Why does it have to happen – first?

Main theme: Psychiatry at war


Ukraine during, but not after, the run-up to the invasion in the early hours of Thursday 24th February latest, is a case in point of what I discuss in the following: our reluctance to grasp danger even if it is impending, and some findings on how that resistance may be changed. Telling signs of horrific danger closing in on Ukraine were in plain view for all who would see them, but it turned out very few would; it was to no avail that the normally so secretive CIA and MI6 on this occasion broke with custom, repeatedly and in detail, held forth to all who would listen exactly what was brewing in the Kremlin and in the Russian armed forces: Among the general populations of Europe and North-America there was little else than listless flapping and inertia.

I put forward the hypothesis that evolution developed a highly sophisticated and efficient capacity of countering lurking danger that if unchecked was apt to cause us trauma or death. Generation upon generation spent their lives constantly in the shadow of death or danger, imbued into our nature that catalogue of adequate responses without which our race would long since have perished. In what is in historical terms the very short span of the last, say, ten generations, many of the former threats to our lives have been near- eradicated or diminished or modified. The question is whether that has deprived us of some vital learning possibilities.

Experience with attempts to communicate risk show that the steps in the KAP model from receiving relevant information/acquiring Knowledge to generating adaptive Attitude and then forming Practice/behavior are not easily taken.

The belief in knowledge as a change agent has long historical roots. The first book in European literature, Homer`s Iliad, served as a warning text book for the young Greek male on what war may do to the soldier (Shay, 1995). In spite of that, according to our colleague Shay, all wrongs committed in the Vietnam war were already described in the Iliad. Shay has also suggested that the Odyssey with the hero`s 10 years long troublesome return voyage is a metaphor for the challenges and time it takes for a combat soldier to become a regular citizen again (Shay, 2002).

War veterans were among the survivors of the first collective life threatening situation that I studied, an industrial explosion in 1976. They shared some characteristics with fellow workers who also had experienced severe life threatening situations prior in their lives. These employees differed on three counts from work mates who never had experienced severe danger: 1) they had a lower risk of developing posttraumatic stress problems, 2) during the exposure they had a more adaptive disaster behavior, and 3) in contrast to the average employee, they had been mentally prepared and had also on their own initiative exercised safety, survival and rescue skills.

The flag of Ukraine. Image by Wix.
The flag of Ukraine. Image by Wix.

The main findings were clear: Suffering and surviving one disaster is also a learning experience, painful as the disaster may have been, it will condition its victim to deal well with any disaster that may subsequently strike him, and build a lasting capacity to foresee and prepare for danger situations.

I think a likely candidate for providing that competence is the adaptive form of the posttraumatic stress syndrome, the disaster response that nearly every one developed in the aftermath of the industrial explosion (Weisæth, 1989). The core element in this stress response is the involuntary and repetitive reliving of the threatening event. Whereas this repetition syndrome continued and developed into posttraumatic stress disorder in some vulnerable individuals, the adaptive form seemed to produce competence through a kind of learning at the experiential level. As an anxiety response the posttraumatic stress syndrome is forward oriented, anticipating danger. For the majority it was a short step from the fear of reoccurrence of the passed danger to a realization that “it has happened, it may happen again”. Additionally, the personal learning included a positive response expectancy, “if it happens I can act”. This expectation of some personal control made them more receptive to danger signals.

It is tempting to speculate that learning from own experience with severe danger provided the necessary capacity to be prepared at the individual level for thousands of generations. If that is the case the protected and safe lives several generations now have enjoyed, may have deprived us of a necessary experience. The fact that information and knowledge are insufficient and that personal experience is a far superior way to achieve that learning support such a hypothesis.

The above begs the question, if a similar lessen can be learnt at a lesser cost; or does it have to have happened - first?

Fortunately, our research on safety training such as reported by Hytten 1989, found that a very realistic exercise approached a real threatening event in achieving that learning.