) was that there were more references to “depression” than to trauma or PTSD. This raised interesting questions for me.
The symptoms of PTSD were mentioned, of course: nightmares, flashbacks, avoidance, sudden fear or anxiety when planes flew overhead or sirens would sound, bodily tension when visiting Ukraine. These and other symptoms would undoubtedly mean that PTSD would have qualified as a “diagnosis” for some of the interviewees that I spoke with (though I need to add that, for most, the responses to “triggers” began to wane after regular safe exposure over a year or so).
Most of those interviewed had access to some psychological (or even psychiatric) consultations while in Warsaw, though there were problematic limitations: in most cases only one to three sessions were available and rarely were these offered in Ukrainian. It’s very challenging to speak to deep matters of the heart in a second (or third) language.
In spite of these professional consultations, formal references to trauma or PTSD were almost absent, almost as if some measure of background trauma was just assumed and rarely became the focus of treatment.1 Instead, the focus – especially for those who managed to find more extended care – was “depression.”
Certainly descriptions sounded like depression: “feeling numb and empty,” “nothing brought joy,” a “robot-like state,” “not wanting to bother others,” “no hope and all are against me,” feeling lonely and powerless, and varied expressions of just being stuck doing nothing. Professionally, I would have been inclined to classify these as part of the “altered mood” aspect of PTSD since most insisted these depressive symptoms began with the trauma of the full-scale invasion. My point, however, is not to argue diagnostically with clinicians who are there on the ground but to be curious. Why were these depressive aspects so consistently the focus of attention as opposed to other aspects of trauma?
I began to wonder whether this was an outcome of the unique type of trauma experienced when: a) one is cut off from home, and b) the events behind that trauma are ongoing, even though the refugees in Warsaw are separated from them in a kind of limbo. Life around them is meant to be “normal,” but the news or personal contacts from Ukraine still testify that battles continue and missiles keep exploding threatening friends, family or even husbands. They live oddly split lives, and a particular kind of depression seems to be an outcome of that split.
There was no question that those pulled deeply into present/future concerns, especially when they had work, and kids or pets to care for, were somewhat protected. They were pulled into the functional, “normal” side of this split and lived more of their lives in this engaged way, while those who “did nothing but listen to the news” fared the worst. Those whose treatment made the most difference were those who were enabled to engage more deeply in the positive side of that split – giving more attention and care for jobs, children and friends - or themselves.
Yet, even those who functioned well on the surface seemed to bear testimony to a depression below the surface. And how could they not? Grief about their homeland was real; concern for families and friends was real. They remained cut off from a life and land to which they longed to return.
I came looking for some of the unique aspects when trauma is experienced in a conflict zone, and this seemed to be one core difference: the depressive aspects when life is lived in a kind of exile while traumatizing events are ongoing.
In the next (final) part, I will speculate on what might be some implications for healing.
P.S. When reflecting on the relevance of this observation to my mom’s experience as shared in Pt. 1, I recalled this memorial to Mennonite victims in Ukraine. Designer, Paul Enns, referred to his attempt to reflect that “we are left with a void.”
When referring to treatment, there was much talk of CBT (cognitive-behavioural therapy) and no talk of contemporary trauma therapies. I’m curious as to the role that this played.