Interview on the war in Ukraine: “We are anticipating a lot of mental problems”

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Thomas Ehring is Professor of Clinical Psychology and Psychological Treatment at LMU, where he also heads the Outpatient Treatment Center.

Estimates suggest that around four million refugees have so far fled from Ukraine. Are there people who can cope with this kind of experience?

Thomas Ehring: People react differently, as we are seeing in the current situation. Feelings such as fear, grief and anger are normal responses to extreme events, and this will undoubtedly also be the case among many of those who have fled from Ukraine.

But the reactions depend to a large extent on what people have experienced in the war, while they were fleeing or on arrival.

Once the immediate threat is over, different patterns can unfold. Many are able to process their experiences well and get on with their lives with little psychological damage. But there are also people who develop mental disorders. And from the most recent movements of refugees to Germany, we know that this, sadly, is the case for many of them. But as I said, it does not happen to everyone.

It is amazing to see the resilience with which people can respond even to extreme situations.

What does it do to people who have themselves only just fled from the war when they see pictures from the war zone, such as those from Bucha, showing civilians who have been killed?

Even for us, it is hard to look at these pictures. And confronting such images is naturally all the more harrowing for people who have themselves only just escaped from war. Some will be triggered by memories of their own experiences. Others will be very fearful for relatives who are still in Ukraine.

When do we speak of trauma?

We have to draw a distinction between the experience and the reaction to it. We speak of trauma when people experience massive threats, are threatened by death, are injured or experience sexual violence. But the reaction to these events can vary greatly.

Some people develop a post-traumatic stress disorder in which memories of the experiences keep resurfacing in the form of flashbacks or nightmares, for example. The sufferers try to avoid anything that reminds them of the experiences. They are easily scared or develop sleep disturbances.

What should we be careful of when integrating refugee children and adults?

Essentially, it is helpful if children and youngsters can go to school and adults can be integrated in training programs or get jobs. That can have a stabilizing effect.

The important thing is to build structures and give them an outlook for the future. If refugees realize that they will not be able to engage in a sensible occupation for a long time, that has a negative impact.

As a general rule, we need to show a lot of understanding – especially at the start, because the people often do not know how their relatives are doing and are therefore deeply concerned.

Should helpers talk to refugees about their experiences?

For people from Ukraine, the experiences are still very fresh. It is always good to show a willingness to talk, but it is important not to force anyone to talk about what they have experienced.

In the early phases, the most important thing is that they feel safe, receive social assistance and can, for example, establish a daily routine. They themselves are then best placed to decide whether, when and with whom they want to talk about their experiences.

Where can traumatized people turn to get help?

There are several organizations that are focused on refugees. The advisory and treatment center Refugio München even has a special program for refugees from Ukraine. I lead LMU’s Outpatient Treatment Center, and we too offer treatment to traumatized refugees.

The psychosocial and psychotherapeutic treatment of people from a different culture involves a number of unique challenges – such as a different language. During the large influx of refugees in 2015 and 2016, the healthcare system was not yet so well attuned to the needs of the newcomers. But we have learned from experience.

What, precisely, has changed since then?

Many organizations now have experience of treating refugees. Additionally, various studies have been conducted to find out how best to help them.

At the Outpatient Treatment Center, for example, we have treated refugees from Syria, Afghanistan and African countries. And we have studied which treatment methods should be retained and which ones need to be overhauled. For example, it is important to adapt treatments so that they fit in with the refugees’ cultural background.

Do we have sufficient capacity in place for the people from Ukraine?

We will have to wait and see. We still know too little about what they have experienced and how many will be suffering from post-traumatic stress and other mental disorders. But from previous wars and displacements, we do know that these groups are much more widely affected by mental disorders than people who already lived here. We therefore expect to see a lot of mental problems after a slight time lag.

Sufferers should definitely seek professional help. The good news is that post-traumatic stress and other mental disorders respond well to treatment.

For how long do the effects of traumas persist?

Many people experience adverse effects shortly after an extreme event. In such cases, though, we do not yet speak of disorders, because this is actually a normal reaction to a very extreme event. Moreover, the recovery curve is very steep in the first few months, especially when people are safe again.

But there will always be a group of people who develop post-traumatic stress disorder or other psychological disorders. If they are not treated, these can even become lifelong conditions. What are known as spontaneous recoveries do still occur, but that happens less and less over time.

Here in Germany, the experiences of World War II still weigh very heavily on some people even when they reach old age.

Can traumas be passed on to subsequent generations?

That is an interesting question. There are certainly indications of this kind of effect. There are several possible explanations relating to how traumas influence parenting behavior, for example, or relating to stories and beliefs passed on within families. Science too points to biological adaptation processes. But there is obviously a difference if you have merely heard about extreme events or have experienced them yourself.