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Preparing to survive in uncertainty

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Interview with Edgaras Diržius


 

Persisting unresolved mental health issues, stemming from the dual impact of the Covid-19 pandemic and the conflict in Ukraine initiated by Russian invaders, contribute to heightened concerns. Media coverage in Lithuania is filled with ominous reports, raising the spectre of the war’s potential expansion into the Baltic states and Western Europe. These circumstances collectively intensify the pervasive sense of uncertainty felt by everyone.



Goda Tikniūtė: How do feelings of uncertainty, exacerbated by the ongoing pandemic and geopolitical tensions, impact mental health?

 

Edgaras Diržius: We know from our experience and from scientific literature that an increase in uncertainty has a diverse effect on mental health. An increase in anxiety disorders, depression, and insecurity in general was observed first after pandemics, and later, when escalation of the war in Ukraine began. The number of patients trying to get mental health care has increased in Lithuania and other countries. 

 

What resources can individuals access to mitigate the adverse effects of uncertainty on mental health?

 

The uncertainty as a phenomenon can’t be resolved by individuals themselves – it is a hardly modifiable factor. General recommendations which were common in the pandemic and now include limited information monitoring (it’s recommended to watch news once a day only), also restrict the time for overthinking, ruminating, leading to an increase in anxiety levels. WHO recommends abstaining from alcohol and other psychoactive substances. And I would stress the importance of social connections, which were degraded in our urban environment even before the pandemic in the context of transferring interpersonal communication to social media, but especially during lockdown. It is known that the higher the usage of social media, the worse mental health. Time spent with other people discussing even such simple things as weather or everyday agenda is a very important mental health factor. It is important to start reanimating our social connections with other people in peaceful times, and it becomes crucial to survival during difficult times. Physical activity, sleep hygiene, and not hesitating to address mental health care specialists if needed.


Team of the Minister of Health of the Republic of Lithuania. From left: deputy minister Olegas Niakšu, advisor to the minister Tomas Bagdonas, deputy minister Aurimas Pečkauskas, chancellor Jurgita Grebenkovienė, assistant to the minister Daiva Stalemėkė, minister Arūnas Dulkys, advisor to the minister Eglė Butkevivičienė, assistant to the minister Edgaras Diržius, and assistant to the minister Edgaras Narkevičius. Photo courtesy of the Ministry of Health of the Republic of Lithuania.
Team of the Minister of Health of the Republic of Lithuania. From left: deputy minister Olegas Niakšu, advisor to the minister Tomas Bagdonas, deputy minister Aurimas Pečkauskas, chancellor Jurgita Grebenkovienė, assistant to the minister Daiva Stalemėkė, minister Arūnas Dulkys, advisor to the minister Eglė Butkevivičienė, assistant to the minister Edgaras Diržius, and assistant to the minister Edgaras Narkevičius. Photo courtesy of the Ministry of Health of the Republic of Lithuania.

In what ways does preparedness for various scenarios influence mental well-being?

 

After the beginning of the full-scale Russian invasion of Ukraine, I, as a member of the Lithuanian Rifleman Union, was invited to share my knowledge that I acquired in the union where we are being prepared for survival in the context of civil resistance. The feedback I received afterwards is another proof that preparedness for emergencies decreases anxiety significantly. Preparedness does not support the illusion of safety but diminishes uncertainty by giving clear instructions on how you can take care of yourself and your family, which is adequately helpful according to evidence.

 

What measures can be implemented at the national or state level to address and alleviate the mental health challenges stemming from uncertainty? 

 

The most important thing is clear and structured communication about the situation itself. Trying to calm the society is not helpful without a clear strategy and decisions on safety, it can produce even diverse effects. The state has to prepare for various threats; it is the responsibility of the authorities, and this preparedness creates safety by itself. Then it has to be communicated to everyone in a very structured and available way, easy to access and understand for everyone. There are no specific guidelines for mental health care in such situations, there is a set of common measures: ensuring psychiatric and psychological help, and, again, public communication of spreading psycho-educational information, relevant to such situations.

 

How can psychiatrists and healthcare professionals prepare themselves mentally to navigate the challenges posed by ongoing crises?

In the woods. Image from Edgaras Diržius personal archive.
In the woods. Image from Edgaras Diržius personal archive.

I don’t think that mental health specialists are any different from other members of society when we speak about preparedness for emergencies at the individual or family level. I think we all feel the same threat of experiencing genocide again. It’s important to have water and food for at least three days. Psychiatrists, like doctors of any other specialty, are subject to mobilization, so everyone should know the details of the medical health care institution they are working in, as they differ from institution to institution. 


As we know from our Ukrainian colleagues, the number of admissions to mental health care institutions decreased at the beginning of the full-scale war. This can be said not only about acute but also exacerbated chronic conditions, eg., schizophrenia. Such mobilization was observed in the beginning, but later they reported a wave of anxiety disorders, especially PTSD; it is to be said about inhabitants of territories that had been occupied. There were huge numbers of people who survived violence, rape, torture, and other awful things. As the war goes on, the number of people with PTSD increases. The abuse of alcohol and other psychoactive substances – the use of psychoactive substances is though maladaptive but a way to deal with anxiety and other mental symptoms. This is what we should be prepared for in the war scenario.

 

Should psychiatrists be ready to change their field from psychiatry to general medicine when we speak of their preparedness for the war? Should we provide general health care closer to the battlefield or should everyone stay doing the work they are best in doing?

 

In my personal opinion, if a psychiatrist or a radiologist were to find themselves in a situation where they have to provide help for the injured people, that would mean that there is none more suitable for that than them. A psychiatrist would not be the worst help provider; at least he would possibly do it better than a person who is not a doctor. We as psychiatrists provide help on planes during flights. War has its own logic, but also chaos. When war begins, the normal life is switched off. Surviving during the war may mean that one would have to gather rainwater for drinking, and sleep in the forest. Similarly, it could imply the necessity to provide health care which is not in our everyday menu.


Edgaras Diržius with his friend Artūras Andriūnas (middle) and his dad Rimintas Diržius (left) at rally in support of Ukraine. Image from Edgaras Diržius personal archive.
Edgaras Diržius with his friend Artūras Andriūnas (middle) and his dad Rimintas Diržius (left) at rally in support of Ukraine. Image from Edgaras Diržius personal archive.

Considering the shared emotional burden, what strategies can psychiatrists employ to support their own mental well-being and that of their families during times of heightened uncertainty?

 

I think that in this particular context, psychiatrists are not distinctive from anybody else. I would give such an example in this context. One year before the full-scale Russian invasion of Ukraine, during a conversation with family friends, I told them that it is worth being basically prepared for the war scenario simply by having your departure bag packed, storing food and water for 72 hours; my friends told me I was crazy. In a year, I was very busy trying to answer everyone’s questions about how to act in the face of an emergency. The thing is that we live in the illusion of safety, although the war in Ukraine has been ongoing since 2014, also Astrav power plant is just in our neighborhood. I think the safety illusion is a defense mechanism. After the war escalation, I even had to record a video because of the high demand, thus responding to the fears and anxiety felt by people in my environment that were posed by the situation. But the thing is that we don’t need profound efforts, just simple ones – to have a radio transistor with charged batteries to keep in touch with the world when mobile connection will be switched off, documents of all family members in one place. In Lithuania, we have a website where all information for survival for critical 72 hours is placed (www.lt72.lt). But the main thing is nurturing relationships with other people in your environment. It is impossible to overestimate it not only in a safe environment but especially in war conditions.


Thank you, Edgaras, for the conversation!



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