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Sitting down with John H. Krystal

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At the end of August, Ukrainian psychologists, social workers, and clergy came to the Yale School of Medicine to learn about the treatment of post-traumatic stress disorder. In coordination with the Open World Leadership Center, a U.S. government agency that promotes communication with leaders in Europe and Asia, Yale professors trained the foreign delegation to work through the psychological effects of the crisis with Russia. The Herald asked John H. Krystal, the chair of the Department of Psychiatry, about the week- long program.

YH: There’s been a ton of media attention directed towards this politicized conflict in Ukraine, but we live in a world where there are conflicts all the time. What was the Open World Leadership Center looking to achieve by bringing this group to Yale?

Krystal: Their sense was that the state-of-the-art in Ukraine was not at the same level as in the U.S., so they thought they would be able to get trained in certain techniques and approaches that would be very helpful to them if they came to the United States for the training. Our interest in helping them was grown purely out of a humanitarian wish to help others who are in distress. There really was no political agenda.

YH: What were the backgrounds of the people you trained?

Krystal: It was really a mixed group of people from a variety of organizations in Ukraine. One of the goals was to help them gel as a group that could be mutually supportive. Working with people with post-traumatic stress disorder, people who are sharing very disturbing experiences, is extremely draining. Trying to do that when you’re in the midst of a context where you might be surrounded by disruptive or even life-threatening events is all the more difficult.

YH: How did such a varied group come to work together to deal with what’s often treated as a strictly medical problem?

Krystal: What we’ve learned from working in the field of post-traumatic stress disorder for a very long time is the very multidisciplinary nature of the work. Some people might be surprised that there was a priest, but many people who experience extreme life traumas feel that their lives have lost meaning and have profound religious questions related to that. During the week, doctors would visit with other doctors at the Yale Global Health Initiative to learn about how healthcare organizations work. At the same time, other people would be visiting the Errera Community Care Center, which is a center associated with the VA hospital that focuses on psychological rehabilitation, in other words getting people back to work, getting their lives more concretely organized. Other people would be meeting not only to learn how to intervene with adults, but also ways to help children and families adapt when children are struggling to cope with traumas. We know that these 20 people can’t treat a population of 45 million Ukrainians to meet their trauma needs. What we were essentially trying to do was not only to equip them to be treaters, but also to be trainers of other people in organizations when they return to in Ukraine.

YH: What would treatment look like for someone who has experienced trauma in this crisis?

Krystal: The idea of this first aid is to assess the whole context of the impact of the trauma for the person. In other words, how they feel that their lives have changed, how their family is changing, the neighborhood they live in, the community, the society. The goal is to help them initially to focus on what they need to do to make themselves and their families safe. We’re not teaching psychoanalysis, we’re not trying to teach a very elaborate approach, but rather give this group of people a very basic and validated toolbox that they could use.

YH: Is there a universality to the signs and treatment methods for trauma?

Krystal: In general, we have programs that we can use to train people that we have never met before in places that we’ve never been to. Often times, they then have to figure out how to implement these techniques in a way that would work for their local environment and culture. It’s not yet like a medication where you write a prescription for a dose of psychotherapy, but it is a lot more standardized than

it ever was before. The modern diagnosis of PTSD only emerged in 1980, and so, in that era, even in our own country, clinicians were not well equipped to recognize or treat PTSD. Now, we can help people make sense of their experiences.

YH: How does what you’ve seen in this conflict in particular change the way you and your colleagues look at trauma in academic terms?

Krystal: We’ve encountered and dealt with survivors from the killing fields in Cambodia to the death marches in Ethiopia. It’s important to recognize that each experience has some elements that are unique. But it’s also critically important to see the universality. We can take the lessons we’ve learned from one population and try to carry them forward to see how they will help us to better understand and intervene in other populations.

YH: Could you speak about the unique nature of the Ukrainian experience?

Krystal: In the United States and the VA hospitals, the VA hospital where I work at least, it’s very safe. One of the critical aspects of treating PTSD is to help people recognize when they are in safe places. It’s very different to try to deliver some of these treatments in settings where people were very close to or in the middle of some ongoing threat or potential for threat. So some of the discussions that occurred were related to that experience—how do you make someone feel safe if they’re not really fully safe?

YH: Did you discuss the workers’ political opinions and ideas about the conflict?

Krystal: People said that in Ukraine they have surgeons to sew up a wound that’s been cut, that they have doctors to prescribe antibiotics for infections, but that treating the psychological casualties of civilian populations was, to them, just as important an objective as dealing with the other medical consequences of the war. At the end of the formal presentations, our Ukrainian visitors and the representatives from the Ukrainian organizations broke out into the Ukrainian national anthem. I had the feeling that they were gearing themselves up to get ready to go back, and the song was their commitment to the Ukrainian people, to see them through whatever they were going to face.

 

—Interview condensed by the author