Ukraine’s Life-or-Death Therapy Sessions

For some, the fear of leaving home to survive can be paralyzing.

Refugees wait for transfer to Poland outside the train station in Lviv, Ukraine. Photo: Kai Pfaffenbach/REUTERS
Refugees wait for transfer to Poland outside the train station in Lviv, Ukraine. Photo: Kai Pfaffenbach/REUTERS

When the Russian attack on Kharkiv began around dawn on February 24, Irina Victor opened a window in her fifth-floor apartment, leaned out, and listened. What she heard in the distance was a faint thud-thud like the beat of drums. It was almost soothing. Then she looked down and saw people crowding outside shops to buy water, bread, and medicine. Normally at this hour, in below-freezing temperatures, the streets would be empty. It was at that moment she first felt fear.

Victor, a 41-year-old university lecturer living with her partner, her 18-year-old daughter, and her 65-year-old mother, soon learned how to tell the difference between bombs and rockets, how to gauge the distance, and even how to distinguish between friendly and enemy fire as it traveled away or toward her. With each sound, her fear of being killed grew. She was racked by cramps, vomiting, fever, and insomnia. At first, no one in the family wanted to leave because they believed the war would be over soon.

Then on her birthday, March 13, a cluster bomb exploded near their home. “My mother and I jumped out of our chairs,” she says. “Two seconds later, there was another explosion, then a third and a fourth.” A piece of flying glass cut her daughter, Elya’s, arm. They ran to the basement, where they could feel the building shake as they waited out the bombardment. When they came back upstairs, Victor found all the windows blown out and metal shrapnel scattered everywhere and melted into surfaces — one piece lodged into the floorboards beside Elya’s bed. Outside in the courtyard, a van wrapped in flames burned bright against the frozen darkness.

“When the bomb hit our home,” Victor says, “Mom and Elya wanted to go. And I didn’t.” By now, she was paralyzed by panic attacks and resigned to what seemed inevitable. “For me, it’s more beautiful to die in your own home,” she says, but “I couldn’t do that to my mother or Elya.” She asked a friend to find her professional help. After a few virtual sessions with therapists, a psychiatrist prescribed antidepressants — which she was able to obtain despite being in the middle of a war — but they didn’t help.

Finally, she was put in touch with Yana Stanislavivna, a psychologist from Kharkiv. Every evening, Stanislavivna hosted a group meditation session for about 30 people on Viber, and slowly the fist that had clenched around Victor’s chest began to loosen. “Yana has a magical voice, and the sessions gave me a sense of hope and unity. We meditated. She used visualization techniques. I imagined myself at home, in the safety of my apartment, a pure white light passing through me to my house, my neighborhood, my city.” After five days of therapy, Victor reached a place where she finally felt she could breathe. “Every day, we waited for the morning to understand how I was doing. And if my health felt normal, we would leave the same day.”

Then one morning, it happened. “There was no breakthrough or specific thought,” Victor says — the panic attacks were just gone. So she gathered her mother and daughter and said good-bye to her partner, Yuri, who stayed behind to take care of his mother, who is too old to travel. Before leaving, Victor had one more session with Stanislavivna. “I was worried that morning, and I called her, but she worked with me. She taught me not to look at the situation as a refugee but as someone taking the opportunity to safely see a new country. She saved my life.”

It may not seem like a choice whether to run from bombs, but for some people, the idea of leaving home can be so anxiety-inducing that it leaves them in a death trap. For them, Stanislavivna says, “there is a great fear of the unknown” that can outweigh the fear of death itself. Her method involves forming a positive motivation by focusing patients’ attention away from themselves and their own safety and onto loved ones and the need to get them out of danger. “Fear always paralyzes or turns into uncontrolled activity, panic, rushing without thinking. Man’s ego thinks only of itself. But we must think of others, the family, to activate a sense of responsibility, of the common good. Then fear fades, and we begin to think soberly again.” Not long after we spoke, Stanislavivna fled Ukraine for Germany.

Natalia Starkova, a psychotherapist from Kyiv, says some of her patients cannot even call her because they are shaking with fear. “These people do not have psychological issues,” she says. “They are normal. But in this situation, they are going crazy. They lose functioning. They cannot recognize themselves. They can’t sleep. They can’t eat. So I help to reduce that.” Starkova said she doesn’t ask her patients how they feel. Instead, she asks, Are you safe? Did you eat? Do you have enough water? Did you sleep? She doesn’t want to unpack their emotions because, “when you have to do something, you kind of hold yourself together till it’s done. So mostly with people who are refugees, when they are safe, then they can kind of relax. So I don’t calm people because anger is a driving energy. I focus on who they are angry with and not to put their anger on loved ones because that’s also what can happen.”

Starkova gave the example of a woman from Kharkiv who, like Victor, didn’t want to leave her home. Her 8-year-old son, husband, and mother were with her. According to Starkova, the woman felt, “This is my home, my walls, everything I know. My life is here. If I leave, I leave my life.” When they did finally leave, their car broke down on the way, and again the woman became overwhelmed with fear. Her husband went into the city to get parts to fix the car, and the woman contacted Starkova, fearing he would not return. “She felt like it’s never gonna stop,” said Starkova. “Like it will be forever. It was hard. And I felt kind of useless. My intention was just to take her from there and put her in a safe place. But I am physically not able to do that.” Starkova said another patient who made it from Kyiv to Berlin is now experiencing post-traumatic stress disorder and is terrified she will lose it all again at any moment.

When I first spoke to Starkova on March 15, I asked if she would ever consider leaving her home, as her patients had, and she said that was not necessary. Everyone felt the fighting would be over in a few days, she said. But when it didn’t stop, it had become difficult to change her mind. Starkova’s home was on an island in the middle of the Dnipro River, in the heart of the city, and the three bridges were now blocked off by militias. When Russian strikes nearby shook the walls of her home, she went to a bomb shelter but found that people were lying on the cold basement floor with no toilets or water. So she returned home and slept in the hallway, hoping the walls would protect her. Then one evening, she pulled the blankets and pillows off the floor, put them back on her bed, and slept there again. “It’s really important for me to have my space, my boundaries,” she said, explaining why she would never leave Kyiv. “And I hear the stories from my patients. How they are living now. How they are stuck for 24 or even 48 hours on the border. And I am scared of that more than of staying.” Days later, she told me she was headed to Lodz, Poland. It was the most difficult decision of her life, she said. Five days after that, she arrived in Norway.

As for Victor, she slowly began to feel better once she and her family settled in Lviv. But there was still anxiety, nausea, and, most of all, guilt for leaving behind the people of Kharkiv including Yuri. “My heart is breaking. I want to go home. Here in Lviv, everything is as if there is no war at all. Everyone is walking, sitting in cafés, laughing,” she says. “I am tormented by my conscience because I can take a hot shower while many in Kharkiv and Mariupol have no water, electricity, or food. My life is good here, and I suffer because of it.”

On March 26, only days after arriving in the city, Russian missiles struck eastern Lviv, injuring five people. The next morning, Victor woke up, got dressed, and took her daughter and mother to the border with Poland and left her homeland behind.

Ukraine’s Life-or-Death Therapy Sessions