With a simple question, Ukrainians probe mental health at a time of war

Ukraine's first lady Olena Zelenska heads the country's mental health campaign, called "How Are You?" She says the country is still overcoming the legacy of the Soviet era, when the government sometimes said dissidents had "psychiatric problems" and locked them in mental institutions. She's shown here meeting with students in Paris last December. Julien de Rosa/AP hide caption

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Ukraine's first lady Olena Zelenska heads the country's mental health campaign, called "How Are You?" She says the country is still overcoming the legacy of the Soviet era, when the government sometimes said dissidents had "psychiatric problems" and locked them in mental institutions. She's shown here meeting with students in Paris last December.

Julien de Rosa/AP

KYIV, Ukraine — How are you?

In Ukraine, this question is much more than a casual conversation starter. It's an invitation to express how you're coping with the war.

"This question becomes like a form of love, an act of love. We ask because we understand that it's a part of our inner therapy," said art historian Halyna Hleba.

Hleba is one of the curators of a large art exhibit — called "How Are You?" — featuring scores of works created by Ukrainians since Russia launched its full-scale invasion 18 months ago.

The paintings, sketches, sculpture and video are on display at Ukrainian House, a sprawling cultural center in Kyiv. The exhibit goes well beyond art, trying to get visitors thinking — and talking — about their mental health.

Hleba wrote the words stenciled onto the wall at the beginning of the exhibit, which fills the five-story center.

A painting by a Ukrainian artist depicts the war at an exhibition at Ukrainian House, a cultural center in Kyiv. The exhibit features works produced since the full-scale Russian invasion last year, and is part of a larger effort to encourage Ukrainians to discuss mental health issues. Kateryna Malofieieva/NPR hide caption

toggle caption Kateryna Malofieieva/NPR

A painting by a Ukrainian artist depicts the war at an exhibition at Ukrainian House, a cultural center in Kyiv. The exhibit features works produced since the full-scale Russian invasion last year, and is part of a larger effort to encourage Ukrainians to discuss mental health issues.

Kateryna Malofieieva/NPR

Ukraine can calculate the agony of war in many ways: lives lost, homes destroyed, families turned into refugees.

Yet there's also trauma that's harder to measure — this collective mental health crisis the war has inflicted. Men and women, young and old, soldiers and civilians are all trying to cope.

Ukraine's first lady leads the campaign

Olena Zelenska, the wife of President Volodymyr Zelenskyy, leads this

In a recent , she said, "I am very pleased with the words and the tone of this program — kindly and friendly. It's not a paternalistic approach."

A painting at the "How Are You?" art exhibit in Kyiv. The cellphone depicts an air raid alert that Ukrainians receive when a Russian airstrike is underway. The background shows a famous World War II photo of Soviet troops capturing Berlin. Greg Myre/NPR hide caption

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A painting at the "How Are You?" art exhibit in Kyiv. The cellphone depicts an air raid alert that Ukrainians receive when a Russian airstrike is underway. The background shows a famous World War II photo of Soviet troops capturing Berlin.

Greg Myre/NPR

She notes that some Ukrainians, particularly the older generation, are still wary of raising mental health issues. This can be traced directly to the Soviet era, when the government often claimed political dissidents had "psychiatric problems" and locked them up in mental institutions.

"This fear still exists," she said. "But people need to understand that it is no longer the case. It's different now. That's why we need to inform people and help them understand about mental health care. It's not scary."

, adding that many therapists like herself are being overwhelmed with requests for treatment.

For Korolovych, the war's trauma is personal. She lost her husband to a Russian missile strike last year, just days after he joined the military.

"Ukrainians have been living in a permanent state of bereavement for the past 18 months," she said. "When I was experiencing bereavement, I lived through the experience with other widows who also lost their husbands."

She's also been surprised by some of the responses she's received from patients.

Anecdotally, she says, more married patients are now coming to her saying they want a divorce.

Also, some Ukrainians have been emboldened by the way the country has responded to the Russian invasion. In some cases, they've shaken off past feelings of helplessness.

"We are learning how to get out of this position as a victim. We are learning how to ask for help," she said.

An online test for anxiety and depression

A recently formed Ukrainian company, , is trying to nudge this process forward.

Neuroscientist Sergiy Danylov (left) and Roman Havrysh are co-founders of Anima, a company that has developed an online test designed to screen for signs of anxiety or depression. They say the test can be used by civilians or members of the military and is already being used by some military psychologists. Greg Myre/NPR hide caption

toggle caption Greg Myre/NPR

Neuroscientist Sergiy Danylov (left) and Roman Havrysh are co-founders of Anima, a company that has developed an online test designed to screen for signs of anxiety or depression. They say the test can be used by civilians or members of the military and is already being used by some military psychologists.

Greg Myre/NPR

"I just wanted to bring it to the wider public and to diagnose depression and anxiety as widespread problems," said , one of the co-founders.

Havrysh and his business partner, neuroscientist , have created a for screening both civilians or soldiers.

The person sits in front of a computer as images appear in rapid succession, two at a time, side by side.

One image is mundane — an empty chair or a desk. The other is graphic and often disturbing — a malnourished child, a dead body on the battlefield, a cobra about to strike.

The sharply contrasting images appear for just a second and are then replaced by two more. By measuring eye movements to the millisecond, the test seeks to determine a person's unguarded reaction.

"You can't lie with your eyeball," said Havrysh. "We track it. We have those tiny, millisecond windows where you don't control, consciously, your eye, and we track it."

A range of approaches

The military is also organizing peer-to-peer discussions among troops after they go through a combat rotation.

"If we have a quite intensive battle, we understand that we need to have a decompression, or debriefing, for our soldiers," said , a military psychiatrist.

"Inside of this group, we are discussing the most traumatic events during battle," he added. "We found a lot that is very useful for mental health. It's a first step for treatment and for healing."

He says preliminary data suggests perhaps 15% of Ukrainian troops suffer from post-traumatic stress — a figure roughly in line with of U.S. troops who served in Iraq and Afghanistan.