The graphic images of Russia’s invasion of Ukraine being televised around the clock, and available on the Internet, might finally answer a long-debated question amongst neuropsychiatrists: Does PTSD by proxy exist? In other words, can people suffer serious mental health consequences when they are exposed to depictions of the horrors inflicted on others? And if so, what are the implications?
According to the current definition of PTSD, the affected person must actually experience the traumatic event. A picture or someone else’s description of the event isn’t sufficient. But does that really make sense? Imagine a man driving up to his house one day. As he gets out of his car, a distraught neighbor runs up to him and relates in graphic detail how the man’s five-year-old son had been run over by a car only moments before. The neighbor relates that the man’s wife went off with their son in the ambulance. There had been no time to call him. Worst of all, the neighbor awkwardly blurts out that she heard one member of the EMS team say that “the little guy might not make it.”
Now if that boy dies, could the father experience the same acute stress response (the initial prodromal symptoms leading to PTSD) as the mother, who had witnessed their son running into the street and being dragged under the wheels of a car? I think that he could. The same risk holds if he later viewed a video taken as the accident occurred.
Which brings us back to the televised images from Ukraine. Not everybody agrees that witnessing carnage on a TV screen instead of “in real life” would be sufficient to result in PTSD. As journalist Hannah Fearn writes, for example, in a recent article in The Independent, “You might be tempted to look away from the photos of Ukraine—don’t.” When the images become difficult to look at, she writes, “resist that temptation, share those images, talk about what you see.”
Although her advice may be appropriate for professionals trained to carry on in the face of sometimes hideously explicit depictions of trauma, other people may be traumatized to the point of PTSD in response to these explicit depictions. For them, looking away or turning off their television may be the better course of action.
We know that PTSD produces distorting effects on judgment—or executive function, as neurologists refer to it. It is probably not coincidental that claims for establishing a no-fly zone over Ukraine have increased in tandem with the increase in the vividness of the imagery. The decision made by NATO and the United States not to establish a no-fly zone seemed reasoned and reasonable only a few days ago, but now this judgment is being harshly criticized not only by members of the public but also by some of our leaders who, presumably, are also looking at these images. Increasing numbers of people are expressing the opinion that we must stop this suffering whatever the cost. Could this change of mind result from the influence of the emotional centers of our brain (the amygdala and its connections) on those areas devoted to judgment (the frontal lobes)?
In some instances, horrific war footage is being deliberately aimed at select populations. As Washington Post reportersDrew Harwell wrote on March 4, Ukraine’s Ministry Of Foreign Affairs has posted “a constant stream of extremely graphic images showcasing the horrors of war and inviting Russians to examine them to determine whether the images feature a missing loved one.” In many of the images, he adds, “soldiers’ corpses can be seen burned, ripped apart, mangled in wreckage, or abandoned in snow; in some, their faces are featured in bloody close-ups, frozen in pain”.
So if horrific images can be used to deliberately traumatize a population, why wouldn’t accidental or casual exposure (say by channel surfing) bring about the same result? Or how about the effect of a single photograph? On the front page of the March 7 edition of The New York Times is a large color picture of a family of three (a mother and two children—a teenage son and a daughter who appears to be about eight) lying dead on a road in Kyiv, Ukraine. Moments earlier they had been killed while trying to flee.
In terms of visual depictions, this is a war unlike any other. Thanks to advances in the resolution of the images obtained and the availability of the Internet, we can see the fighting and suffering with a clarity never encountered in a previous military engagement or war. Most historians agree that the televised images of the fighting in Vietnam served as a spur to the antiwar movement and eventually the ending of the war. This occurred prior to today’s superpowered images and, of course, well before the Internet. One wonders what would have been the mental health result if large numbers of the public were glued to streaming videos of Auschwitz or Treblinka. Even the grainy low-definition photographs from those death camps available to us today are deeply unsettling.
Given my experience in diagnosing and treating PTSD, I fear that a significant proportion of people exposed to these images of the Russian-Ukrainian war will suffer some form of mental distress. I admit that even as a trained neurologist and psychiatrist, I find them disturbing. We can’t yet know whether viewing images of other people’s suffering, mutilation, and death can portend grave consequences for our mental health, our sensibilities, and our shared sense of humanity. At the current rate of exposure, however, we’ll soon have our answer.
